Persistent Diarrhea in Childhood: Issues and Concerns

Objective: The comprehensive review is prompted by a scarcity of consolidated information, about persistent diarrhea that is a matter of concern for all involved in child health. Resource and Design: Systematic review of literature augmented with author's own experience spread over 3 decades. Salient Features: Persistent diarrhea, usually implying persistence of acute diarrhea beyond 2 weeks in an infant or a toddler, is accompanied by failure to thrive or even weight loss, malnutrition, anorexia and superimposed infection(s). Unlike chronic diarrhea, significant malabsorption is not a major issue. Such risk factors as age < 6 months, poor nutritional status, artificial feeding, infection(s), etc predispose to it. Management is primarily through dietary manipulation plus supportive measures. Indications of antimicrobial therapy include identifiable pathogens such as Shigella or E. coli, bloody stools, evidence of systemic infection like sepsis or bacterial overgrowth syndrome and accompanying severe malnutrition. Prognosis is poor if it is undertreated or left untreated with considerable mobidity and mortality. Prompt appropriate therapy leads to good outcome, provided that post-discharge monitoring of nutritional status is continued. Conclusion: Persistent diarrhea in infants and children is better prevented than treated. Attention to risk factors and stress on breast feeding are important constituent of prevention. The mainstay of treatment is dietary manipulation which in severe cases may be in the form of egg-based or chicken-based diet. Poorly treated surviving cases end up with malnutrition and growth failure.