eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Gastroenteritis: Follow-up

Author: Adam Levine, MD, MPH, Assistant Professor of Emergency Medicine, Brown University Alpert School of Medicine
Coauthor(s): Karen A Santucci, MD, Fellowship Director of Pediatric Emergency Medicine, Department of Pediatrics, Assistant Professor, New Haven Children's Hospital, Yale University
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Further Inpatient Care

  • Inpatient management includes frequent evaluation of volume status, replacement of fluid deficit and ongoing losses, and attempts at establishing and demonstrating oral intake sufficient to maintain volume status. 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 are recognized 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 younger than 6 months, or high frequency of stools/vomits should be monitored in the emergency department for a minimum of 4-6 hours before discharge.

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/fontanelle, absence of tears, and dry mucous membranes.
  • Parents should seek medical attention if dehydration returns, oral intake is inadequate, or if their child develops worsening abdominal pain, temperature higher than 101°F, or prolonged diarrhea lasting longer than 14 days.

Deterrence/Prevention

  • The US Advisory Committee on Immunization Practices recommends routine vaccination of US infants with rotavirus vaccine to protect against rotavirus gastroenteritis.16

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose appendicitis, intussusception, or small bowel obstruction places patients at risk of serious complications (including death).
  • Clinical presentations that include these diagnoses as considerations should be thoroughly investigated and the clinician's evaluation clearly documented.
  • Antidiarrheal medications have adverse effects and generally are not necessary.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, David W Marby, MD †, to the development and writing of this article.



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Follow-up: Pediatrics, Gastroenteritis
References
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References

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Further Reading

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Keywords

acute gastroenteritis, gastroenteritis treatment, gastroenteritis symptoms, gastroenteritis causes, diarrhea, dysentery, gastroenteritis in children, gastroenteritis in infants, vomiting, dehydration, norovirus, rotavirus, 

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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.

Medical Editor

James Li, MD, Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, 
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.

CME Editor

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.

 
 
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