Pediatric diarrhea

Rationale

Diarrhea is a disturbance of stool frequency and/or consistency. It is considered acute if the duration is less than fourteen days. Diarrhea is a common problem in infants and children. In most cases, it is mild and self-limited, but the potential exists for significant morbidity and mortality from hypovolemia, dehydration, and/or electrolyte abnormalities.

Causal Conditions

(list not exhaustive)

1. Infections
2. Diet-related (e.g., milk protein intolerance, functional/toddler diarrhea)
3. Ischemic intestinal damage (e.g., intussusception)
4. Malabsorption
   1. Celiac disease
   2. Cystic fibrosis
   3. Lactase deficiency
5. Inflammatory bowel disease
6. Other causes
   1. Medications
   2. Laxative misuse

Key Objectives

Given a pediatric patient with diarrhea, the candidate will obtain a detailed history of the nature of the diarrhea and associated symptoms. The candidate will diagnose the cause, severity, and complications, paying particular attention to signs and symptoms of dehydration, hypovolemia, and/or electrolyte abnormalities. The candidate will initiate an appropriate management plan.

Enabling Objectives

1. list and interpret critical clinical findings, including those based on
   1. an elicited history of risk factors for infectious causes if the case is acute;
   2. an elicited history of infectious exposures, dietary factors, and systemic symptoms, and any complications related to these if the case is chronic, and
   3. a physical examination conducted to assess the etiology, severity, or complications of diarrhea (e.g., growth delay);
2. list critical investigations and interpret the results of the investigations in view of the common etiologies, including
   1. basic investigations for malabsorption, and
   2. basic investigations for chronic infections and other causes;
3. construct an effective management plan, including
   1. resuscitating the patient if acutely ill,
   2. employing isolation measures where indicated,
   3. determining if the patient requires referral to a specialist, and
   4. referring the case to public health authorities if required.