The diagnosis of gastroenteritis is usually made by the pediatrician through the clinical questioning of the parents.
What it is?
Acute gastroenteritis or GEA is an affectation of the gastrointestinal tract in which an inflammation of the mucosa (lining) occurs, produced by an infection. This inflammation leads to an increase in the daily stools that the child has and the change in its consistency, accompanied by other symptoms such as vomiting and fever.
It’s a common disease that is transmitted through water and food. Children who attend nurseries, who live in impoverished areas with malnutrition or with alterations in their defense system, are the ones who are most at risk of suffering from it.
What produces it?
As we have already said, gastroenteritis occurs in most cases due to the infection of the gastrointestinal tract because microorganisms that come into contact with the body through the mouth, either through the ingestion of contaminated food or water, or by contact with a sick person who doesn’t have adequate hand hygiene. These microorganisms can be viruses, bacteria or, less frequently, parasites. The main cause in children is infection by a virus (up to 50%). In addition, they have a typical seasonal incidence, the bacterial ones are more frequent in the summer and the viral ones in the winter.
Among the most common viruses that produce this infection are the so-called Rotavirus, Adenovirus… etc. The causative bacteria can be Echcericha coli, Salmonella, Campylobacter, etc. And among the parasites we can name the Giardia lambia or the Cryptosporidium.
Other diseases and situations that can cause diarrhea and vomiting are allergy or intolerance to the protein of cow’s milk, diseases that produce malabsorption of food in the intestine such as cystic fibrosis, taking antibiotics, etc.
What are the symptoms?
The main symptom of gastroenteritis is the appearance of diarrhea with liquid or semiliquid stools and an increase in the number of stools. Stools, depending on the causative agent of the infection, can be waterier, or be accompanied by mucus, blood or pus. In addition, vomiting, abdominal pain, fever and general alterations may occur. The most usual thing is that the appearance is abrupt and that the duration is limited to 2 or 3 days.
The parents or caregivers of the child, must pay special attention to signs such as dehydration (dry lips and mucous membranes, decreased amount of urine, inability to rehydrate by mouth, etc…), persistent high fever, blood in the stool, prolonged diarrhea and if the child has a marked malaise or has a serious illness as a basis. All these are reasons to consult the pediatrician without delay.
How is the diagnosis?
The diagnosis of gastroenteritis is usually made by the pediatrician by means of a clinical questioning to the parents, in which they will be asked about the characteristics and symptoms that the child presents. He can also ask if there are cases of gastroenteritis in the family, school or daycare center, if the child has been able to eat any food in poor condition, or if have recently traveled. Then, the doctor performs a physical examination of the child looking at the hydration of their skin and mucous membranes, their general condition, the palpation of the abdomen, the auscultation with the stethoscope of abdominal sounds, the heart, etc.
Only in cases of major problems in children or a poor evolution, the doctor will propose that other complementary tests are performed as a culture of the feces to detect in the laboratory the presence of the microorganism that is causing the infection. Additional studies may be performed to detect viruses or toxins in the stool.
Which is the treatment?
The treatment of gastroenteritis in children is mainly based on hydration. During the first 4 to 6 hours, an oral rehydration regimen must be started (with low sodium solutions found in pharmacies). In the first hour, using a syringe or soup spoon, the child is administered with 10 to 20 milliliters (2 to 4 tablespoons) of this type of solution, repeating every 10 minutes. After that time, if the tolerance is adequate, a greater quantity is administered, giving it around 20 to 25 milliliters (4 or 5 soup spoons) every 5 or 10 minutes. In the following hours increasing does are offered to the child. In addition, in babies who exclusively drink breast milk, breastfeeding shouldn’t be interrupted and, in the same way, formula milk should still be offered if the child has an artificial lactation.
If at any given time the child vomits, the administration of the serum should be interrupted for 30 minutes, after which the pattern starts from the beginning.
After these initial 4-6 hours, or when it’s observed that the child no longer vomits, the soft or solid feeding will be reintroduced, which can be according to the child’s desire. We recommend foods with low residue content (banana, apple, potato, rice, etc.). In the case of babies with complementary feeding, you can use compound porridges based on these foods, adapted according to the age of the baby
The administration of any drug for the treatment of gastroenteritis isn’t usually required. In the case of fever, the pediatrician may indicate taking an antipyretic such as paracetamol. An antibiotic treatment will only be prescribed if its suspect that the source of the infection is a bacterium or if it’s confirmed by stool culture. Likewise, the use of antidiarrheal or antiemetic drugs (with anti-vomit action) is very restricted to certain cases and should always be assessed and indicated by the pediatrician.
Sometimes the pediatrician may suspect that, due to gastroenteritis, the intestine cannot absorb the sugar of the milk (lactose). In those cases, it will indicate the taking of artificial formulas without lactose
In addition, it has been observed that the use of probiotics can be beneficial to reduce the number of stools and the duration of diarrhea in the case of gastroenteritis caused by Rotavirus or secondary to the taking of antibiotics.
Only in serious episodes with such as severe dehydration, signs of poor prognosis, serious diseases, alteration of the defenses (immunosuppression), malnutrition, etc., the child should be hospitalized. In the hospital a rehydration treatment will be carried out with intravenous serums and, if necessary, antibiotics or other drugs will be administered according to the origin of the gastroenteritis and its evolution.