Gastroenteritis in Children

What is gastroenteritis and what causes it?

Gastroenteritis is an infection of the gut (intestines). The severity can range from a mild tummy upset for a day or two with some mild diarrhoea, to severe diarrhoea and vomiting for several days or longer. Many viruses, bacteria, and other microbes (germs) can cause gastroenteritis.

• A virus is a common cause in the UK. Sometimes it is just 'one of those germs going about'. Various viruses are easily spread from person to person by close contact, or when an infected person prepares food for others. For example, infection with a virus called rotavirus is the commonest cause of gastroenteritis in children in the UK. Almost every child in the UK has a rotavirus infection before they are five years old.
• Food poisoning (infected food) causes some cases of gastroenteritis. Many different types of germs can cause food poisoning. Common examples are bacteria called campylobacter and salmonella.
• Water contaminated by bacteria or other germs is a common cause of gastroenteritis, particularly in countries with poor sanitation.

What are the symptoms of gastroenteritis?

• The main symptom is diarrhoea, often with vomiting as well.
• Crampy pains in the abdomen (tummy) are common. Pains may ease for a while each time some diarrhoea is passed.
• A high temperature (fever) and headache sometimes occur.

Vomiting often lasts only a day or so, but sometimes longer. Diarrhoea often lasts for several days or more, and often continues after the vomiting stops. Loose stools (loose faeces) may persist for a week or so before a normal pattern returns. Sometimes the symptoms last longer.

Symptoms of dehydration

Diarrhoea and vomiting may cause dehydration (lack of body fluid). Consult a doctor quickly if you suspect your child is becoming dehydrated. Mild dehydration is common and is usually easily and quickly reversed by drinking lots. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to function.

• Symptoms of dehydration in children include: passing little urine, a dry mouth and tongue, sunken eyes, weakness, being irritable or lethargic.
• Symptoms of severe dehydration in children include drowsiness, pale or mottled skin, cold hands or feet, fast (but often shallow) breathing. This is a medical emergency.

Dehydration is more likely to occur in:

• Young babies - particularly those under six months old.
• Any child who does not drink much when they have gastroenteritis.
• Any child with severe diarrhoea and vomiting.

What is the treatment of gastroenteritis in children?

Symptoms often settle within a few days or so as the immune system usually clears the infection. The following are commonly advised until symptoms ease:

Fluids - give your child lots to drink

The aim is to prevent dehydration (low body fluid), or to treat dehydration if it has developed. (Note: if you suspect that your child is dehydrated, you should contact a doctor.) If your child is dehydrated then a doctor will advise on how much fluid to give. To prevent dehydration, your child should be drinking at least what they would normally drink through the day. And, in addition, as a guide, give the following after each loose stool (each time they pass some diarrhoea) to replace the fluid lost by the diarrhoea:

• Children under two: 50-100 ml (a quarter to half a large cup) of fluid.
• Children aged 2-10 years: 100-200 ml (a half to one large cup) of fluid.
• Older children: as much fluid as they want, but at least 200 ml.

If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). However, the total amount should still be as above.

Rehydration drinks are the ideal drinks to give. They are made from sachets that you can get from pharmacies. (The sachets are also available on prescription.) You add the contents of the sachet to water. Rehydration drinks provide a perfect balance of water, salts, and sugar. They are better than just drinking water alone. The small amount of sugar and salt helps the water to be absorbed better from the gut into the body. They do not stop or reduce diarrhoea, but are the best drinks to prevent or treat dehydration.

Do not use home-made salt/sugar drinks as the quantity of salt and sugar has to be exact. If rehydration drinks are not available, then give water as the main drink. It is best not to give drinks that contain a lot of sugar, as they can sometimes make diarrhoea worse. For example, avoid fruit juices, cola, pop or other carbonated (fizzy) drinks until the diarrhoea has stopped.

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not 'starve' a child with gastroenteritis. This used to be advised but is now known to be wrong. So:

• Breast-fed babies should continue to be breast fed if they will take it. This is in addition to extra rehydration drinks (described above).
• Bottle-fed babies should be fed with their normal full strength feeds if they will take it. Again, this is in addition to extra rehydration drinks (described above).
• Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important, and food can wait until the appetite returns.

Medication is not usually needed

You should not give medicines to stop diarrhoea to children under 12 years old. They sound attractive remedies, but are unsafe to give to children due to possible serious complications. However, you can give paracetamol or ibuprofen to ease a high temperature or headache.

If symptoms are severe, or persist for several days or more, a doctor may ask for a sample of the diarrhoea. This is sent to the lab to look for infecting germs (bacteria, parasites, etc). Sometimes an antibiotic or other treatments are needed, depending on the cause of the infection.

Are there any complications that may occur from gastroenteritis?

Complications are uncommon in the UK. They include the following:

• Dehydration and salt (electrolyte) imbalance in the body. This is the most common complication. If a child drinks well then it is unlikely to occur, or is only likely to be mild and soon recovers as the child drinks. Occasionally, if a child becomes severely dehydrated, they need to be admitted to hospital for fluid to be given directly into a vein via a 'drip'.
• Haemolytic-uraemic syndrome (HUS). This is is rare. It is a disorder that can lead to kidney failure. Most cases occur following a gut infection caused by a bacteria called E. coli O157.
• Reactive complications. Rarely, other parts of the body 'react' to an infection that occurs in the gut. This can cause symptoms such as arthritis, skin inflammation, eye inflammation (conjunctivitis and uveitis).
• Spread of infection to other parts of the body. This is rare.
• Malnutrition may follow some gut infections. This is mainly a risk in developing countries.
• Persistent diarrhoea syndromes may rarely develop.
• Irritable bowel syndrome is sometimes triggered by a bout of gastroenteritis.

See a doctor if any of the following develops, or if any other symptoms occur that you are concerned about:

• If you suspect dehydration is developing (see earlier).
• Blood in the diarrhoea.
• Vomiting for more than one day, or diarrhoea that does not start to settle after 3-4 days.
• Pains that are getting worse.
• Drowsiness or confusion.
• Infections caught abroad.

Admission to hospital is sometimes needed if symptoms are severe, or if complications develop.

Other advice

If your baby has gastroenteritis, be especially careful to wash your hands after changing nappies and before preparing food. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry properly after washing. For older children, whilst they have gastroenteritis, the following are recommended:.

• Regularly clean the toilets used. Also, wipe the flush handle and toilet seat with disinfectant (such as household bleach) after each time they use the toilet.
• Make sure they wash their hands after going to the toilet. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry properly after washing.
• Don't share towels and flannels.
• Do not let them help to prepare food for others.
• They should stay off school, nursery, etc, until at least 48 hours after the last episode of diarrhoea or vomiting.
• They should not swim in swimming pools for two weeks after the last episode of diarrhoea.

Can gastroenteritis be prevented?

The advice given in the previous section is mainly aimed at preventing the spread of infection to other people. But, even when we are not in contact with someone with gastroenteritis, proper storage, preparation and cooking of food, and good hygiene help to prevent gastroenteritis. In particular, always wash your hands, and teach children to wash theirs:

• After going to the toilet (and after changing nappies).
• Before touching food. And also, between handling raw meat and food ready to be eaten. (There may be some bacteria on raw meat.)
• After gardening.
• After playing with pets (healthy animals can carry certain harmful bacteria).

The simple measure of washing hands regularly and properly is known to make a big difference to the chance of developing gastroenteritis.

You should also take extra measures when in countries of poor sanitation. For example, avoid water and other drinks that may not be safe, and avoid food washed in unsafe water.

Breastfeeding is also protective. Breast-fed babies are much less likely to develop gastroenteritis compared to bottle-fed babies.

Immunisation

As mentioned earlier, rotavirus is the most common cause of gastroenteritis in children. There is an effective vaccine against rotavirus. In the UK, in February 2009, the Joint Committee on Vaccination and Immunisation (JCVI) ruled out a mass immunisation policy in the UK on the basis that it would not be cost-effective. They said "introduction of rotavirus vaccines would only become cost-effective if the vaccine prices are much less than those at which they are currently being offered." - see www.dh.gov.uk/ab/JCVI/DH_094744

However, in June 2009, the World Health Organization (WHO) recommended that rotavirus vaccine be included in all national immunisation programmes. Therefore, the policy in the UK may change in the future.