Diarrhea

Diarrhea can be acute or chronic and is usually obvious to identify. Acute diarrhea is a frequent digestive disorder in babies, and it can come on quite suddenly. Acute diarrhea is defined as three or more watery or loose stools per day lasting for around seven to 10 days, 14 days at most (Radlović N et al 2015).

Chronic diarrhea lasts longer than 2 weeks. It is usually caused by an illness or health condition and will not go away until the illness/condition has been treated (HSE, 2018).

A change in stool consistency rather than stool number is more indicative of diarrhea in infants (WHO 2013), so ask about the infant’s stool consistency as well as number of stools/day this.

The Brussels Infants and Toddlers Stool Scale (BITSS) is validated as a reliable instrument to assess stools of non-toilet trained children (Huysentruyt et al 2019).

During the first few months of life, babies pass frequent stools which are yellowish in colour and often soft. This is perfectly normal. The following cases indicate a healthy infant and should not be confused with diarrhea (WHO 2013; Medline 2023).

·  Normal or healthy newborn stools are soft and loose
·  Newborn babies pass stools frequently, sometimes after every feed
·  Breastfed infants often have pasty stools

Diarrhea & CMPA

What causes diarrhea in infants?

Diarrhea is usually caused by an infection such as a virus, e.g. Rotavirus and Norovirus, or bacteria, e.g. Campylobacter or Salmonella (Guarino et al JPGN 2014). Other causes of infant diarrhea include parasites, reaction to medicines, or a disease, such as cystic fibrosis (Medline Diarrhea 2023).

In many cases, diarrhea may also be accompanied by vomiting (WHO 2013), which may increase the risk of dehydration (WHO 2013). Dehydration is the main risk associated with diarrhea, therefore it is important to ensure that infants remain hydrated.

Could it be a symptom of Cow’s Milk Protein Allergy?

Diarrhea is the most common gastrointestinal symptom related to Cow’s Milk Protein Allergy (CMPA) and affects more than half of children with CMPA (Koletzko et al 2012;Hill et al 1986; Iacono et al 1989). The presence of infection as a cause for diarrhea in the infant, needs to be ruled out before proceeding to other diagnosis.

However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Host & Halken 1990; Host et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022).