{"id":28108,"date":"2026-05-29T11:54:04","date_gmt":"2026-05-29T10:54:04","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=28108"},"modified":"2026-07-08T11:35:24","modified_gmt":"2026-07-08T10:35:24","slug":"chronic-diarrhoea","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/chronic-diarrhoea\/","title":{"rendered":"Chronic Diarrhoea (Paediatric)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Chronic diarrhoea is the passage of 3 or more loose or liquid stools in a 24-hour period (or more than is normal for the individual) for more than 4 weeks.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th><strong>Causes of chronic diarrhoea<\/strong><\/th><th><strong>Clinical features<\/strong><\/th><\/tr><\/thead><tbody><tr><td>Idiopathic chronic diarrhoea<\/td><td>Self-limiting with no identifiable cause<\/td><\/tr><tr><td>Toddlers&#8217; diarrhoea<\/td><td>Age 1-5 years, up to 10 bowel movements per day, undigested food in stool, otherwise well child, normal growth<\/td><\/tr><tr><td>Irritable bowel syndrome<\/td><td>Abdominal pain, bloating, flatulence, normal growth<\/td><\/tr><tr><td>Overflow diarrhoea<\/td><td>Sticky, soiling\/smearing, features of constipation<\/td><\/tr><tr><td>Transient post- infectious lactose intolerance<\/td><td>Usually after an infectious gastrointestinal illness, bloating, flatulence and loose often explosive stools<\/td><\/tr><tr><td>Coeliac disease<\/td><td>Faltering growth, distended abdomen, anaemia, abdominal pain, vomiting, diarrhoea or constipation<\/td><\/tr><tr><td>Inflammatory bowel disease<\/td><td>Abdominal pain, faltering growth \/ weight loss, clinical features of anaemia, diarrhoea (+\/- blood), nocturnal stooling<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Chronic diarrhoea can also be a feature of rarer disorders such as parasitic infections, hyperthyroidism, pancreatic insufficiency, immunodeficiencies and metabolic diseases.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">History:<\/h4>\n\n\n\n<h2 class=\"wp-block-heading\"><\/h2>\n\n\n<style>.wp-block-kadence-column.kb-section-dir-horizontal > .kt-inside-inner-col > .kt-info-box28108_1b955f-8c{max-width:60%;}.wp-block-kadence-column.kb-section-dir-horizontal > .kt-inside-inner-col > .kt-info-box28108_1b955f-8c .kt-blocks-info-box-link-wrap{max-width:unset;}.kt-info-box28108_1b955f-8c .kt-blocks-info-box-link-wrap{border-top:5px solid #002095;border-right:5px solid #002095;border-bottom:5px solid #002095;border-left:5px solid #002095;background:#ffffff;max-width:60%;padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-right:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);padding-left:var(--global-kb-spacing-sm, 1.5rem);margin-top:50px;}.kt-info-box28108_1b955f-8c .kt-blocks-info-box-media-align-top .kt-blocks-info-box-media-container{max-width:100%;}.kt-info-box28108_1b955f-8c .kadence-info-box-icon-container .kt-info-svg-icon, .kt-info-box28108_1b955f-8c .kt-info-svg-icon-flip, .kt-info-box28108_1b955f-8c .kt-blocks-info-box-number{font-size:30px;}.kt-info-box28108_1b955f-8c .kt-blocks-info-box-media{background:#ffffff;border-color:#002095;border-top-width:5px;border-right-width:5px;border-bottom-width:5px;border-left-width:5px;padding-top:20px;padding-right:20px;padding-bottom:20px;padding-left:20px;}.kt-info-box28108_1b955f-8c .kt-blocks-info-box-media-container{margin-top:-75px;margin-right:0px;margin-bottom:20px;margin-left:0px;}.kt-info-box28108_1b955f-8c .kt-infobox-textcontent h4.kt-blocks-info-box-title{padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-top:5px;margin-right:0px;margin-bottom:10px;margin-left:0px;}.kt-info-box28108_1b955f-8c .kt-blocks-info-box-learnmore{background:transparent;border-width:0px 0px 0px 0px;padding-top:4px;padding-right:8px;padding-bottom:4px;padding-left:8px;margin-top:10px;margin-right:0px;margin-bottom:10px;margin-left:0px;}@media all and (max-width: 1024px){.kt-info-box28108_1b955f-8c .kt-blocks-info-box-link-wrap{border-top:5px solid #002095;border-right:5px solid #002095;border-bottom:5px solid #002095;border-left:5px solid #002095;}}@media all and (max-width: 767px){.kt-info-box28108_1b955f-8c .kt-blocks-info-box-link-wrap{border-top:5px solid #002095;border-right:5px solid #002095;border-bottom:5px solid #002095;border-left:5px solid #002095;}}<\/style>\n<div class=\"wp-block-kadence-infobox kt-info-box28108_1b955f-8c\"><span class=\"kt-blocks-info-box-link-wrap info-box-link kt-blocks-info-box-media-align-top kt-info-halign-left\"><div class=\"kt-blocks-info-box-media-container\"><div class=\"kt-blocks-info-box-media kt-info-media-animate-none\"><div class=\"kadence-info-box-icon-container kt-info-icon-animate-none\"><div class=\"kadence-info-box-icon-inner-container\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fe_alertTriangle kt-info-svg-icon\"><svg viewBox=\"0 0 24 24\"  fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M10.29 3.86L1.82 18a2 2 0 0 0 1.71 3h16.94a2 2 0 0 0 1.71-3L13.71 3.86a2 2 0 0 0-3.42 0z\"\/><line x1=\"12\" y1=\"9\" x2=\"12\" y2=\"13\"\/><line x1=\"12\" y1=\"17\" x2=\"12\" y2=\"17\"\/><\/svg><\/span><\/div><\/div><\/div><\/div><div class=\"kt-infobox-textcontent\"><h4 class=\"kt-blocks-info-box-title\">Red Flags (refer to Medical Paediatrics)<\/h4><p class=\"kt-blocks-info-box-text\">&#8211; Faltering growth or weight loss<br>&#8211; Persistent blood in stools<br>&#8211; Regular nocturnal stooling<br>&#8211; Persistent pyrexia<br>&#8211; Skin, joint or eye manifestations suggesting possible IBD or immunodeficiency<br>&#8211; Family history (1<sup>st<\/sup> degree relative) of IBD\/ Lynch syndrome<\/p><\/div><\/span><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Presence of other GI symptoms e.g. abdominal pain\/oral ulcers\/upper GI symptoms<\/li>\n\n\n\n<li>Previous stool pattern<\/li>\n\n\n\n<li>Triggers including foods, psychosocial stressors or preceding acute gastroenteritis<\/li>\n\n\n\n<li>Diet and fluid intake<\/li>\n\n\n\n<li>Travel and allergy history<\/li>\n\n\n\n<li>Family history of coeliac or other GI diseases<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Examination:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assessment of growth: please include weight &amp; height in referral<\/li>\n\n\n\n<li>Hydration and clinical evidence of nutrient deficiency (e.g. conjunctivae, skin, nails)<\/li>\n\n\n\n<li>Abdominal examination<\/li>\n\n\n\n<li>Visually inspect the mouth and anus<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Investigations:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In most cases of chronic diarrhoea, provided growth is good and in the absence of red flags, no further investigation is required. Provide follow-up to review trend of symptoms and growth.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Investigations should be done in the presence of red flags or may be considered to provide reassurance.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stool samples:<ul><li>MC&amp;S (<em>C.difficile<\/em> toxin will be automatically added by the lab if the sample is loose) +\/- parasites (if history of travel)<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Enteric viruses<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Blood tests may include FBC, ESR, U&amp;Es, LFTs, CRP, TFTs, coeliac screen.<\/li>\n\n\n\n<li>Faecal Calprotectin if 5 years or older and there is a strong clinical suspicion of IBD<ul><li>Poor clinical utility below the age of 5 years<\/li><\/ul><ul><li>If not already sent, send stool MC&amp;S and enteric viruses at the same time<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Faecal calprotectin may be falsely raised in children<ul><li>taking NSAIDs<\/li><\/ul><ul><li>who have had a gastrointestinal infection within the last 4 weeks<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>with polyps.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A clinically significant faecal calprotectin is usually &gt;200ug\/g. If between 50-200ug\/g then, if relevant (i.e. symptoms persist), it should be repeated after 1 month.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.M, A.B, C.H, R.R &amp; P.H &#8211; 29-05-26<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to Refer<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer any child to gastroenterology if there is a strong suspicion of IBD<\/li>\n\n\n\n<li>Refer any child with a positive serology for coeliac disease to paediatric coeliac service<\/li>\n\n\n\n<li>Refer any child with red flags (who <strong>does not<\/strong> have tests suggestive of coeliac disease or IBD) to medical paediatrics<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Toddlers\u2019 diarrhoea:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Provide reassurance that it is very common, it is not a serious problem (due to rapid colonic transit time \/ colonic immaturity &amp; insufficient time for water reabsorption), and it will usually resolve by the age of 5 years.<\/li>\n\n\n\n<li>Dietary changes families can implement to help:<ul><li>Avoid low fat diet<\/li><\/ul><ul><li>Avoid \/ reduce refined sugars &amp; sweeteners (i.e. sweets, fruit juices, diluting juice)<\/li><\/ul><ul><li>Avoid \/ reduce processed foods<\/li><\/ul><ul><li>Avoid excessive fluid intake<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Avoid excessive fibre intake<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Irritable bowel syndrome &#8211; diarrhoea subtype:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dietary changes as listed under toddlers\u2019 diarrhoea can be helpful.<\/li>\n\n\n\n<li>Additionally, avoiding large meals, taking your time to eat and avoiding common triggers e.g. fatty foods, caffeine, fizzy drinks, artificial sweeteners.<\/li>\n\n\n\n<li>Exercise regularly.<\/li>\n\n\n\n<li>Address anxiety and use relaxation techniques (see IBS\/FAP resources section).<\/li>\n\n\n\n<li>Trial of food exclusion for suspected triggers e.g. wheat or dairy may be helpful, but reintroduction following a period of elimination (around 4 weeks) is important to confirm or refute. Excessively restrictive diets may be harmful. Unlike in adults, FODMAP diets are not routinely recommended. Consider Food, mood and symptom diary (see below).<\/li>\n\n\n\n<li>Medications have weak evidence but may be considered if lifestyle changes are not effective. There is clear dosing in the BNFc for the following medications:<ul><li>Fybogel or Loperomide for chronic diarrhoea<\/li><\/ul><ul><li>Buscopan or Mebeverine (immediate release) antispasmodics for pain<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Peppermint oil for bloating (over 15 years)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Post-infectious lactose intolerance:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually transient, lasting around 6-8 weeks but may last up to 6 months.<\/li>\n\n\n\n<li>Diagnosis and treatment is with a lactose-free diet, with reintroduction plan after 8 weeks. <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Paed-GI-Lactose-Free-Diet-Sheet-v1.0-Aug2019.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Paed-GI-Lactose-Free-Diet-Sheet-v1.0-Aug2019.pdf<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">There is weak evidence to support the use of probiotics for chronic gastrointestinal disorders, please see the link in the resources section for further information.&nbsp;<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong>Information for primary care:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rome IV diagnostic criteria for IBS and functional diarrhoea: <a href=\"https:\/\/theromefoundation.org\/rome-iv\/rome-iv-criteria\/\" target=\"_blank\" rel=\"noreferrer noopener\">Rome IV Criteria &#8211; Rome Foundation<\/a><\/li>\n\n\n\n<li>Lactose intolerance information: <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Paediatric-G.I-Lactose-Intolerance-RHCYP-AUG-2019.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Paediatric-G.I-Lactose-Intolerance-RHCYP-AUG-2019.pdf<\/a><\/li>\n\n\n\n<li>Use of probiotics in the management of paediatric gastrointestinal disorders: <a href=\"https:\/\/www.espghan.org\/knowledge-center\/publications\/Gastroenterology\/2023-Synbiotics-in-the-Management-of-Pediatric-Gastrointestinal-Disorders0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.espghan.org\/knowledge-center\/publications\/Gastroenterology\/2023-Synbiotics-in-the-Management-of-Pediatric-Gastrointestinal-Disorders0<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Information for families:<\/strong><strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dietary advice for IBS <a href=\"https:\/\/www.bda.uk.com\/resource\/irritable-bowel-syndrome-diet.html\" target=\"_blank\" rel=\"noreferrer noopener\">Irritable bowel syndrome (IBS) and diet &#8211; BDA<\/a><\/li>\n\n\n\n<li>Food, mood and symptom diary <a href=\"https:\/\/www.cuh.nhs.uk\/patient-information\/food-mood-and-symptom-diary\/\" target=\"_blank\" rel=\"noreferrer noopener\">Food, Mood and Symptom Diary | CUH<\/a><\/li>\n\n\n\n<li>For helpful patient information leaflets on IBS see resources in the IBS\/FAP tab <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricgastrointestinal\/irritablebowelsyndromeibsfunctionalabdominalpainfap\/\" target=\"_blank\" rel=\"noreferrer noopener\">Irritable Bowel Syndrome (IBS) and Functional Abdominal Pain (FAP) \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>General tips for healthy bowels <a href=\"https:\/\/eric.org.uk\/childrens-bowels\/\" target=\"_blank\" rel=\"noreferrer noopener\">Children\u2019s bowels &#8211; ERIC<\/a><\/li>\n\n\n\n<li>Toddler\u2019s Diarrhoea information <a href=\"https:\/\/patient.info\/childrens-health\/acute-diarrhoea-in-children\/toddlers-diarrhoea\" target=\"_blank\" rel=\"noreferrer noopener\">Toddler&#8217;s Diarrhoea: Causes, Symptoms, and Treatment<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Chronic diarrhoea is the passage of 3 or more loose or liquid stools in a 24-hour period (or more than is normal for the individual) for more than 4 weeks. Causes of chronic diarrhoea Clinical features Idiopathic chronic diarrhoea Self-limiting with no identifiable cause Toddlers&rsquo; diarrhoea Age 1-5 years, up to 10 bowel movements per<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1395,1176],"class_list":["post-28108","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-chronic-diarrhoea","category-https-apps-nhslothian-scot-refhelp-medical-paediatrics"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/https-apps-nhslothian-scot-refhelp-chronic-diarrhoea\/\" rel=\"tag\">Chronic Diarrhoea<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/\" rel=\"tag\">Medical Paediatrics<\/a>","rttpg_excerpt":"Chronic diarrhoea is the passage of 3 or more loose or liquid stools in a 24-hour period (or more than is normal for the individual) for more than 4 weeks. Causes of chronic diarrhoea Clinical features Idiopathic chronic diarrhoea Self-limiting with no identifiable cause Toddlers&rsquo; diarrhoea Age 1-5 years, up to 10 bowel movements per","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28108","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=28108"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28108\/revisions"}],"predecessor-version":[{"id":28814,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28108\/revisions\/28814"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=28108"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=28108"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}