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Toddler's diarrhea: is it an under-recognized entity in developing countries?

Ujjal Poddar1, Jaya Agarwal, Surender Kumar Yachha

  • 1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

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Summary

Toddler's diarrhea (TD) is prevalent in developing nations, including India. Anthropometric measurements and hemoglobin levels help distinguish TD from celiac disease (CD) and cow's milk protein allergy (CMPA).

Keywords:
butterceliac diseasecow’s milk protein allergynon-specific diarrhea

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Area of Science:

  • Pediatric Gastroenterology
  • Global Health
  • Clinical Nutrition

Background:

  • Toddler's diarrhea (TD) is a common cause of chronic diarrhea in developed countries, but data from developing regions are scarce.
  • Chronic diarrhea in young children (<5 years) can stem from various etiologies, including infections, malabsorption, and allergic reactions.
  • Understanding the prevalence and differentiating factors of TD in diverse populations is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To investigate the incidence and characteristics of toddler's diarrhea (TD) in a developing country context.
  • To compare the etiological profile of chronic diarrhea in children under five.
  • To identify clinical and laboratory parameters that differentiate TD from other common causes like celiac disease (CD) and cow's milk protein allergy (CMPA).

Main Methods:

  • A retrospective analysis of 191 children under five with chronic diarrhea over seven years.
  • Clinical data, investigations, and outcomes were collected using a standardized proforma.
  • TD was diagnosed in children with normal growth and no evidence of malabsorption or enteric infections.

Main Results:

  • Toddler's diarrhea (TD) accounted for 16% of chronic diarrhea cases, while celiac disease (CD) was 37% and cow's milk protein allergy (CMPA) was 35%.
  • The mean age of children with TD was 2.7 ± 1.2 years.
  • Weight z-score (>-2.2) and hemoglobin levels (>10 g/dL for TD vs. >10.9 g/dL for CD/CMPA) were significant independent variables distinguishing TD from CD and CMPA.

Conclusions:

  • Toddler's diarrhea (TD) is a significant cause of chronic diarrhea in developing countries like India.
  • Anthropometric data and hemoglobin levels are valuable tools for differentiating TD from celiac disease (CD) and cow's milk protein allergy (CMPA).
  • This study highlights the need to consider TD in the differential diagnosis of chronic diarrhea in pediatric populations worldwide.