Vomiting and diarrhoea in children under 5
NICE GUIDELINES
Maria Cardona
GP VTS
Oct 2009
Diagnosis
Ask about Recent contact with someone with similar
symptoms Exposure to known source of enteric infection Recent travel abroad
Look for:
Temperature >38 in under 3 months old >39 in over 3 months old SOB/tachipnoea
Altered conscious state Neck stiffness
Bulging fontanele Rash
Blood/mucous in the stool Bilious vomiting
Severe / localised abdominal pain
Stool sample
Indicated if Septicaemia is suspected Blood and/or mucous in the stool Inmunocompromised
And maybe if Recent travel abroad Diarrhoea has not improved by day 7 Uncertainty about diagnosis of gastroenteritis
Stool sample
If taken:
Collect, store and transport as advised by lab
Provide lab with relevant information
If giving antibiotics:blood culture
Assess dehydration
Beware increased risk of dehydration: < 1 year Low birth weight >six diarrhoeal stools 24h >3 episodes of vomiting Infants who have stopped breastfeeding during illness Signs of malnutrition Children who have not been offered or have not tolerated
fluids supplementation
Management of non-dehydrated child
Continue breastfeeding or other milk feeds Encourage fluid intake Discourage juices/carbonated drinks Offer oral rehydration salt
Nutrition after rehydration
Give full-strength milk straight away Reintroduce usual solid food Avoid fruit juices/carbonated drinks until
diarrhoea has stopped
General advise
Most children can be safely managed at home Information on recognising red flag symptoms,
what to do if they are present Diarrhoea usually last for 5-7 days and stops within
2 weeks Vomiting usually lasts 1-2 days and stops within 3
days
General advise
Encourage Hand washing Do Not share towels Do not attend school during illness and until
48 hours after the last episode of diarrhoea Children should not swim in swimming
pools for 2 weeks after last episode of diarrhoea
Thank you