History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include age <5 years, exposure to people with gastroenteritis, and lack of immunisation against rotavirus.[2][3][4][17][20][21][26]

age <5 years

Acute gastroenteritis is most common in children <5 years of age.[2][3][4]

Rotavirus gastroenteritis, the most common cause of gastroenteritis, is most common and severe in children 6-24 months of age. Infections during the first few months of life are often mild or asymptomatic, possibly owing to maternal antibodies.[13]

exposure to people with gastroenteritis

Viral gastroenteritis can be transmitted by person-to-person contact.[26] Outbreaks have been reported in daycare centres.[17][20][21]

lack of immunisation against rotavirus

Children immunised with rotavirus vaccine are less likely to have rotavirus gastroenteritis.[28][29][30]

vomiting

Almost 4 times more common and is prolonged among children with rotavirus gastroenteritis compared with gastroenteritis due to other infectious agents.[5]

non-bloody diarrhoea

Viral gastroenteritis is rarely associated with bloody diarrhoea, and the presence of blood in the stool suggests bacterial gastroenteritis.[9]

hyperactive bowel sounds

Universal in children with gastroenteritis.

Other diagnostic factors

common

abdominal pain

Many children with gastroenteritis (regardless of whether it is bacterial or viral) >3 years of age complain of crampy abdominal pain.

low-grade fever

Seen in approximately 30% to 50% of children with viral gastroenteritis.[5]

A temperature >39°C (102.2°F) suggests bacterial gastroenteritis.

evidence of dehydration

Mental status; pulse rate; capillary refill; skin turgor; and the state of mucous membranes, eyes, and fontanelles give clues to the severity of dehydration.[40]

Signs of mild dehydration include: alert state; slightly decreased urine output; slightly increased thirst; slightly dry mucous membrane; slightly elevated heart rate; normal capillary refill; normal skin turgor; normal eyes; and normal anterior fontanelle.

Signs of moderate dehydration include: alert state, fatigued, or irritable; decreased urine output; moderately increased thirst; dry mucous membranes; elevated heart rate; prolonged capillary refill; decreased skin turgor; sunken eyes; and sunken anterior fontanelle.

Signs of severe dehydration include: apathetic or lethargic state; markedly decreased or absent urine output; greatly increased thirst; very dry mucous membranes; greatly elevated heart rate; prolonged or minimal capillary refill; decreased skin turgor; very sunken eyes; very sunken anterior fontanelle; cold extremities; hypotension; and coma.

decreased body weight

Must be corroborated by changes in clinical signs of dehydration.

non-distended abdomen

In children with gastroenteritis, the abdomen is usually soft and non-distended. The abdomen may be distended in children with pre-existing signs of malnutrition.

abdominal tenderness

Mild tenderness is not uncommon in older children with viral gastroenteritis. However, significant abdominal tenderness suggests bacterial gastroenteritis.

uncommon

mucus in stool

More common with bacterial gastroenteritis than with viral gastroenteritis, although mucus is present in approximately 20% of children with rotavirus gastroenteritis.[45]

Risk factors

strong

age <5 years

Acute gastroenteritis is most common in children <5 years of age.[2]

Rotavirus gastroenteritis, the most common cause of gastroenteritis, is most common and severe in children 6 to 24 months of age. Infections during the first few months of life are often mild or asymptomatic, possibly owing to maternal antibodies.[13]

poor personal hygiene

Viral gastroenteritis can be transmitted by person-to-person contact and through contaminated food and water.[10]

exposure to people with gastroenteritis

Viral gastroenteritis can be transmitted by person-to-person contact.[26]

daycare attendance

Outbreaks have been reported in daycare centres.[17][20][21] 

winter months

In temperate regions, rotavirus gastroenteritis has a marked seasonality, peaking during cold months.[6]

Families tend to stay indoors in an over-crowded home environment, and the indoor relative humidity is lowered as outside air is brought in and heated. The dry conditions that result tend to encourage the formation of virus-laden dust from faecally contaminated material; rotavirus survives best at medium or low humidity. Particles tend to stay suspended in the dry air and may reach a susceptive person.

poverty

Poverty is often associated with malnutrition, over-crowding, sub-optimal food hygiene, and poor sanitary conditions, all of which increases the risk of viral transmission.[27]

lack of immunisation against rotavirus

Children immunised with rotavirus vaccine are less likely to have rotavirus gastroenteritis.[28][29][30]

lack of breastfeeding

Exclusive breastfeeding significantly reduces the risk of gastrointestinal tract infections in the first 6-8 months of life.[31][32] The protective properties of human milk include both cellular and humoral factors.

Cellular components include T and B lymphocytes, macrophages, and neutrophils. Humoral factors include immunoglobulins, lysozyme, nucleotides, lactoferrin, complements, bifidus factor, interferon, lactoperoxidase, oligosaccharides, vitamin B12 binding protein, and epidermal growth factor.[33]

Human milk also contains glucosamines that promote the growth of Lactobacillus bifidus. As such, breastfeeding decreases the incidence and severity of gastroenteritis.[34]

immunodeficiency

Children with immunodeficiency are prone to gastroenteritis.

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