Pediatric Diarrhea: History & Physical Exam

00:02 So if you see a child with vomiting and/or diarrhea, what are key things you want to ask? First is obviously fever.

00:10 Children with infectious diarrhea typically may have a fever.

00:14 Ask about blood or mucus in the stool.

00:16 This may tip you off if this is bacterial as opposed to a viral pathogen.

00:22 Most bacterial gastroenteritis requiring treatment is bloody.

00:28 Ask about exposure to farm animals or reptiles.

00:31 This is actually a really important question because a common cause of salmonella in children is reptile pets and a common cause of E. coli, especially the variety that causes hemolytic uremic syndrome, is from farm animal exposure.

00:49 Petting zoos are a big problem in the United States if children don’t wash their hands with alcohol after they pet the animals.

00:58 Suspicious foods are always a potential cause and we hear about outbreaks all the time.

01:03 For example, E. coli in spinach, this happens periodically and so when such a thing happened, you might ask about suspicious or also undercooked foods, things like uncooked eggs, which might show up in raw cookie dough.

01:17 Ask about recent travel.

01:18 Recent travel’s important because there are some causes of diarrhea that are unusual in the United States that may be more prevalent in developing countries.

01:27 And of course, as about recent antibiotic use because C. diff is a possibility as well as the antibiotic-associated diarrhea.

01:37 So on exam, critically important to look for signs of dehydration.

01:42 Tenting is rare and is only at extreme ends of dehydration.

01:47 Mostly, you’re going to look at mucus membranes and see if they’re moist.

01:50 See if the child is making tears when they cry.

01:53 Look for sings of systemic infection.

01:55 Is there something else going on.

01:57 The abdominal exam is critical especially, especially looking for rebound guarding, things like that where the child doesn’t want you pressing on their abdomen.

02:07 In babies, this can be tricky.

02:09 The baby, if you’re careful, will seem to resist you if you squeeze on their belly.

02:15 But in a crying baby who doesn’t want to be examined in the first place, this can be a challenge.

02:20 A perianal inspection is important on children especially if you’re concerned about inflammatory bowel disease.

02:27 Sometimes, a rectal tag or fissure is the best clue you have that the child has Crohn’s disease.