Infectious gastroenteritis in children

Last updated: November 7, 2022

Summarytoggle arrow icon

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.

Epidemiologytoggle arrow icon

  • 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.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

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


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

Differential diagnosestoggle arrow icon

Gastrointestinal causes [6]

Extra-intestinal causes [1]

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

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]

Complicationstoggle arrow icon

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

Preventiontoggle arrow icon

Referencestoggle arrow icon

  1. Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006; 118 (3): p.1279-1286.doi: 10.1542/peds.2006-1721 . | Open in Read by QxMD
  2. Hartman S, Brown E, Loomis E, Russell HA. Gastroenteritis in Children. Am Fam Physician. 2019; 99 (3): p.159-165.
  3. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017; 65 (12): p.e45-e80.doi: 10.1093/cid/cix669 . | Open in Read by QxMD
  4. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. J Pediatr Gastroenterol Nutr. 2014; 59 (1): p.132-152.doi: 10.1097/mpg.0000000000000375 . | Open in Read by QxMD
  5. Friedman JN, Goldman RD, Srivastava R, Parkin PC. Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr. 2004; 145 (2): p.201-207.doi: 10.1016/j.jpeds.2004.05.035 . | Open in Read by QxMD
  6. Goldman RD, Friedman JN, Parkin PC. Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis. Pediatrics. 2008; 122 (3): p.545-549.doi: 10.1542/peds.2007-3141 . | Open in Read by QxMD
  7. Gordon M, Akobeng A. Racecadotril for acute diarrhoea in children: systematic review and meta-analyses. Arch Dis Child. 2015; 101 (3): p.234-240.doi: 10.1136/archdischild-2015-309676 . | Open in Read by QxMD
  8. MacGillivray S, Fahey T, McGuire W. Lactose avoidance for young children with acute diarrhoea. Cochrane Database Syst Rev. 2013.doi: 10.1002/14651858.cd005433.pub2 . | Open in Read by QxMD
  9. De Luca A, Zanelli G. Gastroenteritis and Intractable Diarrhea in Newborns. Neonatology. 2018: p.1355-1363.doi: 10.1007/978-3-319-29489-6_233 . | Open in Read by QxMD
  10. Hospital JH. The Harriet Lane Handbook. Elsevier ; 2020
  11. Parashar UD, Nelson EAS, Kang G. Diagnosis, management, and prevention of rotavirus gastroenteritis in children. BMJ. 2013; 347 (dec30 1): p.f7204-f7204.doi: 10.1136/bmj.f7204 . | Open in Read by QxMD
  12. Reust CE, Williams A. Acute Abdominal Pain in Children. Am Fam Physician. 2016; 93 (10): p.830-6.
  13. Thiagarajah JR, et al. Advances in Evaluation of Chronic Diarrhea in Infants. Gastroenterology. 2018; 154 (8): p.2045-2059.e6.doi: 10.1053/j.gastro.2018.03.067 . | Open in Read by QxMD
  14. Benninga MA, Nurko S, Faure C, Hyman PE, St. James Roberts I, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016; 150 (6): p.1443-1455.e2.doi: 10.1053/j.gastro.2016.02.016 . | Open in Read by QxMD

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