Excerpt

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

The symptoms of gastroenteritis are unpleasant and the illness has an impact on both child and family. Vomiting causes distress and anxiety. Diarrhoea is often accompanied by abdominal pain. Infants and young children with severe symptoms may quickly become dehydrated. Dehydration is a serious and potentially life-threatening condition.

The management of young children with gastroenteritis involves many considerations. Depending on the specific circumstances, care may be provided by parents or by a range of healthcare professionals. Children may be managed in a community or a hospital setting. There is debate and controversy regarding various aspects of clinical management. Clinical practice may have a major impact on the use of healthcare resources. Finally, there is evidence of considerable variation in practice in the management of children with gastroenteritis in the UK. It was for these reasons that this NICE clinical guideline on the ‘management of acute diarrhoea and vomiting due to gastroenteritis in children under 5′ was developed.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Scope and methodology
  • 1.1 Introduction
  • 1.2 Aim of the guideline
  • 1.3 Areas within the scope of the guideline
  • 1.4 Areas outside the scope of the guideline
  • 1.5 For whom is the guideline intended
  • 1.6 Who has developed the guideline?
  • 1.7 Guideline development methodology
  • 1.8 Schedule for updating the guideline
• 2. Summary of recommendations
  • 2.1 Key priorities for implementation (key recommendations)
  • 2.2 Summary of recommendations
  • 2.3 Key priorities for research
  • 2.4 Summary of research recommendations
  • 2.5 Flow pathway for fluid management
• 3. Diagnosis
  • 3.1 Clinical diagnosis
  • 3.2 Laboratory investigations in diagnosis
• 4. Assessing dehydration and shock
  • 4.1 Clinical assessment
  • 4.2 Laboratory investigations for assessing dehydration
• 5. Fluid management
  • Introduction
  • 5.1 Primary prevention of dehydration
  • 5.2 Treating dehydration
  • 5.3 Optimal composition and administration of oral fluids
  • 5.4 Intravenous fluid therapy (IVT)
  • 5.5 Fluid management following rehydration
• 6. Nutritional management
  • Introduction
  • 6.1 Feeding during rehydration
  • 6.2 Feeding following rehydration
• 7. Antibiotic therapy
  • Introduction
  • 7.1 Salmonella
  • 7.2 Campylobacter
  • 7.3 Yersinia
  • 7.4 Shigella
  • 7.5 Escherichia coli
  • 7.6 Cryptosporidium
  • 7.7 Treatment without prior identification of a pathogen
  • 7.8 Traveller’s diarrhoea
  • 7.9 Groups for whom antibiotic treatment may be indicated
• 8. Other therapies
  • Introduction
  • 8.1 Anti-emetics
  • 8.2 Antidiarrhoeal agents
  • 8.3 Micronutrients and fibre
  • 8.4 Alternative and complementary therapies
  • 8.5 Probiotics
• 9. Escalation of care
  • Introduction
  • Evidence overview
  • GDG translation from evidence to recommendations
• 10. Information and advice for parents and carers
  • Introduction
  • 10.1 Caring for a child with diarrhoea and vomiting at home
  • 10.2 Preventing primary spread of diarrhoea and vomiting
• Appendix A Cost-effectiveness of IVT versus ORT for children with dehydration
• Appendix B Health economics of ondansetron
• References
• Search strategies
• Evidence tables

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.