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 For the following children presenting with diarrhoea which is the most likely diagnosis?

A 6-year-old boy with Down syndrome has between three and four loose stools a day. He is pale but otherwise the examination is unremarkable. When plotting his growth on a chart specific for Down syndrome children it is clear that both height and weight have fallen across 2 centiles.

- The correct answer       is Coeliac disease

Coeliac disease occurs more frequently in Down syndrome. To screen, anti-TTG antibodies taken with serum IgA must be evaluated.

A 3-year-old has intermittent diarrhoea with stools of varying consistency and sometimes undigested food particles. His growth is satisfactory. His mother had tried to reduce his intake of diary produce, but dietary manipulation has had no impact on the symptoms.

 - The correct answer is Toddler's diarrhoea

Toddler's diarrhoea (thought to be a normal variant) occurs mainly in preschool children and is evidenced by undigested food observed in the faeces of a well child. Poor growth would indicate a likely pathological cause.

A 4-month-old baby girl has severe atopic eczema and is regularly reviewed in the paediatric clinic. She had now developed diarrhoea and her weight has been static in recent weeks. A full blood count shows a slight eosinophilia.

- The correct answer is Cow's milk protein intolerance

CMPI is associated with eczema and eosinophilia. Cow's milk should be excluded from the diet and reintroduced between 1-2 years if tolerated. An alternative milk source such as Pepti Junior can be used until this is done.