Questionnaire/history: Diarrhoea (loose or watery stools)? Duration? - > 10 days? Frequency within 24 hours? - > 6x/24 h? Blood, mucus or pus in stools? Nausea? Vomiting? - Intractable? - Bilious (green)? - Duration? - Frequency within 24 hours? - > 3 x/24 h? Abdominal pain? Systemic features? Fever? Malaise? Recent contact with someone with acute diarrhoea and/of vomiting? Exposure to a possible source of enteric infection (eg eating out)? Recent travel abroad? Red flags? Altered responsiveness (eg irritable, lethargic)? T 38+°C if < 3 months? T 39+°C if ≥ 3 months? SOB? Tachypnoea? Tachycardia? Altered responsiveness (eg irritable, lethargic)? Neck stiffness? Bulging fontanelle in infants? Non-blanching rash? Bilious (green) vomit? Severe or localized abdominal pain? Abdominal distension? Rebound tenderness? Decreased urine output? Sunken eyes? Dry mucous membranes (except for mouth breathing)? Pale or mottled skin? Cold extremities? Prolonged CRT? Reduced skin turgor? Other symptoms? Past medical history? Current medication? Drug allergies? Examination: Consciousness level? Skin? BP? Pulse? Temperature? CRT? Neck stiffness? Chest? Abdomen? Investigations: Stool sample if: - Blood and/or mucus in the stool? - Immunocompromise? - History of recent hospitalization and/or antibiotic treatment? - Recently been abroad to anywhere other than Western Europe, North America, Australia or New Zealand? - Diarrhoea has not improved by day 7? - Uncertainty about the diagnosis of gastroenteritis? Management: Arranged emergency transfer to hospital? Arranged transfer to hospital as eg - Signs consistent with dehydration? - Increased risk of dehydration (eg < 6 months or has persistent vomiting or fever)? - Premature birth? - Chronic medical conditions? - Concurrent illness? - High output diarrhoea including frequent and substantial volumes? - No improvement in 48 hours? - Overall condition worsening? - Not passed urine in the previous 12 hours? - Concerns about parent's ability to monitor the child's condition and to provide appropriate care? Arranged face-to-face assessment (usually on the same day, but clinical judgement to be used) as eg - Symptoms suggestive an alternative, serious diagnosis? - Single episode of bloody diarrhoea? - Symptoms suggest dehydration? - Increased risk of dehydration (eg < 6 (12) months) - Low birthweight - Infants who have stopped breastfeeding during their illness - ≥ 6 diarrhoeal stools in the last 24 hours - ≥ 3 vomits in the past 24 h - Child's social circumstances make assessment over the telephone unreliable? Advised: If no symptoms or signs of dehydration: - To continue with usual feeds, including breastfeeding (if applicable) and other milk feeds - To encourage fluid intake - To offer oral rehydration salt (ORS) solution if increased risk of dehydration - To discourage the drinking of fruit juices and carbonated drinks (until the diarrhoea has stopped) If symptoms or signs of dehydration: - To give ORS solution frequently and in small amounts to rehydrate ≤ 5 years: 50 mL/kg over 4 hours + maintenance volume: 0–10 kg: 100 mL/kg per day 10–20 kg: 1000 mL + 50 mL/kg for each kg over 10 kg per day > 20 kg: 1500 mL + 20 mL/kg for each kg over 20 kg per day Breastfeeding can continue, but not routinely other oral fluids than ORS solution 5-11 years: 200 ml after each loose stool + normal fluid intake 12-16 years: 200-400 ml after each loose stool + normal fluid intake - To consider supplementation with the child's usual fluids if they refuse to take sufficient quantities of ORS solution - To avoid the drinking of fruit juices and carbonated drinks (until the diarrhoea has stopped) - To avoid giving solid food until dehydration is corrected - After rehydration to encourage the child to drink plenty of their usual fluids, including milk feeds (if these were stopped) - To give children at risk of dehydration 5 ml/kg ORS solution after each large watery stool to prevent recurrence of dehydration - To reintroduce the child's usual diet (guided by appetite (small, light, non-fatty, and non-spicy meals may be better tolerated)) Otherwise: - To wash hands thoroughly with soap (liquid if possible) in warm running water and careful drying - To use a flush toilet, if possible - If a potty must be used, to handle it with gloves, to dispose the contents into the toilet, to then wash it with hot water and detergent and allowed it to dry - To wash hands after going to the toilet and changing nappies, and before preparing, serving, or eating food - To clean toilet seats, flush handles, wash-hand basin taps, surfaces, and toilet door handles at least once daily with hot water and detergent - To use a disinfectant (if available) and a disposable cloth (or one dedicated for toilet use) to clean toilets - To not share towels and flannels used by infected children - To wash soiled clothing and bed linen separately from other clothes and at the highest temperature they will tolerate (for example 60°C or higher for linen), after removal of excess faecal matter into the toilet - To make sure that the washing machine is not be more than half full to allow for adequate washing and rinsing - Child should not attend school or other childcare facility while they have diarrhoea or vomiting and only go back until at least 48 hours after the last episode of diarrhoea or vomiting - To visit patient.info to read about 'Gastroenteritis in children' and www.nhs.uk to read about 'Diarrhoea and Vomiting' - To seek urgent medical advice if intractable or bilious vomiting, child unable to drink or vomits persistently, severe dehydration or shock, new features like blood, mucus and/or pus in the stool or symptoms do not resolve within the expected timeframe (advised that diarrhoea usually last 5-7 days and vomiting usually lasts 1-2 days)

Reference(s): NICE CKS: Child gastroenteritis Information for patients/carer(s): NHS Health A to Z: Diarrhoea and vomiting NHS Health A to Z: Food poisoning Patient UK: Gastroenteritis Patient UK: Food poisoning