Pediatric Gastroenteritis Follow-up

  • Author: Adam Levine, MD, MPH; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 7, 2010
 

Further Inpatient Care

Inpatient admission should be considered for all children with acute gastroenteritis in the following situations:

  • Signs of severe dehydration are present.
  • Caregivers are unable to manage oral rehydration or provide adequate care at home.
  • Substantial difficulties exist in administering ORS, such as intractable vomiting or inadequate ORS intake.
  • Failure of treatment occurs, such as worsening diarrhea or dehydration, despite adequate ORS intake.
  • Factors are present necessitating closer observation, such as young age, decreased mental status, or uncertainty of diagnosis.
  • Children with mild-moderate dehydration, age < 6 months, or high frequency of stools/vomits should be monitored in the emergency department for a minimum of 4-6 hours before discharge.
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Further Outpatient Care

  • Parents should be instructed to continue providing maintenance ORS fluids at home as needed. Breastfeeding and formula feeding should be continued for infants, and children should be encouraged to return to a regular diet as rapidly as possible.
  • Parents should be instructed to look for the various signs of dehydration outlined above, such as change in mental status, decreased urine output, sunken eyes, absence of tears, dry mucous membranes, and slow return of abdominal skin pinch.
  • Parents should seek medical attention if dehydration returns, oral intake is inadequate, or if their child develops worsening abdominal pain, fever >101°F, or prolonged diarrhea lasting longer than 14 days.
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Deterrence/Prevention

  • The US Advisory Committee on Immunization Practices recommends routine vaccination of US infants with rotavirus vaccine to protect against rotavirus gastroenteritis.[6]
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Patient Education

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Contributor Information and Disclosures
Author

Adam Levine, MD, MPH  Assistant Professor of Emergency Medicine, Brown University Alpert School of Medicine

Adam Levine, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Karen A Santucci, MD  Fellowship Director of Pediatric Emergency Medicine, Department of Pediatrics, Assistant Professor, New Haven Children's Hospital, Yale University

Karen A Santucci, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, Sigma Xi, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James Li, MD  Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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  26. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. Jan 5 2006;354(1):11-22. [Medline].

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Child with sunken eyes.
Child with slow skin pinch (reduced skin turgor).
Child with absent tears.
Child with lethargy/poor general appearance.
Child with hyperpnea (deep, acidotic breathing)
Table 1. Assessment of Dehydration*
Symptom or Sign No or Minimal Dehydration Mild to Moderate Dehydration Severe Dehydration
Mental statusAlertRestless, irritableLethargic, unconscious
ThirstDrinks normallyDrinks eagerlyDrinks poorly
Heart rateNormalNormal to increasedTachycardia
Quality of pulsesNormalNormal to decreasedWeak or unpalpable
BreathingNormalNormal or fastDeep
EyesNormalSlightly sunkenDeeply sunken
TearsPresentDecreasedAbsent
Mouth and tongueMoistDryParched
Skin foldInstant recoilRecoil < 2 secondsRecoil >2 seconds
Capillary refillNormalProlongedProlonged or minimal
ExtremitiesWarmCoolCold, mottled, cyanotic
Urine outputNormalDecreasedMinimal
*Adapted from King et al. MMWR Recomm Rep. 2003;52(RR-16):1-16.[2]
Table 2. Assessment of Dehydration According to the World Health Organization*
Severe DehydrationTwo of the following signs:



-Lethargic or unconscious



-Sunken eyes



-Not able to drink or drinking poorly



-Skin pinch goes back very slowly



Some DehydrationTwo of the following signs:



-Restless, irritable



-Sunken eyes



-Thirsty, drinks eagerly



-Skin pinch goes back slowly



No DehydrationNot enough of the above signs to classify as some or severe dehydration
*Adapted from World Health Organization.[9]
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