clinical assessment of child with gastroenteritis

Last edited 04/2018

Suspect gastroenteritis if there is a sudden change in stool consistency to loose or watery stools, and/or a sudden onset of vomiting. The clinician should be aware that in children with gastroenteritis:

• diarrhoea usually lasts for 5-7 days, and in most it stops within 2 weeks
• vomiting usually lasts for 1-2 days, and in most it stops within 3 days (1)

A complete history and physical examination should be carried out to determine whether the child is dehydrated and if possible the aetiology of acute gastroenteritis (2,3)

• duration of illness
• the number of episodes per day
• vomiting
• whether vomiting is interfering with the child's ability to keep down fluids and solid food
• type of emesis (e.g., whether bile is present)
• diarrhoea
• whether blood or mucus is present
• urine output
• the presence of blood in the stool
• accompanying symptoms such as fever, abdominal pain, and urinary complaints
• child's mental status
• any accompanying medical conditions
• whether oral rehydration therapy has been attempted with any success
• recent contact with someone with acute diarrhoea and/or vomiting and
• exposure to a known source of enteric infection (possibly contaminated water or food) and
• recent travel abroad (1,2,3)

Physical examination can be useful in identifying signs of dehydration e.g. - level of alertness, presence of sunken eyes, dry mucous membranes, and skin turgor

Recognise that the following are at increased risk of dehydration:

• children younger than 1 year, particularly those younger than 6 months
• infants who were of low birth weight
• children who have passed more than five diarrhoeal stools in the previous 24 hours
• children who have vomited more than twice in the previous 24 hours
• children who have not been offered or have not been able to tolerate supplementary fluids before presentation
• infants who have stopped breastfeeding during the illness
• children with signs of malnutrition (1).

Reference:

• (1) National Institute for Health and Care Excellence (NICE) 2009. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management  
• (2) Churgay CA, Aftab Z. Gastroenteritis in children: Part 1. Diagnosis. Am Fam Physician. 2012;85(11):1059-62.
• (3) Granado-Villar D et al. Acute gastroenteritis. Pediatr Rev. 2012;33(11):487-94; quiz 495