As I write this, we have just survived both boys having had gastroenteritis in close succession. Sleep deprivation – something I thought had disappeared with their infant days – was a stark reality and washing machines running at midnight became the new norm.
Telling my five-year-old that he had to sleep in a nappy to catch any accidents even though “mommy knows you’re not a baby” was a little heart-breaking. But barring a few days of discomfort, a house that smelt most unwelcoming and several days of missed school, we came off pretty lightly.
Unfortunately, gastroenteritis does not always have favourable outcomes. According to the CDC, worldwide diarrhoeal diseases are a leading cause of paediatric morbidity and mortality, with 1.5 billion episodes and 1.5 to 2.5 million deaths estimated to occur annually among children under five years.
A measurable decrease has been observed with the development of the rotavirus vaccine, which is currently part of our vaccination schedule.
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What is gastroenteritis?
Gastroenteritis (gastro) is an inflammation of the gastrointestinal tract, i.e. the stomach and intestines. Symptoms may include diarrhoea, vomiting and abdominal pain/cramping. Fever, lack of energy and dehydration may also occur.
Statistically, it is most usually viral, although patients who have recently been travelling or are immunocompromised may be more likely to have picked up bacteria, parasites or fungal infections. Eating improperly prepared food, drinking contaminated water or close contact with a person who is infected can spread the disease.
“The single most effective way to prevent the spread of viral gastroenteritis is frequent, thorough hand-washing with soap and water.”
How diarrhoea is diagnosed
Patients often announce at the beginning of the consult: “I don’t know if I ate something funny or if I picked up an infection somewhere…” Truth be told, it’s really not important. The symptoms are identical and the treatment plan would be the same, too.
In instances of mass outbreaks with contaminated foodstuffs, stool testing would be warranted. Similarly, in a patient who has recently travelled or is presenting with bloody stools, testing is indicated.
Should you run to the doctor at the first sign of diarrhoea or vomiting in your little one?
The answer is generally no. Gastroenteritis is usually an acute and self-limiting disease that does not require medication. There are certain products we can use to attenuate symptoms such as antiemetics (drugs to reduce nausea and vomiting), antispasmodics (for cramping) and mucosal protective agents. Specific products and their doses depend on the age and size of the child, so it is best to ask a healthcare professional.
Two good items to have in your “gastroenteritis kit” are rehydration solution and probiotics. The most important treatment for your child with gastroenteritis is replacing fluid. They must drink small amounts at frequent intervals.
When should I take my child to the doctor?
The biggest risk with gastroenteritis is dehydration, and moderate to severe dehydration certainly warrants a trip to your doctor or emergency room. A degree of mild dehydration is to be expected and can be carefully watched.
Signs of mild dehydration include:
Thirst, child is alert, moist mucous membranes (look inside mouth), cries tears, normal breathing and heart rate, decreased urine output (but still passing urine).
Signs of severe dehydration include:
If your child is lethargic, has dry mucous membranes, decreased tears, a thready fast pulse, sunken eyes and fontanelles (soft spot), or reduced skin turgor you must get medical attention. Parents should also be far more cautious with small babies, since their reserves are much lower and they tend to deteriorate far quicker.
If your child is experiencing large fluid volume losses through diarrhoea and/or vomiting and you are unable to replace those losses with oral fluids, a drip may be necessary in order to replace those fluids bypassing the gastrointestinal tract.
Can gastro be prevented?
The single most effective way to prevent the spread of viral gastroenteritis is frequent, thorough hand-washing with soap and water. Always wash your hands after using the toilet and changing diapers and before eating, preparing, or handling food.
Alcohol-based hand sanitisers can be used in addition to hand-washing, but not as a substitute. Good hygiene for contaminated surfaces and bedding/clothing is also important.
When is it safe to take a child back to school?
Your child needs to not have had a single episode of diarrhoea, vomiting or fever for at least 24 hours. Some guidelines recommend waiting even 48 hours. They also need to be back to their old selves when it comes to energy, and eating and drinking happily and comfortably.