Viral Gastroenteritis in Children

Viral gastroenteritis is often called stomach flu. But it's not really related to the flu or influenza. It's irritation of the stomach and intestines due to infection with a virus. Most children with viral gastroenteritis get better in a few days without a healthcare provider’s treatment. Because a child with gastroenteritis may have trouble keeping fluids down, they are at risk for fluid loss (dehydration) and should be watched closely.

Symptoms of viral gastroenteritis

Symptoms of gastroenteritis include loose, watery stools (diarrhea), sometimes with nausea and vomiting. The child may have cramps or pain in the stomach area. They may also have a fever or headache. Symptoms usually last for about 2 days but may take as long as 7 days to go away.

How is viral gastroenteritis spread?

Viral gastroenteritis is highly contagious. The viruses that cause the infection are often passed from person to person by unwashed hands. Children can get the viruses from food, eating utensils, or toys. People who have had the infection can be contagious even after they feel better. And some people are infected but never have symptoms. Because of this, outbreaks of gastroenteritis are common in childcare and other group settings.

Treatment

Most cases of viral gastroenteritis get better without treatment. Antibiotics don't work against viral infections. The goal of treatment is to make your child comfortable and to prevent dehydration. These tips can help:

• Be sure your child gets plenty of rest.

• To prevent dehydration:

  • Give your child plenty of liquids, such as water. You can also give your child an oral rehydration solution, which you can buy at the grocery store or pharmacy. Ask your child's healthcare provider which types of solutions are best for your child. Have your child take small sips of fluid at first to prevent nausea. Don’t dilute juice or give other drinks with sugar in them (such as sports drinks), as this may worsen the diarrhea.

  • If your older child seems dehydrated, give 1 to 2 teaspoons of an oral rehydration solution. Do this every 10 minutes until vomiting stops and your child is able to keep down larger amounts of liquid.

  • If your baby is bottle fed, you can give an oral rehydration solution for 4 to 6 hours and then resume formula. You may need to feed your baby more often to ensure they get enough fluids. You can also give an oral rehydration solution if your baby is urinating less often or the urine is dark in color.

  • If your baby is breastfeeding, you may need to feed your baby more often. You can also give an oral rehydration solution if your baby is urinating less often or the urine is dark in color. 

• When your child is able to eat again:

  • Feed your child regular foods as tolerated. Returning to a regular diet quickly has been shown to reduce the length of symptoms of gastroenteritis. Don't offer foods high in sugar and fats.

  • Ask your child’s healthcare provider if there are any foods to avoid while your child is recovering from gastroenteritis.

• Don’t give your child any medicines unless they have been recommended by your child's healthcare provider.

• Some children may develop a short-term (temporary) intolerance to dairy products after a diarrheal illness. If dairy items seem to make your child's symptoms worse, you may need to stop them temporarily.

Preventing viral gastroenteritis

Handwashing is the best way to prevent the spread of viruses that cause "stomach flu."

These steps may help lessen the chances that you or your child will get or pass on viral gastroenteritis:

• Wash your hands often with soap and clean, running water, especially after going to the bathroom, diapering your child, and before preparing, serving, or eating food.

• Have your child wash their hands often.

• Keep food preparation areas clean.

• Wash soiled clothing promptly.

• Use diapers with waterproof outer covers or use plastic pants.

• Prevent contact between your child and those who are sick.

• Keep your sick child home from school or childcare.

• All infants should get the rotavirus vaccine. This vaccine protects infants and young children against rotavirus infection, one cause of viral gastroenteritis.

When to call the healthcare provider

Call your child’s healthcare provider right away if your child:

• Has a fever (see Fever and children, below)

• Has had a seizure

• Has been vomiting and having diarrhea for more than 6 hours

• Has blood in vomit or bloody diarrhea

• Is lethargic

• Has severe stomach pain

• Can’t keep even small amounts of liquid down

• Shows signs of dehydration, such as very dark or very little urine, excessive thirst, dry mouth, or dizziness

• Is a baby and doesn't urinate for 8 hours or more

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider