Acute Gastroenteritis


Gastroenteritis is a common illness affecting the young and occurs several times a year affecting millions. It is important to recognize symptoms that would warrant medical evaluation by a health professional. Most importantly the individual characteristics help us decide which child needs medical attention. If a child is immunocompromised, or has a chronic illness or has a possible hospital acquired infection or has been exposed to foreign travel in endemic areas or exposed to food poisoning then medical evaluation is warranted. Most other diarrheal illnesses are likely to be self limiting.


Most diarrheal illnesses are viral gastroenteritis associated with watery, light colored diarrhea, without mucus or blood, with or without fever and cramping,  with vomiting occurring from a few to many episodes over 1 to 7 days and are associated with dehydration as the main complication. Causative viri include rota virus, noro virus ( calcivirus), astrovirus, adenovirus, aichi virus, etc. Noro virus is associated with more frequent vomiting.


Warning signs that bacterial (E Coli, Shigella, Salmonella, food poisoning) or protozoal/parasitic (giardiasis, amoebic,etc) may be present include prolonged mucusy diarrhea, bloody diarrhea and other features atypical for viral illnesses (rash, jaundice, etc). Severe pain and vomiting, fever and chills, with guarding of the abdomen or belly may be a sign of appendicitis, diverticulitis, cholecystitis, kidney stones or other worrisome intestinal and abdominal conditions requiring medical attention.


Warning signs that warrant a visit to a medical professional for any diarrheal illness include signs of dehydration such as lethargy, listless state, dry skin, prolonged diarrhea, high fever, chills, etc.


Treatment should include rehydration with oral rehydration solutions, eg pedialyte or electrolyte solutions available at most pharmacies, and with ORS satchets. Antimicrobial agents are only recommended if non viral etiologies are suspected. Lactose intolerance develops frequently due to injury to the intestinal villi lining cells. Once the diarrhea settles down Probiotic or lactobacillus acidophilus supplements(eg: Culturelle for kids sachets or chewables once or twice daily for a few weeks) helps restore intestinal flora and reduce bloating, diarrhea and poor appetite.


Antimotility agents Imodium (loperamide) and lomotil (diphenoxylate) are associated with significant side effects, respiratory depression, coma and slowing of the gut and are best avoided in young children.


No antisecretory drugs or adsorbents are of benefit.


Dietary restrictions should include candies, and sweets.  Even though no lactose or milk restriction is necessary, probiotic helps restore a normal intestinal environment since lactose intolerance can continue to prolong the symptoms of diarrhea and GI upset. In such cases slow and cautious introduction of milk products, possibly after a few weeks may be warranted on an individual case by case basis. Complex carbohydrates, yogurts, potato, banana, vegetables and fruits are helpful in refeeding to help recovery.


Tips for Gastroenteritis


Wash hands often.


Rehydrate using appropriate oral solutions as described above and watch for signs of dehydration.

Probiotics once or twice a day after the diarrheal episode may help decrease temporary lactose intolerance.

Monitor for fever, and abnormal stools and atypical features that may warrant a trip to your physician.