Gastroenteritis In Children, What You Should Know as a Parent

Gastroenteritis (also known as stomach flu) is a common condition that affects the digestive system, causing inflammation in the stomach and bowels. It can cause a person to have symptoms such as diarrhea, vomiting, abdominal pain, fever, and dehydration. It is often caused by viruses, bacteria, parasites, or toxins. In rare cases, it can be caused by medications or allergies.

Gastroenteritis is especially important in children because they are more prone to dehydration and its complications.

According to a 2019 study, gastroenteritis is among the most frequent reasons for visits to the pediatric emergency department. This study estimated that gastroenteritis caused 1.7 million outpatient visits, 77,000 hospitalizations, and 18 deaths per year in Canada.

What are the symptoms of gastroenteritis?

The symptoms of gastroenteritis may vary based on the cause and severity of the disease.

Some of the most common symptoms include the following:

• Diarrhea: loose or watery stools, usually more than three times a day.
• Nausea and Vomiting: throwing up food or liquids, sometimes forcefully or repeatedly. Or the feeling that you might throw up.
• Abdominal pain: feeling of cramping, bloating, or discomfort in the abdomen.
• Fever: higher than normal body temperature, usually above 38°C.
• Dehydration: loss of fluids and electrolytes from the body, which can cause having a dry mouth, being thirsty, decreased urine output, and, in severe cases, becoming drowsy and sleepy.
• Pain in head and muscles
• Fatigue: feeling tired, weak, or exhausted.

The symptoms of gastroenteritis usually start a few hours to a few days after exposure to the infection or trigger. They typically last for a few days but can sometimes take longer to recover.

Almost all children recover without any complications.

Why is gastroenteritis more important in children?

Gastroenteritis is more important in children because they are more likely to become dehydrated. The reason for that is that, first, children have a higher proportion of body water than adults, which means they lose more fluids when they have diarrhea or vomiting. Second, they have less developed kidney function compared to adults, which means they are unable to effectively conserve fluids and electrolytes when they are dehydrated. Third, they may not be able to communicate their thirst or symptoms effectively, or may refuse to drink fluids because of nausea or fear. Therefore, it is important that children be closely monitored for signs and symptoms of dehydration.

Signs and symptoms of dehydration vary based on their severity.

• Mild dehydration usually causes thirst, a dry mouth, decreased urine output, slightly sunken eyes, and a normal or slightly increased heart rate and breathing rate. But the child is overall active and alert.
• Moderate dehydration causes increased thirst, a very dry mouth, dark yellow or reduced urine output, moderately sunken eyes, an increased heart rate, decreased blood pressure, a normal or slightly increased body temperature, and the child being irritable or sleepy.
• Severe dehydration causes extreme thirst, no urine output or very dark urine, very sunken eyes, a very increased heart rate, and very decreased blood pressure. The blood temperature might be very high or very low. The child is usually drowsy, confused, or even completely unconscious.

What causes gastroenteritis in children?

The most common causes of gastroenteritis in children are:

• Viruses: Rotavirus is the leading cause of severe gastroenteritis and dehydration in infants and young children worldwide. Norovirus is the most common cause of outbreaks of gastroenteritis in schools, daycare centers, hospitals, and cruise ships. Viral gastroenteritis is usually spread by direct contact with an infected person or by consuming contaminated food or water. It can also be spread by touching contaminated surfaces or objects or by breathing in airborne droplets from an infected person’s cough or sneeze.

• Bacteria: E. coli One of the most common causes of bacterial gastroenteritis is a normal inhabitant of the human intestine, but some variants can produce toxins that can cause severe diarrhea. Salmonella, Shigella, and Campylobacter are usually transmitted by eating undercooked or raw poultry, eggs, meat or dairy products, or by contact with animals or their feces. Clostridium difficile is a bacterium that can overgrow in the intestine after taking antibiotics, producing toxins that cause severe diarrhea and colitis. Bacterial gastroenteritis is usually spread by consuming contaminated food or water or by contact with an infected person or animal.

• Parasites: Giardia and Cryptosporidium are protozoa that can infect the small intestine, causing diarrhea, gas, bloating, and malabsorption. Parasitic gastroenteritis is usually spread by consuming contaminated water or food, especially fresh fruits and vegetables, or by contact with an infected person or animal.

• Toxins: The most common toxins that cause gastroenteritis in children are staphylococcal enterotoxin, bacillus cereus toxin, and clostridial toxin. Staphylococcal enterotoxin is produced by a bacteria named Staphylococcus aureus, which can grow in improperly stored or cooked food, especially dairy products, meat, and eggs. Bacillus cereus toxin is produced by a bacteria named Bacillus cereus, which can grow in cooked rice, pasta, cereals, and spices if they are not consumed for a while after they are prepared. Clostridial toxin is produced by a bacteria named Clostridium perfringens, which can grow in cooked meat, poultry, and gravy.

What are gastroenteritis epidemics?

Gastroenteritis epidemics are outbreaks of gastroenteritis that affect a large number of people in a specific area or population (for example, a school, a neighborhood, or a city) within a short period of time. Gastroenteritis epidemics can happen with all of the agents that we mentioned earlier, but the most common cause of a gastroenteritis epidemic is norovirus. Norovirus epidemics can happen all throughout the year, but they mostly occur in the winter.

How can you prevent your child from taking or spreading gastroenteritis?

• Hand washing is the most effective way of preventing the transmission of gastroenteritis agents. Teach your child to wash their hands often and thoroughly with soap and water. Especially before eating, after using the toilet, after touching likely contaminated surfaces, and after getting in touch with people who look sick.
• Teach your child to avoid sharing food, drinks, cups, plates, towels, and toys with anyone who has symptoms of gastroenteritis or who may have been exposed to it.
• Disinfect surfaces or objects that could have been contaminated with gastroenteritis agents, such as countertops, tables, doorknobs, toilets, sinks, toys, and bedding.
• Drink safe water and avoid ice made from tap water, especially if there is an epidemic going around. Use bottled water, boiled water, or filtered water for drinking, cooking, brushing teeth, or making ice. Avoid drinking water from wells, streams, lakes, or ponds that may be contaminated with animal or human feces. This can help prevent the ingestion of gastroenteritis agents that may be present in water or ice.
• Vaccinate your child against rotavirus if it’s recommended by your doctor.

How can you treat gastroenteritis in children?

The treatment of gastroenteritis in children depends on the cause, severity, and symptoms of the condition. The principles of treatment for gastroenteritis in children are:

Fluid and Electrolyte replacement: this is the most important and effective part of a proper treatment. As we have mentioned earlier, diarrhea and vomiting cause the body to lose not only water but also electrolytes such as sodium and potassium. Fluid and electrolyte replacement can be done by giving your child oral rehydration solutions (ORS), which are specially formulated liquids that contain water, sugar and salts to replenish the fluids and electrolytes lost through diarrhea or vomiting. ORS solubles are available in pharmacies, grocery stores, or health centers and can be given in small and frequent sips or spoons. As a general guide, you can give your child 50 to 100 ml of ORS per kilogram of body weight per day, or more if it is needed. You can also monitor a child’s hydration status by checking his or her urine output, skin turgor, and alertness.

Symptomatic relief: This is the treatment of the symptoms of gastroenteritis, such as diarrhea, vomiting, abdominal pain, fever, and headache. Symptomatic relief can make your child more comfortable and help him or her recover faster. Symptomatic relief can be achieved by giving your child medications, such as anti-diarrhea drugs, anti-emetics, analgesics, or antipyretics, depending on the type and severity of the symptoms. However, keep in mind that some medications may not be suitable or safe for children or may have side effects or interactions with other drugs; therefore, you should always consult your doctor or pharmacist before giving any medication to your child and follow the instructions on the label or prescription carefully.

Specific treatment: This is the treatment of the underlying cause of gastroenteritis, such as a virus, bacteria, parasite, or toxin. Specific treatments can eliminate the infection or toxins. Specific treatment may not be necessary for most cases of viral gastroenteritis, as they usually heal on their own within a few days. But some cases of bacterial, parasitic, or toxin-induced gastroenteritis may require specific treatment, such as antibiotics, antiparasitics, or anti-toxins, to kill the germs or neutralize the toxins. Specific treatments can only be prescribed by your doctor based on the diagnosis, severity, and symptoms of your child’s condition.

What are some home remedies for the treatment of gastroenteritis in children?

• Ginger: Ginger is considered a natural herb that has anti-inflammatory, anti-nausea, and anti-spasmic specificities. It has been shown that ginger can help reduce vomiting, nausea, and pain in the abdomen. You can give your child ginger in different forms, such as fresh, dried, or as tea. However, you should avoid giving your child too much ginger, as it can cause heartburn, irritation, or bleeding.

• Chamomile: Chamomile is also considered a natural herb that has anti-inflammatory, antispasmodic, and sedative specificities. It has been proven that chamomile can help soothe the stomach and intestines, reduce diarrhea, and relax the muscles. You can give your child chamomile in various forms, such as fresh, dried, or as tea. However, you should avoid giving your child too much chamomile, as it may cause allergic reactions, drowsiness, or bleeding.

• Probiotics: Probiotics are live microorganisms that can help restore the balance of the good bacteria in the bowels, which is disrupted by gastroenteritis. Probiotics can help reduce diarrhea, improve digestion, and boost immunity. You can give your child probiotics in various forms, such as yogurt, kefir, cheese, or probiotic supplements. However, you should avoid giving your child too many probiotics, as they can cause gas, bloating, or infection.

When should you take your child to a medical doctor?

You should take your child to the doctor’s office or the emergency room of a pediatric hospital as soon as possible if he or she:

• Shows signs of severe dehydration, such as no urine output, very sunken eyes, a very increased heart rate and breathing rate, very decreased blood pressure, a very increased or very decreased body temperature, being drowsy, sleepy, or unconscious.
• Has blood or pus in the stool, or black or tarry stool.
• Has severe or persistent vomiting, or vomits blood or bile (yellow or green vomit).

• Has severe or persistent abdominal pain or signs of appendicitis, such as pain in the lower right abdomen, fever, nausea, and loss of appetite.
• Has a high fever (above 39°C) or a fever that lasts more than three days.
• Has a rash, hives, swelling, or difficulty breathing, which may be a sign of an allergic reaction or a serious infection.
• Has a diagnosis of chronic medical conditions, such as diabetes, kidney disease, liver disease, or immune deficiency diseases, which might increase the risk of complications or require special treatment.
• Does not improve or even worsens after 48 hours of home treatment or shows signs of malnutrition, such as weight loss or lack of energy.

Authored By:
Dr. Alireza Sarmadi
Family Physician

References:

https://patient.info/childrens-health/acute-diarrhoea-in-children/gastroenteritis-in-children

https://www.medicalnewstoday.com/articles/gastroenteritis-in-children

https://www.oxfordhealth.nhs.uk/publication/caring-for-your-child-with-gastroenteritis/

https://www.canada.ca/en/public-health/services/food-poisoning/norovirus.html

https://www.mayoclinic.org/diseases-conditions/viral-gastroenteritis/symptoms-causes/syc-20378847

https://my.clevelandclinic.org/health/diseases/gastroenteritis

https://www.health.vic.gov.au/infectious-diseases/viral-gastroenteritis-not-rotavirus

https://www.healthline.com/health/bacterial-gastroenteritis

https://www.mayoclinic.org/first-aid/first-aid-gastroenteritis/basics/art-20056595

https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-gastroenteritis

https://www.webmd.com/digestive-disorders/gastroenteritis