diarrhea in children

Common Causes

Gastroenteritis is a common cause of diarrhoea in children, often presenting with a sudden change in stool consistency to loose or watery stools and/or sudden onset of vomiting ¹. Exposure to a known source of enteric infection (possibly contaminated water or food), recent travel abroad, and contact with someone with acute diarrhoea and/or vomiting are key historical points ¹.

Investigations

In primary care, stool microbiological investigations should be considered if the child has recently been abroad, if diarrhoea has not improved by day 7, or if there is uncertainty about the diagnosis of gastroenteritis ¹. Stool microbiological investigations are indicated if septicaemia is suspected, if there is blood and/or mucus in the stool, or if the child is immunocompromised ¹. Blood cultures should be performed if antibiotic therapy is being given ¹.

Management Strategies

For children not requiring immediate hospital admission, advice should be given on fluid intake and preventing/treating dehydration ². Parents/carers should be advised to continue usual feeds, including breastfeeding, and encourage regular fluid intake ². Offering a low-osmolarity oral rehydration salt (ORS) solution as supplemental fluid is recommended for children at increased risk of dehydration ². Fruit juices and carbonated drinks should be discouraged, especially in those at increased risk ².

In children with clinical features of dehydration who can be managed at home, ORS solution should be given frequently and in small amounts ². After rehydration, parents/carers should be advised to encourage the child to drink plenty of usual fluids, including milk feeds, and reintroduce the child's usual diet ². Fruit juices and carbonated drinks should be avoided until the diarrhoea has stopped ².

Drug treatment with antidiarrhoeal drugs, antiemetics, zinc supplements, and probiotics is not recommended for use in children in primary care ². Antibiotics should not be routinely prescribed for children with gastroenteritis ². Treatment of confirmed microbial pathogens may be arranged following stool culture and sensitivity testing, if appropriate ².

Prevention of transmission includes thorough handwashing with liquid soap in warm running water, careful drying, and using flush toilets where possible ². Cleaning toilet seats, flush handles, wash-hand basin taps, surfaces, and toilet door handles daily with hot water and detergent is advised ². A disinfectant and disposable cloth should be used to clean toilets ². Towels, flannels, and bathwater used by infected children should not be shared ².

Red Flag Symptoms

Red flag symptoms that may indicate diagnoses other than gastroenteritis include fever (38°C or higher in children younger than 3 months, or 39°C or higher in children aged 3 months or older), shortness of breath or tachypnoea, altered conscious state, neck stiffness, bulging fontanelle in infants, non-blanching rash, blood and/or mucus in stool, bilious (green) vomit, severe or localised abdominal pain, and abdominal distension or rebound tenderness ¹. Parents and carers should be informed that symptoms of dehydration may include appearing to get more unwell, changing responsiveness (e.g., irritability, lethargy), decreased urine output, pale or mottled skin, and cold extremities, and they should contact a healthcare professional if these develop ¹.