Intended for healthcare professionals

Practice Guidelines

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years: summary of NICE guidance

BMJ 2009; 338 doi: (Published 22 April 2009) Cite this as: BMJ 2009;338:b1350
  1. Rajesh Khanna, senior research fellow 1,
  2. Monica Lakhanpaul, clinical codirector 1, senior lecturer in child health 2,
  3. Shona Burman-Roy, research fellow1,
  4. M Stephen Murphy, consultant paediatric gastroenterologist and senior lecturer in paediatrics and child health 3
  5. on behalf of the Guideline Development Group and the technical team
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA
  2. 2University of Leicester, Leicester LE1 9NH
  3. 3Birmingham Children’s Hospital NHS Foundation Trust and University of Birmingham, Birmingham B4 6NH
  1. Correspondence to: M S Murphy M.S.MURPHY{at}

    Why read this summary?

    Gastroenteritis is common, with many children having more than one episode a year. The characteristic symptoms—sudden onset of diarrhoea with or without vomiting—are unpleasant and affect both the child and family or carers. Although the illness usually resolves without treatment and can be managed in the community, many children are admitted to hospital each year.1 2 In the absence of national guidance, clinical practice is thought to vary considerably across the United Kingdom, with a major effect on the use of healthcare resources.3 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis, assessment, and management of diarrhoea and vomiting caused by gastroenteritis in children under 5 years.4


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.


    Clinical diagnosis

    • Suspect gastroenteritis if stools suddenly change to a loose or watery consistency or onset of vomiting occurs suddenly (or both). In suspected cases, ask about recent contact with someone with acute diarrhoea or vomiting (or both), exposure to a known source of enteric infection (possibly contaminated water or food), and recent travel abroad. Notify and act on the advice of the public health authorities if you suspect an outbreak of gastroenteritis.

    • Any of the features given below are possible indicators of diagnoses other than gastroenteritis:

      • -Fever:

        1. Temperature of 38°C or higher in children under 3 months

        2. Temperature of 39°C or higher in children aged 3 months or more.

      • -Shortness of breath or tachypnoea

      • -Altered state of consciousness

      • -Neck stiffness

      • -Bulging fontanelle in infants

      • -Non-blanching rash

      • -Blood or mucous in stool

      • -Bilious (green) vomit

      • -Severe or localised abdominal …

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