Acute Gastroenteritis Management

Diagnosis and Assessment

The Centers for Disease Control and Prevention recommends considering bacterial gastroenteritis if there is bloody diarrhea, high fever >38.5°C, or exposure to contaminated food/water 1
The World Health Organization classifies dehydration severity as mild (3-5% weight loss), moderate (6-9% weight loss), or severe (≥10% weight loss), with corresponding signs and symptoms 2
The American Academy of Pediatrics suggests evaluating hydration status through physical examination findings, including abnormal respiratory pattern, abnormal skin turgor, and prolonged capillary refill time 2

The American College of Gastroenterology recommends oral rehydration with 50 mL/kg of oral rehydration solution (ORS) over 2-4 hours for mild dehydration, and 100 mL/kg ORS over 2-4 hours for moderate dehydration 2
The Infectious Diseases Society of America suggests that ondansetron may be given to children >4 years of age to facilitate oral rehydration tolerance, at a dose of 4 mg orally, 30 minutes before attempting oral rehydration 3
The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends resuming age-appropriate diet immediately after rehydration is completed, without restricting food or prolonging fasting 3

The World Gastroenterology Organisation suggests that probiotics may reduce symptom severity and duration, but are not a substitute for oral rehydration therapy 4
The American Academy of Pediatrics recommends zinc supplementation for 10-14 days in children with signs of malnutrition or residing in zinc-deficient populations, at a dose of 20 mg elemental zinc daily 5

The Centers for Disease Control and Prevention advises against giving antimotility drugs (loperamide) to children <18 years of age, due to risk of ileus, abdominal distension, lethargy, and death 3
The Infectious Diseases Society of America recommends against using antibiotics unless there is bloody diarrhea with confirmed bacterial pathogen, high fever with positive stool culture, or symptoms persisting >5 days with identified treatable organism 3

The American Academy of Pediatrics instructs parents to return or call if the child becomes increasingly lethargic or irritable, has decreased urine output, or develops intractable vomiting, blood in stool, high fever, or symptoms persisting beyond 5-7 days 6
The World Health Organization suggests monitoring for signs of severe dehydration, including lethargy, sunken eyes, and weak pulse 2

The Centers for Disease Control and Prevention emphasizes handwashing as the single most effective prevention strategy, and recommends rotavirus vaccination to significantly reduce incidence of severe gastroenteritis in young children 2
The American Academy of Pediatrics suggests continuing breastfeeding throughout illness if applicable, and practicing proper diaper changing and hygiene to prevent household spread 2