Chronic protracted diarrhea of infancy: a nutritional disease

Diarrhea is an extremely common cause of morbidity in infancy. Occasionally, it becomes protracted, leading to a vicious cycle of malabsorption, malnutrition, and failure to thrive. A number of causes of chronic diarrhea in infancy are discussed, including postinfectious enteritis, celiac sprue, cow's milk allergy, and parasitic infection. Although many mechanisms may contribute to diarrhea, a similar pathophysiologic syndrome of mucosal atrophy, inflammation, and malabsorption results. Attention should be paid to recognition of malnutrition as well as etiologic diagnosis. Therapeutic efforts should concentrate on nutritional rehabilitation, through appropriate oral elemental formulas or total parenteral nutrition. However, encouragement of breast-feeding is probably a more effective way of preventing this difficult problem.