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Chronic non-specific diarrhoea in childhood: how often is it iatrogenic?
P Boehm1, G Nassimbeni, A Ventura
1Department of Clinical Paediatrics, Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy.
Insights
Chronic non-specific diarrhoea (CNSD) in children often improves with unrestricted diets, despite initial parental concerns. Most cases resolve spontaneously over time, indicating a self-limiting nature.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Chronic non-specific diarrhoea (CNSD) affects children, often leading to multiple hospital admissions and diagnoses.
- Children with CNSD frequently present with malnutrition, inadequate caloric intake, and reliance on elimination diets.
Purpose of the Study:
- To evaluate epidemiological data, medical approaches, and the effectiveness of unrestricted diets in pediatric CNSD.
- To assess the long-term course and spontaneous resolution of CNSD in children.
Main Methods:
- Retrospective analysis of 20 children diagnosed with CNSD.
- Assessment of dietary intake, nutritional status, and medical history before and during hospitalization.
- Follow-up via telephone interview 5.6 years post-discharge.
Main Results:
- Hospitalization with an unrestricted diet improved diarrhoea and weight in all children.
- Despite initial parental apprehension regarding unrestricted diets, CNSD resolved spontaneously in a mean of 1.7 years.
- Children experienced a mean of 2.4 prior admissions and 2.5 other diagnoses before CNSD admission.
Conclusions:
- Unrestricted diets are effective in managing pediatric CNSD symptoms and improving nutritional status.
- CNSD demonstrates a self-limiting course, with spontaneous resolution occurring over time.
- Parental education and support are crucial when implementing unrestricted diet strategies for CNSD.
Abstract:
Epidemiological data, the appropriateness of the medical approach, the effectiveness of unrestricted diet and the subsequent course of chronic non-specific diarrhoea (CNSD) were evaluated in 20 children, mean age at diagnosis 4.7 y, and mean duration of diarrhoea 24 months. A mean of 2.4 previous hospital admissions and a mean of 2.5 diagnoses other than CNSD were recorded per child before admission. On admission, 14/20 were following an elimination diet and 8/20 had an inadequate caloric intake; 16/20 had a weight/height ratio below the 50th percentile. In all cases a normal diet prescribed during hospitalization improved the diarrhoea and increased weight. A telephone interview performed 5.6 y after discharge revealed that in 10/20 of the cases, the parents were disappointed with the unrestricted diet prescribed during hospitalization. Nevertheless they reported that CNSD stopped spontaneously in a mean time of 1.7 y.