Toddler's Diarrhoea

Question 1

What are the two types of diarrhoea?

Answer 1

• acute
• chronic (last > 2 weeks)

Question 2

What features suggest a diagnosis other than acute diarrhoea?

Answer 2

• A generally unwell child - out of proportion to the level of dehydration.
• Abdominal pain with tenderness and guarding (possible surgical problem - eg, appendicitis or intussusception).
• Shock, pallor, jaundice, poor urinary output.
• Bilious vomiting.
• Blood in stool (possible intussusception or haemolytic uraemic syndrome (HUS)

Question 3

What are the causes of acute diarrhoea?

Answer 3

• Gastroenteritis (most common)
  
  • Virus: rotavirus (common), norovirus
  • Bac: Shigella spp., Salmonella spp. and Campylobacte - all persent c bloody diarrhoea
  • protozoal: Giargia (chronic infection)
• Systemic infection: eg, urinary tract infection, pneumonia, otitis media, meningitis, septicaemia
• Abx associated colitis
• lactose intolerance
• cow’s milk protein intolerance
• surgical conditions: eg, appendicitis; intussusception; volvulus, Hirschsprung’s disease; Meckel’s diverticulum; short bowel syndrome.
• cystic fibrosis, coeliac disease
• ulcerative colitis, Crohn’s disease​

Question 4

What will the sx be for toddler’s diarrhoea?

Answer 4

• Nonspecific non-focal abdominal pain and cramping

Question 5

What should you consider when taking hx for toddler’s diarrhoea?

Answer 5

• Food history
• Ask whether other family members affected
• Water exposure - shigellosis, giardiasis, cryptosporidiosis and amoebiasis
• Travel history - Enterotoxigenic E. coli
• Animal exposure - Campylobacter

Question 6

What ix would you order for acute diarrhoea?

Answer 6

• Stool culture
• Rotavirus antigen tests
• Adenovirus antigen test
• FBC
• U&E
• Others to consider
  
  • endomysial antibodies (coeliac disease)
  • intestinal biopsy (coeliac disease or inflammatory bowel disease)
  • sweat test (cystic fibrosis)

Question 7

How would you mx acute diarrhoea?

Answer 7

• self limiting
• oral rehydration
• continue breastfeeding
• Racecadotril (intestinal antisecretory enkephalinase inhibitor) - if sx persist

Question 8

When would you consider hospital admisison for acute dirrhoea?

Answer 8

• There is any concern regarding the underlying diagnosis.
• There are signs of dehydration, especially if aged under 6 months.
• There is inability to comply with oral rehydration - eg, vomiting, poor social circumstances.
• There is a pre-existing medical condition which may worsen with diarrhoea (eg, diabetes)

Question 9

What are the cx of acute diarrhoea?

Answer 9

• rotavirus infection > lactose intolerance
• bac infection > sepsis, meningitis, osteomyelitis
• HUS
• Reactive arthritis

Question 10

What are the differential diagnosis of chronic diarrhoea?

Answer 10

A well child with no weight loss

• Toddler’s diarrhoea
• Breast-fed babies

unwell child with weight loss

• cow’s milk protein intolerance
• CF
• coeliac disease
• IBD
• Giardia Lambia
• Hyperthyroidism

Question 11

What ix would you order for chronic diarrhoea?

Answer 11

• stool microscopy, culture and sensitivities
• Endomysial antibodies, jejunal biopsy (coeliac disease)
• Sweat test (cystic fibrosis)
• faecal calprotectin

Question 12

When does toddler’s diarrhoea typically occur?

Answer 12

• 2y/o
• resolves by age 4

Question 13

What is toddler’s diarrhoea assoicated with?

Answer 13

• undigested food such as peas and carrots in the stools
• related to a rapid intestinal transit time