Diarrhoea and vomiting in children: fluids, dehydration signs and staying off nursery

Gastroenteritis causes diarrhoea and vomiting and is usually due to a viral or bacterial bug. NHS inform says it is common in young children and that most children's cases are due to rotavirus. Symptoms usually appear up to a day after infection and typically last less than a week. Besides watery diarrhoea and vomiting, which can be projectile, a mild fever, loss of appetite, aching limbs and headaches are listed.

NICE guideline CG84 for children under 5 says diarrhoea usually lasts 5 to 7 days and in most stops within 2 weeks, while vomiting usually lasts 1 to 2 days and in most stops within 3 days.

Fluids are the priority. The NHS and NHS inform give the following advice.

• Offer small sips of fluid often if the child feels sick.

• Carry on breast or bottle feeding; if the baby is being sick, give small feeds more often than usual (NHS).

• Let a child eat when hungry; NHS inform suggests small amounts of plain foods such as soup, rice, pasta and bread.

• Use paracetamol for fever or aches if needed, checking the leaflet.

• Use special rehydration drinks from a pharmacy if dehydrated; the pharmacist can advise how much.

The NHS says not to give fruit juice or fizzy drinks because they can make diarrhoea worse, not to make baby formula weaker, not to give children under 12 medicine to stop diarrhoea, and not to give aspirin to children under 16. NHS inform adds that antidiarrhoeal and anti-vomiting medication should only be given if advised by a GP or pharmacist, and that alcohol hand gels are not always effective so soap and water should be used.

NHS inform lists these as symptoms of dehydration in a child: passing less urine than normal, being unusually irritable or unresponsive, pale or mottled skin, and cold hands and feet. The NHS adds fewer wet nappies in a child under 5.

NICE sets out who is at increased risk of dehydration: children younger than 1 year, particularly under 6 months, infants who were of low birth weight, children who have passed more than five diarrhoeal stools or vomited more than twice in the previous 24 hours, and infants who have stopped breastfeeding during the illness. It says oral rehydration solution is the first choice for treating dehydration, with intravenous fluids reserved for shock, red flag signs that worsen, or persistent vomiting of the solution.

The NHS says to call 111 now if you are worried about a baby under 12 months, if the child stops breast or bottle feeding, a child under 5 shows dehydration signs, keeps being sick and cannot keep fluid down, has bloody diarrhoea, or has diarrhoea for more than 7 days or vomiting for more than 2 days.

The NHS says to call 999 or go to A&E for vomit that contains blood or looks like ground coffee, yellow-green or green vomit in a child, a stiff neck with pain looking at bright lights, a sudden severe headache or tummy ache, blue, grey, pale or blotchy skin, severe breathing difficulty, or confusion or not responding as usual. NHS inform adds a baby under 3 months with a temperature of 38C or above or 36C or below and no vaccination in the past 2 days.

The bugs spread through small particles of vomit or poo and contaminated surfaces. NHS inform says a person is most infectious from the start of symptoms until 48 hours after they have passed. Hygiene steps include frequent soap and water handwashing, washing soiled clothing and bedding separately on a hot wash, cleaning toilet seats, flush handles, taps and door handles daily, not sharing towels or cutlery, and not using a swimming pool for a period after symptoms stop: the NHS says at least 48 hours, while NHS inform says at least 2 weeks for children.

NHS inform says young children can have the rotavirus vaccination at 2 to 3 months, which can reduce their risk of developing gastroenteritis.

UKHSA says people with diarrhoea and vomiting, including norovirus and rotavirus, should stay away from the setting until 2 days after diarrhoea and vomiting have stopped. The NHS gives the same 2-day rule and NHS inform describes at least 48 hours after symptoms have passed. For food poisoning, cryptosporidiosis and giardiasis the UKHSA table also says 2 days after symptoms stop, with a small number of exceptions such as E. coli (STEC), where children under 6 stay away until a healthcare professional confirms it is safe.