💩 Diarrhoea in children is a common presentation and may be acute or chronic, infective or non-infective. The priorities are to assess hydration status, identify red flags (blood, fever, failure to thrive), and distinguish self-limiting illness from conditions requiring targeted treatment. Most cases are viral, but persistence, systemic features, or poor growth should prompt further evaluation.

🧠 Common Causes of Paediatric Diarrhoea – Clinical Comparison

🦠 Cause	📋 Clinical Presentation	🔎 Diagnostic Tests	💊 Management
🦠 Viral Gastroenteritis (Rotavirus, Norovirus)	Large-volume watery diarrhoea Vomiting, fever, abdominal cramps Dehydration: dry mouth, lethargy, sunken eyes Typically resolves within 3–7 days	Clinical diagnosis in most cases Stool PCR rarely needed	💧 Oral rehydration solution (ORS) Continue breastfeeding/formula Paracetamol for fever 🚫 Avoid antidiarrhoeals
🧫 Bacterial Gastroenteritis (Salmonella, Shigella, E. coli)	May be bloody (dysentery) Abdominal pain, fever More prolonged course (>7 days)	Stool culture & sensitivity Stool PCR for rapid identification Bloods if systemically unwell	Hydration (ORS or IV fluids) Antibiotics only if indicated (e.g. Shigella) 🚫 Avoid antidiarrhoeals
🪱 Parasitic Infection (Giardia, Cryptosporidium)	Prolonged watery diarrhoea Bloating, weight loss Failure to thrive if chronic	Stool ova & parasites Stool antigen (Giardia) PCR for confirmation	Metronidazole or tinidazole (Giardia) Hydration support Nutritional rehabilitation
🥛 Food Allergy / Intolerance (Lactose intolerance, CMPA)	Diarrhoea after specific foods Bloating, flatulence No fever Symptoms resolve with avoidance	Elimination diet Hydrogen breath test (lactose) IgE/skin prick testing (CMPA)	Dietary exclusion Lactase supplements if appropriate Dietetic input
💊 Antibiotic-Associated Diarrhoea (C. difficile)	Watery diarrhoea Recent antibiotic exposure May progress to colitis	Stool toxin or PCR testing CBC (leukocytosis if severe)	Stop precipitating antibiotic Oral metronidazole or vancomycin Hydration and supportive care
🍞 Malabsorption Syndromes (Coeliac disease, Cystic fibrosis)	Chronic bulky, foul-smelling stools Poor weight gain or growth faltering Abdominal distension, fatigue	tTG-IgA (coeliac) Sweat test (CF) Stool fat analysis	Gluten-free diet (coeliac) Pancreatic enzyme replacement (CF) Vitamin and nutritional supplementation

🚨 Red Flags – Escalate Care

⚠️ Signs of severe dehydration
🩸 Persistent bloody diarrhoea
📉 Failure to thrive or weight loss
🌡️ High fever or systemic toxicity
⏳ Diarrhoea lasting >2 weeks

📚 Teaching Pearls

💧 Hydration is the cornerstone of management in all diarrhoeal illness.
🦠 Most acute diarrhoea in children is viral and self-limiting.
🚫 Antidiarrhoeals are unsafe in young children.
📉 Chronic diarrhoea + poor growth = think malabsorption.
👶 Always assess hydration before focusing on aetiology.

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Diarrhoea (Children)

🧠 Common Causes of Paediatric Diarrhoea – Clinical Comparison

🚨 Red Flags – Escalate Care

📚 Teaching Pearls

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