eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Rotavirus: Follow-up

Author: David D Nguyen, MD, FACEP, Attending Physician, Methodist Willowbrook Hospital, Houston, Texas
Coauthor(s): Sally Henin Awad, MD, FACEP, Medical Director, Forensic Nursing Program, Memorial Hermann Hospital System; Brent R King, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Texas Health Science Center at Houston; Chair, Department of Emergency Medicine, Memorial Hermann Hospital, Lyndon B Johnson General Hospital
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is usually not needed for rotavirus infection unless the child is dehydrated, cannot tolerate oral liquids, has a poor social network, or appears toxic.

Further Outpatient Care

  • Follow-up with the patient's primary physician is recommended to ensure patient improvement. The caretaker should also be instructed on clinical warning signs and the need to seek further care if the patient's symptoms worsen.
  • Breastfeeding can continue regularly before and after the patient receives the rotavirus vaccine.15

Inpatient & Outpatient Medications

  • Antiemetics have been used with some success in prevention of vomiting for gastroenteritis.13  Risk versus benefit of the medications must be determined by the treating clinician.

Transfer

  • Transfer may be indicated for the dehydrated child who requires admission to a pediatric inpatient or ICU bed.

Deterrence/Prevention

  • Rotavirus is contagious. Parents who have more than one young child or who help care for several small children should be cautioned about good hand-washing technique. Children who are asymptomatic should not play with children who are symptomatic during the diarrheal phase of the illness.
  • Daycare centers should keep symptomatic children together and separated from those who are not symptomatic. Ideally, the staff should be segregated as well, so that some staff members care for only the symptomatic children, and some staff members care for the others. Fomites should also be disinfected, as viral spread from these objects has also been demonstrated.22
  • Health care workers can be vectors for this illness. Extra vigilance with regard to hand washing, stethoscope cleaning, and housekeeping is warranted during rotavirus outbreaks.

Complications

  • The most important complication of rotavirus infection is dehydration.
  • Multisystem organ failure is possible when dehydration leads to shock and even death.

Prognosis

  • The prognosis for rotavirus infection is excellent as long as adequate hydration is maintained.
  • Most children recover within a week of symptom onset.
  • Rotavirus enteritis has virtually no important long-term sequelae.
  • Reinfection is a common phenomenon.

Patient Education

  • Parents should be taught the signs and symptoms associated with dehydration and should be instructed to seek care immediately upon noticing any of these signs or symptoms in a child.
  • Parents must know which fluids should and should not be given and how to administer these fluids to young children who are vomiting.
  • Parents should be informed about early refeeding with a soy-based infant formula and a bland, general diet, which may include lactose-free milk for toddlers.
  • Diarrhea can last for 5-7 days.

Miscellaneous

Medicolegal Pitfalls

  • Discharge instructions should include the signs of dehydration and clear instructions to return if any of these signs are noticed. Instructions also should warn against use of very osmolar or very salty fluids for the maintenance of hydration. On the other hand, excessive use of free water may be detrimental as well.
  • Inadequate volume resuscitation with associated organ failure may result in shock and possibly death.
 


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References
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References

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Further Reading

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Keywords

rotavirus, rotavirus infection, rotavirus symptoms, rotavirus treatment, rotavirus vaccine, gastroenteritis, contagious virus, infection in children, enteritis, viral infection, diarrheal illness, childhood dehydrating gastroenteritis, severe dehydration, dehydration, fluid loss, diarrhea, Reoviridae, hypovolemia, viral enteritis, rotavirus outbreak, rotavirus genome

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Contributor Information and Disclosures

Author

David D Nguyen, MD, FACEP, Attending Physician, Methodist Willowbrook Hospital, Houston, Texas
David D Nguyen, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Harris County Medical Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Sally Henin Awad, MD, FACEP, Medical Director, Forensic Nursing Program, Memorial Hermann Hospital System
Sally Henin Awad, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Writers Association, American Professional Society on the Abuse of Children, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Brent R King, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Texas Health Science Center at Houston; Chair, Department of Emergency Medicine, Memorial Hermann Hospital, Lyndon B Johnson General Hospital
Brent R King, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American College of Physician Executives, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
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

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
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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