Acute gastroenteritis

Acute gastroenteritis (AGE) is the inflammation of the digestive tract that results in frequent, watery bowel movements, often accompanied by vomiting, fever, and abdominal pain. It typically lasts less than 7 days but no more than 14 days.

Children under 3 years of age may experience between 0.5 and 2 episodes per year, with a higher incidence among children attending preschool, and the condition can be more severe in younger children. It is one of the most common illnesses during childhood. The most common cause is viral, particularly rotavirus. The introduction of the rotavirus vaccine has led to a significant decrease in cases. Other causes of AGE include food or water contamination by bacteria or parasites, respiratory or urinary tract infections, food allergies, antibiotics, etc.

Sometimes it is difficult to differentiate between a viral and bacterial cause of AGE. Both can present with fever, discomfort, and abdominal pain. Viral infections are more common in winter, while bacterial infections are more associated with summer and the consumption of contaminated or spoiled food, often accompanied by blood or mucus in the stool. Parasitic causes are rare in developed countries and can last for weeks or months. Therefore, it is important to inform healthcare providers if the child has recently traveled abroad.

Infectious diarrhea is contagious. Depending on the microorganism, it can be transmitted from before symptoms appear to even weeks or months after symptoms have resolved. Good hand hygiene is crucial, especially after changing diapers or using the bathroom. The child should not attend school or daycare while experiencing symptoms.

When a child has vomiting or diarrhea, it is important to monitor for SIGNS OF DEHYDRATION:

1. Dry mouth.
2. Absence of tears.
3. Concentrated and reduced urination.
4. Loss of skin turgor (skin remains pinched when pulled).
5. Pallor, slow capillary refill (skin takes more than 2 seconds to regain its pink color after being pressed).
6. Sunken fontanelle.
7. Dizziness or decreased level of consciousness.
8. Normal breathing.

Management of a Child with Vomiting and Diarrhea

Start by offering oral rehydration solution (ORS) with a syringe or teaspoon (50ml per kg of body weight over 4 hours). This will “trick” the digestive system and replace lost fluids. It’s okay if the child goes several hours without eating, but it is VERY IMPORTANT to keep them well hydrated, and this can only be achieved with ORS, not water or sports drinks (which have excessive sugar and inappropriate levels of electrolytes for a child with diarrhea).

For exclusively breastfed infants, breastfeeding should continue on demand and should not be interrupted.

Once the child has gone several hours without vomiting and has regained their appetite, foods can be reintroduced:

• There is no need to avoid dairy products.
• Well-tolerated foods include carbohydrates (rice, wheat, potatoes, bread), lean meats, plain yogurt, fruits, and vegetables.
• Avoid foods that contain sugars, fats, or are gas-producing.
• Probiotics can help restore damaged intestinal flora, reducing stool volume and the duration of diarrhea.

Diarrhea usually resolves on its own and does not require medication. Antibiotics are only used when the cause is known or strongly suspected, particularly after recent travel to an endemic country. Antiemetics and antidiarrheal medications are contraindicated in children as they increase the risk of bacterial invasion and septicemia.

A pediatrician should evaluate the child if they have

1. Age younger than two months.
2. Vomiting for 12 hours (6 hours in infants).
3. More than eight abundant bowel movements per day.
4. Abdominal pain lasting more than 3 hours.
5. Signs of dehydration.
6. High fever (39-40°C) not responding well to antipyretics.
7. A chronic illness such as diabetes or chronic renal failure.