What is the 'objective' differential factor of diarrhea in infancy?: Normal state versus diarrheal illness in infants with chronic frequent and loose stool

Abstract

PurposeThis study aimed to identify 'objective' differential factors for normal frequent loose stool (NFLS) and diarrheal illness with dehydration and nutritional deficiency (DIDN) among infants with chronic frequent loose stool (CFLS).MethodsData were analyzed from infants under 2 years of age with CFLS who had been transferred from general pediatricians. These 46 patients were divided into 2 groups (NFLS versus DIDN). Nocturnal stool was defined as evacuation between 10 pm and 6 am. Maximal stool amount/day (measured using the mother's hand) was specified as the highest score during the period of CFLS obtained by adding up each evacuation's score (range, 0-2 points).ResultsThere were 36 cases of NFLS and 10 of DIDN. A failure to gain weight (P=0.0001), fever (P=0.0079), colic/abdominal pain (P=0.0014), gross blood in stool (except allergic proctocolitis) (P=0.0113), nocturnal stool (P=0.0001), and the score of stool amount (P=0.0001) were found to significantly differentiate the groups. A failure to gain weight was observed in 39% of even NFLS. The frequency, mucus content, and microbiological findings of stools, as well as diaper dermatitis were not found to significantly differentiate the groups.ConclusionNFLS was more common than DIDN in infants with CFLS. The most 'objective' differential factors were nocturnal stool and the score of stool amount (≥7 points/day).

How to Do in Persistent Diarrhea of Children?: Concepts and Treatments of Chronic Diarrhea

“…The patients who have had prolonged watery stool with weight loss should be differentiated from normal frequent loose stool, it is difficult to differentiate between chronic diarrhea and normal frequent loose stool not only in parents but also even in physicians, especially in infants who have normal frequent loose stool. Hwang et al [7] recommended the stool amount scoring system using the mother's hand for easily differentiating between normal frequent loose stool and diarrhea with dehydration and nutritional impairments in children on clinical circumstance. An accurate diagnosis and the proper treatments are very important because chronic diarrhea effects physical and psychological development in children.…”

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

“…The stool amount scoring system using the mother's hand (From Hwang JB, et al Korean J Pediatr 2010;53: 1006-1011)[5].Small=0Medium=1Large=2…”