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Gastroenteritis

gastro; gastroenteritis; diarrhoea; dehydration; clear; fluids; oral; rehydration; vomit; virus; drink; drinks; vomiting; norovirus ;

Gastroenteritis is the name for an infection in the bowel causing diarrhoea (loose, watery poo). It can affect all age groups but is more common and severe in young children.

For the first 24 to 48 hours a child may have vomiting and fever. Diarrhoea usually develops during this time and often lasts 4 to 10 days. Gastro may also cause tummy pain.

Contents

In most cases gastro is caused by viruses which come in epidemics, particularly in winter.

  • Rotavirus is a common cause of gastro in children who have not been immunised against it. Immunisation against Rotavirus works well and Rotavirus infections in babies and very young children are now less common in Australian children who have been immunised.
  • Norovirus infection is another common cause of gastro in Australia. It can be spread through food as well as through contact with someone who has the infection. This information comes from the SA Health website.

Occasionally gastro is caused by bacteria in Australia, in which case the diarrhoea may last longer and have blood and mucus in the poo.

The effects of gastro on babies and children depend on several things including:

  • the age of the child
  • the type of infection
  • how well the child was before getting the illness.

This topic has information about gastro in babies and children in Australia who are usually well before getting the infection. The advice may not fit children from other countries.

What is gastroenteritis?

  • Gastroenteritis (gastro) is an illness which
    • starts by causing a child to feel unwell, and not wanting to eat or drink because she feels nauseated (as though she may vomit). Often a child will vomit (be sick or ‘throw up’), for the first 24 to 48 hours,
    • then causes the child to have runny poo (diarrhoea) and often tummy pains, which can last for several days.
  • The child may also have a fever, runny nose, cough, and headache.
  • It affects people of all ages but it is more common and more severe in babies and young children.
  • The amount of time it takes to develop vomiting and diarrhoea after exposure to someone with gastro depends on the type of infection, but a common cause of gastro is rotavirus and this can develop 1 to 3 days after exposure. Other causes can take up to a week to develop.

Vomiting and diarrhoea can also be caused by many other health problems such as food poisoning, infections in other parts of the body (such as pneumonia or ear infections) and appendicitis.

What to do for gastro (a summary)

Giving the child more to drink is the main treatment for gastro. This helps replace the losses from vomiting and diarrhoea. Small drinks given often may be better than large drinks given less often.

Have your baby or child checked by a doctor

  • A child who does not want to drink and is vomiting often and/or has a lot of diarrhoea can become dehydrated and needs to be checked by a doctor - more information

Breast fed babies

Formula fed babies and young children

Older children with gastro

  • can continue to eat if they are hungry, but many will not eat
  • they need to have extra drinks (clear fluids) - more information

Extra drinks (clear fluids)

  • extra drinks need to be given, but it is important to give the right drinks
  • drinks such as soft drinks and fruit juice have too much sugar for sick babies and children unless they have extra water added 
  • 'oral rehydration fluids' are the best drinks for babies and children with gastro
  • more information

If they refuse to drink, continue to vomit and have diarrhoea

  • keep giving them drinks of clear fluids (lots of small sips, ice blocks)
  • have them checked by a doctor again
  • more information

Starting solids again

  • babies and children can usually start solids again as soon as they seem hungry
  • more information

Diarrhoea which does not go away

  • diarrhoea can last for several days, or longer, due to gastro, but sometimes diarrhoea is caused by other problems
  • more information

Protect other children and adults

  • keep the child away from other children
  • be very careful with hygiene, especially hand washing
  • more information

Have your baby or child checked by a doctor

  • When babies and children refuse to feed or drink, and vomit and/or have a lot of diarrhoea, (8 to 10 or more watery bowel actions) they can lose a lot of water from their body and they can become dehydrated. This can cause them to be very ill.
  • A baby should usually be seen within a few hours of becoming unwell (refusing to feed, vomiting or having runny poo). It may be safe to wait a little longer for an older child, but you have the right to ask for your child to be seen at any time if you are worried.
  • If the child is dehydrated, she may need extra fluids (for example through a tube into the stomach) as well as extra drinks.
  • It is difficult to tell how dehydrated a child is unless she is seen by a doctor or health care worker. Signs that doctors look for include being unwell and drowsy, dry lips and mouth, decreased urine (fewer wees).
  • If your child is not getting better, or is becoming more unwell, go back to your doctor.

Gastro can spread to other people in the doctor’s waiting room, so let the staff know your child probably has gastro and leave other children at home if possible.

Breast fed babies

  • Breast feeding should continue during gastro because:
    • breast milk has the food and water in it that babies need and their bodies can get what they need from it even when they are sick
    • breastfeeding can be very comforting for a sick child.
  • However extra drinks are needed to replace the extra water lost by vomiting and diarrhoea, and these need to be clear drinks. (see Extra drinks (clear fluids) below).
  • Keep giving feeds and drinks even if the baby is vomiting. He will usually keep down some of the breastmilk and drinks.
  • Keep giving extra drinks while the baby is vomiting or has diarrhoea.
  • Do not give medicines to stop vomiting or diarrhoea.

If the baby gets more unwell, becomes drowsy, refuses to drink, goes on vomiting, has a lot of diarrhoea, fewer wet nappies or does not get better fairly quickly (within a day or so), the baby should be seen again by a doctor.

  • To protect yourself and other family members, very good hygiene including cleaning and hand-washing after holding and feeding your baby, changing nappies and before preparing food, is needed.

    Formula fed babies and young children

    • It is now thought best for babies on infant formula (bottle fed babies) and young children drinking milk to stay on their formula or milk and, as well, have extra drinks of clear fluid.
    • In the past parents were often advised to stop milk, but it seems that babies and young children recover more quickly if they can continue to have their normal milk.
    • Offer small amounts of milk often, and extra clear fluids.
    • Keep giving feeds and drinks even if the baby is vomiting. She will usually keep down some of the milk and drinks.
    • If your baby will not drink milk, or goes on vomiting, give only clear fluids for a few hours.
    • If you have needed to stop your baby having formula, start giving it to her again the next day.
    • Keeping a baby or child on just clear drinks for more than a couple of days can slow down her recovery and itself cause diarrhoea.
    • Do not give medicines to stop vomiting or diarrhoea.

    If the baby gets more unwell, becomes drowsy, refuses to drink, goes on vomiting, has a lot of diarrhoea, fewer wet nappies or wees, or does not get better fairly quickly (within a day or so), the baby should be seen again by a doctor.

  • To protect yourself and other family members, very good hygiene including cleaning and hand-washing after holding and feeding your baby, changing nappies and before preparing food, is needed.

    Older children with gastro

    • Can continue to eat if they are hungry, but many will not eat.
    • If the child was well fed before he became ill, it will not harm him if he does not eat for a day or two, but he needs to have drinks.
    • Give clear fluids for the first day. Even if he vomits some of the drinks, he will usually keep some of it down.
    • Give lots of small drinks often.
    • Sometimes children will suck on small iceblocks made from the clear fluids.
    • When he starts to feel hungry, foods like toast without butter or margarine, fruit such as pear or banana, rice, potato and chicken are often well accepted. Milk and milk products such as yoghurt can also be given.
    • Keeping a child off food for several days can itself cause diarrhoea.
    • Don't try any new foods while the child has gastro and for the next few days.
    • Do not give medicines that stop vomiting or diarrhoea.

    See the doctor again if your child continues to be unwell, is refusing to drink, and/or still vomits. Also check with the doctor if diarrhoea lasts more than a few days.

    Extra drinks (clear fluids)

    Contents

    Extra drinks need to be given when babies and children have gastro, but it is important to give the right drinks.

    • Drinks such as soft drinks and fruit juice have too much sugar for sick babies and children.
    • 'Oral rehydration fluids' are the best drinks for babies and children with gastro.

    These drinks are called ‘clear’ fluids (clear drinks) because they are mainly water with a small amount of extra sugars and salts. Never add salt to any drink that you make up yourself since it is very easy to add too much salt, which can be harmful.

    • Clear drinks are given during gastro to:
      • replace water lost by diarrhoea and vomiting
      • give the water needed for normal health
      • provide some sugars and salts that children need to keep their strength up.
    • The drinks should be cool (room temperature). Cold drinks or hot drinks can make a child vomit if the child is unwell.

    Oral Rehydration Solution

    • Oral rehydration solutions (ORS) are the best clear drinks for babies (of any age) and children with gastro because they have the right amounts of sugar, salt and water to be easily absorbed in the gut.
    • You must make them up exactly according to directions in the package, and give the amount of fluid that is advised in the directions on the package.
    • Most babies and children will take them and there are different flavours to choose from, but they do have a salty taste which some children refuse.
    • You can get them from your chemist in Australia. Always ask the pharmacist which one would be best for your child. These include Gastrolyte**, Gastrolyte-R**, Pedialyte**, Repalyte** (New Formulation) and Hydralyte** (ice blocks).
    • In other countries different drinks may be needed because the kind of gastro may be different.

    If you find it very hard to get your baby or young child to take ORS, or you do not have ORS, it is possible to give other fluids such as cordial, fruit juice or soft drinks with extra water.

    Cordial with extra water

    • Cordial can also be used to make the drink taste better for a sick child, and to give the child some sugars, but you need to add more water than normal to the cordial. Do not use diet cordial.

    Mix 10 ml of undiluted cordial with 160 ml of water to give 170 ml of drink.

    Fruit juice with extra water (diluted fruit juice)

    • Fruit juice without extra water has too much sugar in it and this can draw water from the body into the gut, so that the baby or child can become even more dehydrated.
    • Mix 20 ml of juice with 80 ml of water to give 100 ml of drink.
    • This should be the juice of a fruit that the child has already had (eg apple or pear). If you can, don't give any new food during gastro. This is not the time to start orange juice unless your baby has had it before.
    • Fruit juice for babies.
      • It is suggested that fruit juice should not normally be given to young babies (under 6 months). This is mainly because if babies drink fruit juice they may not drink enough milk. A few babies under 4 months may also react to the fruit juice.
      • But during gastro it is important for a child to have enough to drink. So if the baby (over 4 months) won't drink any other clear drinks you can try fruit juice mixed with water.
      • For a younger baby, or if you do not want to use fruit juice, try cordial or sugar in the water.
    • Back to Extra drinks (clear fluids)

    Flat soft drink with extra water

    • Flat soft drink used to be recommended for children with gastro, but it has too much sugar in it and can make a child more ill (like full strength fruit juice does).
    • Soft drinks like lemonade are used because children seem to like the taste of them even when they feel sick and the sugars do help them build up strength.
    • Warm water should be added to get rid of the bubbles.
    • Mix 20 ml of soft drink with 80 ml warm water to make 100 ml of drink.
    • Back to Extra drinks (clear fluids)

    Water with glucose or sugar added

    • Add 10 ml (2 level teaspoons) of Glucose (eg Glucodin) to 240 ml water to give 240 ml of drink.
    • Add 10 ml sugar (2 level teaspoons) to 240 ml water to give 240 ml of drink.
    • Back to Extra drinks (clear fluids)

    Quick check dilution table 

    Kind of drink How much drink How much water
    Cordial (undiluted) 10 ml 160 ml
    Fruit juice (undiluted) 20 ml 80 ml
    Flat soft drink 20 ml 80 ml
    Glucose (eg Glucodin) 2 level teaspoons 240 ml
    Sugar  2 level teaspoons 240 ml

    What not to give 

    • Do not give children with gastro:
      • 'sports' drinks or 'energy' drinks (which have too much sugar and salt)
      • soft drinks, fruit juice or cordial which do not have extra water
      • low calorie drinks
      • more than a little plain water
    • Back to Extra drinks (clear fluids)

    If they refuse to drink, continue to vomit and have diarrhoea

    • When a child is sick, she will not want to drink as much as usual, but most children with gastro will drink some fluids.
    • If she will not drink anything, this might be a sign that the child is very ill or that the problem is not just gastro, and the child needs to be seen by a doctor as soon as possible. Going to a hospital emergency department may be a good idea if you can't see your usual doctor on the same day.
    • Offer small drinks often. She might take sips from a spoon rather than a cup.
    • Try small iceblocks or crushed ice with a spoon.

    Starting solids again

    • Babies and children can usually start solids again as soon as they seem hungry.
    • In the first few days after a child is recovering from gastro, it is important not to give foods that the child has not had before. Only give them things that they have had before they got sick, and which did not upset them.
    • Foods which are usually fine for babies and young children getting over diarrhoea and vomiting are:
      • baby rice
      • baby cereal
      • stewed apple or pear, mashed banana
      • dry biscuits
      • toast without butter or margarine
      • potato
      • lean meat, fish
    • Keeping the child off food for more than a few days can itself cause diarrhoea.
    • When solids are started again, poos may come more often and there may be more of it than before. This is normal and will settle over a few days.

    Diarrhoea which does not go away

    Diarrhoea due to gastro can last for several days, or longer, but sometimes diarrhoea is caused by other problems.

    • Many children have runny poos for several days after gastro, but they usually return to normal in less than a week.
    • Keeping children off food can cause runny poo, so usually it is best to start giving children solids and formula when they start to feel hungry. Don't wait until the diarrhoea has stopped.
    • Gastro can damage the lining of the gut, so that lactose, which is the sugar in milk, is not absorbed as well as usual. This can cause diarrhoea which does not settle. It is called lactose intolerance and there is more information about it in the topic  'Lactose intolerance in babies'. If a baby or child has lactose intolerance due to gastro, she may need to have lactose free milk and avoid foods with lactose in them for several weeks and then go back to their normal food and milk.
    • Too much fruit juice can also cause diarrhoea.

    Protect other children and adults

    • Keep your child away from friends and other children until after the vomiting and diarrhoea stops.
    • Do not take a child who is vomiting or has diarrhoea to child care or other places where there are young children. Gastro spreads very easily among young children. Have a look at the topic Exclusion for infectious diseases  for more information.
    • To protect yourself and other family members, very good hygiene including cleaning and hand-washing after changing nappies and before preparing food, is needed.
    • Clothes soiled with diarrhoea should be washed and rinsed separately from the rest of the family's clothes.
    • Avoid sharing food and drinks.

    Causes of gastroenteritis

    • Gastroenteritis (gastro) is an inflammation of the intestines, mostly caused by viral or bacterial infections, but also protozoa, eg giardia.
    • In Australia a common cause of gastroenteritis in young children is Rotavirus. Before immunisation for Rotavirus began some research showed that over 50% of Australian children under 3 needed medical attention for Rotavirus gastro. Rotavirus infections are still very common in children who have not been immunised.
    • Norovirus infections are a very common cause of foodborne illness outbreaks in South Australia. For more information have a look at 'Norovirus infection'  on the website of the South Australian Department of Health.
    • The most common bacterial gastro in Australia is Campylobacter.
    • Several causes of gastro (information on the South Australian Health Department website):
      Campylobacter 
      Cryptosporidium  
      Giardia  
      Salmonella   

    The topic Feeling sick has other suggestions for caring for a sick child.

    Resources 

    South Australia

    Women's and Children's Health Network Parent Helpline, 1300 364 100

    Helplines in other Australian states

    These are listed at the bottom of our helpline page.

    **Any products referred to in our health topics are usually well-known brands readily available in Australia. The brand names are given as examples only, and do not necessarily represent the best products, nor the full range of effective products on the market.

    References 

    Women's and Children's Hospital (South Australia) 'Gastroenteritis' 2010

    Department of Health - South Australia - Public Health 
    http://www.health.sa.gov.au/pehs/ 

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    The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

    This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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