Acute gastroentritis in children

Gastroenteritis is the infection of the small intestine.

Gastroenteritis in children always concerns the parents. It will cause vomiting and diarrhea. Most of the time, it only happened in a mild form and often settles within 48 hours of onset. However, more serious form of gastroenteritis can occur especially in babies and young children. The main danger from small intestine infection is dehydration and electrolyte imbalance that cause by persistent of watery stool and vomiting. Dehydration occurs when fluids lost from the body are not replaced. So, the treatment is mainly to replace the fluids quick enough before the children develop dehydration.

SIGNS OF DEHYDRATION
1.   Passing less urine. Dry nappies may be noted.
2.   Dry mouth and coated tongue
3.   Sunken eyes and no tears
4.   Drowsiness and irritability
5.   The child will appear lethargy, less active and refuse to playShould any of these signs present, the child will need urgent medical attention. Worldwide, diarrhea alone kills more than 3 000 000 children per year.

CAUSES
Rotavirus is the most common noted organism. Others include small round structured virus and astrovirus.There is often associated otitis media or upper respiratory tract infection.

TESTS AND INVESTIGATIONS
- Stools for pathogens (including ova, cyst and parasites)TREATMENTS

Fluid replacement – encourage your child to drink plenty of water. Oral rehydration solution is the fluid of choice.
Stop bottle milk. It can be restarted after 24 hours (or sooner if the child recovers and feels hungry).
Children who have diarrhea but not dehydrated should continue their normal feed if they wish. Do not starve your child to reduce severity of diarrhea. Early use of full strength feed is safe even in small babies.
If your child is breast feed, it should be continued through out the duration of the illness.
Antibiotics and antidiarrhoeals should used. Many of these agents have potential to cause more harm than good especially when use in infants and young children.
If your child is moderate to severe dehydrated, he or she may be need admission to hospital. Intravenous fluid will be given to replace the fluid.
Monitor the temperature because a raised temperature will make the baby irritable and will cause more fluid loss by evaporation. In this case, paracetomol and tepid sponging will be a great help.

COMPLICATIONS
·    Dehydration.
·    Malnutrition.
·    Temporary sugar intolerance after persistent diarrhea and vomiting with explosive watery acid stools. (Rare)

References:
1. Oxford Handbook of Clinical Specialties. 4th edition. 2001.
2. Fact sheet by Health Promotion Unit, Ireland.