Gastroenteritis in Children

 

Am Fam Physician. 2019 Feb 1;99(3):159-165.

  Patient information: See related handout on gastroenteritis in children: treating dehydration, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output. Significant dehydration is unlikely if parents report no decrease in oral intake or urine output and no vomiting. The physical examination is the best way to evaluate hydration status. The four-item Clinical Dehydration Scale can be used to determine severity of dehydration based on physical examination findings. In children with mild illness, stool microbiological tests are not routinely needed when viral gastroenteritis is the likely diagnosis. Mild gastroenteritis in children can be managed at home. Oral rehydration therapy, such as providing half-strength apple juice followed by the child's preferred liquids, is the mainstay of treatment for mild dehydration and is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department. Oral rehydration solutions are recommended for moderate dehydration. Ondansetron may be prescribed if needed to prevent vomiting and improve tolerance of oral rehydration solutions. Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration (i.e., signs of shock or more than 10% dehydration). Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children.

Acute gastroenteritis is defined as diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain.1 It involves increased stool frequency or altered stool consistency that is unrelated to chronic conditions.2

WHAT IS NEW ON THIS TOPIC

The Clinical Dehydration Scale evaluates four clinical features to estimate degree of dehydration and is particularly useful in identifying moderate to severe dehydration. It has been validated in multiple settings in both high- and low-resource areas and compares well with assessing weight before and after rehydration, which is the standard method of evaluating for dehydration.

The WHO now recommends rehydration with a reduced osmolarity ORS. The official WHO ORS or a solution comprised of ½ teaspoon salt and 6 teaspoons sugar per 1 L water may be used.


ORS = oral rehydration solution; WHO = World Health Organization.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Oral rehydration therapy is recommended for children with mild to moderate dehydration from acute gastroenteritis. It is as effective as intravenous rehydration in preventing hospitalizations and return emergency department visits.

B

25, 26, 28

Children with mild dehydration should receive half-strength apple juice followed by preferred fluids (regular juices, milk). This approach reduces the need for eventual intravenous rehydration compared with a formal oral rehydration solution.

B

27

Handwashing with soap is an effective method for preventing episodes of gastroenteritis. Handwashing and hygiene alone, however, do not prevent rotavirus infection.

A

37, 38, 41

All children should receive an oral live, attenuated rotavirus vaccine to reduce the incidence of hospitalization, severe gastroenteritis, and death from rotavirus infection.

A

43, 44

Breastfeeding reduces the incidence of acute gastroenteritis and hospitalization from diarrheal disease in young children.

B

46, 47


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Oral rehydration therapy is recommended for children with mild to moderate dehydration from acute gastroenteritis. It is as effective as intravenous rehydration in preventing hospitalizations and return emergency department visits.

B

25, 26, 28

Children with mild dehydration should receive half-strength apple juice followed by preferred fluids (regular juices, milk). This approach reduces the need for eventual intravenous rehydration compared with a formal oral rehydration solution.

B

27

Handwashing with soap is an effective method for preventing episodes of gastroenteritis. Handwashing and hygiene alone, however, do not prevent rotavirus infection.

A

37, 38, 41

All children should receive an oral live, attenuated rotavirus vaccine to reduce the incidence of hospitalization, severe gastroenteritis, and death from rotavirus infection.

A

43, 44

Breastfeeding reduces

The Authors

show all author info

SCOTT HARTMAN, MD, is an associate professor in the Department of Family Medicine at the University of Rochester (N.Y.) Medical Center....

ELIZABETH BROWN, MD, MPH, is an associate professor in the Department of Family Medicine at the University of Rochester Medical Center.

ELIZABETH LOOMIS, MD, is an assistant professor in the Department of Family Medicine at the University of Rochester Medical Center.

HOLLY ANN RUSSELL, MD, MS, is an assistant professor in the Department of Family Medicine at the University of Rochester Medical Center.

Author disclosure: No relevant financial affiliations.

Address correspondence to Scott Hartman, MD, University of Rochester Medical Center, 274 Goodman St. N., #618, Rochester, NY 14607 (e-mail: sghart@yahoo.com). Reprints are not available from the authors.

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