Differential diagnosis of acute diarrheal disorders in children

Acute diarrhea is one of the most common symptoms in children. Common causes and differential diagnosis are reviewed in this article. In children with suspicious diarrhea, one should consider whether the stool is normal variant or true diarrhea and in the case of true diarrhea, whether it is infectious or noninfectious diarrhea, particularly bacterial or viral infection; last, in the case of bacterial infection, whether antibiotics is needed or not. Rotaviruses and noroviruses are the most common causes in children with acute diarrhea. The seasonal distribution of rotavirus infection is changing. Epidemics of norovirus are increasing. The main symptom of norovirus infection in children is vomiting, unlike rotavirus infection. Bacterial infection is not a common cause. When a child shows bloody and mucoid diarrhea, the use of antibiotics should be considered if the patient is a young infant, is immunocompromised, or has toxic symptoms such as high fever, severe dehydration, or malnutrition. Clinical approaches focused on etiology can support the proper management and prediction of prognosis. Genetic epidemiology research is needed to monitor the efficacy of rotavirus vaccination and to develop a norovirus vaccine.