What is acute gastroenteritis?

Acute gastroenteritis (AGE) is an infection of the gut and the second leading cause of illness in young children, especially in resource-limited tropical countries like Viet Nam where places are crowded, and food hygiene can be an issue. AGE can vary in severity, from mild symptoms such as mild diarrhoea and upset stomach for a couple of days to stomach cramps, serious vomiting and diarrhoea. In some cases, it may result in severe dehydration and shock.

What are the causes?

Almost all cases of AGE in Viet Nam are caused by infectious agents. Several viruses, bacteria and other germs can cause it, but the most common is Rotavirus. Almost every child will have had a Rotavirus infection before the age of five, after which the body develops immunity, hence it is uncommon in older children and adults. Adenoviruses are another source of AGE and, similar to Rotavirus, it is less common in older children.

Food poisoning is another common cause of AGE. Food poisoning refers to food or water that has been contaminated by certain bacteria and toxins produced by bacteria such as Salmonella, Shigella, Staphylococcus and E. coli, or even parasites.

What are the symptoms?

• Diarrhoea and vomiting are the main symptoms of AGE. Diarrhoea refers to loose or watery stool that occurs frequently (three times or more in 24 hours), sometimes with blood and mucus. In infants, diarrhoea occurs when bowel movements are twice as normal. Most symptoms are mild and disappear within a couple of days, but some may last up to a week. If diarrhoea is more frequent and is associated with serious vomiting, it can cause severe dehydration, especially in infants.

• Common associated symptoms are:

 -Upset stomach and cramps.

 -High fever and general malaise, such as sore limbs and headache.

When should one seek medical advice?

Please seek medical advice if your child less than six months old exhibits any of the following symptoms or whenever he or she shows other symptoms you are concerned about:

• has fever,

• has an underlying medical condition such as heart problem, diabetes or history of premature birth,

•refuses to eat and drink while having diarrhoea and vomiting,

• vomits green liquid (bile) or blood,

• has bloody diarrhoea,

• has severestomach ache,

• keeps crying constantly, sleeps too much, has difficulty in waking up and feels drowsy or confused,

• has symptoms that do not improve after 24 hours,

• has dehydration which can result in some of the following:

- thirst

- dry tongue or mouth

- no wet diaper for six hours

- not peeing for eight hours

- dry, wrinkly or doughy skin

- sunken eyes and/or fontanel

- decrease or absence of tears

• If you feel uncomfortable taking care of your child at home, or your home is far from the medical centre.

What will the doctor do?

Your doctor will do a physical examination of your child to check for temperature, heart rate, signs of dehydration and tenderness in his stomach. He may ask questions to help identify the most likely cause of your child’s condition, including information about recent travels and contact with any other person with similar symptoms. He may prescribe additional blood or stool tests to help identify the cause.

How to take care of your child at home?

The bottom line is to compensate for the lack of fluids in the body.

• Oral rehydration solutions (ORS): some ORS are available over-the-counter, such as Oresolor Hydrite. You can dissolve the contents of one sachet in a glass (200ml) of clean drinking water or as instructed by the doctor. Give as much fluid as the child wants until diarrhoea or vomiting stops.

• Diet for children with AGE: For infants who are breast-fed or formula-fed, continue to feed your baby normally, but more frequently. For older children, offer smaller but more frequent meals.

• Avoid misconception: Vietnamese parents sometimes think it is beneficial for a child with AGE to fast, to not drink and to not be breast-fed. They instead opt for condensed milk and higher concentrations of ORS. This can make the child’s dehydration worse, even making it life threatening in some cases.

• If your child has vomiting or diarrhoea just after taking medicine, consult your doctor if it needs to be given again as it may not have been absorbed.

- If your child has fever, you can give antipyretics such as paracetamol available in oral or rectal formulas, given at an average single dose of 10-15mg per kilogramme of body weight three to four times per day.

- You should not give any other medication without consulting your doctor.

Can you prevent AGE?

• Viruses and bacteria can spread from an infected person to another by hands. Washing hands frequently can help prevent them from spreading.

• Be sure your child only eats foods that have been prepared carefully and stored properly.

• Breast-fed babies are much less likely to develop AGE compared to bottle-fed babies.

• Immunisation against Rotavirus, the most common cause of AGE in children, is available and can help protect your baby.

(Source: VNS/ by Dr Nguyen Trung Ha from the Ha Noi French Hospital)