Initial Assessment
The priorities in the initial assessment include:
- Could something else be causing these symptoms?
- Does this child have risk factors for a more serious clinical course?
- Are there any red flags that this child is very unwell / needs resuscitation?
- How dehydrated is this child?
In your history and examination, any of the following features should prompt you to consider an alternative diagnosis [1]:
- fever:
- temperature of 38°C or higher in children younger than 3 months
- temperature of 39°C or higher in children aged 3 months or older
- shortness of breath or tachypnoea
- altered consciousness
- neck stiffness
- bulging fontanelle in infants
- non-blanching rash
- blood and/or mucus in stool
- bilious (green) vomit
- severe or localised abdominal pain
- abdominal distension or rebound tenderness
- vomiting lasting more than 24 hours without diarrhoea
- persistent diarrhoea (more than 10 days)
These alternative causes include:
- Other infections: meningitis, septicaemia, urinary tract infection, pneumonia
- Acute surgical abdominal conditions: appendicitis, volvulus, intussusception
- Non-infective gastroenterological conditions: inflammatory bowel, coeliac disease, malabsorption, overflow constipation
- Antibiotic associated diarrhoea: including Clostridium Difficile