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Guidelines for the management of acute gastroenteritis in children in Europe

Diarrhoea in childhood remains a major cause of morbidity and mortality throughout the world, currently accounting for 0.8 million deaths per year under the age of 5 years. This problem is not confined to low-income countries but is also a significant cause of morbidity in high-income countries, particularly in the first year of life. The incidence of diarrhoea ranges from 0.5 to 2 episodes per child per year in children <3 years in Europe.1 The rate of UK hospital admission for acute gastroenteritis in 2001 was 65.7/10 000 children <5 years of age.2 Gastroenteritis is a major cause of hospital admission and has a large economic impact.

In response to the morbidity, mortality and costs associated with acute gastroenteritis, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)3 reviewed the current evidence (on management of acute gastroenteritis) and published guidelines in 2014. This updated ESPGHAN guideline differs from the original one published 20084 in two aspects: 

1. The quality of evidence and the weight of recommendations have been rated according to the Grading of Recommendations, Assessment, Development and Evaluations system, which has advantages over other rating systems.

2. A section on the management of children in hospital has been added.

The 2014 ESPGHAN guidelines on management of acute gastroenteritis largely complement the National Institute for Health and Care Excellence (NICE) guideline published in 2009,5 but differences are highlighted in table 1, and by italics throughout the text.

View this table:

Table 1 
Comparison of ESPGHAN 2014 and NICE 2009 guidelines on acute gastroenteritis in children



### Definition

Acute gastroenteritis is a decrease in the consistency of stools (loose or liquid) and/or an increase in the frequency of evacuations (typically >3 in 24 h), with or without fever or vomiting. However, a change in stool consistency is more indicative of diarrhoea than stool number, particularly in the first …