Page 40 - 15Diarrhoeaandvomiting

Summary of recommendations

• in children without red flag symptoms or signs (see Table 4.6), do not routinely give oral
fluids other than ORS solution; however, consider supplementation with the child’s usual
fluids (including milk feeds or water, but not fruit juices or carbonated drinks) if they
consistently refuse ORS solution.
After rehydration:
• give full-strength milk straight away
• reintroduce the child’s usual solid food
• avoid giving fruit juices and carbonated drinks until the diarrhoea has stopped.

Chapter 7 Antibiotic therapy
Do not routinely give antibiotics to children with gastroenteritis.

Give antibiotic treatment to all children:
• with suspected or confirmed septicaemia
• with extra-intestinal spread of bacterial infection
• younger than 6 months with salmonella gastroenteritis
• who are malnourished or immunocompromised with salmonella gastroenteritis
• with Clostridium difficile-associated pseudomembranous enterocolitis, giardiasis, dysenteric
shigellosis, dysenteric amoebiasis or cholera.

For children who have recently been abroad, seek specialist advice about antibiotic therapy.

Chapter 8 Other therapies
Do not use antidiarrhoeal medications.

Chapter 9 Escalation of care

During remote assessment:
• arrange emergency transfer to secondary care for children with symptoms suggesting shock
(see Table 4.6)
• refer for face-to-face assessment children:
– with symptoms suggesting an alternative serious diagnosis or
– at high risk of dehydration, taking into account recognised risk factors or
– with symptoms suggesting clinical dehydration or
– whose social circumstances make remote assessment unreliable
• provide a ‘safety net’ for children who do not require referral. The safety net should include
information for parents and carers on how to:
– recognise developing red flag symptoms (see Table 4.6) and
– get immediate help from an appropriate healthcare professional if red flag symptoms
develop.
During face-to-face assessment:
• arrange emergency transfer to secondary care for children with symptoms or signs suggesting
shock (see Table 4.6)
• consider repeat face-to-face assessment or referral to secondary care for children:
– with symptoms and signs suggesting an alternative serious diagnosis
– with red flag symptoms and/or signs of dehydration (see Table 4.6)
– whose social circumstances require continued involvement of healthcare professionals
• provide a safety net for children who will be managed at home. The safety net should
include:
– information for parents and carers on how to recognise developing red flag symptoms (see
Table 4.6) and
– information on how to get immediate help from an appropriate healthcare professional if
red flag symptoms develop and
– arrangements for follow-up at a specified time and place, if necessary.

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