Diarrhoea and sickness in children

Gastroenteritis is inflammation of the stomach and bowel that causes diarrhoea and vomiting. Rotavirus is the most common cause.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think your child they may not need to see a doctor.

How is it diagnosed?

You can recognise gastroenteritis on the basis of your child’s symptoms.

What is the treatment?

There is no specific treatment for gastroenteritis; symptoms usually get better in a few days.

  • It is important to keep hydrated.
  • Non-prescription painkillers can be taken for fever and pain.

When to worry?

If your child develops any of the following symptoms you should see a doctor immediately:

  • vomiting blood
  • blood in stool
  • dark, black or tarry stool
  • not able to eat or drink due frequent vomiting
  • your symptoms have not improved after several days
  • not passing urine or passing minimal amounts of urine.

Introduction

Gastroenteritis is inflammation of the stomach and bowel. The most common cause is a viral or bacterial infection.

The illness usually lasts for three to five days, and the two most common symptoms are diarrhoea and vomiting.

Read more about the symptoms of gastroenteritis.

What causes gastroenteritis?

Gastroenteritis can have a number of possible causes, including a norovirus infection or food poisoning. However, rotavirus is the leading cause in children.

A rotavirus is an infection of the stomach and bowel. It is spread when a child who is infected does not wash their hands properly after going to the toilet.

If the child leaves tiny samples of infected faeces on surfaces or utensils, they can be picked up by another child. Small droplets of infected faeces can also be carried in the air, which children can breathe in.

This section is about gastroenteritis in children. Read more about gastroenteritis in adults.

When to see your doctor

In most cases, gastroenteritis does not need to be diagnosed because the illness usually clears up without treatment.

You should see your doctor if:

  • Your child has recently been abroad. They may have acquired a more serious type of infection, for example one caused by a parasite.
  • Their diarrhoea symptoms do not improve after seven days.
  • They have persistent vomiting without diarrhoea.
  • They have symptoms that are not usually associated with gastroenteritis.
  • There is blood or mucus in their stools.
  • Your child has a weakened immune system due to a health condition, such as acute leukaemia, or as a side effect of a medical treatment, such as chemotherapy.

Read more about diagnosing gastroenteritis.

Treating gastroenteritis

Most cases of gastroenteritis in children are mild and usually pass within three to five days without the need for treatment.

However, young children, particularly those under two years of age, are at risk of dehydration, so it is very important that they drink plenty of fluids.

In severe cases of gastroenteritis, where there has been significant fluid loss, hospital treatment may be required so that fluid can be replaced intravenously (directly into a vein).

Read more about treating gastroenteritis.

Preventing gastroenteritis

As gastroenteritis can be very infectious, it is important to take steps to prevent it spreading from your child to other children. You should:

  • Encourage your child to wash their hands properly after going to toilet and before eating.
  • Clean the potty or toilet thoroughly using disinfectant after each episode of diarrhoea and vomiting, making sure that you also clean the handle and seat.
  • Wash your hands regularly, particularly after changing a nappy or cleaning a potty.
  • Don't share your child’s towels, flannels, cutlery or eating utensils with other members of your household.
  • Don't allow your child to return to nursery or school until 48 hours have passed since their last episode of diarrhoea and vomiting.
  • Don't allow your child to go swimming in a pool for the first two weeks after their last episode of diarrhoea. Even though they won't have symptoms, research has found that the rotavirus can spread to other children through pool water.

Read more about preventing gastroenteritis.

Who is affected?

Rotavirus gastroenteritis is very common in children. It is estimated that every child will have at least one rotavirus infection before the age of five. Most infections occur among children aged between three months and three years old.

The first rotavirus infection tends to be the most severe because the body builds up immunity (resistance) to the virus afterwards. This is why these types of infections are extremely rare in adults.

Symptoms

Gastroenteritis usually begins with the symptoms of:

Your child may also have:

The symptoms of vomiting usually pass within one to two days. In most children, vomiting will not last longer than three days.

The symptoms of diarrhoea usually pass within five to seven days. Most children's diarrhoea symptoms will not last more than two weeks.

Dehydration

Gastroenteritis can cause dehydration, which can be more serious than the rotavirus infection itself. It is very important to be aware of the symptoms of dehydration so that you can recognise them in your child.

The symptoms of dehydration include:

  • dry mouth and eyes
  • no tears produced when the child cries
  • sunken appearance of the eyes
  • weakness and drowsiness
  • deep, rapid breathing
  • passing urine infrequently

Read more about dehydration.

Contact your doctor if you think your child is dehydrated.

When to seek medical advice

Rotavirus gastroenteritis shares many of the initial symptoms of more serious childhood conditions. It is important to be aware of the signs and symptoms that suggest your child has a more serious condition.

Signs and symptoms to look out for are:

  • a temperature of 38C (100.4F) or higher in children younger than three months
  • a temperature of 39C (102.2F) or higher in children older than three months
  • shortness of breath
  • abnormally rapid breathing
  • a change in their normal mental state, such as appearing confused
  • stiff neck
  • a swelling in the soft part of their head (fontanelle)
  • a blotchy red rash, which (unlike most other rashes) does not fade when you put a glass against it
  • blood or mucus in their stools (faeces)
  • green vomit
  • severe stomach pain
  • swelling of their stomach
  • symptoms of vomiting that last longer than three days
  • symptoms of diarrhoea that last longer than two weeks
  • symptoms of dehydration that persist or get worse, despite treatment with fluids and oral rehydration solutions

Contact your doctor for advice as soon as possible if you notice any of the above signs and symptoms.

Causes

Gastroenteritis is usually caused by a rotavirus that infects a child's stomach and bowel. The virus is highly infectious and is often spread to other children as a result of poor hygiene.

If an infected child does not wash their hands after going to the toilet, any rotaviruses on their hands will be transferred to whatever they touch, such as a glass, kitchen utensil or food.

If another child touches the contaminated object before touching their face, or if they eat contaminated food, they may become infected.

Rotavirus infections are easily spread in this way, particularly among young children who often forget to wash their hands after going to toilet or before eating. The virus can also survive for several days on surfaces or utensils.

This is why these types of infections often occur in places where there are a high number of young children, such as playgroups, nurseries and infant schools.

Rotaviruses affect one of the main functions of the intestines – the absorption of water from digested food into the body. This is why one of the most common symptoms of gastroenteritis is diarrhoea, and why dehydration is such a common complication.

Other causes

In a small number of cases, gastroenteritis in children may be caused by factors other than the rotavirus. These include:

  • food poisoning from eating contaminated food
  • drinking contaminated water
  • a side effect of antibiotics (medicines that kill bacteria)

Diagnosis

In most cases of gastroenteritis, a diagnosis is not needed because your child's symptoms should disappear after three to five days without treatment.

A diagnosis is usually only needed in certain situations, such as if:

  • Your child has recently been abroad. They may have acquired a more serious type of infection caused by a parasite.
  • Their diarrhoea symptoms do not improve after seven days.
  • They have signs and symptoms that are not usually associated with gastroenteritis.
  • There is blood or mucus in their stools.
  • Your child has a weakened immune system due to a health condition, such as acute leukaemia, or as a side effect of a medical treatment, such as chemotherapy.

To diagnose gastroenteritis, your doctor will take a stool (faeces) sample so that it can be checked for the presence of viruses, bacteria or parasites.

In some cases, a blood test or urine test may be used to rule out other conditions, such as a urinary tract infection or pneumonia.

Treatment

If your child has gastroenteritis, you will usually be able to treat them at home.

Dehydration

An important part of treatment is to assess whether your child has an increased risk of dehydration.

Your child may have an increased risk of dehydration if they:

  • are less than one year old, particularly if they are younger than six months old
  • have passed more than five stools in the last 24 hours
  • have vomited more than twice in the last 24 hours
  • cannot hold down fluids
  • suddenly stop breastfeeding
  • are less than two years old and had a low birth weight

If your child has symptoms of dehydration, use an oral rehydration solution (see below) before contacting your doctor. If your doctor is unavailable, contact your local out-of-hours service

The healthcare professional you speak to will ask questions about your child’s symptoms and their general health, to assess whether they are well enough to be treated at home or whether they need to be admitted to hospital (see below).

No increased risk of dehydration

If your child does not appear to be dehydrated and has no increased risk of dehydration, you should continue to feed them as usual, whether with breast milk, other milk feeds or solids.

If your child is eating solids, encourage them to eat as soon as their vomiting is under control. There is no evidence that not allowing your child to eat will shorten their episodes of diarrhoea. Simple foods that are high in carbohydrates, such as bread, rice or pasta, are recommended.

Drinking fruit juice or fizzy drinks is not recommended because it can make the symptoms of diarrhoea worse.

Increased risk of dehydration

The advice above still applies if your child does not appear to be dehydrated, but has an increased risk of becoming dehydrated. You should also give your child an oral rehydration solution.

Oral rehydration solutions usually come in sachets and are available without a prescription, over the counter, from your local pharmacist. You dissolve them in water and they help replace salt, glucose and other important minerals that are lost through dehydration.

If your child vomits after drinking an oral rehydration solution, wait 5–10 minutes before giving them some more. However, make sure that they drink it slowly. For example, you could try giving them a spoonful every few minutes.

It is usually recommended that your child drinks an oral rehydration solution each time they pass a large amount of watery stools. The exact amount that they should drink will depend on their size and weight.

Your pharmacist will be able to advise you. The manufacturer’s instructions that come with the solution will also provide information about the recommended dosage.

Hospital treatment

Admission to hospital is usually recommended if your child has signs and symptoms of severe dehydration such as:

  • a decreased level of consciousness, such as appearing drowsy or unaware of their surroundings
  • pale or blotchy skin
  • cold hands and feet
  • rapid heartbeat (tachycardia)
  • rapid breathing (tachypnoea)
  • a weak pulse

It may also be recommended that your child is admitted to hospital if their symptoms get worse despite treatment with oral rehydration solution, or if they keep vomiting it up.

Treatment at hospital usually involves replacing lost fluids and other nutrients directly into the vein (intravenous fluid therapy). Most children respond very well to treatment and are able to leave hospital after a few days.

Other symptoms

Symptoms of pain and fever can usually be relieved using paracetamol. Young children may find liquid paracetamol easier to digest than tablets.

Children under 16 years of age should not be given aspirin.

Anti-diarrhoeal and anti-sickness medication

Anti-diarrhoeal medicine is not recommended for children under 12 years of age.

Medication to prevent vomiting (anti-emetics) is also not usually recommended for children because of the risk of adverse side effects, such as muscle spasms or allergic reactions. Consult your doctor before giving your child anti-emetic medicine.

Prevention

As gastroenteritis can be highly infectious, it is important to take steps to prevent it spreading from your child to other children.

Even if you isolate your child, it may be possible for adults in your household to spread the infection to other children without realising it.

To prevent the spread of infection, it is recommended that you:

  • Encourage your child to wash their hands thoroughly after going to toilet and before eating.
  • Clean the potty or toilet thoroughly using disinfectant after each episode of diarrhoea and vomiting. Make sure that you include the toilet handle and seat.
  • Wash your hands regularly, particularly after changing a nappy or cleaning a potty.
  • Do not share your child’s towels, flannels, cutlery or eating utensils with other members of your household.
  • Do not allow your child to return to nursery or school until 48 hours have passed since their last episode of diarrhoea and vomiting.
  • Do not allow your child to go swimming in a pool for the first two weeks after their last episode of diarrhoea. Even though they will not have symptoms, research has found that the rotavirus can spread to other children through the pool water.

Food hygiene

Practising good food hygiene will help your child avoid getting gastroenteritis as a result of food poisoning. For example:

  • Regularly wash your hands, surfaces and utensils using hot, soapy water.
  • Don't store raw and cooked foods together.
  • Keep food properly refrigerated.
  • Always cook food thoroughly.
  • Don't eat food that is past its use by date.

Read more about food poisoning and home hygiene.

Rotavirus vaccine

It's given as a liquid from a dropper straight into the baby's mouth for them to swallow at two months and then again at three months of age.

Two possible side effects of the vaccine are diarrhoea and irritability. These are usually mild and should disappear with time.

Read more about the rotavirus vaccine.

Your.MD Local Advice (India)

If you are concerned about Diarrhoea and sickness in children you should always contact emergency services by calling 112 or visit a Health Centre, nurse or doctor.

The National Health Portal (NHP) India has more information on causes, diagnosis and prevention for people living in India. The NHP also operates a toll-free helpline on 1800-180-1104 with health information in English, Hindi, Tamil, Bangla and Gujarati.

Content supplied by NHS Choices