Gastroenteritis

History. Sequence of the onset of symptoms, nausea, vomiting, diarrhea, and whether there are signs of bleeding. Description of abdominal pain. Description of bowel movements. Determine whether any OTC or prescription remedies have been used. Briefly review usual dietary habits and, more specifically, any preceding change(s) that might account for this illness. Are there sitters, others at home or school with similar symptoms? Is this a recurring problem?

Physical Examination. General appearance, vital signs, ENT, chest, abdominal exam, and if indicated, gloved little finger rectal.

Lab. Stool guaiac during digital exam. Consider also stool for enteric pathogens and ovum and parasites. Recurring illness warrants additional evaluation.

ASSESS severity and possible etiologies with suspected food contamination or common source outbreak (most commonly viral etiologies, bacterial toxin, bacterial pathogen, protozoan (giardia), and other parasitic infestations).

Differential Diagnosis would include causes of acute abdomen (see NON-TRAUMATIC ABDOMINAL PAIN, INFANTS AND CHILDREN, p. 2-17).

Complications include volume depletion and electrolyte imbalance. Usually in the recovery phase, there are transient food intolerances, such as lactose from lactase deficiency.

General Measures. Remind parents that the best treatment for vomiting is to give their child nothing by mouth for 1-2-3^* hour(s). This gives the GI tract a rest. Then begin small amounts of clear liquids every 15 minutes for the bottle‑fed child. Recommend World Health Organization Oral Rehydration Solution (see at p. 7-2B), or a similar product (e.g., Pedialyte or Ricelyte). (A teaspoon every 1-2 minutes, then, if holding down, increase.) The breast‑fed baby can be returned to breast milk when vomiting has not recurred for 12 to 24 hours, then begin re‑introducing small amounts of solid foods.

Treat diarrhea similarly with clear liquids or resumption of nursing, and then advance in a similar fashion. It is prudent to avoid lactose-containing products such as milk in these first few days, as well as acid fruit juices and spicy foods.

Review signs of dehydration (sunken eyes, dry and doughy skin, decreased urination or dark yellow urine, and more significantly if lethargy or refusal to drink). Clinician should see that all caregivers know these signs. This may be a life-threatening emergency.

Physician Consultation. For all children under 3 months of age. Similarly, consult for children with significant signs of dehydration (approaching or greater than 5% by body weight) or with severe abdominal pain, and for situations indicative of common source outbreak. Consult immediately for any significant bleeding, or signs or symptoms of shock.

Immediate Transfer. If unstable (vomiting 6-12 hours, acute abd, or moderate to severe dehydration, poor skin turgor, oliguria, unexplained irritability, dry mucous membranes, no tears, sunken eyes), follow the Site Emergency Medical Services Transport Protocol .

Follow‑up Plan. Recheck in 1-3 day(s), if not better, sooner if worse, if the temperature remains over 103°F (39.4°C) or if there is significant blood in the feces or vomitus. Parents should give daily telephone update.

^*Depending on the child’s age and estimated level and type of dehydration.

^**Unless allergic, contraindicated, or pregnant/lactating

Sunbelt Medical Publishers, Inc., PO Box 13512 Dept. WEB2, Tallahassee, FL 32317-3512
Business purchase orders by Fax: 850-893-7738
Business purchase orders by EMAIL: sunbeltmedorders@earthlink.net