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Gastroenteritis in children

Published by Bupa's health information team, June 2008.

This factsheet is for parents of children with gastroenteritis. For information on gastroenteritis in adults, see Related topics.

Gastroenteritis is an inflammation of the stomach and intestines caused by infection. In the UK, gastroenteritis is one of the most common childhood illnesses. In most cases, gastroenteritis clears up without the need for specific medical treatment. In babies and young children it can be more dangerous because they become dehydrated more easily.

About gastroenteritis
Symptoms
Complications
Causes
Diagnosis
Treatment
Prevention
Further information
Questions and answers
Video
Related topics
Sources

About gastroenteritis

The stomach and intestines are known collectively as the gastrointestinal tract - or gut. Gastroenteritis is an infection of the gut.

Some bacteria, viruses and parasites can damage the cells lining the inner surface of the gut and interfere with its normal functions.

Certain bacteria or viruses may also produce toxins that irritate the gut and cause it to produce excess amounts of fluid. This can lead to the various symptoms of gastroenteritis such as diarrhoea.

Symptoms

The time between catching the infection and the start of symptoms - the incubation period - depends on the cause of gastroenteritis. Depending on the type of infection, it can range from a few hours to a couple of weeks.

Your child may have some, or all, of the following symptoms:

diarrhoea, which may contain blood and mucus, or be watery, greasy or frothy
nausea and vomiting
tummy cramps, bloating or pain
fever

Most children recover within a week. However, with severe infections the illness may persist for many weeks. It's important to seek medical advice if your child's symptoms have lasted for more than a week or if you have recently travelled abroad.

In older children the symptoms of gastroenteritis may be confused with other conditions, such as irritable bowel syndrome (IBS), Crohn's disease or ulcerative colitis.

Complications

Possible complications of gastroenteritis include:

dehydration - this can lead to kidney failure if severe
haemolytic uraemic syndrome (HUS) - this is rare but occurs mainly in young children and causes anaemia and kidney failure
malnutrition
irritable bowel syndrome

The main risk of gastroenteritis in children is that they become dehydrated. This can occur quickly in babies because they don't need to lose much fluid to lose a significant percentage of their total body fluid. The symptoms of mild to moderate dehydration include:

lack of energy or sleepiness
loss of elasticity in the skin - when pinched gently it doesn't immediately spring back into its normal position
in young babies the soft spot on the scalp (called the fontanelle) may be sunken
dry lips and mouth
sunken eyes
fewer tears when crying than usual
fewer wet nappies than usual - due to less urine being made by the baby's kidneys

With severe dehydration, symptoms include:

pale or mottled skin
very few wet nappies
significant drowsiness
fast heart rate
cold fingers and toes - when gently squeezed, blood takes a long time to return

You should contact your GP if your child is becoming dehydrated, or if there is a possibility that his/her illness isn't a simple gut infection.

You should also contact your GP if:

your child's pain is severe or doesn't respond to normal painkillers
your child's vomiting or diarrhoea continues for more than a few days or your child can't hold fluids down - this can lead to dehydration
there is blood or mucus in the diarrhoea
your child has a high temperature - over 38°C for three days, or any high temperature in a child under three months
your child has signs of dehydration
your child has recently travelled abroad
your child has recently completed a course of antibiotics for another infection (see Other causes)

Following gastroenteritis your child may have a temporary lactose (milk sugar) intolerance. You shouldn't give your child milk products if his/her faeces (stool) is frothy.

Causes

Viruses

Viruses are a major cause of gastroenteritis, particularly in children under two. Viral infections cause about seven out of 10 cases of gastroenteritis in children. These include:

rotavirus
norovirus
hepatitis A

Viral infection can be seasonal and there is a peak of infections with rotaviruses and noroviruses during the winter months.

Bacteria

The most common cause of bacterial gastroenteritis is food poisoning. Food poisoning is caused by different bacteria from different foods, for example:

Salmonella - dairy, eggs and poultry
Campylobacter - dairy, meats and poultry
Bacillus - reheated rice
Vibrio - seafood
Escherichia coli (E. coli) - minced beef

Some E. coli strains are particularly harmful, including E. coli 0157. These infections can be fatal and children can be particularly vulnerable.

Parasites

Parasites rarely cause gastroenteritis in the UK, but are a major problem in less developed countries and can be contracted if your child goes abroad.

Other causes

There are a number of other conditions that can cause vomiting or diarrhoea in children. Cow's milk intolerance (in infants) or allergy to foods can cause nausea and vomiting.

In babies, diarrhoea or vomiting can also be caused by other infections such as a chest infection or urinary tract infection. However, very occasionally it may be due to other conditions, such as encephalitis, diabetes, appendicitis or a blockage of the gut.

Some medicines, such as antimalarials, can also cause symptoms of gastroenteritis. Antibiotics can lead to gastroenteritis by killing the normal, healthy bacteria in your child's gut.

How is gastroenteritis spread?

The infections are transmitted:

in contaminated food
from person to person - if an infected person goes to the toilet and doesn't wash his/her hands properly afterwards, before handling food or touching other people
if an individual infected with a virus sneezes or coughs, as another person could breathe in the virus
in shellfish harvested from polluted waters
in contaminated drinking water - the majority of infections are spread this way in the developing world.

Diagnosis

Your GP will ask you about your child's symptoms and will examine them. He or she may also ask about your child's medical history and may ask you for a faeces (stool) sample from your child, to send for laboratory testing. If you have been travelling, your GP will ask you which countries your child has visited and which vaccinations he/she has had.

Treatment

Self-help

The most important part of treatment is to replace the fluids your child has lost, to prevent dehydration. If your child is very young, seek medical advice, because babies and children are at high risk of becoming dehydrated.

If your child has mild gastroenteritis, he or she should continue with his/her normal diet and their usual drinks (water, squash). Allow for the fluid lost - "little and often" is a good rule of thumb for them. You shouldn't give your child fatty foods and food or drinks that have lots of sugar.
If your child has a more severe infection, he or she may need an oral rehydration solution (eg Dioralyte), which you can buy in pharmacies. These are usually a powder that is made into a solution by adding water. They contain the right balance of sugars and salts for the body to encourage rehydration. You should give your child foods high in carbohydrates such as rice or toast until he/she can take solid food and return to a normal diet.

Probiotics (foods containing live, beneficial bacteria) can help to reduce the duration of diarrhoea.

If you are breastfeeding your child, you should continue, and give oral rehydration as well if needed.

Medicines

Children under 12 shouldn't be given medicines to stop diarrhoea (antidiarrhoeals) or vomiting (anti-emetics). These medications slow down movement in the intestines, but have no effect on the excess fluid in the intestines, so it will come out later. These medicines may also cause side-effects such as tummy cramps, dizziness and skin reactions.

If your child is in pain, give a painkiller that you would normally give him/her for a headache. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Most cases of gastroenteritis are caused by viruses, which are not treatable with antibiotics. Your GP won't usually prescribe antibiotics for gastroenteritis.

Hospital treatment

If your child has lost so much fluid that he or she is very dehydrated, hospital treatment may be needed to replace fluids directly into the child's bloodstream (intravenously).

Prevention

Most children will get gastroenteritis at some time, no matter how high the standards of hygiene at home.

To help prevent gastroenteritis encourage children to always wash their hands with soap after going to the toilet and before handling food.

Before travelling make sure you and your child have had any vaccinations required and use bottled water if necessary when abroad.

If your child has gastroenteritis, help to prevent spreading the infection to other family members by:

washing your hands thoroughly after changing your child's nappy
hygienically disposing of, or properly cleaning, all soiled items such as nappies
cleaning the toilet with disinfectant
not sharing towels and flannels
not letting your child help to prepare food for others

If your child has gastroenteritis he/she may be infectious to others. Your child should stay off school/nursery for at least 48 hours after his/her symptoms have stopped.

Further information

Health Protection Agency
www.hpa.org.uk

Food Standards Agency
www.foodstandards.gov.uk