Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management

you suspect septicaemia or

there is blood and/or mucus in the stool or

the child is immunocompromised.

continue breastfeeding and other milk feeds

encourage fluid intake

discourage the drinking of fruit juices and carbonated drinks, especially in those at increased risk of dehydration (see recommendation 1.2.1.2)

offer oral rehydration salt (ORS) solution as supplemental fluid to those at increased risk of dehydration (see recommendation 1.2.1.2).

use low-osmolarity ORS solution (240–250 mOsm/l) for oral rehydration therapy (the BNF for children (BNFC) 2008 edition lists the following products with this composition: Dioralyte, Dioralyte Relief, Electrolade and Rapolyte)

give 50 ml/kg for fluid deficit replacement over 4 hours as well as maintenance fluid

give the ORS solution frequently and in small amounts

consider supplementation with their usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks) if they refuse to take sufficient quantities of ORS solution and do not have red flag symptoms or signs (see table 1)

consider giving the ORS solution via a nasogastric tube if they are unable to drink it or if they vomit persistently

monitor the response to oral rehydration therapy by regular clinical assessment.

shock is suspected or confirmed

a child with red flag symptoms or signs (see table 1) shows clinical evidence of deterioration despite oral rehydration therapy

a child persistently vomits the ORS solution, given orally or via a nasogastric tube.

use an isotonic solution, such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for both fluid deficit replacement and maintenance

for those who required initial rapid intravenous fluid boluses for suspected or confirmed shock, add 100 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response

for those who were not shocked at presentation, add 50 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response

measure plasma sodium, potassium, urea, creatinine and glucose at the outset, monitor regularly, and alter the fluid composition or rate of administration if necessary

consider providing intravenous potassium supplementation once the plasma potassium level is known.

give full-strength milk straight away

reintroduce the child's usual solid food

avoid giving fruit juices and carbonated drinks until the diarrhoea has stopped.

washing hands with soap (liquid if possible) in warm running water and careful drying is the most important factor in preventing the spread of gastroenteritis:

hands should be washed after going to the toilet (children) or changing nappies (parents/carers) and before preparing, serving or eating food

towels used by infected children should not be shared

children should not attend any school or other childcare facility while they have diarrhoea or vomiting caused by gastroenteritis

children should not go back to their school or other childcare facility until at least 48 hours after the last episode of diarrhoea or vomiting

children should not swim in swimming pools for 2 weeks after the last episode of diarrhoea.