G5. Diagnostic Criteria for Functional Diarrhea
Must include all of the following:
- 1
Daily painless, recurrent passage of 3 or more large, unformed stools
- 2
Regurgitation of stomach contents into the esophagus and mouth is common and normal in infants. Uncomplicated regurgitation in otherwise healthy infants is a developmental issue, not a disease. Regurgitation is the involuntary return of previously swallowed food or secretions into or out of the mouth. Regurgitation is distinguished from vomiting, which is defined by a central nervous system reflex involving both autonomic and skeletal muscles in which gastric contents are forcefully expelled
Infant rumination syndrome is a rare disorder characterized by voluntary, habitual regurgitation of stomach contents into the mouth for self-stimulation. Rumination is regurgitation of recently swallowed food, rechewing, and either reswallowing or spitting out the food. Although rumination is a functional symptom, infant rumination syndrome is a life-threatening psychiatric disorder caused by social deprivation. Rumination in healthy older children and adults is discussed in other reports in
Cyclic vomiting syndrome (CVS) consists of recurrent, stereotypic episodes of intense nausea and vomiting lasting hours to days that are separated by symptom-free intervals lasting weeks to months.9 The frequency of episodes ranges from 1 to 70 per year and averages 12 per year. Attacks occur at regular intervals or sporadically. Typically, episodes begin at the same time of day, most commonly during night or morning. Episode duration tends to be the same in each patient. CVS reaches its
The term “colic” implies abdominal pain caused by obstruction to flow from the kidney, gallbladder, or intestine. In contrast, “infant colic” is a behavioral syndrome of early infancy involving long crying bouts and hard-to-soothe behavior. Infant colic was defined as “paroxysms of irritability, fussing or crying lasting >3 hours per day and occurring >3 days each week.”13 There is no proof that crying in infant colic is caused by pain in the abdomen or any other body part. Nevertheless,
Functional diarrhea is defined by daily painless, recurrent passage of 3 or more large, unformed stools for 4 or more weeks with onset in infancy or preschool years. There is no evidence for failure to thrive if the diet has adequate calories. The child seems unperturbed by the loose stools, and the symptom resolves spontaneously by school age.
Must include all of the following:
Daily painless, recurrent passage of 3 or more large, unformed stoolsG5. Diagnostic Criteria for Functional Diarrhea
Defecation frequency in healthy infants and children decreases with age.22 Breast-fed infants may defecate as frequently as 12 times per day or as infrequently as once in 3 or 4 weeks. Firm stools may occur from the first weeks of life in formula-fed infants. These infants may experience painful defecation and so have a predisposition toward developing functional constipation (see following text).
There is a decline in stool frequency from an average of more than 4 stools daily in the first week
Parents describe infants with dyschezia as straining for many minutes, screaming, crying, and turning red or purple in the face with effort. The symptoms persist for 10–20 minutes, until there is passage of soft or liquid stool. Stools pass several times daily. The symptoms begin in the first months of life and resolve spontaneously after a few weeks.
Must include both of the following in an infant younger than 6 months of age:
At least 10 minutes ofG6. Diagnostic Criteria for Infant Dyschezia
Constipation represents the chief complaint in 3% of pediatric outpatient visits. Approximately 40% of children with functional constipation develop symptoms during the first year of life.27, 28 Sixteen percent of parents of 22-month-old children reported constipation.29
Must include 1 month of at least 2 of the following in infants up to 4 years of age:
Two or fewer defecations per week At least 1 episode per week of incontinence after theG7. Diagnostic Criteria for Functional Constipation
Validating the diagnostic criteria for the childhood functional gastrointestinal disorders will be an important goal for the next decade. Epidemiologic community-based studies and studies of populations believed to be at risk (eg, children of patients with functional gastrointestinal disorders, female child abuse victims) are needed to determine the applicability of the diagnostic criteria, which were arrived at by consensus rather than by data analysis.
Clinical trials measuring symptom change