The Child with Diarrhoea

Question 1

What is a quick rule for assessing severity of dehydration in a child e.g. with gastroenteritis?

Answer 1

• >4% weight loss: moderate, >6% severe - admit these patients

Question 2

How is the diagnosis of coeliac disease made?

Answer 2

• Antibody screening:
  
  • anti-TTG-IgA (in combination with total IgA - IgA deficiency is associated with coeliac disease so these levels need to be checked to make sense of the others)
  • anti-gliadin-IgG
• Tissue biopsy (gold standard)

Question 3

What might the presenting signs of lactose intolerance be in a child?

Answer 3

• Vomiting after feeds, flatulence, signs of stomach pain/spasmodic, explosive bowel motions, perianal excoriation

Question 4

Suggest some strategies to manage lactose intolerance in a child

Answer 4

• Extend periods between feeds, enable lactase build-up
• Breast-fed? - trial maternal dairy-free diet
• Formula-fed? - supplement with hydrolysed (partial or full) formula