Acute gastroenteritis (peds)

For adult adult patients see acute gastroenteritis

Background

  • Extremely common childhood illness
  • Most commonly viral etiology [1]
  • Usually benign in absence of severe dehydration/electrolyte imbalance

Clinical Features

Differential Diagnosis

Nausea and vomiting (newborn)

Newborn '
Obstructive intestinal anomalies
Neurologic
Renal
Infectious
Metabolic/endocrine
Miscellaneous

Nausea and vomiting infant (<12 mo)

'
Obstructive intestinal anomalies
Neurologic
Renal
Infectious
Metabolic/endocrine
Miscellaneous

Nausea and vomiting child (>12 mo)

' '
Obstructive intestinal anomalies
Neurologic
Renal
Infectious
Metabolic/endocrine
Miscellaneous

Evaluation

  • Usually clinical

Pediatric signs of dehydration

Significantly dehydrated if has 2 or more of the following (LR+ 6.1, CI:3.8-9.8):[2]

  • Prolonged capillary refill (>2 sec)
  • Dry mucous membranes
  • Absence of tears
  • Abnormal overall appearance

Management

Pediatric acute gastroenteritis treatment

  1. Oral rehydration therapy
    • Avoid IV fluids before doing a trial of oral rehydration therapy in uncomplicated cases of mild to moderate dehydration in children.[3]
  2. If fails, oral ondansetron as a single dose PO (>6 months of age)[4][5]
  3. If fails, IV fluids (e.g. normal saline)

Probiotics have NOT been shown to provide any benefit[6]

Disposition

Discharge

  • Presumed self-limited etiology
  • Well appearing
  • Tolerating fluids

Admission and/or Observation

  • All others

See Also

External Links

References

  1. Pediatric Gastroenteritis in Emergency Medicine. Medscape. http://emedicine.medscape.com/article/801948-overview. Updated Jul 23, 2015. Accessed Jul 24, 2016.
  2. Gorelick MH et al. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997; 99(5):E6
  3. Choosing wisely ACEP
  4. Cheng A. Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children. Paediatrics & Child Health. 2011;16(3):177-179.
  5. A Cheng; Canadian Paediatric Society, Acute Care Committee. Paediatr Child Health 2011;16(3):177-9
  6. Freedman, et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026 DOI: 10.1056/NEJMoa1802597