Acute diarrhea in children is usually caused by a virus, and the main danger is the loss of water and salts. Young children dehydrate fast, so the key skills are grading the dehydration and replacing fluids safely.
Key symptoms
- Frequent loose or watery stools, often with vomiting
- Fewer wet diapers or less urine
- Thirst, dry mouth and no tears when crying
- Sleepiness, irritability or low energy
- Fever or belly cramps
What you find on exam
- Weight compared with a recent weight, if known
- Capillary refill, heart rate and breathing pattern
- Mucous membranes, tears, sunken eyes or fontanelle
- Skin turgor and general alertness
- Belly exam to look for a surgical cause
Tests
- Most children with mild dehydration need no tests
- Glucose and electrolytes if moderate to severe or on IV fluids
- Stool tests if bloody diarrhea, recent travel or outbreak
- Urine output monitoring
Treatment basics
- Oral rehydration solution in small, frequent sips, about 50 to 100 mL/kg over 3 to 4 hours
- Ondansetron for vomiting to help oral fluids work
- Normal saline bolus of 20 mL/kg for severe dehydration or shock
- Restart normal diet early and keep breastfeeding
- Teach hand hygiene and when to return
Red flags
- Lethargy, poor perfusion or cold mottled skin
- Blood in the stool or bilious, green vomiting
- No urine for 8 hours or more, or unable to keep fluids down
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Related guides
Sources: NCCPA PANCE Content Blueprint; Open RN, Nursing Fundamentals 2e; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.