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Rome IV Diagnostic Criteria for Infant Functional Diarrhea

Symptom-based diagnosis of chronic nonspecific diarrhea in a thriving young child.

Rome IV Diagnostic Criteria for Infant Functional Diarrhea
Daily, painless, recurrent passage of ≥4 large, unformed stools
Duration of at least 4 weeks
Symptom onset between 6 and 60 months of age
No failure to thrive if caloric intake is adequate
ResultCriteria not met

Does not meet Rome IV criteria for infant functional diarrhea; evaluate for infection, malabsorption, food protein intolerance, or another organic cause.

When to use

  • Well-appearing child aged 6-60 months with chronic loose stools and normal growth, to support a functional diagnosis over an extensive workup.

Formula

Diagnosis requires all of: daily painless passage of ≥4 large, unformed stools; duration ≥4 weeks; onset between 6 and 60 months of age; no failure to thrive when caloric intake is adequate.

Pearls and pitfalls

  • Excess fruit juice/sorbitol intake and a low-fat, high-carbohydrate diet are common contributors and a first-line target for management.

References

  1. Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.