abdominal pain

Gastroenteritis is a condition which causes a child to have frequent vomits, watery stools (diarrhoea) and tummy cramps. Gastroenteritis has many causes and may just last a day or two but in the worst-case scenario, your child may end up becoming dehydrated. Once this happens, your child will most likely need to be admitted to hospital and have a drip set up to replace lost fluids and to allow the tummy to settle.

Gastroenteritis, which includes vomiting and or diarrhoea may be caused by either a virus, bacteria or parasite. Other common causes of gastroenteritis include food poisoning, food intolerances or a reaction to medication. Regardless of the cause, the key to keeping your child from becoming dehydrated is to ensure that the child is taking in adequate fluid.

Let’s take a look at some of the causes and what parents and caregivers can do to avoid dehydration.

Causes of gastroenteritis in children

A viral infection

Viral infections are probably the number one cause of gastroenteritis in children. The most common viruses include rotavirus and adenovirus. Fortunately, we now have a vaccine which helps to prevent rotavirus. Prior to the introduction of the vaccine some 450 000 children died each year from Rotavirus, but thankfully this number has been dramatically reduced. The vaccine can only be administered in the first 8 months of life and a child should ideally receive two doses to give adequate immunity to the virus.

Other than the vaccination, a child would need to develop his or her own immunity to a virus. During this time the child needs to be supported with fluids, a bland diet and medication for pain and fever. A virus may cause gastroenteritis for 2 to 7 days.

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A bacterial infection

Again there are many bacteria which may cause gastroenteritis in children but the three most common are Campylobacter, Salmonella and Escherichia coli (usually shortened to E. coli). A bacterial infection may require antibiotic treatment if the gastroenteritis persists and your child’s body is not able to fight the infection. These bacteria are usually spread from animal products such as poultry, beef, fish, eggs, and dairy products. In my experience, the source is often fast foods.

A child may also get gastroenteritis from contaminated water. This can be as easy as swallowing water while playing around in the swimming pool, at a water park or in a stream.

Parasites

When I mention the word parasite to parents, they usually look at me wide-eyed but in fact parasites are fairly common in children, especially if they attend day care. The transmission is faecal-oral which really means that contaminated faeces from an infected person is somehow ingested by someone else. This almost never happens deliberately but as you can imagine a little child who is unwell may not wash his or her hands properly after using the bathroom. If that child then touches the door knob or any other counter, the organism is left behind. Your child may touch the surface and then put those little fingers into his or her mouth.

The most common parasites include Giardia and Cryptosporidium. Worms are also parasites that are found in the gut and that cause gastroenteritis. Your doctor will recommend the correct treatment for the type of parasite.

Medicine

A lot of medications, especially antibiotics, can cause diarrhoea in children. This is because they may affect the flora of the tummy. Giving a probiotic with an antibiotic is always a good idea but if the diarrhoea persists your doctor may need to change the antibiotic. Antacids can also cause diarrhoea.

In the incidence of a child accidently taking medication that was not intended for them, gastric upset is very common.

Food intolerance

A child may develop severe gastric upset if he or she is intolerant to certain foods. Most common in the early years are milk protein allergies or gluten intolerance. In such cases a child would need to have these excluded from their diet completely. It is advisable that your child sees a dietician if any of the major food groups needs to be taken out of the diet. This is to ensure that your child still receives all the necessary nutrients for normal growth and development. 

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Causes of gastroenteritis in children & when to see a doctor

If your child has had gastroenteritis symptoms for more than three days or if you are unable to ensure that your child is getting enough fluid then it is important that you get urgent medical advice.

Your doctor will most likely order a stool test and this will include MC&S plus parasites. The stool test will be able to tell your doctor if the cause of the gastroenteritis is something which requires treatment. Remember that a viral infection cannot be treated with an anti-biotic. An antibiotic in this setting would definitely make the situation worse.

How to keep a child hydrated when they have diarrhoea or are vomiting

If a child is feeling nauseous or if he or she has a sore tummy, food is probably not high on the agenda. Fluids are, however, of utmost importance. We refer to these fluids as oral rehydration solution (ORS). It is far more difficult to keep a baby hydrated if the baby has both vomiting and diarrhoea, so at any stage that you feel your child may be losing more fluid than he or she can take in, please get medical attention.

Dehydration in babies under 6 months:

A child in this age group can dehydrate very quickly so ensuring that baby is getting adequate fluid is extremely important.

Offer your baby small, frequent volumes of ORS – 15mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as the baby begins to tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit. Breast feeding should be continued in addition to the ORS.

Dehydration in infants 6 months to 1 year:

This is also a high-risk group and any vomiting or diarrhoea needs to be monitored very carefully. Again, offer your baby small, frequent volumes of ORS – 25ml-50mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as the baby begins to tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit. If your child is still being breast fed, then breast feeding should be continued in addition to the ORS.

Dehydration in children 1 year or older:

The advice is really the same for this age group. You should offer your child small, frequent volumes of ORS – 25ml 50mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as your child starts to tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit.

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What kind of fluids can I give to my child when they have diarrhoea or are vomiting?

• Pharmacies and most grocery stores sell sachets of rehydration/electrolyte solutions. You will follow the recommendation on the sachet and mix the powder with the recommended amount of cooled, boiled water.
• If you are unable to buy a sachet then making your own solution will work just the same. To make it you will need to mix: 8 level teaspoons of sugar and ½ a teaspoon of salt to 1 litre of boiling water. Mix well and allow to cool before giving it to your baby. It is important not to use more than ½ a teaspoon of salt.

• If your child is older than 4 months old then you can also try one of the following:
• 1. A mixture of one part clear apple juice to one part rehydration solution.
  2. A mixture of one part clear apple juice to one part cooled boiled water.
  3. Sports drinks are not ideal fluids BUT if all else fails you can try them in children older than 1 year.

How long should I continue with Oral Rehydration Solution?

Once your child is tolerating ORS, special milk feeds can be attempted if the child is not breast fed. Gastroenteritis (vomiting and diarrhoea) can result in the inability of the intestine to digest lactose in cow’s milk or formulas based on cow’s milk. For this reason, it is advised that lactose containing products be avoided.

Lactose free (LF) formulas are available and are preferable to the other formulas at this time if possible. Once your child’s illness has passed you will once again be able to go back to the original formula that was being offered.

Once your child is tolerating fluids adequately, solids can gradually be introduced. These would include the following:

• Apples
• Bananas
• Cereals (milk free)
• Carrots
• Rice cereal mixed with a lactose-free formula or water
• Starches such as bread, rice or potato

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Further tolerated foods:
NOTE some of these may not be appropriate to your child’s age group.

• Creamy meal
• Marmite/Bovril
• Toasted white bread
• White pasta
• Chicken soup
• White chicken meat or lean meats
• Yellow vegetables.

The following foods should be avoided as they can aggravate gastroenteritis:

• Bran
• Raw fruits (other than apples and bananas)
• Green vegetables
• Butter

Vomiting and diarrhoea in children: when should I worry or take them to a doctor?

• If there are signs of dehydration in the child

These will include:
Few or no tears when crying
No wet nappies for 3 hours or more hours (decreased urine)
Sunken eyes, cheeks, abdomen or fontanel
Dry mouth or tongue
Irritability or excessive sleepiness or low energy
Skin that seems to have lost its elasticity (turgor)
If there is blood in the stool or vomit – this may indicate that your child has a serious infection and this should be assessed.

• If the gastroenteritis is coupled with a high temperature

A normal temperature is anything between 36.5 and 37.5. If your child’s temperature goes above 38°C then you will probably need your child assessed.

• If your child is in a lot of pain or is crying excessively

 Conclusion

Gastroenteritis is an illness which affects children predominantly in the age group 0 to 5 years. If your baby is less than six months you need to be especially vigilant to ensure that baby doesn’t dehydrate. If you are at all concerned rather seek medical help early. Keep in mind that the vomiting may stop after about two days but the diarrhoea may last up to 10 days. Fluids are extremely important but ensure that you avoid fizzy cooldrinks as these contain a lot of sugar and are likely to make the diarrhoea worse.

References

https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/vaccines-quality/rotavirus
https://www.msdmanuals.com/home/children-s-health-issues/digestive-disorders-in-children/gastroenteritis-in-children