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NICE Issues Guidelines for Managing Gastroenteritis in Children LONDON -- April 22, 2009 -- The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women's and Children's Health has published a clinical guideline on assessing and managing diarrhoea and vomiting caused by gastroenteritis in children aged 5 years and under. The guideline provides healthcare professionals with consistent advice on key issues such as fluid intake, nutritional management and preventing and managing dehydration. It also provides recommendations on advice to be given to parents and carers, and when care should be escalated -- from home management through to hospital admission. The guideline recommends: · In children with gastroenteritis but without clinical dehydration, continue breastfeeding and other milk feeds; encourage fluid intake; discourage the drinking of fruit juices and carbonated drinks; and offer oral rehydration salt (ORS) solution as supplemental fluid to those at increased risk of dehydration. · In children with clinical dehydration, including hypernatraemic dehydration use low-osmolarity ORS solution for oral rehydration therapy; give 50 ml/kg for fluid deficit replacement over 4 hours as well as maintenance fluid; give the ORS solution frequently and in small amounts; consider supplementation with their usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks) if they refuse to take sufficient quantities of ORS solution and do not have red flag symptoms or signs; and monitor the response to oral rehydration therapy by regular clinical assessment. · Use intravenous fluid therapy for clinical dehydration if shock is suspected or confirmed; a child with red flag symptoms shows clinical evidence of deterioration despite oral hydration therapy; or if a child persistently vomits the ORS solution. · If intravenous fluid therapy is required for rehydration use an isotonic solution for both fluid deficit replacement and maintenance; for those who required initial rapid intravenous fluid boluses for suspected or confirmed shock, add 100 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response; for those who were not shocked at presentation, add 50ml/kg for fluid deficit replacement to maintenance fluid requirements and monitor the clinical response; measure plasma sodium, potassium, urea, creatinine and glucose at the start, and monitor regularly; and consider intravenous potassium supplementation when the plasma potassium level is known · After rehydration, give full strength milk straight away, reintroduce the child's usual solid food and avoid giving fruit juices and carbonated drinks until the diarrhoea has stopped. "This is an extremely important guideline for the many thousands of children who contract gastroenteritis each year, and their parents or carers," said guideline chair Stephen Murphy, MD, Birmingham Children's Hospital NHS Trust, Institute of Child Health, Birmingham, United Kingdom. "Most children can be looked after at home but if a child becomes dehydrated they may need to go to hospital. In this guideline we are calling for healthcare professionals to use oral rehydration solutions where possible rather than intravenous drips, which can be painful and unnecessary. Of course, where a child is at the more severe end of the spectrum and severely dehydrated, they will be most safely managed with a drip. We are also recommending that careful evaluation of the child is carried out to monitor them and ensure they are becoming rehydrated and well again." SOURCE: National Institute for Health and Clinical Excellence E-mail this page to a friend or colleague! To print, use this version