Gastroenteritis in Children

Diarrhea and vomiting are common reasons parents bring their children to the doctor or even to BIMC Hospital’s emergency room. Most are related to gastroenteritis, infection of the stomach and intestines. While usually it is a non-fatal illness, statistics show gastroenteritis to cause 3 million deaths annually worldwide.

Many children have more than one episode in a year. The severity can range from a mild tummy upset for a day or two with some mild diarrhea, to severe diarrhea and vomiting for several days or longer.

What Causes Gastroenteritis?

Virus infection is the most common cause of gastroenteritis, Rotavirus and Adenovirus being the major virus infecting the digestive system. It is estimated nearly every child in the world will suffer an episode of diarrhea caused by rotavirus before age five. Once someone is infected by Rotavirus, their body will develop immunity and becomes immune against it. Therefore, it is uncommon for adults to get rotavirus because most will have had it as a child. Seeing the very high incidence, in 2009, WHO recommended the rotavirus vaccine included in the primary vaccine in all national immunisation program.

Other causes are bacteria infection. Common examples are Campylobacter, Salmonella and Escherichia coli. Other causes of gastroenteritis are parasite infections.

Transmission

The most common transmission of either viral and parasite infection is fecal-oral routes, examples are:

  • When someone doesn’t wash their hands properly after changing diapers of a baby having diarrhea, then handling food, can transmit the disease to people who eat the food products
  • After going to the toilet and not washing hands properly, then unknowingly put the hand in the mouth.  Any surface on or near the toilet, can be source of contamination.
  • Children who play with dirt, putting their hands in their mouth.
  • Drinking water contaminated by sewage.
  • And many other possible ways.

Though you must keep in mind, someone can be without symptom and still have microbes in their digestive system ready to give infection to someone else.

Bacterial infection is more commonly obtained from food poisoning. Botulism was famous as canned food poisoning. While Salmonellosis is known as the cause of food poisoning in dairy products not prepared properly.

Treating Gastroenteritis

In most cases, since the most common cause is viral infection, gastroenteritis is self limited, lasting between 5 to 7 days. During the illness, treatment is aimed to reduce the symptoms and avoiding or correcting dehydration. For bacterial and parasite infection, antibiotic is added.

Dehydration

Whatever the cause is, the most important thing is to make sure the child is not dehydrated. Children have a good preservation regulation of their bodies, and may not show any significant symptom until they are moderately or even severely dehydrated. This means, once they show the symptoms of dehydration, their body regulation has started to fail, and it should be corrected immediately because the condition can deteriorate rapidly.

Signs of dehydration:

  • Symptoms of dehydration in children include: passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes, weakness, being irritable or lethargic.
  • Symptoms of severe dehydration in children include: drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, fast (but often shallow) breathing. Severe dehydration is a medical emergency and immediate medical attention is needed.

The most effective treatment for dehydration is fluid replacement.

  • Use an oral rehydration solution. Many oral rehydration solutions are available commercially. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They’re also designed for easier digestion. Begin giving fluids early in the course of an illness instead of waiting until the situation becomes urgent.
  • Make your own rehydration solution. In an emergency situation where a pre-formulated solution is unavailable, you can make your own oral rehydration solution by mixing 1/2 teaspoon salt, 6 level teaspoons of sugar and 1 litre (about 1 quart) of safe drinking water. Be sure to measure accurately because incorrect amounts can make the solution less effective or even harmful.
  • How much is enough? Until you can get contact with a doctor, the general rule of the amount you should give is until your child’s urine becomes clear in color. Give liquids in small amounts at frequent intervals, ie. a spoonful every 2-3 minutes. The temperature of the solution should be room temperature. After you have contacted a medical personnel you can ask a more specific calculation of fluid replacement.
  • Continue to breast-feed. Don’t stop breast-feeding when your baby is sick, but offer your baby an oral rehydration solution in a bottle as well. If you give your baby formula, try switching to one that’s lactose-free until diarrhea improves — lactose can be difficult to digest during diarrhea, making diarrhea worse. Never dilute formula more than the instructions advised. Your doctor also may suggest substituting an oral rehydration solution for the formula for 12 to 24 hours.
  • Avoid broth. The common home remedy broth should be avoided because of their high sodium content, which might worsen the dehydration.
  • IV treatment. For moderate to severe dehydration, the best is to see a doctor for possible intravenous rehydration. Although you might be concerned regarding “a needle stuck into your child”, this might be a life-saving treatment for your child.

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not ‘starve’ a child with gastroenteritis. This used to be advised but is now known to be wrong. So:

  • Breast-fed babies should continue to be breast-fed if they will take it. This will usually be in addition to extra rehydration drinks.
  • Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks.
  • Older children – offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important, and food can wait until the appetite returns.
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