chronic diarrhea

  Please help, I have a friend who's two year old has had watery diarrhea off and on for almost a year. The diarrhea occurs every 1/2 to 1 hr, the doctors have run tests for yeast, parasites, etc. All negative. The child has been an antibiotics and diflucan, has been put on sterile water, etc. The stools are very abrasive and his skin integrity is damaged at this point. A couple of times the diarrhea stopped for approx. a month, then returned. Can you tell me any ideas you may have? Would Rotavirus do this? Would a biopsy be the next step? Thank you.

[HFHS.RN-AM]

Daer Theresa,
Thank you for your question.  The first thing that pops to mind is milk allergy or possibly lactose intolerance. I would assume that this child was on breast milk or formula until one year of age and by your history, the onset of diarrhea coincided with the introduction of milk into his diet. Your friend could try eliminating ALL dairy products from the child's diet until the diarrhea stops, that includes cheese, yougurt, and ice cream as well as milk itself. Your friend will need to read labels carefully to determine if there are milk products in the incredients. Whey is one product in many foods that comes from milk that can be allergenic (remember little Miss Muffett who ate curds and whey).  If the diarrhea stops, she may or may not decide to reintroduce a SMALL amount of milk to see if the diarrhea resumes.
I would recommend that if the diarrhea stops with the cessation of milk intake, that she consult with an allergist or pediatrician knowlegable about allergies to find ways to replace the calcium he will be missing from a milk-free diet.
If on the other hand, there is no difference after stopping milk, and the child continues to have diarrhea, perhaps it is time to seek a consultation with a gastroenterologist . You did not say if the child has maintained normal growth and development despite constant diarrhea. If the child has fallen to a lower percentile, another possibility could be a malabsorbtion disorder. This a gastroenterologist would be needed to determine.
Rotovirus is really a simple virus in that it usually runss it's course (no pun intended) in 7-10 days with out the help of antibiotics or antiviral medications.  The risk with rotovirus is in very young children who quickly become dehydrated from the diarrhea.
Let us know how the child fares.
HFHS.RN-AM
KEYWORD: rotovirus, malabsorbtion diseases, lactose intolerance, milk allergy, special diets