Gastroenteritis in Children
Related Subjects:
|Rotavirus
|Norovirus
|Diarrhoea (Children)
|Dehydration (Child)
|Viral Gastroenteritis (Adults and Children)
|Gastroenteritis in Children
|Acute Appendicitis
|Acute Appendicitis in Children
|Gastro-oesophageal reflux in Children
|Intussusception in Children
|Gastroenteritis in Children
Introduction
- Diarrhoea can be an early sign of any septic illness. In infants, stools may be so watery they are mistaken for urine.
- It is important to note that breastfed babies often have loose stools, which is a normal physiological variation.
- Gastroenteritis is a leading global cause of childhood morbidity and mortality, with ~1.5 million child deaths annually, largely due to dehydration.
Causes of Gastroenteritis
- Viral causes:
- Rotavirus – most common in infants/children; accounts for ~600,000 childhood deaths annually (vaccine-preventable).
- Norovirus – common in adults and school-age children, outbreaks in communities.
- Astrovirus, Adenovirus, Human Metapneumovirus – less common but important causes.
- Bacterial causes:
- Pneumococcus / Salmonella / E. coli / Shigella / Campylobacter – can cause severe or dysenteric diarrhoea.
- Vibrio cholerae – causes massive watery diarrhoea in endemic regions.
- Parasitic causes: Giardia, Cryptosporidium, Entamoeba histolytica (persistent or recurrent diarrhoea).
⚠️ Worsening Clinical Features of Dehydration
| Feature |
Mild / None |
Moderate |
Severe |
| General appearance |
Alert, normal |
Thirsty, restless, irritable |
Drowsy, floppy, cold peripheries |
| Eyes |
Normal |
Slightly sunken |
Very sunken |
| Mucous membranes |
Moist |
Sticky |
Dry |
| Tears |
Present |
Decreased |
Absent |
| Skin turgor |
Normal |
Slow recoil |
Very slow / >2 sec |
| Urine output |
Normal |
Reduced |
Minimal / absent |
🔎 Investigations
- Usually clinical diagnosis in the UK.
- Stool microscopy and culture if:
- Blood or mucus in stool
- History of recent foreign travel
- Immunocompromised child
- Outbreak suspected
- Blood tests: U&E, glucose if severe dehydration or IV fluids are required.
⚠️ Complications
- Dehydration → most dangerous, may progress to hypovolaemic shock.
- Malnutrition → due to prolonged illness and reduced intake.
- Temporary lactose intolerance → watery acidic stools post-illness; resolves with lactose-free diet in 1–2 weeks.
- Post-enteritis enteropathy → persistent gut dysfunction, usually resolves spontaneously over ~7 weeks.
💊 Management
- Oral Rehydration Therapy (ORT):
- Gold standard: Dioralyte® 50 mL/kg over 4 hours (≈1 mL/kg every 5 min).
- Continue breastfeeding.
- If refusing ORT → try small sips, spoon feeding, NG tube if needed.
- IV fluids: Only for severe dehydration, shock, or failed ORT (use 0.9% NaCl + 5% glucose).
- Antiemetics: Ondansetron (0.1–0.15 mg/kg) may reduce vomiting and admissions; not yet universal in NICE guidance.
- Avoid: Fruit juices, fizzy drinks, antidiarrhoeal drugs (e.g., loperamide contraindicated in children).
Prevention
- Rotavirus vaccination (part of UK immunisation schedule).
- Hand hygiene, safe food prep, clean water.
- Education for parents on red flags (persistent vomiting, blood in stool, lethargy).
Conclusion
- Gastroenteritis is usually self-limiting but dangerous due to risk of dehydration.
- ORT is cornerstone of management; IV fluids reserved for severe/shock.
- Vaccination, hygiene, and parental education remain key to prevention.
References
- NICE CG84: Diarrhoea and vomiting caused by gastroenteritis in under 5s.
- WHO: Management of Childhood Illness – Diarrhoea Guidelines.
- BMJ Best Practice: Acute gastroenteritis in children.
