EVALUATING THE CHILD WITH CHRONIC DIARRHEA

The occurrence of chronic diarrhea in infants younger than three month s suggests disaccharidase deficiency, cow's milk or soy protein intole rance, cystic fibrosis or an immunodeficiency state, while chronic dia rrhea In children three to 18 years of age suggests celiac disease, la te-onset primary lactose deficiency and inflammatory bowel disease. Ga strointestinal infection is the most common cause of chronic diarrhea in children of all ages. Diarrhea that develops after the introduction of cow's milk, cereals and fruits suggests an enzyme deficiency or pr otein intolerance. Watery, explosive stools suggest sugar intolerance, and foul-smelling, greasy, bulky stools suggest fat malabsorption. Ma rked weight loss suggests malabsorption, inflammatory bowel disease, h yperthyroidism or malignancy. The presence of neutrophils or red blood cells in the stool indicates bacterial gastroenteritis or inflammator y bowel disease, while the presence of eosinophils suggests protein in tolerance or parasitic infestation A toddler who is thriving and cheer ful despite having diarrhea may have chronic nonspecific diarrhea of c hildhood.