- Diarrhea in first 3 days of life: congenital diseases of liver, pancreas, biliary tract, small or large intestine.
- Fever, vomiting, diarrhea: Rotavirus, rarely other microbes;
- Mild diarrhea: overfeeding, neonatal drug withdrawal;
- Skin rash, strain to vomiting (gagging), irritability, diarrhea: allergy to cow's milk or soy formula;
Newborn normally have bowel movement 8-10 times a day.
Medications to treat diarrhea in adults can be dangerous for children.
Infant and Toddler Diarrhea
ACUTE DIARRHEA:
Fever, vomiting, diarrhea: Rotavirus; less commonly: bacteria, parasites, middle ear and urinary tract infections, intusussception, hemolytic-uremic syndrome;
mild diarrhea: newly introduced food, liquid starvation diet, food allergies, antibiotics.
CHRONIC DIARRHEA:
- Diarrhea with undigested food particles, the toddler looks healthy: excessive drinking of fruit juices (toddler's diarrhea);
- Constipation, alternating with diarrhea: post-infectious irritable bowel syndrome;
- Coughing, hives, face flushing, watery/bloody diarrhea: food allergy;
- Skin rash, underweight, watery/bloody diarrhea: parasites, celiac disease, autoimmune enteropathy; rarely: Crohn's disease, ulcerative colitis, tuberculosis, AIDS, cystic fibrosis, congenital diseases of biliary tract, liver, pancreas or intestine, surgery of small intestine, marasmus, kwashiorkor, zinc deficiency.
- Diarrhea fakedby child's caregiver (usually mother): factitious diarrhea, Munchausen by Proxy Syndrome (1).
ACUTE DIARRHEA:
- Sudden diarrhea: bacteria; rare: pesticides or heavy metals poisoning, Pseudomembranous colitis;
- Mild (recurrent) diarrhea: stress, medications, bowel investigation or surgery, parasites, appendicitis, diarrhea in pregnancy;
- Diarrhea after eating, vomiting: food poisoning (staph, mushrooms, tropical fish, alcohol), plant poisoning.
CHRONIC DIARRHEA:
- Diarrhea after eating: IBS, lactose intolerance, food allergies, rapid gastric emptying (Dumping syndrome), carcinoid syndrome;
- Mild chronic diarrhea: fructose malabsorption, diabetes, alcoholism, pregnancy, rare: collagenous/lymphocytic colitis, neuroendocrine tumors;
- Weight loss, bloody diarrhea, recurrent fever, skin rash: Crohn's disease, ulcerative colitis, typhoid fever, chronic infection (tuberculosis, AIDS, HSV, CMV);
- Weight loss, bloating, pale loose stool: malabsorption due to gallbladder, liver or pancreatic disease, Crohn's disease, celiac disease, small intestinal bacterial overgrowth, chronic infection, or laxative abuse; rare: tropical sprue, Whipple disease, intestinal lymphoma, systemic sclerosis, amyloidosis.
- White coated tongue, fatigue, sugar craving, anal itching: candida (see other candida symptoms);
- Diarrhea after travel: parasites,tropical sprue;
- Constipation/diarrhea in children: encopresis, post-infectious irritable bowel syndrome;
- Weakness, dizziness, salt craving: dehydration or Addison's disease;
- Irritability, sweating, bulging eyes, enlarged thyroid, weight loss, diarrhea: hyperthyroidism;
- Leg swelling, mucous diarrhea: protein-losing enteropathy (in ulcerations of the esophagus, stomach or duodenum, Crohn's disease, intestinal lymphangiectasia, tuberculosis, lymphoma, congestive heart failure, carcinoid syndrome etc), (2).
CHRONIC DIARRHEA:
- Constipation and/or diarrhea: diverticulitis, ischemic colitis, partial obstruction of the colon or small intestine (fecal impaction, polyps, cancer, adhesions);
- Pins and needles sensations in hands and feet, early satiety, diarrhea, blurred vision, difficult swallowing, urine retention/incontinence, fainting, etc: autonomic neuropathy (in diabetes, alcoholism, Parkinson's disease, vit B12/folate deficiency, Sjögren syndrome, SLE, amyloidosis);
- Diarrhea after eating: carcinoid, VIPoma;
- Mild constant diarrhea: small intestinal bacterial overgrowth, intestinal lymphoma, systemic sclerosis.
Exact location of abdominal pain may help in finding the cause of diarrhea.
- Upper right quadrant: gallbladder, biliary tract, liver disease; rarely: duodenal, pancreatic disease;
- Upper middle abdomen: gastric, duodenal, pancreatic disease;
- Upper left quadrant (rarely): gastric, pancreatic disease;
- Lower right quadrant: Crohn's disease, appendicitis;
- Lower left quadrant: Ulcerative colitis, diverticulitis, ischemic colitis; rarely: colorectal cancer.
History. Expect these questions from a doctor :
- When did diarrhea start?
- Color and consistency of the stool, any blood or mucus?
- Is diarrhea related to meals, stress, or daytime? Any recent travel in tropics?
- Fever, abdominal pain or other symptoms?
- Diet, alcohol intake?
- Chronic disease, medications, recent investigation or surgery?
- Family members: anyone has diarrhea or chronic disease?
- Skin: rash, jaundice, pale skin, scaling, turgor;
- Abdomen: distension or lumps, enlarged liver or spleen, painful spots;
- Neck: enlarged thyroid, lymph nodes;
- Rectal examination: internal hemorrhoids, polyps, inflamed skin around the anus, fistula.
