Gastroenteritis is an inflammation of the stomach and intestines that causes diarrhea, vomiting, nausea and other symptoms of digestive upset. In the industrialized world, the most common causes of gastroenteritis in children are viruses, bacteria (food poisoning), and intestinal parasites.
All of these viruses tend to spread on hands that have touched either an infected person's stool or surfaces contaminated with infected stool. For this reason, young children -- especially those just starting to learn good hygiene -- are particularly vulnerable to viral gastroenteritis. They may touch a dirty diaper (either their own or a playmate's), forget to wash their hands after using the toilet, put dirty fingers in their mouths, bite their fingernails, or chew and suck on toys that other children have touched with soiled hands.
Parents and child-care personnel also can spread viral gastroenteritis from child to child, particularly if they do not wash their hands thoroughly after changing every soiled diaper. In addition, adults who have viral gastroenteritis themselves sometimes can spread their viral infections to children, especially if they prepare children's meals without first washing their hands. Occasionally, some of the viruses that cause viral gastroenteritis also have been found in drinking water or food, primarily in developing countries and rural areas where sanitation is poor. Norovirus has gotten plenty of press in recent years, mostly because of outbreaks of Norwalk-like viruses on cruise ships.
Worldwide, gastroenteritis kills 3 million to 5 million children every year, primarily in developing nations where sanitation and health care are poor. Most of these children die from extreme dehydration (abnormally low levels of body water) resulting from a combination of severe diarrhea, vomiting and not drinking enough fluids. Even in the industrialized world, millions of episodes of gastroenteritis occur each year, especially in young children. In the United States, rotavirus infections used to be responsible for more than 3 million cases of gastroenteritis in children each year, with at least 50,000 hospitalizations and 20 to 40 deaths. Fortunately, the rotavirus vaccine that is given to young infants has really cut down the number of moderate to severe cases of rotavirus disease in the United States.
Overall, about 90% of children with gastroenteritis in the United States have such mild symptoms that they do not need to be treated by a doctor. Occasionally, however, gastroenteritis can lead to severe dehydration and other dangerous complications. This is more likely to happen in infants, children with chronic illnesses and children taking immune-suppressing medications.
In children, symptoms of gastroenteritis include:
Some children also have a low-grade fever or complain of a headache.
To help make a diagnosis, your doctor may ask the following questions:
To help assess your child's risk of dehydration, your doctor also may ask questions related to your child's fluid intake and fluid losses over the past several hours. Specifically, you doctor may want to know about:
In most cases, a doctor diagnoses gastroenteritis and dehydration based on the symptoms, history of exposure to someone with diarrhea, spoiled food or impure water, and the results of a physical examination. Special tests rarely are needed unless your child has unusually severe symptoms, such as:
If more tests are needed, they may include blood tests to check for evidence of infection and dehydration, as well as other laboratory tests, such as a stool culture. In the lab, stool samples may be cultured for the presence of bacteria (especially Campylobacter, Salmonella, or, less commonly, E. coli 0157) or examined for microscopic parasites.
In children, most cases of mild, uncomplicated gastroenteritis last about two to three days. However, even after most symptoms go away, your child may continue to have occasional loose stools for more than a week.
It would be ideal never to get these infections in the first place and being up-to-date with your child's vaccines can help reach that goal. For example, young infants should receive the rotavirus vaccine, which has been shown to protect children against 85% to 98% of severe illness from rotavirus. There is also a hepatitis A vaccine now universally recommended for all toddlers 12 to 23 months of age.
In addition, to help prevent gastroenteritis in all members of your family, you can take the following steps:
If your child attends day care, make sure that all day-care personnel wash their hands frequently, especially after changing soiled diapers and before preparing food. Also, check that your center follows pediatricians' standard recommendations for managing cases of diarrhea:
In otherwise healthy children, most cases of mild gastroenteritis gradually go away within a few days. In the meantime, you can try the following suggestions:
If your child is showing signs of significant dehydration and cannot drink fluids, your doctor will send him or her to the hospital to receive fluids intravenously (through a vein). Your child also may need to take antibiotics if stool tests confirm that a more serious bacterial infection is causing the gastroenteritis. For intestinal parasites, your doctor will prescribe an antimicrobial medication.
Call your doctor promptly whenever an infant less than 2 months old has symptoms of gastroenteritis. For older children with diarrhea and vomiting, call your doctor if your child has any one of the following:
Also, call your doctor promptly if your child is taking any oral medication for a chronic medical condition and is either too nauseated to swallow the medicine or has vomited after taking it. It is not good for children to miss doses of the medicines recommended by their doctors. Do not repeat any vomited doses of medicines without contacting your child's doctor.
Overall, the outlook is excellent. Almost all children with mild gastroenteritis recover completely without complications.
National Institute of Allergy and Infectious Diseases (NIAID)
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National Institute of Diabetes & Digestive & Kidney Disorders
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National Center for Infectious Diseases
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Centers for Disease Control and Prevention
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American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827-2260
American Academy of Pediatrics (AAP)
141 Northwest Point Blvd.
Elk Grove Village, IL 60007-1098