Acute gastroenteritis (AGE) is the second leading cause of child mortality and morbidity, particularly in low-income countries. Although 30% reduction in mortality for diarrhea has been achieved, AGE still accounts for 550,000 deaths per year in infants and children younger than 5 years.

The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISP-GHAN) Working Group (WG) for AGE identified the reduction of inappropriate medical interventions and the large-scale implementation of effective recommendations to reduce the burden of AGE in children worldwide.

The aim of this work was to develop a core of consensus clinical recommendations for the management of non-malnourished children affected by AGE worldwide.

Recommendations:

Definitions of Diarrhea

AGE is characterized by the presence of diarrhea defined as a decrease in the consistency of stool leading to loose or liquid stools and/or an increase in the frequency of evacuations to three or more in 24 hours, with or without fever or vomiting.

Acute diarrhea lasting 7 days or less.

Prolonged diarrhea lasting 8 to 13 days.

Chronic or persistent diarrhea lasting 14 days or more.

Assessment of Dehydration

Dehydration is the consequence of diarrhea, vomiting, and fever. It is a major risk for child health and the main reason for medical visit, hospitalization, and cause of death. Assessing dehydration in a reliable and rapid way is essential to prevent severe dehydration and its consequences and promptly start treatment.

Recommendations:

The percentage of body weight lost is the best measure of dehydration.

Dehydration reflects disease severity particularly in the community setting. In hospitalized children other parameters (such as respiratory distress, deep breathing, signs of shock, inability to drink, neurological signs, electrolyte abnormalities, or body weight loss) may also be used as markers of severity.

The best parameters to estimate the degree of dehydration are: skin turgor, sunken eyes, general appearance, capillary refill time, and mucous membranes. These parameters are frequently included in clinical scores that may be used to estimate the degree of dehydration in individual children.

The Clinical Dehydration Scale is commonly considered a reliable tool to estimate the degree of dehydration in non-malnourished children with AGE.

Diagnostic Workup

Children otherwise healthy with AGE do not require a specific diagnostic work-up, as the results of laboratory and microbiological investigations are not likely to change their management. Diagnostic work-up may be required in selected cases.

Recommendation

Children presenting with uncomplicated AGE do not require routine of microbiological investigation.

In severe conditions and/or in the hospital setting, investigations may be appropriate in individual cases.

Microbiological investigations should be considered in the following circumstances:

1. Children with underlying chronic conditions (e.g., oncologic diseases, inflammatory bowel disease, immunodeficiency)
2. Extremely severe clinical conditions (e.g., sepsis)
3. Prolonged symptoms (>7 days)
4. During outbreaks (childcare, school, hospital)
5. Children with severe bloody diarrhea and high fever
6. History of travel to at-risk areas

Doctors Liked to Read More