Chronic Diarrhoea in Children

Overview

Chronic diarrhea in children is when a child has loose or watery stools 3 or more times a day for more than two weeks. 

In developing countries, 

  • chronic diarrhea often stems from an ongoing intestinal infection that lasts longer than usual. 
  • This is sometimes called protracted diarrhea. 
  • However, there’s no clear line between protracted and chronic diarrhea. 

In countries with better living conditions, 

  • chronic diarrhea is less common 
  • its causes often differ depending on the child’s age. 
    • The outcome of chronic diarrhea can vary greatly, ranging from mild conditions that resolve on their own, like toddler’s diarrhea, to more severe, inherited diseases that can lead to serious digestive problems.

Chronic diarrhea can be a cause of concern for parents and caregivers, as it can affect a child’s overall health, including their growth and development. At Gertrude’s Children’s Hospital, we understand how distressing this condition can be for families. Our goal is to provide thorough information and expert care to help you navigate this challenging time.

Symptoms

Chronic diarrhoea is characterized by the frequent passage of loose or watery stools over an extended period. Here are some common symptoms that may accompany chronic diarrhoea in children:

  • Frequent Loose Stools: The primary symptom is the consistent presence of loose or watery stools, often occurring more than three times a day.
  • Abdominal Pain or Cramping: Some children may experience discomfort or pain in the abdominal area.
  • Bloating and Gas: Chronic diarrhoea can be accompanied by feelings of bloating or excessive gas.
  • Fatigue: Persistent diarrhoea can lead to dehydration and malnutrition, causing fatigue and lack of energy.
  • Weight Loss: Unexplained weight loss or failure to gain weight as expected can occur if the diarrhea affects the child’s ability to absorb nutrients properly.
  • Dehydration: Signs of dehydration may include dry mouth, sunken eyes, reduced urine output, and lethargy.
  • Poor Growth: Chronic diarrhoea can impact a child’s growth and development, leading to stunted growth in some cases.
  • Irritability: Children with chronic diarrhoea may become more irritable or fussy, especially if the condition affects their comfort and sleep.

Causes

Chronic diarrhea in children can result from various underlying causes, including:

Infections: 

    • Enteric infections are the leading cause of chronic diarrhea in children, both in developing and industrialized countries.

Abnormal Digestive Processes:

    • Some children may have conditions that affect how their digestive system works, leading to chronic diarrhea.

Nutrient Malabsorption:

    • Some children have conditions from birth that prevent their bodies from properly absorbing certain nutrients. 

Immune/Inflammatory Conditions:

    • Conditions like celiac disease, eosinophilic gastroenteritis, and inflammatory bowel diseases (like Crohn’s disease or ulcerative colitis) are common causes.

Structural Defects:

    • Some children are born with genetic conditions that affect the structure of their intestines, which can lead to chronic diarrhea. 

Issues with Electrolyte and Nutrient Transport:

    • Some children have conditions where their bodies struggle to move nutrients and electrolytes properly through their system. 

Problems with Intestinal Movement:

    • Conditions like Hirschsprung Disease and Chronic Intestinal Pseudo-obstruction:
      • These are issues where the intestines don’t move food through as they should, leading to chronic constipation or diarrhea.
    • An overactive thyroid gland (thyrotoxicosis) can also speed up the movement of food through the intestines, causing diarrhea.

Tumor-Related Conditions:

    • Rare tumors that produce certain hormones, like VIPomas or those associated with Zollinger-Ellison syndrome, can lead to chronic diarrhea.

Dietary Factors: 

    • Drinking too much soda or consuming foods and drinks that contain artificial sweeteners like sorbitol, mannitol, or xylitol; 
    • overdoing it on caffeinated drinks like cola, tea, or coffee.

Medications: Long-term use of certain medications, like antibiotics or laxatives, can disrupt the normal balance of bacteria in the gut, leading to diarrhea.

Diagnosis

Diagnosing the underlying cause of chronic diarrhea involves a thorough evaluation, which may include:

  • Medical History and Physical Examination
    • A detailed history of the child’s symptoms, diet, and any recent illnesses or travel is taken. The physical examination may include checking for signs of dehydration, malnutrition, or other physical symptoms.
  • Stool Tests: 
    • These tests can help identify infections, the presence of blood, or signs of malabsorption.
  • Blood Tests: 
    • Blood tests can reveal signs of infection, inflammation, or anemia, and assess the child’s overall nutritional status.
  • Allergy Tests: 
    • If a food allergy or intolerance is suspected, tests may be conducted to identify specific allergens.
  • Imaging Studies: 
    • Ultrasound, X-rays, or other imaging techniques may be used to check for structural abnormalities in the gastrointestinal tract.
  • Endoscopy and Biopsy: 
    • In some cases, an endoscopy may be performed to visualize the inside of the intestines and take biopsies to examine the tissue for signs of disease, such as celiac disease or IBD.

Treatment Options

Treatment involves supportive care, improving nutrition, specific diets, and medications tailored to the underlying cause. These treatments aim to reduce fluid loss and help heal the intestinal lining.

  • Critical First Steps in Treatment
    • Rehydration: Since dehydration is a major risk in chronic diarrhea, replacing lost fluids and electrolytes is the most important initial treatment step.
  • Nutritional Rehabilitation
    • Evaluating Nutritional Needs: A thorough assessment of the child’s nutrition status is essential. Foods that may worsen the condition should be identified and avoided.
    • Boosting Caloric Intake: For children with moderate to severe malnutrition, it’s important to gradually increase calorie intake
    • Digestive Function Monitoring: Regular tests to check how well the child’s digestive system is absorbing nutrients are important.
    • Special Diets:
  • Lactose-Free Diet: Recommended for all children with chronic diarrhea.
  • Sucrose-Free Formula: Needed for children with sucrase-isomaltase deficiency.
  • Elemental or Semi Elemental Diets: These diets are designed to overcome food intolerances and improve nutrient absorption. The type of diet is chosen based on the child’s specific needs, starting with less restrictive options
  • Feeding Approaches:
    • Enteral Nutrition: If oral feeding isn’t possible, enteral nutrition (feeding through a tube) might be needed. 
    • Parenteral Nutrition: For children who can’t tolerate enteral feeding, intravenous nutrition is necessary, especially in severe cases of malnutrition.
  • Micronutrient and Vitamin Support
    • Adding essential vitamins and minerals, particularly zinc, plays a key role in both preventing and treating chronic diarrhea. 
    • Zinc helps with ion absorption, encourages the healing of the intestinal lining, and boosts the immune system.
  • Managing Functional Diarrhea
    • Dietary Adjustments: 
      • Children with functional diarrhea may benefit from following the “4 F” diet principles: reducing fructose and fluids, and increasing fat and fiber intake.
  • Probiotics
    • These can be beneficial in managing diarrhea by supporting healthy gut bacteria, which may help improve various intestinal conditions.
  • Medications

Treatment options include drugs that 

  • fight infections
  • suppress the immune system 
  • reduce fluid loss and help the body heal.
      • Antibiotics
  • If a bacterial infection is found to be causing the diarrhea, specific antibiotics will be prescribed to target that bacteria. 
  • Sometimes, antibiotics may be given based on suspicion of a bacterial infection
  • Immune Suppression: 
  • In certain conditions medications that suppress the immune system may be recommended.
  • Zinc Supplementation: 
  • Zinc is important because it supports the growth of intestinal cells and helps the intestines absorb ions, making it beneficial in certain cases of chronic diarrhea, especially when the intestinal lining is damaged.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Chronic Diarrhoea. Here’s why families trust us:

“When our son was diagnosed with Chronic Diarrhoea, we were terrified. The doctors at Gertrude’s Children’s Hospital acted quickly, and thanks to their expertise, he made a full recovery. We are so grateful for their care and support during such a difficult time.”

Jamesparent of a child with Chronic Diarrhoea

Chronic Diarrhoea in Children

If your child has chronic diarrhea, the first step is to consult a healthcare professional. They can help determine the underlying cause and recommend appropriate treatment to manage the condition.

Yes, chronic diarrhea can lead to malabsorption of nutrients, which can affect your child’s growth and development. Early diagnosis and treatment are crucial to preventing long-term effects.

While maintaining hydration and making dietary changes can help manage symptoms, it’s important to consult a healthcare provider to address the underlying cause of the diarrhea and receive appropriate treatment.

Yes, chronic diarrhea is treatable, especially once the underlying cause is identified. Treatment may include dietary changes, medications, or other interventions depending on the diagnosis.

Preventive measures include ensuring proper hygiene, managing food allergies or intolerances, and providing a balanced diet. Regular medical check-ups can also help in early identification and management of potential issues.

Contact Us

If your child is experiencing chronic diarrhoea, it’s important to seek expert care as soon as possible. Gertrude’s Children’s Hospital is here to help. Our team of specialists is dedicated to providing the best possible care for your child, ensuring that they receive the treatment and support they need to thrive.

Contact us today to learn more about our Chronic Diarrhoea in Children treatment options.

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