The most likely diagnosis is celiac disease. Celiac disease is an auoimmune condition caused by a reaction to gluten ingestion. Symptoms include, but are not limited to, weight loss, suboptimal growth and delayed puberty, bloating, diarrhea or constipation. The diarrhea in celiac disease is non-bloody. The pattern of failure to thrive only after introduction of solid foods makes celiac disease the most likely diagnosis in this case.
A father brings a girl, 11 months old, to the Emergency Department with a 5 month history of diarrhea which is described as frequent liquid stools. There is no blood in the stool. The child has not been vomiting and has abdominal pain. The child is in daycare. The child is fully immunized and is breastfed with a variety of solids. Family history is unremarkable. On examination the child looks tired. The vital signs are as follows, bp: normal, hr: normal and temp: 36.6°C. Abdominal examination is normal. Perianal examination is normal. Skin examination is normal.
Partially Correct
Zella GC & Israel EJ. Chronic Diarrhea in Children. Pediatrics in Review 2012; 33: 207-218
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Author
Dr. Joanna Holland
joanna.holland@iwk.nshealth.caReviewers
Dr. Karen Forbes