Diarrhea, Red Diapers, and Child Abuse

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Abstract
Three children were chronically given phenolphthalein in the form of laxatives by emotionally disturbed mothers. All children had repeated hos pitalizations and extensive diagnostic testing because of recurrent intractable unexplained diarrhea. One child died. Pink-red urine and stool were passed at some time during their illnesses. The presence of phenolphthalein was tested for by application of dilute acid or dilute alkali to the diapers causing respec tively disappearance or deepening of the pink-red color. Cases went un- diagnosed for prolonged intervals because mothers seemed exemplary. Evidence of their psychiatric illnesses was found once the possibility was considered.Phenolphtalein poisoning should be tested for in any case of intractable diarrhea when objective evidence of intestinal mucosal damage cannot be found. The condition represents a heretofore unrecognized variant of child abuse or battering.

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