Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Acute viral gastroenteritis in children in resource-rich countries: Management and prevention

David O Matson, MD, PhD
Section Editors
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


The prevention and treatment of viral gastroenteritis in children in resource-rich countries will be reviewed here. The epidemiology, clinical features, and diagnosis of acute viral gastroenteritis in children in resource-rich countries; acute diarrhea in children in resource-limited countries; and chronic diarrhea in children are discussed separately.

(See "Acute viral gastroenteritis in children in resource-rich countries: Clinical features and diagnosis".)

(See "Approach to the child with acute diarrhea in resource-limited countries".)

(See "Overview of the causes of chronic diarrhea in children in resource-rich countries" and "Approach to the diagnosis of chronic diarrhea in children in resource-rich countries" and "Persistent diarrhea in children in resource-limited countries".)


Acute gastroenteritis is a clinical syndrome often defined by increased stool frequency (eg, ≥3 loose or watery stools in 24 hours or a number of loose/watery bowel movements that exceeds the child's usual number of daily bowel movements by two or more), with or without vomiting or fever [1-4]. It usually lasts less than one week and not longer than two weeks. Diarrhea that lasts >14 days is "persistent" or "chronic." Diarrhea that recurs after seven days without diarrhea is "recurrent."

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 30, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr 2014; 59:132.
  2. National Institute for Health and Care Excellence. Diarrhoea and vomiting in children: Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. https://www.nice.org.uk/guidance/cg84 (Accessed on May 26, 2017).
  3. King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003; 52:1.
  4. Velázquez FR, Matson DO, Calva JJ, et al. Rotavirus infection in infants as protection against subsequent infections. N Engl J Med 1996; 335:1022.
  5. Rossignol JF, Lopez-Chegne N, Julcamoro LM, et al. Nitazoxanide for the empiric treatment of pediatric infectious diarrhea. Trans R Soc Trop Med Hyg 2012; 106:167.
  6. Rossignol JF, Abu-Zekry M, Hussein A, Santoro MG. Effect of nitazoxanide for treatment of severe rotavirus diarrhoea: randomised double-blind placebo-controlled trial. Lancet 2006; 368:124.
  7. Teran CG, Teran-Escalera CN, Villarroel P. Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children. Int J Infect Dis 2009; 13:518.
  8. Rossignol JF, El-Gohary YM. Nitazoxanide in the treatment of viral gastroenteritis: a randomized double-blind placebo-controlled clinical trial. Aliment Pharmacol Ther 2006; 24:1423.
  9. Harris C, Wilkinson F, Mazza D, et al. Evidence based guideline for the management of diarrhoea with or without vomiting in children. Aust Fam Physician 2008; 37:22.
  10. World Gastroenterology Organisation Global Guidelines. Acute diarrhea in adults and children: A global perspective. February 2012. www.worldgastroenterology.org/acute-diarrhea-in-adults.html (Accessed on July 29, 2015).
  11. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017; 65:e45.
  12. World Gastroenterology Organisation. WGO Practice Guideline - Probiotics and Prebiotics www.worldgastroenterology.org/probiotics-prebiotics.html (Accessed on July 29, 2015).
  13. Granado-Villar D, Cunill-De Sautu B, Granados A. Acute gastroenteritis. Pediatr Rev 2012; 33:487.
  14. Gregorio GV, Dans LF, Silvestre MA. Early versus Delayed Refeeding for Children with Acute Diarrhoea. Cochrane Database Syst Rev 2011; :CD007296.
  15. Khin MU, Nyunt-Nyunt-Wai, Myo-Khin, et al. Effect on clinical outcome of breast feeding during acute diarrhoea. Br Med J (Clin Res Ed) 1985; 290:587.
  16. Elliott EJ. Acute gastroenteritis in children. BMJ 2007; 334:35.
  17. Alarcon P, Montoya R, Perez F, et al. Clinical trial of home available, mixed diets versus a lactose-free, soy-protein formula for the dietary management of acute childhood diarrhea. J Pediatr Gastroenterol Nutr 1991; 12:224.
  18. MacGillivray S, Fahey T, McGuire W. Lactose avoidance for young children with acute diarrhoea. Cochrane Database Syst Rev 2013; :CD005433.
  19. Brown JW. Toxic megacolon associated with loperamide therapy. JAMA 1979; 241:501.
  20. Curtis JA, Goel KM. Lomotil poisoning in children. Arch Dis Child 1979; 54:222.
  21. Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Med 2007; 4:e98.
  22. DuPont HL, Hornick RB. Adverse effect of lomotil therapy in shigellosis. JAMA 1973; 226:1525.
  23. Pickering LK, Obrig TG, Stapleton FB. Hemolytic-uremic syndrome and enterohemorrhagic Escherichia coli. Pediatr Infect Dis J 1994; 13:459.
  24. Figueroa-Quintanilla D, Salazar-Lindo E, Sack RB, et al. A controlled trial of bismuth subsalicylate in infants with acute watery diarrheal disease. N Engl J Med 1993; 328:1653.
  25. Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate--containing compound (Pepto-Bismol). J Pediatr 1981; 99:654.
  26. Lehert P, Chéron G, Calatayud GA, et al. Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis 2011; 43:707.
  27. Gordon M, Akobeng A. Racecadotril for acute diarrhoea in children: systematic review and meta-analyses. Arch Dis Child 2016; 101:234.
  28. Moré J, Bénazet F, Fioramonti J, Droy-Lefaix MT. Effects of treatment with smectite on gastric and intestinal glycoproteins in the rat: a histochemical study. Histochem J 1987; 19:665.
  29. Brouillard MY, Rateau JG. [Adsorption potency of 2 clays, smectite and kaolin on bacterial enterotoxins. In vitro study in cell culture and in the intestine of newborn mice]. Gastroenterol Clin Biol 1989; 13:18.
  30. Das RR, Sankar J, Naik SS. Efficacy and safety of diosmectite in acute childhood diarrhoea: a meta-analysis. Arch Dis Child 2015; 100:704.
  31. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med 2006; 354:1698.
  32. Levine DA. Antiemetics for acute gastroenteritis in children. Curr Opin Pediatr 2009; 21:294.
  33. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open 2012; 2.
  34. Marchetti F, Bonati M, Maestro A, et al. Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial. PLoS One 2016; 11:e0165441.
  35. Yilmaz HL, Yildizdas RD, Sertdemir Y. Clinical trial: oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children--a double-blind randomized study. Aliment Pharmacol Ther 2010; 31:82.
  36. Freedman SB, Uleryk E, Rumantir M, Finkelstein Y. Ondansetron and the risk of cardiac arrhythmias: a systematic review and postmarketing analysis. Ann Emerg Med 2014; 64:19.
  37. Brenner SM, Boucher J. Fatal Cardiac Arrest in 2 Children: Possible Role of Ondansetron. Pediatr Emerg Care 2016; 32:779.
  38. Gener B, Burns JM, Griffin S, Boyer EW. Administration of ondansetron is associated with lethal outcome. Pediatrics 2010; 125:e1514.
  39. US Food and Drug Administration. Zofran (ondansetron): Drug Safety Communication - Risk of Abnormal Heart Rhythms. www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm272041.htm (Accessed on September 20, 2011).
  40. Sturm JJ, Hirsh DA, Schweickert A, et al. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Ann Emerg Med 2010; 55:415.
  41. Cheng A. Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children. Paediatr Child Health 2011; 16:177.
  42. DeCamp LR, Byerley JS, Doshi N, Steiner MJ. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. Arch Pediatr Adolesc Med 2008; 162:858.
  43. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open 2012; 2.
  44. Carey MJ, Aitken ME. Diverse effects of antiemetics in children. N Z Med J 1994; 107:452.
  45. Phenergan (promethazine HCl) tablets and suppositories [package insert]. Philadelphia: Wyeth Pharmaceuticals Inc.
  46. van Noord C, Dieleman JP, van Herpen G, et al. Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case-control study in the Netherlands. Drug Saf 2010; 33:1003.
  47. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev 2010; :CD003048.
  48. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 2002; 109:678.
  49. Szajewska H, Skórka A, Ruszczyński M, Gieruszczak-Białek D. Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children--updated analysis of randomised controlled trials. Aliment Pharmacol Ther 2013; 38:467.
  50. Feizizadeh S, Salehi-Abargouei A, Akbari V. Efficacy and safety of Saccharomyces boulardii for acute diarrhea. Pediatrics 2014; 134:e176.
  51. Freedman SB, Pasichnyk D, Black KJ, et al. Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0128754.
  52. Thomas DW, Greer FR, American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and prebiotics in pediatrics. Pediatrics 2010; 126:1217.
  53. Acute Gastroenteritis Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for prevention and management of acute gastroenteritis in children age 2 months to 18 years. December 2011. www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/recommendations/default (Accessed on August 05, 2015).
  54. Venugopalan V, Shriner KA, Wong-Beringer A. Regulatory oversight and safety of probiotic use. Emerg Infect Dis 2010; 16:1661.
  55. CDC Health Advisory. Fatal gastrointestinal mucormycosis in an infant following ingestion of contaminated dietary supplement - Connecticut, 2014. http://emergency.cdc.gov/HAN/han00373.asp (Accessed on August 05, 2015).
  56. Lewis ZT, Shani G, Masarweh CF, et al. Validating bifidobacterial species and subspecies identity in commercial probiotic products. Pediatr Res 2016; 79:445.
  57. Szajewska H, Guarino A, Hojsak I, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr 2014; 58:531.
  58. Parker MW, Schaffzin JK, Lo Vecchio A, et al. Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis. Pediatrics 2013; 131 Suppl 1:S96.
  59. Szajewska H, Skórka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007; 25:257.
  60. Bernstein DI, Atmar RL, Lyon GM, et al. Norovirus vaccine against experimental human GII.4 virus illness: a challenge study in healthy adults. J Infect Dis 2015; 211:870.
  61. Treanor JJ, Atmar RL, Frey SE, et al. A novel intramuscular bivalent norovirus virus-like particle vaccine candidate--reactogenicity, safety, and immunogenicity in a phase 1 trial in healthy adults. J Infect Dis 2014; 210:1763.
  62. Sundararajan A, Sangster MY, Frey S, et al. Robust mucosal-homing antibody-secreting B cell responses induced by intramuscular administration of adjuvanted bivalent human norovirus-like particle vaccine. Vaccine 2015; 33:568.
  63. Lindesmith LC, Ferris MT, Mullan CW, et al. Broad blockade antibody responses in human volunteers after immunization with a multivalent norovirus VLP candidate vaccine: immunological analyses from a phase I clinical trial. PLoS Med 2015; 12:e1001807.
  64. Luby SP, Agboatwalla M, Painter J, et al. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA 2004; 291:2547.
  65. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 2003; 3:275.
  66. Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 2008; 98:1372.
  67. Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, et al. Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev 2015; :CD004265.
  68. Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in U.S. children. N Engl J Med 2013; 368:1121.
  69. Liu P, Yuen Y, Hsiao HM, et al. Effectiveness of liquid soap and hand sanitizer against Norwalk virus on contaminated hands. Appl Environ Microbiol 2010; 76:394.
  70. Barclay L, Park GW, Vega E, et al. Infection control for norovirus. Clin Microbiol Infect 2014; 20:731.
  71. MacCannell T, Umscheid CA, Agarwal RK, et al. Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. Infect Control Hosp Epidemiol 2011; 32:939.
  72. Clasen T, Roberts I, Rabie T, et al. Interventions to improve water quality for preventing diarrhoea. Cochrane Database Syst Rev 2006; :CD004794.
  73. Gilman RH, Skillicorn P. Boiling of drinking-water: can a fuel-scarce community afford it? Bull World Health Organ 1985; 63:157.
  74. American Academy of Pediatrics. Children in out-of-home childcare. In: Red Book, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.132.
  75. Public Health England. Guidance on infection control in schools and other childcare settings. September 2014 https://www.gov.uk/government/publications/infection-control-in-schools-poster (Accessed on July 29, 2015).
  76. Centers for Disease Control and Prevention. Healthy Swimming. Diarrheal Illness. https://www.cdc.gov/healthywater/swimming/swimmers/rwi/diarrheal-illness.html (Accessed on May 22, 2017).
  77. American Academy of Pediatrics. Prevention of illnesses associated with recreational water use. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.216.
  78. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep 2011; 60:1.
  79. Cheng FW, Leung TF, Lai RW, et al. Rapid control of norovirus gastroenteritis outbreak in an acute paediatric ward. Acta Paediatr 2006; 95:581.
  80. Valentini D, Vittucci AC, Grandin A, et al. Coinfection in acute gastroenteritis predicts a more severe clinical course in children. Eur J Clin Microbiol Infect Dis 2013; 32:909.
  81. American Academy of Pediatrics. Rotavirus infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.684.
  82. American Academy of Pediatrics. Adenovirus infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.226.
  83. American Academy of Pediatrics. Norovirus and other human calicivirus infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.573.
  84. Pickering LK, Bartlett AV 3rd, Reves RR, Morrow A. Asymptomatic excretion of rotavirus before and after rotavirus diarrhea in children in day care centers. J Pediatr 1988; 112:361.
  85. Matson DO, O'Ryan ML, Herrera I, et al. Fecal antibody responses to symptomatic and asymptomatic rotavirus infections. J Infect Dis 1993; 167:577.