J Korean Med Assoc.  2012 Jun;55(6):539-545. 10.5124/jkma.2012.55.6.539.

Toward an objective definition of diarrhea for differential diagnosis of chronic diarrhea in infants and toddlers

• Hwang JB

• KMID: 2015652
• DOI: http://doi.org/10.5124/jkma.2012.55.6.539

Abstract

Among infants and toddlers with chronic frequent loose stool, normal frequent and loose stool (NFLS) is more common than diarrheal illness with dehydration and nutritional deficiency (DIDN). To identify more objective factors for differentiating between NFLS and DIDN is important. The frequency, mucus content, and microbiological findings of stools, as well as diaper dermatitis are not important factors to significantly differentiate the groups. Instead, a failure to gain weight, fever, colic/abdominal pain, gross blood in stool (except allergic proctocolitis), nocturnal stool, and the score of the stool quantity are important factors to significantly differentiate the groups. A failure to gain weight is also observed even in NFLS, which may come from iatrogenic diet manipulation with nutritionally deficient food. The most objective differential factors are nocturnal stool and the score of stool amount (> or =7 points/day). The use of these objective factors could lessen parental anxiety and distress, iatrogenic undernutrition of patients, and socioeconomic loss due to improper medical investigations or inappropriate management of NFLS.

Keyword

Infant; Chronic disease; Diarrhea

MeSH Terms

Anxiety
Chronic Disease
Dehydration
Dermatitis
Diagnosis, Differential
Diarrhea
Diet
Fever
Humans
Infant
Malnutrition
Mucus
Parents

Figure

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  Figure 1 The stool amount scoring system using the mother's hand (From Hwang JB, et al. Korean J Pediatr 2010;53: 1006-1011) [5].

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  Figure 2 The scores of stool amount for normal controls, patients with normal frequent loose stool (NFLS), and patients with diarrheal illness with dehydration and nutritional deficiency (DIDN) (From Hwang JB, et al. Korean J Pediatr 2010;53:1006-1011) [5].

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  Figure 3 A diagnostic guideline for the clinical differentiation of normal frequent loose stool (NFLS) and diarrheal illness with dehydration and nutritional deficiency (DIDN). OB, occult blood; WBC, white blood cell. a)Except allergic proctocolitis (From Hwang JB, et al. Korean J Pediatr 2010; 53:1006-1011) [5].

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