Gastroenteritis in children - what you need to know

Gastroenteritis, sometimes called the “stomach flu,” is the most common digestive disorder among young children. Although the symptoms can be unpleasant, in most cases, it isn't serious and your child will usually start to feel better within a few days. However, it can sometimes cause your child to become severely dehydrated and medical intervention is necessary.

WHAT IS GASTROENTERITIS?

Gastroenteritis is an inflammation of the digestive system caused by an infection that can lead to vomiting, abdominal cramps, diarrhoea, loss of appetite and fever. It can be of viral, bacterial or parasitic origin.

WHEN TO SEEK MEDICAL ADVICE?

Persistent vomiting and diarrhea can sometimes cause your child to become severely dehydrated. There are different stages of dehydration: mild, moderate and severe.

Weight loss is the first sign of dehydration, however, there is no cause for alarm if your child loses less than 5% of their original body weight (i.e. approximately 500 gr for a child of 10 kg).

Signs of a more severe dehydration can include a dry mouth, dark and sunken eyes, crying without producing tears, darker and less frequent urine (or less wet nappies) cold hands and feet, and drowsiness.

You should contact your GP or visit your nearest A&E department if:

• you think your child is dehydrated 
• your child has been vomiting for more than a day or two
• your child is unable to hold down fluids
• your child has high fever, severe abdominal pain or blood in the stool
• your child is floppy, irritable or less responsive
• your child has diarrhoea after travelling abroad.

TREATMENT

In most cases, you can treat your child safely at home if the child's weight loss is less than 5% of their body weight. The most important thing you can do is make sure they keep drinking fluids to prevent dehydration.

In some cases your child is prescribed an oral rehydration solution, a special powder that you dissolve into a drink. It contains sugar and salts to help replace the water and salts lost through vomiting and diarrhoea. Oral rehydration solution can be given by bottle, spoon or syringe and should improve the general condition of the child in 4 to 6 hours.

A nasogastric tube will only be considered in cases of repeated vomiting and severe fatigue. Occasionally, intravenous rehydration may be necessary.

Children are generally not very fond of rehydration solutions that contain water, sugar and salt. It is possible therefore to give them solutes that taste of strawberries, bananas and other fruits.

Another alternative would be to make them a drink of apple juice diluted with water (half/half). A recent Canadian study states that this mixture is also effective in treating mild dehydration and more appreciated by children.

After about 4 hours of starting the rehydration process, children should regain their appetite. If your child is less than 4 months old and is breastfeeding, continue giving them breast milk. If necessary, a doctor can prescribe the available cow's milk protein hydrolysate (Nutramigen, Althera, Nutrilon Pepti) for 1 to 2 weeks.

If your child is more than 4 months old, keep giving them breast milk or your child's usual milk in normal concentration (1 serving per 30 ml of water) and age-appropriate solid food.

AVOID SOY MILK

Always avoid soy milk. From the age of one, your child will be able to drink cow's milk and eat a solid diet adapted to his age.

Children who are vomiting should keep taking small sips of clear fluid, such as water or clear broth. Fruit juice and fizzy drinks should be avoided until they are feeling better. If they are not dehydrated and have not lost their appetite, it's fine for your child to eat solid foods as normal. Rice, bread and cereals, yogurt, vegetables (potatoes, carrots), lean meat, fruits (bananas, apples) are recommended. Fast sugars (sweet teas, juices, lemonades) and animal fats (fatty meat, eggs and cheese) are to be avoided.

Regarding drug treatment, it should be noted that drugs against vomiting or diarrhoea are ineffective and useless in more than 90% of cases.

In a paediatric emergency department, Ondansetron (Zofran), an initially recommended medicine for vomiting following chemotherapy or anaesthesia, is generally prescribed. And it works pretty well! After a single dose, 70% of children no longer vomit. Probiotics and Racecadotril (Tiorfix) can also be used to treat the symptoms of acute diarrhoea and shorten its duration.