Page 29 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

Setting

• Community care, primary care and secondary care, and indications for referral.
Management

• When to consider the management of acute diarrhoea and vomiting in infants and young
children who were previously healthy.
• How to identify infants and young children with acute diarrhoea and vomiting who are at
risk of dehydration and whose condition needs immediate management.
• How to differentiate between acute infective diarrhoea and diarrhoea due to other causes.
• How to manage symptomatic infants and young children, including:
– when to start rehydration
– what type of rehydration fluids to use
– what route of administration to use
– what additional treatment to consider
– appropriate feeding strategies for infants with gastroenteritis
– when and what investigations should be performed.
• Threshold of referral:
– what clinical signs or symptoms can be used to identify infants and young children who
should be referred
– what additional factors should be taken into consideration when deciding whether or not
to admit an infant or young child to hospital.
• Following the infant or young child’s initial assessment by the healthcare professional,
what information should be given to parents and carers, for example regarding signs of
dehydration, and replacement of fluids and feeding strategies at home.

1.4 Areas outside the scope of the guideline

Population

• Children who have passed their fifth birthday.
• Infants and young children with chronic diarrhoea and vomiting (lasting more than 14 days).
• Infants and young children with disorders other than gastroenteritis that cause diarrhoea or
vomiting (for example, specific food intolerances or inflammatory bowel disease).
• Children with medical disorders that significantly alter the approach to their fluid
management, such as those with cardiac or renal failure.
• Neonates who are admitted to the neonatal unit.
Management

• Public health issues such as the contamination of food products and factors that may prevent
acute diarrhoea and vomiting, for example breastfeeding.
• Immunisations to prevent diarrhoea and vomiting.

1.5 For whom is the guideline intended

This guideline is of relevance to those who work in or use the National Health Service (NHS) in
England, Wales and Northern Ireland, in particular:
• general practitioners, paediatricians, gastroenterologists, emergency department physicians,
nurses and any healthcare professional involved in the care or management of children
younger than 5 years with diarrhoea and vomiting.
• those responsible for commissioning and planning healthcare services, including primary
care trust and local health board commissioners, Wales commissioners, and public health
and trust managers
• parents/carers and families of children.
A version of this guideline for parents, carers and the public is available, entitled ‘Understanding
NICE guidance: Diarrhoea and vomiting in children’. It can be downloaded from the National
Institute for Health and Clinical Excellence (NICE) website (www.nice.org.uk/CG84publicinfo).

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