Chronic nonspecific diarrhea of infancy (CNSD) or irritable bowel syndrome represents one of the most common gastrointestinal problems confronted by practicing pediatricias. In the subspecialty setting of the pediatric gastroenterologist, this entity comprised almost 35% of the outpatient referral practice. CNSD, originally thought to be part of the celiac syndrome, was described as a separate clinical entity by Cohlan in 1956.1 Since that time in the classic paper on this subject, Davidson and Wasserman2 have described consistent diagnostic criteria further characterizing CNSD as a recognizable syndrome. The onset of symptoms occurs classically between 6 and 30 months of age with the development of three to six loose stools with mucous per day, with no associated malabsorption or growth and development abnormalities (to be discussed in detail below). Whereas spontaneous resolution of CNSD is anticipated by 39 months of age, longitudinal observations indicate that these patients have a high incidence of functional bowel complaints during adolescence and beyond suggesting a continuum with "irritable bowel syndrome" of adulthood.3 From the standpoint of the child, this "complaint" all too frequently becomes the "problem" when the frequency and/or consistency of the bowel movements impair training or become intolerable to the parents.
Irritable Bowel Syndrome: Patient-Provider Interaction and Patient Education
