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Chronic Nonspecific Diarrhea

Diarrhea is considered chronic when it persists for longer than 3 weeks. Chronic nonspecific diarrhea (CNSD) presents in toddlers between 18 months and 3 years of age, with frequent, large, watery stools in the absence of physical or laboratory signs of malabsorption or infection and without effect chronic nonspecific diarrhea, diarrhea, children, toddlers, babies on growth or development. Children have 3 to 6 large, watery bowel movements daily. The diarea spontaneously resolves in 90% of children between by 40 months of age, often coincidentally with


Chronic Nonspecific Diarrhea Chronic Nonspecific Diarrhea

Factors Causing CNSD

Excess fluid intake

Carbohydrate malabsorption from excessive juice ingestion

Disordered intestinal motility

Excessive fecal bile acids

Low fat intake

Fluid intake exceeds the absorptive capacity of the intestinal tract. Malabsorption of carbohydrates (sucrose, fructose, sorbitol) in fruit juices contributes to

Presentation. CNSD presents between 18 months and 3 years, with 3-6 large, loose, watery stools per day for more than 3 weeks. Stools may have been loose throughout infancy, especially in breast fed infants.

Stools may have been formed until a recent episode of gastroenteritis or other acute illness; or the stools may have become diarrheal without an antecedent illness.

Stooling is most frequent in the morning and does not occur during sleep. There is an absence of nausea, vomiting, abdominal pain, flatulence, blood, fever, anorexia, weight loss, or poor growth.

Clinical Evaluation of Chronic Nonspecific Diarrhea

The current number and type of stools should be determined. A diet history should determine the total calories, fat, milk and juice consumed daily, the history should assess prior trials of elimination diets or currently eliminated foods.

The timing of introduction of foods into the diet relative to the onset of diarrhea, and a 3-day diet history should be assessed. Usage of antibiotics, vitamins, iron, and medications should be sought.

A family history of irritable bowel syndrome, celiac disease, inflammatory bowel disease, infectious diarrhea, or food allergies should be sought.

Physical Examination

Growth chart plotting of weight, height, and head circumference are essential. Children who have CNSD should continue to grow normally; deviation from the growth chart or a downward trend suggests inadequate caloric intake.