GASTROENTERITIS – It is summer and the season for ‘gastro’ – Dr Willem Smit Paediatrician

Between 500 thousand and a million children would die each year from gastroenteritis world wide. Malnourished children and children in third world counties are more at risk.

By GASTRO we mean an infectious cause of nausea and vomiting and or diarrhea.

In most cases the cause is viral but in a small percentage of cases it is bacterial and that needs to be treated with antibiotics.

VIRAL:

1) ROTAVIRUS was by far the most common cause but has reduced significantly since the introduction of the Rotavirus vaccine. It does not give 100 percent protection but does reduce the severity by at least 60 to 80 percent. So vaccinated children can still get Rotavirus gastroenteritis but the severity and duration is markedly reduced and keeps most children out of hospital.
2) ADENOVIRUS is the second most frequent viral cause that we see or test for anyway. Its severity is often less than that of the ROTAVIRUS.

BACTERIAL:

1) Enteropathic E. COLI
2) SALMONELLA
3) SHIGELLA
4) CAMPYLOBACTER

PARASITES:
1) Entamoeba hystolitica that causes chronic diarrhea.
2) Cryptosporidium in immune compromised children.
These are just the most common causes we see and test for.

Presenting symptoms:
1) Low grade FEVER in mostly viral gastros and often a high temperature of over 38,5 degrees Celsius in the bacterial causes.
2) NAUSEA and VOMITING are often the first symptoms that could indicate that it is ‘stomach bug’. Some children only have these symptoms.
3) Tummy CRAMPS are often present and usually more severe with bacterial causes.
4) DIARRHEA often follows up to 24 hours after the initial vomiting started.
When they have diarrhea and vomiting children can dehydrate very quickly and the younger they are the quicker. Usually very watery in most cases and fowl smelling in the case of Rotavirus. With the bacterial cause they often have BLOODY diarrhea.
5) As they start getting dehydrated they might get THIRSTY and want to drink more but if they are still very nauseous they might refuse all oral intake of fluids and food.
6) REDUCED URINE out put when they start dehydrating.
7) LETHARGIC and weak and just lying down when dehydrated.

Signs of Dehydration:
1) PALE.
2) COLD hands and feet.
3) LETHARGIC
4) SUNKEN eyes and fontanelle.
5) DRY mouth and reduced tears and less or no wet nappies.
6) SKIN on tummy my seem very loose and like old skin.
7) Reduced level of consciousness in extreme dehydration and even convulsions.
8) In case they are shocked from excessive fluid loss they will have a very fast heart beat and fast shallow breathing and a low blood pressure.

Treatment:
1)The priority is to prevent dehydration and to rehydrate if necessary. Give a rehydration solution like Hydrol or Ceralyte . Try to give at least 60 ml per hour and an additional 50- 100 ml after each watery stool.
2) To feed and prevent malnutrition. Do not stop breast feeding. If the baby or infant is vomiting it might be advisable to stop the formula milk for a few hours and just give the rehydration solution. Avoid fizzy drinks and drinks with sugar in.
3) Probiotics like Lactobacillus Reuteri. Give Reuterina 5 drops twice a day until diarrhea has cleared up or at least for 5 days. Bigger children can take the chew tablets.
4) Anti-emetics for nausea and vomiting like Stemitil, Valoid or Zofer Rapitabs.
5) Antibiotics prescribed by a doctor if a bacterial cause is suspected.
6) It is not a priority to stop the diarrhea. We usually do not use Immodium to stop the diarrhea since it can cause complications. We however could consider using something that helps the cells in the gut to recover and leak less fluids . Tasectan sachets one every 6 hours until the diarrhea has cleared up and or Smecta one sachet twice a day for 5 days.

When to seek medical assistance and consider hospital admission.
1) Persistent vomiting and diarrhea.
2) Any of the above signs of dehydration.
3) Severe cramps and pain , high fevers and bloody diarrhea.
4) If you are unsure if your child is dehydrated.
5) Babies under a year.
6) Children that totally refuses to eat and drink.

Hospitalization:
The above criteria would be reasons to admit a child with gastro to hospital.
In the hospital they would be put in an isolation room.
They will either get a drip for intravenous rehydration or a nasogastric tube.
They will get something for nausea and vomiting and probiotics.
Blood and stools will be tested to determine the cause and antibiotics will be given if indicated.
Children would be put on a gastro diet and the will get treatment for the severe nappy rashes they may develop.
The stay in hospital is usually at least two nights but can be as long as five or more.
Other causes of nausea and vomiting and or diarrhea or bloody stools will also be investigated if necessary.

Dr Willem Smit Paediatrician

Suite 4,  Sadre Park , Hibiscus street
Durbanville
Tel: 021 975 0035

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