Sickness and diarrhoea in children
Gastroenteritis is an infection of the stomach and bowel. The most common symptoms are diarrhoea and vomiting.
Gastroenteritis can have a number of causes, such as a norovirus infection or food poisoning. However, in children, the rotavirus is the leading cause.
This topic focuses on gastroenteritis in children. See the Health A-Z topic about gastroenteritis in adults for more information about this condition.
A rotavirus is a virus that infects the stomach and bowel. It is spread by infected children who do not wash their hands properly after going to the toilet. They may then leave tiny samples of infected faeces on surfaces or utensils, which can be picked up by another child. Small droplets of infected faeces can be carried in the air, which children can breathe in.
How common is rotavirus gastroenteritis?
Rotavirus gastroenteritis is extremely common in children. It is estimated that every child will have at least one rotavirus infection before the age of five. Most infections occur among children aged between three months and three years.
Rotavirus gastroenteritis is more common during winter and spring. The first infection tends to be the most severe, because the body builds up immunity (resistance) to the virus afterwards. This is why rotavirus infections are extremely rare in adults.
The rotavirus is highly contagious among children with no immunity to the virus. Even if your child has had a previous infection, they may not have built up full immunity. There are also different strains of the virus that your child may not be immune to.
Therefore, it is important to keep an infected child isolated from other children for 48 hours after their last episode of diarrhoea and vomiting.
Most cases of rotavirus gastroenteritis in children are mild and normally pass within five to seven days, without the need for medical treatment. However, children (particularly those under the age of two) are at risk of dehydration, so it is very important that they drink plenty of fluids.
More severe cases of gastroenteritis and associated dehydration may require hospital treatment. However, it is estimated that only 1.5% of all childhood cases of gastroenteritis in England will require hospital treatment.
Deaths caused by rotavirus gastroenteritis are extremely rare in England. Only three deaths occurred in England and Wales in 2008.
Contagious is when a disease or infection can be easily passed from one person to another.
Dehydration is an excessive loss of fluids and minerals from the body.
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
The stomach is the sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Symptoms of gastroenteritis in children
The symptoms of rotavirus gastroenteritis normally begin with a rapid onset of diarrhoea and vomiting.
Your child may also have a high temperature (fever) of 38°C (101 °F) or above, and complain of abdominal (tummy) pain.
The symptoms of vomiting usually pass within one to two days. In most children, it will not last longer than three days.
The symptoms of diarrhoea usually pass within five to seven days. Most children's diarrhoea symptoms will not last more than two weeks.
It is very important to be aware of the symptoms of dehydration and recognise them in your child because dehydration is potentially more serious than the rotavirus infection itself.
Symptoms of dehydration include:
- dry mouth and eyes
- no tears produced when the child cries
- sunken appearance of the eyes
- weakness and drowsiness
- deep, rapid breathing
- passing urine infrequently
Contact your GP for advice if you think your child has become dehydrated. If this is not possible, call NHS Direct on 0845 4647.
When to seek medical advice
Rotavirus gastroenteritis shares many of the initial symptoms of more serious childhood conditions. So, it is important to be alert for signs and symptoms that suggest your child has a more serious condition.
Signs and symptoms to watch out for are:
- a temperature of 38ºC (101ºF) or higher in children younger than three months
- a temperature of 39ºC (102.2ºF) or higher in children older than three months
- shortness of breath
- abnormally rapid breathing
- a change in their normal mental state, such as appearing confused
- stiff neck
- a swelling in the soft part of their head (fontanelle)
- a blotchy red rash, which (unlike most other rashes) does not fade when you put a glass against it
- blood and/or mucus in their stools (faeces)
- green vomit
- they complain of severe abdominal pain
- swelling of their abdomen
- their symptoms of vomiting last longer than three days
- their symptoms of diarrhoea last longer than two weeks
- symptoms of dehydration persist or worsen, despite treatment with fluids and oral rehydration solutions
If you notice any of the signs and symptoms listed above, call your GP for advice as soon as possible. If this is not possible, call NHS Direct on 0845 4647.
Causes of gastroenteritis in children
Rotaviruses infect the stomach and intestines (bowel) of children. They often spread to other children before the infected child starts to feel unwell. Poor hygiene usually causes the spreading.
For example, if an infected child does not wash their hands after going to the toilet, any rotaviruses on their hands will be transferred to whatever they touch, such as a glass, kitchen utensil or food. If another child touches this contaminated object, then touches their face, or they eat contaminated food, they may swallow some of the viruses.
Rotavirus infections spread easily in this way, particularly among young children who often forget to wash their hands after going to toilet or before eating. The virus can also survive for several days on surfaces or utensils.
This is why these types of infections frequently occur in places where there is a high concentration of young children, such as playgroups, nurseries and infant schools.
The rotavirus affects one of the main functions of the intestines: the absorption of water from digested food and into the body. This is why one of the most common symptoms of gastroenteritis is diarrhoea, and why dehydration is such a common complication.
In a minority of cases, gastroenteritis in children may be caused by factors other than the rotavirus. These include:
- food poisoning from eating contaminated food
- drinking contaminated water
- a side effect of antibiotics
Diagnosing gastroenteritis in children
In most cases of gastroenteritis, your child will not need a diagnosis from your GP because their symptoms should disappear without treatment.
A diagnosis is usually only required if any of the circumstances or situations listed below occur:
- your child has recently been abroad (they may have acquired a more serious type of infection caused by a parasite)
- their diarrhoea symptoms do not improve after seven days
- they have signs and symptoms not usually associated with gastroenteritis (see Rotavirus gastroenteritis - symptoms for examples of these)
- there is blood and/or mucus in their stools
- your child has a weakened immune system, due to a health condition, such as acute leukaemia, or as a side effect of a medical treatment, such as chemotherapy
Your GP can make a diagnosis by taking a sample of their stools (faeces). This can be checked for the presence of viruses, bacteria or parasites.
In some circumstances, blood and urine tests may be used in order to rule out other conditions, such as a urinary tract infection or pneumonia. This is normally recommended when the child has symptoms suggesting that their infection is not simply limited to their digestive system, such as a rapid heartbeat or low blood pressure.
Treating gastroenteritis in children
You should usually be able to treat your child at home. An important part of treating your child is assessing whether they have an increased risk of dehydration.
Factors that can increase your child's risk of dehydration include:
- your child is younger than one, particularly if they are younger than six months
- your child has passed more than five stools (faeces) in the last 24 hours
- your child has vomited more than twice in the last 24 hours
- your child has not been able to hold down fluids
- your child has suddenly stopped breastfeeding
- your child is less than two years old and had a low birth weight when born
No increased risk
If your child does not appear dehydrated and has no increased risk of dehydration, continue to feed them as usual, whether with breast milk, other milk feeds or solids.
If your child is eating solids, encourage them to eat as soon as their vomiting is under control. There is no evidence to suggest that not allowing your child to eat will shorten their episodes of diarrhoea. Simple foods that are high in carbohydrates, such as bread, rice or pasta, are recommended.
It is not recommended that your child drinks fruit juices or carbonated drinks ('fizzy drinks'). These can worsen their symptoms of diarrhoea.
If your child does not appear dehydrated but does have an increased risk of dehydration, the advice above still applies. Also, give your child an oral rehydration solution (ORS).
ORS usually come in sachets that are available over the counter (without a prescription) from your local pharmacist. You dissolve them in water and they help to replace salt, glucose and other important minerals that your child loses through dehydration.
If your child vomits after drinking an ORS solution, wait 5-10 minutes before giving them some more. However, make sure they drink it slowly. For example, you could try giving them a spoonful every few minutes.
It is usually recommended that your child drinks an ORS each time they pass a large amount of watery stools. The exact amount of ORS they should drink will depend on their size and weight.
Your pharmacist will be able to advise you. The manufacturer's instructions that come with the ORS also give information on recommended dosage.
If your child has symptoms of dehydration, use an ORS then call your GP. If your GP is unavailable, contact your local out-of-hours service or NHS Direct on 0845 4647.
Your GP or the NHS Direct health advisor will ask questions about your child's symptoms and general state of health, to assess whether your child is well enough to be treated at home or whether they need to be admitted to hospital.
Treatment at hospital
Admission to hospital is usually recommended if your child has signs and symptoms of severe dehydration, such as:
- a decreased level of consciousness, such as appearing drowsy or unaware of their surroundings
- pale or blotchy skin
- their hands and feet feel cold
- rapid heartbeat (tachycardia)
- rapid breathing (tachypnoea)
- their pulse feels weak
Admission to hospital may also be recommended if your child's symptoms get worse despite treatment with ORS, or if they keep vomiting up the ORS.
Treatment at hospital usually involves feeding the child some fluids and other nutrients directly into their vein (intravenous fluid therapy).
Most children respond very well to treatment and are able to leave hospital after a few days.
Treating other symptoms
Symptoms of pain and fever can normally be relieved using paracetamol. Young children may find liquid paracetamol easier to digest than tablets.
Do not give aspirin to children who are under 16 years of age.
Anti-diarrhoeal medicine is not recommended for children under 12 years old.
The use of medicine to prevent vomiting (anti-emetic medication) is also not usually recommended for children due to the risk of adverse side effects, such as muscle spasms or allergic reactions. Consult your GP before giving your child anti-emetic medicine.
Preventing gastroenteritis in children
As gastroenteritis can be very infectious, it is important to take steps to prevent it spreading from your child to other children. Even if you isolate your child, it may be possible for adults in your household to spread the infection to other children without realising it. Recommended steps include:
- Encourage your child to wash their hands thoroughly after going to toilet, and before eating.
- Thoroughly clean the potty or toilet using disinfectant after each episode of diarrhoea and vomiting. Make sure that you include the handle and the seat.
- Wash your hands regularly, particularly after changing a nappy or cleaning a potty.
- Do not share your child's towels, flannels, cutlery or eating utensils with other members of your household.
- Do not allow your child to return to nursery or school until 48 hours have passed since their last episode of diarrhoea and vomiting.
- Do not allow your child to enter a swimming pool for the first two weeks after their last episode of diarrhoea - even though they are free of symptoms, research has found that the rotavirus can spread to other children via the pool water.
Practising good food hygiene will help your child to avoid getting gastroenteritis as a result of food poisoning. Some ways of achieving this include:
- regularly washing your hands, surfaces and utensils using hot, soapy water
- never storing raw and cooked foods together
- making sure that food is kept properly refrigerated
- always cooking food thoroughly
- never eating food that is past its sell-by date
There is a licensed vaccine in England that protects children against rotavirus gastroenteritis, known as Rotarix.
Rotarix is available as a liquid that is sprayed into your baby's mouth. Two doses are given, with at least four weeks between each dose.
Ideally, the vaccine should be given before a baby is 16 weeks old. It must be given before a baby is 24 weeks old or it will not be effective.
Side effects of rotarix include:
These side effects are usually mild and should resolve with time.
Rotarix is not given as part of the routine childhood immunisation schedule, and is not usually available free of charge on the NHS. This is because it is currently felt that the public health risks posed by the rotavirus are not serious enough to justify routine immunisation.
If you want to vaccinate your baby, you are likely to have to pay a fee. Fees can vary across private practices from around £60 to £100 a dose.
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