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.¹

A change in stool consistency rather than stool number only, is more indicative of diarrhea in infants. Therefore, frequent passing of formed stools is not diarrhea, nor is the passing of loose, "pasty" stools in a breastfed baby.² So ask about the infant’s stool consistency as well as number of stools/day.

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.^2,3

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

The Brussels Infants and Toddlers Stool Scale (BITSS) is validated as a reliable instrument to assess stools of non-toilet trained children.⁴

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.⁵ Other causes of infant diarrhea include parasites, reaction to medicines, or a disease, such as cystic fibrosis.³

In many cases, diarrhea may also be accompanied by vomiting², which may increase the risk of dehydration². 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) affecting more than half of children with CMPA.^6-8 Regardless, the presence of an infection as the cause for diarrhea in the infant, should first be ruled out before proceeding to other diagnosis.

When considering if the diagnosis could be CMPA, it’s important to understand that the majority of these infants have at least two symptoms affecting at least two different organ systems.^9-11

Therefore, 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.^12,13