【Major Points】

1. Viral gastroenteritis usually requires a symptomatic treatment. Antibiotics are not usually used for gastroenteritis.
2. Please follow the doctor’s instructions to properly replenish water and electrolyte drinks, and avoid taking milk or other foods which are too oily or too sweet.
3. When your children vomit, turn their face facing the side to prevent aspiration pneumonia.
4. Hand washing is the most important measure in preventing gastroenteritis.

What is gastroenteritis?

Gastroenteritis is inflammation of the gastrointestinal tract. It is usually caused by a bacterial, viral, or parasitic infection. Transmission often occur from eating contaminated food, poor personal hygiene or touching contaminated objects (vomits or poo).

What are the symptoms of gastroenteritis?

1. The main symptom of gastroenteritis is diarrhea, which is the condition of having at least three or above loose, liquid, or watery bowel movement each day. Stool may be green in color, have a foul odor, or have blood and mucus.
2. Fever 
3. Vomiting and abdominal pain
4. Activity change: restlessness, fatigue, sleepiness, or agitation.
5. Dehydration: dry lip and skin, lack of tears, low urine output and dark urine. Infants may have a sunken front fontanel or eyes.

If your child has any of the above symptoms, it does not necessarily mean that it is gastroenteritis, please go to a pediatric clinic.

What are the common treatments?

Acute gastroenteritis is commonly caused by a virus. Unless a specific bacterial infection is known, antibiotic is not required. Symptomatic treatment is usually offered, such as having electrolyte drinks to help infants replace water and electrolytes.

 Principles of care:

1. Prevent the spread of pathogens: One of the most important things is hand washing. Both children and caregivers should wash hands with soap or hand sanitizer for at least 40-60 seconds, especially before eating, after changing diapers, or using the toilet. Make sure to clean your hands, including your fingers, nails and elbows.
2. Dietary for diarrhea
   1. Breast-milk feeding: Babies who are breast fed should continue to be breast fed after doctor’s evaluation. Breast milk contains large amount of antibodies from mother that can help baby recover from gastroenteritis. Baby is eager to feel calm down by breast-milk feeding.
   2. Formula-milk feeding: Formula-milk fed babies should be give lactose-free formula milk or diluted formula milk according to physician’s instruction.
   3. General diet: Oral electrolyte solutions might be given to the children with gastroenteritis upon physician’s instructions. When diarrhea improves, some light soft food, such as rice soup, white toast, steamed bread, or rice can be taken. Avoid greasy food, beans, dairy products, and high sugar food (juice, soda, snack etc.) so that the gastrointestinal tract can take its proper rest. Under physician’s instructions, probiotics can be given to children who have normal immune functions. If diarrhea does not improve, then it is recommended to go to an emergency room or pediatric clinic.
3. Stools with higher acidity during diarrhea may irritate the skin. Skin redness or diaper rash may occur if the skin is lack of good care (More information: Care of Baby with Diaper Rash). Therefore, the skin on the buttocks needs to receive proper attention.
   1. Chang diapers often, clean skin around the anus with warm water and gently wipe it dry with a soft cotton towel. Leave the diaper open for a while to expose skin of bottom and perineum to allow the skin dry.
   2. If there is not reddish or damaged on the buttocks, vaseline cream can be applied around anus to isolate irritates from feces.
   3. In case of a diaper rash on the buttocks, apply ointment by the physician’s instructions.
4. How to manage children’s vomiting
   1. When the child vomits, keep the child’s upper body leaning forward and maintain the head in a lower position or the face facing the side. The vomit should be cleaned up immediately so as to prevent aspiration pneumonia.
   2. After vomiting, skin and oral care should be careful. To proper cleaning especially of the face, ear back and neck skin folds. Keep skin dry to prevent eczema happens.
   3. In cases of acute vomiting, the child has to fast 2-4 hours by doctor’s instruction. Drink a small amount of water while vomiting improved. Start your diet pattern gradually. 

References:

1. Florez, I. D., Nino-Serna, L. F., & Beltran-Arroyave, C. P. (2020). Acute infectious diarrhea and gastroenteritis in children. Current Infectious Disease Reports, 22, 1-12. https://doi.org/10.1007/s11908-020-0713-6
2. Hartman, S., Brown, E., Loomis, E., & Russell, H. A. (2019). Gastroenteritis in children. American Family Physician, 99(3), 159-165. https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html/
3. Li Chi, Huang. (2022). Pediatric care of digestive system. In Chen, Y.Z. (Ed.), Practical Pediatric Care (9th ed., pp 564-568). Hua Xing.
4. Pediatric Infectious Diseases Society of Taiwan. (2019). Acute gastroenteritis in children. https://www.pids.org.tw/index.php?route=education/education&path=111