Differential Diagnosis for a 9-year-old with Intermittent Nocturnal Waking, Cramping, and Diarrhea

• Single most likely diagnosis:
  • Inflammatory bowel disease (IBD) - This includes conditions like Crohn's disease and ulcerative colitis, which can cause chronic diarrhea, abdominal cramping, and nocturnal waking due to symptoms. The age of onset can vary, and some children may start experiencing symptoms around this age.
• Other Likely diagnoses:
  • Gastroesophageal reflux disease (GERD) - Although more commonly associated with heartburn and regurgitation, GERD can cause abdominal pain and discomfort that may worsen at night, potentially leading to waking and diarrhea in some cases.
  • Irritable bowel syndrome (IBS) - A functional gastrointestinal disorder that can cause abdominal pain, changes in bowel movements (including diarrhea), and may disrupt sleep patterns.
  • Lactose intolerance or other food intolerances - These can lead to abdominal cramps, diarrhea, and discomfort after consuming certain foods, potentially worsening at night if the child eats a problematic food close to bedtime.
  • Infectious gastroenteritis - Although typically presents with more acute symptoms, some viral or bacterial infections can cause prolonged or intermittent gastrointestinal symptoms.
• Do Not Miss diagnoses:
  • Intussusception - A condition where a part of the intestine slides into an adjacent part, potentially causing bowel obstruction. It's a medical emergency and can present with intermittent abdominal pain, vomiting, and sometimes diarrhea.
  • Appendicitis - While classically presents with right lower quadrant pain, early or atypical appendicitis can have varied symptoms, including diarrhea and generalized abdominal pain.
  • Inflammatory or infectious conditions (e.g., appendicitis, diverticulitis) - These conditions require prompt medical attention to prevent serious complications.
• Rare diagnoses:
  • Celiac disease - An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, causing malabsorption and various gastrointestinal symptoms, including diarrhea.
  • Thyroid disorders - Both hyperthyroidism and hypothyroidism can have gastrointestinal manifestations, including changes in bowel habits, though these are less common presentations.
  • Abdominal migraines - A condition that can cause recurrent episodes of abdominal pain, often accompanied by other symptoms like headache, nausea, or vomiting, and can disrupt sleep.

Each of these diagnoses has a different set of implications for treatment and management, emphasizing the importance of a thorough diagnostic evaluation to determine the underlying cause of the child's symptoms.