Diarrhoea and vomiting
(gastroenteritis)

Description
Diarrhoea is an increase in the frequency, runniness or volume of the faeces. It may be caused by different organisms, for example viruses (such as rotavirus), bacteria (such as campylobacter, salmonella and shigella), and parasites (such as giardia and cryptosporidium). Diarrhoea is spread when hands, objects and surfaces become contaminated with organisms from faeces. Infected people do not always show symptoms. Campylobacter and salmonella infections can result from drinking contaminated water or unpasteurised (raw) milk or by eating contaminated food, especially undercooked poultry, fish or shellfish. Sometimes, diarrhoea has a non-infectious cause, such as antibiotic treatment. The exact cause of the diarrhoea can only be diagnosed by laboratory tests of faecal specimens. Sometimes multiple specimens must be tested. Other symptoms which may accompany diarrhoea include vomiting and stomach pain. Blood or mucus may be seen in the faeces, especially in bacterial infections. Diarrhoea can cause dehydration and serious illness requiring hospitalisation.


Incubation Period
Viral and bacterial infections, usually 1-3 days. Parasitic infections, 5-15 days.


Infectious Period
People are infectious for as long as the organisms are present in their faeces, whether or not they are ill.


Controlling the Spread of Infection
A person with active diarrhoea is more likely to spread the disease than one who is well but has infectious organisms in their faeces. For this reason, children and staff with infectious diarrhoea should not attend the centre until diarrhoea has stopped. Do not exclude children with organisms in their faeces but no diarrhoea. Staff with organisms in their faeces but no diarrhoea should not be involved in the preparation of food. Review the centre's infection control practices, including nappy changing, toileting and handwashing procedures. Ensure that food is properly cooked and stored.


Treatment
(This section draws on information provided in the pamphlet, "Gastroenteritis: A guide for Parents and Caregivers" which was endorsed by the NHMRC 1996.) Preventing dehydration in children with gastroenteritis Children with diarrhoea need extra fluid to replace what they lose. However, many fluids have too much sugar and the wrong amount of salt. Giving a sick child the wrong kind of fluid can lead to more dehydration and illness. Safe drinks The best fluids to give contain a mixture of special salts (electrolytes) and sugars. You can buy Gastrolyte from the chemist. Mix the sachet of powder with water, not other kinds of fluids. (1 packet of Gastrolyte in 200 ml water). If children refuse Gastrolyte they may be given diluted soft drinks or fruit juice. Diluted cordial 10m1 + 150ml water. Diluted soft drink (eg lemonade) 50ml + 150m1 water Diluted fruit juices 50ml + 150m1 water Unsafe drinks Do not give undiluted fruit juice, fizzy drinks, cordial or lucozade to children with diarrhoea. They may increase diarrhoea and dehydration. Breastfed children Breastfeeding mothers should continue to breastfeed and offer the breast more often. Offer water (boiled if the baby is under 6 months) between feeds. Bottle/Formulae fed babies Continue normal strength formulae or milk if the child is hungry, and offer Gastrolyte or safe drinks as recommended above. Remember that withholding formulae for more than 24 hours may result in the baby losing weight. Re-introducing food Re-introduce food within 24 hours, even if the diarrhoea has not settled. Suitable foods to start off with include bread, plain biscuits, potatoes, rice, noodles, vegetables, plain meats, fish and eggs. Gradually re¬introduce other foods, such as dairy foods and sweet foods such as jelly, honey and jam.


Comments
Children with diarrhoea, who vomit or who refuse extra fluids should see a doctor. In severe cases hospitalisation may be needed. The parent and doctor will need to know the details of the child's illness while at the centre. Photocopy the letter on page 32 and fill in the details. If the child wears a nappy or has used a potty and you can, collect a bowel motion. Any clean glass jar can be used to store the faeces. Keep the jar of faeces in a plastic bag in the fridge and ask the parent to take this with them to the doctor. You have a better chance of knowing what germ is causing a problem in your centre if you collect the sample early. Make sure you wash your hands well after collecting the sample.


Disclaimer
The information contained in this website is intended as a guide only. Wollongong Medical Centre is not liable for any problems that may arise from incorrectly or otherwise applying information found in this website.


Further General Information

The following web site has information on infectious diseases: www.health.nsw.gov.au/infect/ or contact the Division of Population and Planning on 4255-2200.

For information on a large range of medical conditions and problems visit www.mayoclinic.com