GPAtlas🧭 When to suspect
Suspect gastroenteritis in a child with a sudden change in stool consistency to loose or watery stools, and/or a sudden onset of vomiting. It is almost always a viral infection – rotavirus was historically the commonest cause in young children before routine vaccination, and norovirus is a frequent cause across all ages; bacterial (Campylobacter, Salmonella, Escherichia coli) and protozoal (Giardia, Cryptosporidium) causes are less common.
The illness is self-limiting: diarrhoea usually lasts 5–7 days and settles within 2 weeks, while vomiting usually lasts 1–2 days and settles within 3 days. The single clinical priority in primary care is to assess for and prevent dehydration, which is the main cause of serious harm, and to identify the few children who need admission.
NICE guideline CG84 formally covers children younger than 5; the same principles broadly apply to older children. Two skills matter: do not anchor on gastroenteritis (exclude the mimics below), and stratify the risk of dehydration.
| Consider an alternative diagnosis if any of these are present |
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• Fever – temperature ≥ 38°C in an infant under 3 months, or ≥ 39°C in a child 3 months or older |
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• Shortness of breath or rapid breathing (tachypnoea) – consider pneumonia or sepsis |
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• Altered conscious state, neck stiffness, bulging fontanelle in an infant, or a non-blanching rash – consider meningitis or meningococcal disease |
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• Blood and/or mucus in the stool – consider dysentery, or STEC infection with its risk of haemolytic uraemic syndrome |
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• Bilious (green) vomit – consider bowel obstruction |
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• Severe or localised abdominal pain, or abdominal distension or rebound tenderness – consider appendicitis or intussusception |
Source: NICE CG84 · NICE NG143
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