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