1. Vomiting and diarrhoea in children under 5 NICE GUIDELINES Maria Cardona GP VTS Oct 2009

2. Diagnosis  Ask about Recent contact with someone with similar symptoms Exposure to known source of enteric infection Recent travel abroad

3. Look for:  Temperature >38 in under 3 months old >39 in over 3 months old  SOB/tachipnoea  Altered conscious state  Neck stiffness  Bulging fontanele  Rash  Blood/mucous in the stool  Bilious vomiting  Severe / localised abdominal pain

4. Stool sample  Indicated if Septicaemia is suspected Blood and/or mucous in the stool Inmunocompromised  And maybe if Recent travel abroad Diarrhoea has not improved by day 7 Uncertainty about diagnosis of gastroenteritis

5. Stool sample If taken: Collect, store and transport as advised by lab Provide lab with relevant information If giving antibiotics:blood culture

6. Assess dehydration  Beware increased risk of dehydration: < 1 year Low birth weight >six diarrhoeal stools 24h >3 episodes of vomiting Infants who have stopped breastfeeding during illness Signs of malnutrition Children who have not been offered or have not tolerated fluids supplementation

7. Management of non-dehydrated child  Continue breastfeeding or other milk feeds  Encourage fluid intake  Discourage juices/carbonated drinks  Offer oral rehydration salt

8. Nutrition after rehydration  Give full-strength milk straight away  Reintroduce usual solid food  Avoid fruit juices/carbonated drinks until diarrhoea has stopped

9. General advise  Most children can be safely managed at home  Information on recognising red flag symptoms, what to do if they are present  Diarrhoea usually last for 5-7 days and stops within 2 weeks  Vomiting usually lasts 1-2 days and stops within 3 days

10. General advise  Encourage Hand washing  Do Not share towels  Do not attend school during illness and until 48 hours after the last episode of diarrhoea  Children should not swim in swimming pools for 2 weeks after last episode of diarrhoea

11. Thank you