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, such as intractable vomiting
Failure of treatment occurs, such as worsening diarrhea or dehydration, despite adequate fluid 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

Deterrence/Prevention

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.

Patient Education

Parents should be instructed to continue providing maintenance 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, temperature >101ºF (38.3ºC), or prolonged diarrhea lasting longer than 14 days.

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Media Gallery

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)

of 5

Table 1: Dehydration: Assessing Kids Accurately (DHAKA) Score

Clinical Sign	Finding	Points
General Appearance	Normal	0
	Restless/irritable	2
	Lethargic/unconscious	4
Tears	Normal	0
	Decreased	1
	Absent	2
Skin Pinch	Normal	0
	Slow	2
	Very slow	4
Respirations	Normal	0
Respirations	Deep	2

Table 2: Clinical Dehydration Scale

General Appearance	Normal	Thirsty, restless, or irritable	Lethargic or unconscious
Eyes	Normal	Slightly sunken	Very sunken
Mucous Membranes	Moist	Dry	Very dry
Tears	Tears present	Decreased tears	Absent tears

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Author

Adam C Levine, MD, MPH Associate Professor of Emergency Medicine, The Warren Alpert Medical School of Brown University

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

Disclosure: Nothing to disclose.

Coauthor(s)

Monique Gainey, MPH, MS Clinical Research Program Coordinator, Department of Emergency Medicine, Rhode Island Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

Karen A Santucci, MD Professor of Pediatrics (Emergency Medicine), Professor of Emergency Medicine, Medical Director, Pediatric Emergency Medicine, Section Chief, Pediatric Emergency Medicine, Yale University School of Medicine; Chief Medical Officer, Greenwich Hospital, Yale New Haven Health

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

Disclosure: Nothing to disclose.

Huy Nguyen Brown University

Disclosure: Nothing to disclose.

Acknowledgements

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