National Collaborating Centre for Women's and Children's Health

Diarrhoea and vomiting: management of acute diarrhoea with or without vomiting in the under 5s

Diarrhoea is defined as a change in bowel habit resulting in substantially more frequent and/or very loose or watery stools.  Acute diarrhoea due to gastroenteritis comes on suddenly and is usually short lived (lasting 14 days or fewer).  In children, acute diarrhoea due to gastroenteritis can occur with or without vomiting.

Acute diarrhoea with or without vomiting most commonly presents in primary care, accounting  for 20% of GP consultations and more than 12% of emergency department presentations each year in infants and children younger than 5 years.  It is also a very common reason for requests to NHS Direct for advice, and the majority of children are managed out of hospital.

The most common cause of acute diarrhoea is infection, 87% of which are viral with rotaviral making up the majority of these.  The remaining causes are generally of bacterial or parasitic origin.  Infections are generally acquired by person-to-person transmission within families or nursery/school environments, and as a result, the incidence of acute diarrhoea is likely to remain high as it is easily and quickly transmitted in these environments.

Guidance on the following aspects of care will be provided:

• The immediate management in infants and young children of diarrhoea (on its own or with vomiting) caused by an acute infection
• when to consider management of acute diarrhoea and vomiting in children who were previously healthy
• How to identify infants and children with acute diarrhoea and vomiting who are at risk of dehydration
• How to differentiate between acute infective diarrhoea and other causes of diarrhoea
• What clinical signs or symptoms can be used to identify infants and young children who should be referred.

For general enquires about this guideline please contact enquiries@ncc-wch.org.uk.