Infectious gastroenteritis in children

Last updated: November 7, 2022

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Acute gastroenteritis is a common infection in childhood. The majority of cases are caused by viruses, while ∼20% are bacterial, and a small number are parasitic. Most children have a mild presentation where nausea, vomiting, and diarrhea are not severe enough to prevent adequate oral intake or participation in normal activities. Severe disease is characterized by signs of significant dehydration, end-organ damage, fevers ≥ 40°C, signs of sepsis, bloody or bilious emesis, and toxic appearance. Children with mild-to-moderate gastroenteritis can be diagnosed clinically. Children with severe illness, atypical presentations, or signs of significant dehydration should undergo laboratory studies. Treatment is usually supportive with fluid replacement, antiemetics, and antipyretics. Antimicrobial therapy (empiric or tailored) may be utilized for children with suspected or confirmed bacterial or parasitic infections. Prevention of infectious gastroenteritis involves vaccination of infants against rotavirus, travel vaccines where appropriate, and patient/caregiver education on hand hygiene and food and water hygiene.

  • Common illness in children, causing each year: [1]
    • > 1.5 million outpatient visits
    • ∼ 200,000 hospitalizations
  • Severe illness is more common in children < 5 years of age. [1]

Epidemiological data refers to the US, unless otherwise specified.

Clinical dehydration scale for acute gastroenteritis in children ≤ 5 years of age [1][4][5]
Clinical feature Points
Appearance/behavior Normal 0
Thirsty, restless, and/or lethargic but irritable with stimuli 1
Cold, sweaty, drowsy, limp, or unarousable 2
Eyes Normal 0
Mildly sunken 1
Extremely sunken 2
Mucous membranes Moist 0
Tacky or sticky 1
Dry 2
Tear production Present 0
Decreased 1
Absent 2

Interpretation

Diagnosis of viral gastroenteritis in children is usually clinical; diagnostic studies for infectious gastroenteritis are not routinely indicated. [1]

Gastrointestinal causes [6]

Extra-intestinal causes [1]

The differential diagnoses listed here are not exhaustive.

Treatment of infectious gastroenteritis in children is generally supportive.

All patients [1][3]

Mild to moderate gastroenteritis [1][2]

Breastmilk should not be withheld in order to give ORS. [1][11]

Severe gastroenteritis or children with admission criteria for dehydration [1][2]

When feasible, ORS is preferred over IV fluids; children unable to tolerate oral fluids can receive ORS via a nasogastric tube. [2][12][13]

We list the most important complications. The selection is not exhaustive.

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