Treatment Guidelines for Gastroenteritis-induced Diarrhea and Vomiting in Children Under Five

May 4, 2009

The National Institute for Health and Clinical Excellence and the National Collaborating Centre for Women's and Children's Health have published guidelines for treating diarrhea and vomiting due to gastroenteritis in children younger than age five years.

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women's and Children's Health have published guidelines for treating diarrhea and vomiting due to gastroenteritis in children younger than age five years.

The guidelines provide information for clinicians on fluid intake, managing nutrition, and preventing and treating dehydration. Also covered is how parents and caregivers can help to manage the symptoms, with information on “when care should be escalated—from home management through hospital admission.”

“This guideline will help all healthcare professionals to assess children with gastroenteritis and decide how sick a child is so that they can be followed up by the right people at the right time and within the right healthcare setting,” said Dr Monica Lakhanpaul, Co-director National Collaborating Centre for Women's and Children's health and Consultant Pediatrician. “Gastroenteritis can usually be treated at home with varying levels of support and this guideline will ensure that parents are provided with good advice to help them manage the condition once they have seen a healthcare professional - for example, information on how to use oral hydration solutions to prevent dehydration early on. This guideline will save children's lives."

Guideline recommendations, per the NICE website:

1. In children with gastroenteritis but without clinical dehydration:

- continue breastfeeding and other milk feeds

- encourage fluid intake

- discourage the drinking of fruit juices and carbonated drinks

- offer oral rehydration salt (ORS) solution as supplemental fluid to those at increased risk of dehydration (eg, Dioralyte)

2. In children with clinical dehydration, including hypernatraemic dehydration:

- use low-osmolarity ORS solution for oral rehydration therapy

- give 50 ml/kg for fluid deficit replacement over 4 hours as well as maintenance fluid

- give the ORS solution frequently and in small amounts

- consider supplementation with their usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks) if they refuse to take sufficient quantities of ORS solution and do not have red flag symptoms or signs

- monitor the response to oral rehydration therapy by regular clinical assessment.

3. Use intravenous fluid therapy for clinical dehydration if:

- shock is suspected or confirmed

- a child with red flag symptoms shows clinical evidence of deterioration despite oral hydration therapy

- a child persistently vomits the ORS solution

4. If intravenous fluid therapy is required for rehydration:

- use an isotonic solution for both fluid deficit replacement and maintenance

- for those who required initial rapid intravenous fluid boluses for suspected or confirmed shock, add 100 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response

- for those who were not shocked at presentation, add 50ml/kg for fluid deficit replacement to maintenance fluid requirements and monitor the clinical response

- measure plasma sodium, potassium, urea, creatinine and glucose at the start, and monitor regularly

- consider intravenous potassium supplementation when the plasma potassium level is known

5. After rehydration, give full strength milk straight away, reintroduce the child's usual solid food and avoid giving fruit juices and carbonated drinks until the diarrhoea has stopped.

6. Advise parents, carers and children that:

- washing hands with soap in warm running water and careful drying are the most important factors in preventing the spread of gastroenteritis

- hands should be washed after going to the toilet or changing nappies and before preparing, serving or eating food