Sickness and diarrhoea in children
Gastroenteritis is a common condition where the stomach and bowel become inflamed. It is usually caused by a viral or bacterial infection.
The two main symptoms of gastroenteritis are diarrhoea and vomiting, which usually clear up in around five to seven days.
What causes gastroenteritis?
The most common cause of gastroenteritis in children is a virus called the rotavirus. This virus is passed out in the stools (faeces) of someone with the infection. It can be transferred to food, objects and surfaces if the infected person doesn't wash their hands after going to the toilet.
The infection is usually then passed to someone else when they either eat contaminated food or touch a contaminated object or surface and then touch their mouth.
Young children are particularly vulnerable to this infection because they often forget to wash their hands after going to the toilet or before eating, and they have not yet built up a resistance to the rotavirus.
It's estimated that almost every child will have at least one rotavirus infection before the age of five and many children will have several episodes a year. Most infections occur among children under four years old.
Gastroenteritis can also have a number of other causes, including a norovirus infection or food poisoning, although these are more common in adults.
When to see your GP
In most cases, gastroenteritis does not need to be diagnosed, as the illness usually goes away without treatment.
However, you should see your GP if your child:
shows signs of dehydration, or has an increased risk of dehydration
shows additional symptoms of a more serious illness
has been vomiting for longer than three days or has had diarrhoea for more than a week
has blood or mucus in their stools
has recently been abroad
has a weakened immune system caused by an underlying health condition, such as acute leukaemia, or as a side effect of a medical treatment, such as chemotherapy
If your GP is unavailable, contact your local out-of-hours service or 111 for advice.
Most cases of gastroenteritis in children are mild and pass within five to seven days without any specific treatment.
However, young children – particularly those less than one year old – are at risk of dehydration, so it is very important that they drink plenty of fluids. In some cases, special oral rehydration solutions may be recommended.
In severe cases where there has been significant fluid loss, hospital treatment may be needed so that fluid can be replaced through a tube inserted down the nose (nasogastric tube) or directly into a vein (intravenously). However, this is only needed in very rare cases.
As gastroenteritis is easily spread, it's important to take steps to prevent it spreading from your child to other children by:
encouraging your child to wash their hands properly after going to the toilet and before eating
cleaning the potty or toilet thoroughly using disinfectant after each episode of diarrhoea and vomiting, making sure you clean the seat and handle
washing your hands regularly, particularly after changing a nappy or cleaning a potty
not sharing your child's towels, flannels, cutlery or eating utensils with other members of your household
not allowing your child to return to nursery or school until at least 48 hours after their last episode of diarrhoea or vomiting
There is also a rotavirus vaccination that is included in the routine childhood vaccination schedule for children aged two to three months, which can help reduce your child's risk of developing gastroenteritis.
Symptoms of gastroenteritis in children
The main symptoms of gastroenteritis are diarrhoea and vomiting. Your child may also have some additional symptoms caused by the infection, such as a high temperature (fever) and a tummy ache.
The vomiting will usually stop within one to three days, and the diarrhoea will usually pass within five to seven days, although it can last up to two weeks in some children.
Signs of dehydration
Gastroenteritis can also cause dehydration, which can be more serious than the infection itself. It is very important to be aware of the symptoms of dehydration so that you can recognise them in your child.
Symptoms of dehydration can include:
dry mouth and eyes
no tears produced when the child cries
sunken appearance of the eyes
urinating less frequently or having fewer wet nappies (no wet nappies for eight hours)
drowsiness or reduced consciousness
cold hands and feet
pale or blotchy skin
a sunken fontanelle (the soft spot on a baby's head)
Contact your GP immediately if you think your child is dehydrated. If this is not possible, call 111 or your local out-of-hours service for advice.
Signs of a more serious illness
Gastroenteritis shares many of the initial symptoms of more serious childhood conditions. It is important to be aware of the signs and symptoms that suggest your child has a more serious condition.
Signs and symptoms to look out for are:
a temperature of 38°C (100.4°F) or higher in children younger than three months
a temperature of 39°C (102.2°F) or higher in children older than three months
shortness of breath
abnormally rapid breathing
a change in their normal mental state, such as appearing confused
a swelling in the soft part of their head (fontanelle)
a blotchy red rash, which, unlike most other rashes, does not fade when you put a glass against it
blood or mucus in their stools (faeces)
severe stomach pain
swelling of their stomach
vomiting for longer than three days
diarrhoea that lasts longer than a week
symptoms of dehydration that persist or get worse, despite treatment with fluids and oral rehydration solutions
Contact your GP for advice as soon as possible if you notice any of the above signs and symptoms. Call 111 or your local out-of-hours service if you cannot get hold of your GP.
Causes of gastroenteritis in children
Gastroenteritis is usually caused by a type of virus called a rotavirus, which infects a child's stomach and bowel. The virus is highly infectious and is often spread to other children as a result of poor hygiene.
The virus is passed out in the stools (faeces) of an infected child. It can be transferred to any surfaces, objects and food a child touches if they do not wash their hands after going to the toilet.
The infection can then be passed to another child who eats contaminated food, or touches a contaminated object or surface, and then touches their mouth.
Small droplets of infected faeces or vomit can also be carried in the air, which children can then breathe in.
Rotavirus infections are easily spread in this way, particularly among young children, who often forget to wash their hands after going to the toilet or before eating, and who have not built up a resistance to the infection yet. The virus can also survive for several days on surfaces or utensils.
This is why these types of infections often occur in places where there is a high number of young children, such as playgroups, nurseries and infant schools.
Rotaviruses affect the absorption of water from digested food into the body, which is why one of the most common symptoms of the infection is diarrhoea and why dehydration is a common complication.
In a small number of cases, gastroenteritis in children may be caused by infections other than the rotavirus. These include:
other viruses – such as the adenovirus or norovirus
food poisoning – this is usually caused by eating food contaminated with bacteria such as salmonella or E. coli
parasitic infections – such as giardiasis, which is usually picked up when travelling abroad
Diagnosing gastroenteritis in children
In most cases of gastroenteritis, a diagnosis is not needed. Your child's symptoms should disappear in around five to seven days, without specific treatment.
A diagnosis is usually only needed in certain situations, such as:
if your child has recently been abroad to an area where they could have picked up a more serious type of infection caused by a parasite
if their diarrhoea has not improved after seven days
if they show signs and symptoms that are not usually associated with gastroenteritis
if there is blood or mucus in their stools
if they have a weakened immune system caused by an underlying health condition, such as acute leukaemia, or as a side effect of a medical treatment, such as chemotherapy
A diagnosis of gastroenteritis is based on the symptoms your child is having, although there may be some instances where a stool (faeces) sample is sent to a laboratory, so it can be checked for viruses, bacteria or parasites.
In some cases, a blood test or urine test may also be used to rule out other conditions, such as pneumonia or a urinary tract infection.
Treating gastroenteritis in children
Children with gastroenteritis can usually be treated at home. In most cases, the illness lasts for around five to seven days.
When looking after your child, you should take steps to stop the infection spreading to others. You should keep your child away from school or nursery until at least 48 hours have passed since their last episode of diarrhoea or vomiting.
An important part of treatment is to assess whether your child is dehydrated or has an increased risk of dehydration.
Your child may have an increased risk of dehydration if they:
are less than one year old, particularly if they are younger than six months
have passed more than five stools in the last 24 hours
have vomited more than twice in the last 24 hours
cannot hold down fluids
have stopped breastfeeding while they have been ill
are less than two years old and had a low birth weight
Contact your GP if your child has symptoms of dehydration or may be at an increased risk. If your GP is unavailable, contact your local out-of-hours service or call 111.
The healthcare professional you speak to will ask questions about your child's symptoms and general health to assess whether they are well enough to be treated at home, or if they should be admitted to hospital.
Fluids and food
If your child does not appear to be dehydrated and does not have an increased risk of dehydration, you should continue to feed them as usual, either with breast milk, other milk feeds or solids.
If your child is eating solids, encourage them to eat as soon as their vomiting is under control. Simple foods that are high in carbohydrates – such as bread, rice or pasta – are usually recommended.
Withholding food does not make diarrhoea go away quicker and can even prolong the illness.
Drinking fruit juice or fizzy drinks is not recommended, as it can also make diarrhoea worse.
Oral rehydration solutions
If your child is visibly dehydrated, or is thought to be at risk of dehydration, you should follow the above advice and use oral rehydration solutions.
These solutions usually come in sachets and are available without a prescription from your local pharmacist. You dissolve the mixture in water to make a drink, which helps replace salt, glucose and other important minerals that a child can lose if they become dehydrated.
If your child vomits after drinking an oral rehydration solution, wait 5 to 10 minutes before giving them more. Make sure they drink it slowly – a good method is to give them a spoonful every few minutes. Contact your GP if your child repeatedly vomits after drinking oral rehydration solution.
It is usually recommended that your child drinks an oral rehydration solution each time they pass a large amount of watery stools. The exact amount that they should drink will depend on their size and weight.
Your GP or pharmacist can advise you on how much to give your child. The manufacturer's instructions that come with the solution will also provide information about the recommended dosage.
If your child experiences pain and a high temperature (fever), this can be relieved by giving them paracetamol. Young children may find liquid paracetamol easier to swallow than tablets.
Children under 16 years of age should not be given aspirin.
Medication to prevent vomiting (anti-emetics) and antidiarrhoeal medication are not usually recommended for children with gastroenteritis. This is because they are not usually needed and side effects are possible.
Antibiotics are not usually used to treat gastroenteritis in children, as most cases are caused by viruses rather than bacteria. Even for gastroenteritis caused by a bacterial infection, antibiotics have been found to be no more effective than simply waiting for the symptoms to pass. Using antibiotics for mild conditions also increases the risk of antibiotic resistance.
Admission to hospital is usually only recommended if your child has signs and symptoms of severe dehydration, which include:
a decreased level of consciousness, such as appearing drowsy or unaware of their surroundings
a rapid heartbeat
a weak pulse
It may be recommended that your child is admitted to hospital if their symptoms get worse, even after treatment with oral rehydration solution, or if they keep being sick.
Hospital treatment usually involves replacing lost fluids and other nutrients either directly into a vein (intravenous fluid therapy) or through a tube passed into the stomach through the nose (nasogastric tube). Most children respond well to treatment and are able to leave hospital after a few days.
Preventing gastroenteritis in children
As gastroenteritis can be highly infectious, it's important to try and stop it spreading from your child to other children.
Even if you isolate your child, it's still possible for adults in your household to spread the infection to other children without realising it.
To prevent the spread of infection:
encourage your child to wash their hands thoroughly after going to the toilet and before eating
clean the potty or toilet thoroughly using disinfectant after each episode of diarrhoea and vomiting, making sure to clean the toilet seat and handle
wash your hands regularly, particularly after changing a nappy or cleaning a potty
do not share your child's towels, flannels, cutlery or eating utensils with other members of your household
wash soiled clothing and bed linen separately from other clothes and at the highest temperature possible (for example, 60°C or higher for linen), after first removing any poo into the toilet
do not allow your child to return to school or nursery until 48 hours have passed since their last episode of diarrhoea or vomiting
do not allow your child to go swimming in a pool until at least two weeks have passed since their last episode of diarrhoea – even if they no longer have symptoms, research has found that the rotavirus can spread to other children through pool water before this point
Preventing food poisoning
Practising good food hygiene will help your child avoid getting gastroenteritis as a result of food poisoning. You should:
regularly wash your hands, surfaces and utensils using hot, soapy water
not store raw and cooked foods together
keep food properly refrigerated
always cook food thoroughly
not eat food after its use-by date
A vaccine that helps protect children against gastroenteritis caused by the rotavirus is now part of the routine childhood vaccination schedule.
This vaccine is given as a liquid that is dropped into a baby's mouth. It is given in two doses, with the first given at two months and another at three months.
Sickness and diarrhoea in children
Two possible side effects of the vaccine are diarrhoea and irritability, but these are usually mild and short-lived.