Pediatric Gastroenteritis Follow-up
- Author: Randy P Prescilla, MD; Chief Editor: Russell W Steele, MD more...
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 greater than 101°F, or prolonged diarrhea lasting longer than 14 days.
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 oral rehydration solution (ORS), such as intractable vomiting or inadequate ORS intake
Treatment failure, such as worsening diarrhea or dehydration despite adequate ORS intake, occurs
Factors are present necessitating closer observation, such as young age, decreased mental status, or uncertainty of diagnosis
Children with mild-to-moderate dehydration, children younger than 6 months, or children with a high frequency of stools/vomits should be monitored in the emergency department for a minimum of 4-6 hours before discharge.
The US Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend routine vaccination of US infants with rotavirus vaccine to protect against rotavirus gastroenteritis.
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|Symptom or Sign||No or Minimal Dehydration||Mild-to-Moderate Dehydration||Severe Dehydration|
|Mental status||Alert||Restless, irritable||Lethargic, unconscious|
|Thirst||Drinks normally||Drinks eagerly||Drinks poorly|
|Heart rate||Normal||Normal to increased||Tachycardia|
|Quality of pulses||Normal||Normal to decreased||Weak or not palpable|
|Breathing||Normal||Normal or fast||Deep|
|Eyes||Normal||Slightly sunken||Deeply sunken|
|Mouth and tongue||Moist||Dry||Parched|
|Skin fold||Instant recoil||Recoil < 2 seconds||Recoil >2 seconds|
|Capillary refill||Normal||Prolonged||Prolonged or minimal|
|Extremities||Warm||Cool||Cold, mottled, cyanotic|
|Severe Dehydration||Two of the following signs:
|Some Dehydration||Two of the following signs:
|No Dehydration||Not enough of the above signs to classify as some or severe dehydration|