What is Pediatric Gastroenteritis?
Gastroenteritis, or stomach flu, is a common condition in children that could potentially be extremely serious, even deadly. This illness is responsible for about 10% of deaths in children and is estimated to cause 70 million deaths per year globally, making it the second leading cause of death worldwide. In babies and toddlers younger than 24 months, the most frequent cause of gastroenteritis is a virus called rotavirus. However, for children older than 24 months, another bacteria called Shigella is usually the main cause, pushing rotavirus to the second place.
What Causes Pediatric Gastroenteritis?
Gastroenteritis, a condition that inflames your stomach and intestines, typically occurs when you accidentally consume fecal matter. This can happen through direct contact with feces, consuming contaminated food or water, or from person-to-person contact. These transmission methods are common in norovirus and Shigella outbreaks and are often linked to poor hygiene and poverty.
In the United States, the most common viruses causing diarrhea, a primary symptom of gastroenteritis, are rotavirus and noroviruses – they account for nearly 58% of all cases. Other viruses that can cause the same symptoms include enteric Adenoviruses, Sapovirus, and Astroviruses.
Risk factors of gastroenteritis include environmental conditions, seasonal changes, and certain demographics – interestingly, young children are more prone to catching this illness. Having other illnesses, like measles or deficient immune systems, can also increase the risk. Poor nutrition, such as lacking in vitamin A or zinc, is another significant risk factor for gastroenteritis.
Most episodes of gastroenteritis result in acute diarrhea, which lasts less than a week. If diarrhea continues beyond 14 days, it becomes ‘persistent diarrhea’, accounting for 3% to 19% of gastroenteritis cases. Unfortunately, prolonged diarrhea contributes to about 50% of deaths related to this illness.
Risk Factors and Frequency for Pediatric Gastroenteritis
Kids under the age of 5 are the group most often impacted by diarrheal episodes. The majority of these instances occur in Asia and Africa, which make up 80% of the annual occurrences.
Signs and Symptoms of Pediatric Gastroenteritis
The symptoms of an illness can depend on the type of germs causing it. If toxins from a bacteria called S. aureus are consumed, usually you can start to feel nauseous and begin vomiting within 6 hours after eating. Along with that, there may be other symptoms like fever, cramps, and diarrhea that can occur anywhere from 8 to 72 hours after eating.
There are also other types of bacteria — Clostridium perfringens and Bacillus cereus — that can cause watery diarrhea within 8 to 16 hours after eating them. Viral infections, on the other hand, typically cause cramps and watery diarrhea about 16 to 48 hours after eating. Some germs can even cause bloody diarrhea, and these symptoms can show up to 120 hours after eating. There are certain harmful substances, like copper, shellfish toxins, tin, and tetrodotoxin from pufferfish or histamine from scombroid, that can cause problems within minutes of eating.
However, even though these symptoms may point to a certain cause, they’re not always the best way to identify specifically what is causing the illness. For instance, even if there is no fever, it doesn’t mean there is no infection. Also, the visual evidence of dysentery may not conclusively mean that it’s the cause of the illness. If a doctor suspects acute gastroenteritis, they will need to perform laboratory tests to correctly identify what is causing the illness.
Testing for Pediatric Gastroenteritis
When a doctor needs to find out if a patient has gastroenteritis, they’ll first ask the patient about their recent activities, like if they’ve traveled or been in contact with other people who are ill. They’ll also ask about specific symptoms, as these can provide clues to the cause of the discomfort. For example, a fever might suggest an inflammation or infection. Severe stomach pain and a constant need to go to the bathroom could point to a problem in the large intestine. Nausea, vomiting, stomach pain, and watery diarrhea without a fever might suggest a less serious infection in the small intestine.
The doctor will also consider if the patient might be dehydrated, a common risk in people with diarrhea. Understanding how much dehydration has occurred is important to know, as it can help the doctor decide on the best treatment, like whether the patient should increase their fluid intake orally or if they need intravenous fluids.
Another way for a doctor to identify the cause of gastroenteritis is to test a stool sample. They’ll look at it under a microscope and may send it for lab testing. Specific signs in the stool, like mucus, blood, or white blood cells, can suggest what might be causing the illness. However, the problem here is that the test can sometimes fail to pick up on the disease-causing agent in the early stages of the condition.
As a result, a specific test may be used, which can detect a variety of disease-causing agents. This test looks for the genetic material (nucleic acid) of specific types of bacteria (like C. difficile or E. coli), viruses (like Rotavirus or Norovirus), or parasites (like Giardia or Cryptosporidium).
A more detailed stool culture may be done for children with white blood cells in their stool or for patients with compromised immune systems. Nowadays, this process is usually done using a technique called polymerase chain reaction (PCR).
Treatment Options for Pediatric Gastroenteritis
Treating children with acute gastroenteritis generally involves rehydration (either by mouth or through an IV), choosing the right diet, supplements like zinc, and additional options like probiotics.
Some kids may require IV fluids for rehydration. These include infants under 6 months, those with chronic illnesses, babies born prematurely, and those with a fever above 100.4°F if under 3 months old and above 102.2°F between 3 and 36 months old. Other symptoms that could point to a need for IV fluids include frequent vomiting, bloody diarrhea, changes in consciousness, sunken eyes, and reduced urination.
The preferred fluid for treatment has specific concentrations of elements like sodium, chloride, potassium, and glucose and should also have a specific level of osmolarity. If a child is experiencing mild to moderate vomiting, a medication called ondansetron can help improve oral rehydration. When IV rehydration is necessary, it’s usually done with a solution called lactated Ringer’s or normal saline, dosed based on the child’s body weight.
Antibiotics may be considered in some cases to lessen the severity and duration of the illness or prevent complications like spreading the infection. Antibiotics that may be used include ciprofloxacin, TMP-SMX, erythromycin, and metronidazole. However, they should be avoided when the illness is caused by certain bacteria, like Bacillus cereus, Clostridium, and some Salmonella species.
The effectiveness of probiotics in helping recovery or reducing symptoms has not been proven conclusively by scientific studies. It’s believed that they could potentially prevent diarrhea when the illness is caused by a bacteria called C. difficile. In the case of a virus called rotavirus, antibiotics could potentially lead to a shorter duration of diarrhea. Agents that reduce spasms in the gut, like loperamide, aren’t advised for children who have dysentery.
What else can Pediatric Gastroenteritis be?
When a doctor is trying to diagnose acute gastroenteritis, there are many potential causes that need to be looked at. These can include viruses, bacteria, and other types of infections:
- Norovirus
- Rotavirus
- Shigella
- Hepatitis A
- Listeria
- Clostridium
- S. aureus
- V. cholerae
- Giardia
- E. coli
- Campylobacter
- Ciliary dysentery
- Typhoid fever
- Vibriosis
- Yersiniosis
- C. difficile
Another condition that needs to be taken into consideration is Proctitis, which can be caused by:
- Gonococcus
- Herpes simplex
- Chlamydia
- Syphilis
Other medical conditions that could cause similar symptoms include:
- Necrotizing enterocolitis
- Chronic infections like parasites
- Crohn’s disease
- Ischemic colitis
- Allergic enteritis
Finally, exposure to certain substances can also result in symptoms similar to gastroenteritis. These can include:
- Arsenic
- Cadmium
- Copper
- Mercury
- Pesticides
- Zinc
What to expect with Pediatric Gastroenteritis
The outlook and complications of a medical condition are directly linked to how promptly and effectively a patient can receive medical care and treatment.
