Page 42 - 15Diarrhoeaandvomiting

Summary of recommendations

10.2 Preventing primary spread of diarrhoea and vomiting

Advise parents, carers and children that: *
• washing hands with soap (liquid if possible) in warm running water and careful drying are
the most important factors in preventing the spread of gastroenteritis
• hands should be washed after going to the toilet (children) or changing nappies (parents/
carers) and before preparing, serving or eating food
• 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.

2.3 Key priorities for research

Assessment for dehydration and shock (Chapter 4)
In children with gastroenteritis, what is the predictive value of clinical symptoms and signs
in assessing the severity of dehydration, using post-rehydration weight gain as the reference
standard, in primary and secondary care settings?

Why this is important
†
Evidence from a systematic review suggests that some symptoms and signs (for example,
prolonged capillary refill time, abnormal skin turgor and abnormal respiratory pattern) are
associated with dehydration, measured using the accepted ‘gold standard’ of the difference
between pre-hydration and post-hydration weight. However, 10 of the 13 included studies were
not blinded and had ill-defined selection criteria. Moreover, all these studies were conducted in
secondary care where children with more severe dehydration are managed.
‡
Most children with gastroenteritis can and should be managed in the community but there is a
lack of evidence to help primary care healthcare professionals correctly identify children with
more severe dehydration. Symptoms and signs that researchers may wish to investigate include
overall appearance, irritability/lethargy, urine output, sunken eyes, absence of tears, changes in
skin colour or warmth of extremities, dry mucous membranes, depressed fontanelle, heart rate,
respiratory rate and effort, character of peripheral pulses, capillary refill time, skin turgor and
blood pressure.

Fluid management (Chapter 5)
In children who do not tolerate oral rehydration therapy, is ORS solution administration via
nasogastric tube cost-effective, safe and acceptable in treating dehydration compared with
intravenous fluid therapy?

Why this is important
Oral rehydration therapy is normally preferable to intravenous fluid therapy for rehydration in
children with gastroenteritis. However, some children may not tolerate oral rehydration therapy,
either because they are unable to drink ORS solution in adequate quantities or because they
persistently vomit. In such cases, ORS solution could be administered via a nasogastric tube,
rather than changing to intravenous fluid therapy. This overcomes the problem of ORS solution
refusal. Continuous infusion of ORS solution via a nasogastric tube might reduce the risk of

* This recommendation is adapted from the following guidelines commissioned by the Department of Health:
Health Protection Agency. Guidance on Infection Control In Schools and other Child Care Settings. London: HPA; 2006 [www.hpa.org.
uk/web/HPAwebFile/HPAweb_C/1194947358374]
Working Group of the former PHLS Advisory Committee on Gastrointestinal Infections. Preventing person-to-person spread following
gastrointestinal infections: guidelines for public health physicians and environmental health officers. Communicable Disease and Public
Health 2004;7(4):362–84.
† Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated? JAMA: the Journal of the American Medical Association 2004;291(22):2746–54.
‡ Hay AD, Heron J, Ness A; the ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon
Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Family Practice 2005;22(4):367–74.

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