Page 36 - 15Diarrhoeaandvomiting

Summary of recommendations

• towels used by infected children should not be shared
• children should not attend any school or other childcare facility while they have diarrhoea or
vomiting caused by gastroenteritis
• children should not go back to their school or other childcare facility until at least 48 hours
after the last episode of diarrhoea or vomiting
• children should not swim in swimming pools for 2 weeks after the last episode of diarrhoea

2.2 Summary of recommendations

Chapter 3 Diagnosis

3.1 Clinical diagnosis
Suspect gastroenteritis if there is a sudden change in stool consistency to loose or watery stools,
and/or a sudden onset of vomiting.

If you suspect gastroenteritis, ask about:
• recent contact with someone with acute diarrhoea and/or vomiting and
• exposure to a known source of enteric infection (possibly contaminated water or food) and
• recent travel abroad.
Be aware that in children with gastroenteritis:
• diarrhoea usually lasts for 5–7 days, and in most it stops within 2 weeks
• vomiting usually lasts for 1–2 days, and in most it stops within 3 days.

Consider any of the following as possible indicators of diagnoses other than gastroenteritis:
• fever:
– temperature of 38 °C or higher in children younger than 3 months
– temperature of 39 °C or higher in children aged 3 months or older
• shortness of breath or tachypnoea
• altered conscious state
• neck stiffness
• bulging fontanelle in infants
• non-blanching rash
• blood and/or mucus in stool
• bilious (green) vomit
• severe or localised abdominal pain
• abdominal distension or rebound tenderness.
3.2 Laboratory investigations

Consider performing stool microbiological investigations if:
• the child has recently been abroad or
• the diarrhoea has not improved by day 7 or
• there is uncertainty about the diagnosis of gastroenteritis.
Perform stool microbiological investigations if:
• you suspect septicaemia or
• there is blood and/or mucus in the stool or
• the child is immunocompromised.

Notify and act on the advice of the public health authorities if you suspect an outbreak of
gastroenteritis.
If stool microbiology is performed:
• collect, store and transport stool specimens as advised by the investigating laboratory
• provide the laboratory with relevant clinical information.
Perform a blood culture if giving antibiotic therapy.
In children with Escherichia coli O157:H7 infection, seek specialist advice on monitoring for
haemolytic uraemic syndrome.

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