Acute gastroenteritis in children

Abstract

What is the epidemiology and impact of gastroenteritis? Acute gastroenteritis—diarrhoea or vomiting (or both) of more than seven days duration—may be accompanied by fever, abdominal pain, and anorexia. Diarrhoea is the passage of excessively liquid or frequent stools with increased water content. Patterns of stooling vary widely in young children, and diarrhoea represents a change from the norm.1 Worldwide, 3-5 billion cases of acute gastroenteritis and nearly 2 million deaths occur each year in children under 5 years.2 In the United States, gastroenteritis accounts for about ∼10% (220 000) of admissions to hospital, more than 1.5 million outpatient visits, and around 300 deaths in children under 5 annually, with a cost of around $1bn (£0.5bn; €0.8bn).2 In the same age group in Australia, about 10 000 hospital admissions, 22 000 visits to emergency departments, and 115 000 general practice consultations occur annually for rotavirus alone, with an estimated cost of $A30m (£12m; €18m; $23m).3 In the United Kingdom, 204 of 1000 consultations with general practitioners in children under 5 are for gastroenteritis, and the annual hospital admission rate in this group is about seven per 1000 children.4 Children in childcare settings are often infected but asymptomatic and may unwittingly transmit infection. Children with poor nutrition are at increased risk of complications. In the north end of Australia, Aboriginal and Torres Strait Islander children have increased rates of admission for gastroenteritis, malnutrition, comorbidity, and electrolyte disturbance (especially hypokalaemia) and a longer hospital stay than their non-indigenous counterparts.5 The cost of gastroenteritis to the community is huge but often underestimated if costs to the family, including lost time at work, are not considered. Summary points Rotavirus is the most common cause of acute gastroenteritis worldwide and vaccination will have a major impact on disease rates, morbidity, and mortality Most children are not dehydrated and can be managed at home Dehydration, metabolic acidosis, and electrolyte disturbance can be prevented and treated by fluid therapy Most children with mild-moderate dehydration can be treated with oral or enteral rehydration using low osmolality oral rehydration solutions Severely dehydrated or shocked children usually need intravenous fluids and hospital admission Drugs are usually unnecessary and may do harm General practitioners have an important role in prevention, through encouraging breastfeeding, recommending and advocating free access to rotavirus vaccination, and educating carers about personal and food hygiene