Gastroenteritis

IN CHILDREN

An illness of acute onset, of less than 10 days’ duration associated with fever, diarrhoea and/or vomiting, where there is no other evident cause for the symptoms.

Prevention: Rotavirus vaccine <6 mths

Causes

• Viral (80%): mainly rotavirus (developed countries), norovirus and adenovirus

• Bacterial: C. jejuni and Salmonella sp. (two commonest), E. coli and Shigella sp.

• Protozoal: Giardia lamblia, Entamoeba histolytica, Cryptosporidium

• Food poisoning—staphylococcal toxin

Note: Dehydration from gastroenteritis is an important cause of death, particularly in obese infants (esp. if vomiting accompanies the diarrhoea).

Exclude acute appendicitis and intussusception in the very young.

Symptoms

• Anorexia, nausea, poor feeding, vomiting, fever, diarrhoea (fever and vomiting may be absent)

• Fluid stools (often watery) 10–20/d

• Crying due to pain, hunger, thirst or nausea

• Bleeding uncommon (usually bacterial)

• Anal soreness

Assessment of dehydration The simplest way is by careful clinical assessment (e.g. urine output, vomiting, level of thirst, activity, pinched skin test). The most accurate way is to weigh the child, preferably without clothes, on the same scale each time. Percentage loss of body weight is the best measure of dehydration. It is usual to classify dehydration as:

• mild (up to 3% dehydration): normal signs, incl. urine output

• moderate (3–9%): irritable, lethargic, dry mucous membranes, decreased urine

• severe <9% dehydration: very sick child, no urine output

Management Management is rehydration based on the assessment and correction of fluid and electrolyte loss.

Avoid:

• Drugs—antidiarrhoeals, anti-emetics and antibiotics

• Lemonade—osmotic load too high: can use if diluted 1:6 in water

To treat or not to treat at home

• Treat at home—if family can cope, vomiting is not a problem and no dehydration

• Admit to hospital—if dehydration or persisting vomiting or family cannot cope; infants <6 mths; high-risk patients

• Keep child isolated from other children until settled; maintain hygiene, carers wash hands carefully and careful nappy disposal

ADVICE TO PARENTS (FOR MILD-TO-MODERATE DIARRHOEA)

General rules

• Give small amounts of fluids often

• Continue normal meals judiciously: no specific dietary restrictions necessary

• Continue breastfeeding (can be increased) or start bottle-feeding after 24 h

• Provide maintenance fluid and fluid loss

Day 1 Give fluids, a little at a time and often (e.g. 5 mL every 1–2 mins by spoon or syringe or 50 mL every 15 mins if vomiting a lot). A good method is to give 200 mL (about 1 cup) of fluid every time a watery stool is passed or a big vomit occurs.

Ideal fluid is Gastrolyte or New Repalyte. Other suitable oral rehydration preparations are WHO recommended solutions Electrolade and Glucolyte.

A useful product is Hydralyte paediatric rehydration, which is a solution as an ‘icy ...