Clinical Notes : Paediatrics

26. Gastroenteritis in Children

Diagnosis

Suspect gastroenteritis in the presence of sudden

  • Change in stools to loose or watery (usually 3 or more times in 24hrs), OR

  • Onset of vomiting

  • Systemic features

    • contact with someone with acute diarrhoea/vomiting,

    • source of enteric infection (e.g. food)

    • recent foreign travel

  • Document frequency and consistency of stools including

    • blood or mucous,

    • frequency of vomiting

    • oral intake

  • Consider alternative diagnoses, e.g. pneumonia, UTI, meningitis

    • if T >38 C in <3month old,

    • if T >39 C in ≥3month old,

    • blood/mucous in stool,

    • signs of meningitis,

    • severe abdominal pain,

    • abdominal distension,

    • SOB

 

Assess severity of dehydration

  • There is an increased risk of dehydration in:

    • Children <1yr,

    • infants with low birth weight,

    • 6+ diarrhoeal +/- 3+ vomiting episodes in 24hrs,

    • unable to take supplementary fluids or stopped breast feeding,

    • malnourished

 

Remote assessment

  • Ensure emergency transfer to secondary care if

    • child appears unwell to parent/carer,

    • altered responsiveness

    • decreased urine output

    • Any child with signs of shock (e.g. cold extremeties, mottled skin, LOC)

  • Manage at home with appropriate advice on fluid management and safety netting if

    • the child is well and alert,

    • normal urine output,

    • normal skin colour and extremities

 

Face to face assessment

  • Measure and record basic obs excluding shock

    • Responsiveness, lethatgy, irritability

    • HR,

    • RR,

    • temp,

    • cap refill, (consider BP in older children)

    • reduced skin turgor

  • Manage accordingly :

    • Refer A+E

    • Next day OOH review or GP review

    • If well, manage at home with safety netting and preventative advice

 

Investigations

  • Not usually required, often not practical out of hours

  • Consider stool culture if

  • diarrhoea >7 days,

  • history of foreign travel or

  • diagnostic uncertainty

 

Management

 

In most cases :

  • vomiting lasts 1-2/7, stops within 3/7

  • diarrhoea lasts 5­-7/7, stops by 2/52

 

In children without clinical dehydration :

  • Continue breast feeding and other milk feeds

  • Encourage fluid intake – discourage fruit juices or carbonated drinks (high osmolality)

 

In children at risk of dehydration :

  • Continue to breast feed if an infant

  • Oral replacement therapy (ORT) with Dioralyte or equivalent

  • Aged 1 month- 1 year : 1-1.5 x usual feed volume

  • Aged 1-12 years : 200ml ORT solution after each loose stool

  • Give the ORT solution little and often

  • Avoid solid foods

  • If the child refused ORT solution, consider supplementing with normal fluids as long as there are no red flag symptoms or signs

  • After rehydration

  • Give full strength milk straight away

  • Reintroduce usual solid food

  • Avoid fruit juices and carbonated drinks until the diarrhoea has stopped

 

Medications

  • Anti-diarrhoeals and anti-emetics are not recommended

  • Do not routinely give antibiotics – children in whom antibiotics are appropriate should be reviewed by secondary care

  • In certain cases, such as E coli 0157 infection, antibiotics are contraindicated

  • Probiotics may be beneficial

 

Preventative measures are important :

  • Careful hand-washing is the most effective way to prevent spread of gastroenteritis

    • Reduces cases by 30-40%.

  • Children should not attend school during D+V episodes and until 48hrs after the last episode

  • Children should not swim in swimming pools for 2 weeks after D+V

    • Cryptosporidium oocytes can resist standard chlorination and may be shed after illness

 

Gastroenteritis is a notifiable disease in certain situations such as

  • suspected food poisoning

  • bloody diarrhoea, some specific causative organisms such as cholera

  • Haemolyitc Uraemic Syndrome due to E. coli 0157.

 
 
 
 
 
 
 
 
 
 
 
 

Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management

NICE Clinical guideline CG84.

April 2009

Access

Acute Diarrhea in Adults and Children : A Global Perspective

World Gastroenterology Organisation Global Guidelines

February 2012

Access

 

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years: summary of NICE guidance

Rajesh Khanna, Monica Lakhanpaul, Shona Burman-Roy, M Stephen Murphy

BMJ 2009;338:b1350. April 2009

Access

Drugs for the doctor's bag: 2 - Children

Volume 43, Issue 11 . 2007.

Access

 

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