Diarrhea In The ChildAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

546 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Fever In The Neonate And Young Infant Pediatric Fever By Age 0 To 28 Days Pediatric Fever By Age 29 To 60 Days Pediatric Fever By Age 2 To 24 Months Pediatric Respiratory Distress Croup And Stridor In Children Pediatric Dehydration Pediatric Abdominal Pain Febrile Seizure Rash In The Child Poor Feeding And Lethargy In The Infant Vomiting In The Child Diarrhea In The Child Pediatric Trauma Evaluation Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern Lethargy And Altered Mental Status In The Child

Environmental and Exposure4▾

01History/hx83

HPI

›Diarrhea history

›Duration

›Frequency per day

›Volume

›Baseline stool pattern

›Nocturnal stools

›Blood

›Mucus

›Melena

›Color

›Watery

›Greasy

›Tenesmus

›Incontinence

›Hydration and output

›Oral intake

›Breastfeeding tolerance

›Formula intake

›Vomiting

›Urine output

›Wet diapers per day

›Tears

›Exposure context

›Sick contacts

›Daycare outbreaks

›Recent travel

›Recent swimming

›Well water

›Farm exposure

›Reptile exposure

›Undercooked foods

›Unpasteurized dairy

›Fever pattern

›Maximum temperature

›Antipyretic response

›Baseline status

›Weight trajectory

›Recent weight loss

›Growth concerns

›Developmental baseline

Onset

›Onset features

›Sudden onset

›Gradual onset

›Post exposure onset timing

Provocation/Palliation

›Modifiers

›Worse with oral intake

›Worse with specific foods

›Improvement with fasting

›Improvement with ORS

Quality

›Stool quality descriptors

›Watery

›Bloody

›Mucoid

›Greasy

›Foul smelling

Region/Radiation

›Pain location pattern

›Diffuse abdominal pain

›Periumbilical pain

›RLQ pain

›Colicky episodic pain

Severity

›Severity indicators

›Dehydration symptoms

›Inability to keep fluids down

›Functional limitation

›Lethargy

Timing

›Course

›Constant

›Intermittent

›Worsening

›Improving

›Recurrent episodes

Associated symptoms

›Associated symptoms set

›Vomiting

›Abdominal pain

›Fever

›Rash

›Respiratory symptoms

›Dysuria

›Headache

›Myalgias

›Joint pain

›Recent antibiotics

›Recent hospitalization

02Alarm Features/alarm35

High risk history

›High risk history triggers

›Age under 3 months

›Prematurity

›Immunocompromised state

›Chronic kidney disease

›Chronic cardiac disease

›Chronic lung disease

›Complex medical device dependence

›Recent international travel

›Known exposure to Shiga toxin producing E coli

›Ingestion of high risk foods

Vital sign danger thresholds

›Vital sign danger patterns

›Hypotension for age

›Persistent tachycardia for age

›RR elevation with work of breathing

›Fever with toxicity

›Hypothermia in infant

High risk exam findings

›High risk exam findings set

›Altered mental status

›Severe dehydration signs

›Poor perfusion

›Capillary refill over 3 seconds

›Mottling

›Cyanosis

›Peritoneal signs

›Bilious emesis

›Abdominal distension

›Palpable abdominal mass

›Petechiae or purpura

›Neck stiffness

Immediate escalation triggers

›Escalation logic

›If shock signs then resuscitation pathway

›If bilious emesis or peritonitis then urgent surgical consult

›If bloody diarrhea with pallor or oliguria then HUS evaluation pathway

›If severe lethargy then immediate glucose check and resuscitation pathway

03Medications/meds19

Current and recent meds

›Medication exposure review

›Recent antibiotics

›Recent laxatives

›Recent magnesium containing products

›Recent sorbitol containing products

›Recent NSAIDs

›Acid suppression therapy

›Immunosuppressants

›Chemotherapy

OTC and supplements

›Non prescription agents

›Antidiarrheals

›Probiotics

›Herbal products

›Zinc supplementation

Medication risks and contraindications

›Medication hazards

›Loperamide avoidance in children with dysentery

›Bismuth salicylate avoidance in children

›Antibiotic associated diarrhea risk

›C difficile risk with recent antibiotics

04Diet/diet13

Recent intake pattern

›Intake and exposures

›Breastfeeding continuation

›Formula concentration changes

›New foods

›Excess fruit juice

›Sugar alcohol exposure

›High lactose intake after gastroenteritis

Hydration pattern

›Hydration details

›ORS use

›Water only intake

›Sports drinks

›Soda

›Caffeinated beverages

05Review of Systems/ros25

›GI symptoms

›Vomiting

›Abdominal pain

›Distension

›Blood in stool

›Constipation history

›Weight loss

›GU symptoms

›Urine output reduction

›Dysuria

›Flank pain

Respiratory

›Respiratory symptoms

›Cough

›Rhinorrhea

›Dyspnea

Neuro

›Neuro symptoms

›Lethargy

›Irritability

›Seizure

›Headache

Skin and MSK

›Skin and MSK symptoms

›Rash

›Petechiae

›Arthralgia

›Myalgia

06Collateral History and Family History/chafh14

Collateral source

›Collateral and reliability

›Caregiver historian reliability

›Daycare report

›Public health notification

Family history

›Familial conditions

›Inflammatory bowel disease

›Celiac disease

›Primary immunodeficiency

›Hemolytic uremic syndrome history

Household exposures

›Household context

›Sick contacts at home

›Food shared exposure

›Pets and animal contact

›Water source

07Risk Factors/rf18

Patient factors

›Patient risk profile

›Age under 6 months

›Prematurity

›Malnutrition

›Chronic disease

›Immunocompromised state

›Incomplete immunizations

Exposure risks

›Infectious exposure risks

›Daycare attendance

›Recent travel

›Untreated water exposure

›Farm or petting zoo exposure

›Reptile exposure

›Recent antibiotics

Complication risks

›Complication risk profile

›Prior dehydration hospitalization

›Limited caregiver support

›Barriers to oral rehydration at home

08Differential Diagnosis/ddx60

Life threatening

›Life threatening causes

›Sepsis (A41.9)

›Toxic appearance

›Hypotension for age

›Hypovolemic shock (R57.1)

›Poor perfusion

›Altered mental status

›Intussusception (K56.1)

›Colicky pain

›Lethargy

›Bloody stool

›Volvulus with malrotation (K56.2)

›Bilious vomiting

›Distension

›Hemolytic uremic syndrome (D59.3)

›Bloody diarrhea

›Pallor

›Oliguria

›Diabetic ketoacidosis (E10.10)

›Polyuria history

›Kussmaul breathing

Common

›Common causes

›Viral gastroenteritis (A08.4)

›Watery diarrhea

›Sick contacts

›Foodborne bacterial gastroenteritis (A05.9)

›Fever

›Abdominal cramping

›Antibiotic associated diarrhea (K52.1)

›Recent antibiotic exposure

›Non bloody diarrhea

›Functional toddler diarrhea (K59.1)

›Normal growth

›Excess juice intake

›Lactose intolerance after infection (E73.9)

›Worse with dairy

›Bloating

Less common

›Less common causes

›Giardiasis (A07.1)

›Foul smelling greasy stool

›Untreated water exposure

›C difficile infection (A04.7)

›Recent antibiotics

›Recent hospitalization

›Appendicitis (K35.80)

›RLQ tenderness

›Anorexia

›Inflammatory bowel disease (K50.90)

›Weight loss

›Nocturnal stools

›Celiac disease (K90.0)

›Growth faltering

›Chronic diarrhea

Key mimics and pitfalls

›Mimics and pitfalls

›Overflow diarrhea from constipation (K59.00)

›Stool withholding history

›Palpable stool burden

›UTI in young child with fever (N39.0)

›Fever without source

›Poor feeding

09Past Medical History/pmh16

Relevant conditions

›Chronic and prior conditions

›Prior dehydration episodes

›Prior hospitalization for gastroenteritis

›Congenital heart disease

›Chronic kidney disease

›Diabetes mellitus

›Inflammatory bowel disease

Surgeries and devices

›Surgical and device history

›Abdominal surgery history

›Short bowel syndrome

›Gastrostomy tube

›Central venous catheter

Baseline function

›Baseline status

›Baseline oral intake

›Baseline urine output pattern

›Baseline weight percentile trend

10Physical Exam/exam46

General and vitals

›General status

›Appearance

›Toxicity

›Consolability

›Work of breathing

›Vital sign interpretation

›HR for age

›BP for age

›RR for age

›Temperature

›Oxygen saturation

Hydration and perfusion

›Hydration assessment

›Mental status

›Eyes

›Tears

›Mucous membranes

›Skin turgor

›Capillary refill

›Peripheral pulses

›Extremity temperature

›Fontanelle in infants

HEENT

›HEENT findings

›Sunken eyes

›Dry mouth

›Otitis media signs

›Pharyngeal erythema

Abdomen

›Abdominal exam

›Distension

›Tenderness localization

›Guarding

›Rebound

›Bowel sounds

›Hepatosplenomegaly

›Mass

Skin and MSK

›Skin and MSK findings

›Rash

›Petechiae

›Purpura

›Signs of poor perfusion

›Joint swelling

Neuro

›Neuro status

›Alertness

›Lethargy

›Tone

›Irritability

›Seizure activity evidence

11Lab Studies/labs35

Point of care

›Bedside labs

›Glucose

›Hypoglycemia threshold 3.0 mmol/L

›Hyperglycemia trigger for DKA workup

›Capillary ketones when DKA concern

›Elevated ketones support DKA pathway

›Normal ketones support alternate diagnosis

Basic labs for dehydration or toxicity

›Dehydration and severity labs

›Electrolytes

›Sodium risk pattern

›Potassium risk pattern

›Urea and creatinine

›Prerenal azotemia pattern

›Baseline comparison when known

›Venous blood gas

›Metabolic acidosis pattern

›Severe acidosis triggers escalation

Infection and complication labs

›Infection complication labs

›CBC

›Leukocytosis support bacterial infection context

›Anemia and thrombocytopenia support HUS concern

›Blood culture when sepsis concern

›Higher yield in toxic or immunocompromised child

›Lower yield in mild gastroenteritis without red flags

Stool studies

›Stool testing indications

›Stool culture or multiplex PCR

›Bloody diarrhea

›Severe illness

›Outbreak public health needs

›Ova and parasites

›Persistent diarrhea over 14 days

›Travel exposure

›C difficile testing

›Recent antibiotics

›Recent hospitalization

12Imaging/img28

Scoring Systems

›Clinical severity tools

›Clinical Dehydration Scale

›Mild to moderate dehydration stratification

›Use with overall clinical judgment

›Gorelick dehydration scale

›Dehydration risk stratification

›Limited accuracy in some age groups

MRI

›MRI use cases

›IBD complications evaluation

›Perianal disease evaluation

›Avoid in unstable child

›Sedation risk consideration

›CT indications and cautions

›Complication concern

›Perforation concern

›Abscess concern

›Radiation risk discussion

›Contrast nephrotoxicity risk in dehydration

Ultrasound

›Ultrasound pathways

›Intussusception evaluation

›Target or donut sign

›Enema reduction pathway coordination

›Appendicitis evaluation

›Non compressible appendix

›Secondary signs

›Hydronephrosis when UTI concern

›Febrile infant pathway alignment

›Dehydration confounders

13Special Tests/spec14

Bedside tests

›Bedside diagnostics

›Urinalysis

›Febrile child without source

›Dehydration ketonuria confounder

›Stool occult blood testing

›Supports inflammatory diarrhea context

›Limited specificity

Procedural diagnostics

›Procedural and consult driven tests

›Air or contrast enema for intussusception

›Diagnostic and therapeutic

›Perforation risk awareness

›Lumbar puncture when meningitis concern

›Toxic appearance with neuro signs

›Local protocol dependent thresholds

14ECG/ecg11

When to obtain

›ECG indications

›Severe dehydration with electrolyte abnormalities

›Potassium abnormality concern

›Arrhythmia symptoms

High risk patterns

›ECG red flags

›QT prolongation

›Risk increased with electrolyte derangements

›Medication contribution review

›Wide QRS

›Hyperkalemia concern

›Immediate escalation pathway

15Assessment/ax19

Working diagnosis and severity

›Acute diarrhea syndrome

›Acute gastroenteritis likely (A09)

›Inflammatory diarrhea consideration (A09)

›Antibiotic associated diarrhea consideration (K52.1)

›Dehydration severity

›No dehydration

›Mild dehydration

›Moderate dehydration

›Severe dehydration

Complications to rule out

›High consequence complications

›Shock physiology

›HUS risk

›Surgical abdomen

›DKA risk when hyperglycemia pattern

Diagnostic uncertainty

›Alternative diagnoses

›UTI in young child with fever

›Appendicitis

›Intussusception

›IBD flare

16Plan/plan44

Approach to the critical patient

›First 5 minutes workflow

›Airway and breathing support if altered mental status

›Oxygen for hypoxemia

›Cardiac monitoring if shock or severe electrolyte concern

›IV or IO access if shock or severe dehydration

›Isotonic fluid bolus if shock

›20 mL per kg

›Reassess after each bolus

›Glucose check if lethargy or altered mental status

›Broad sepsis pathway if toxic with concern for bacterial source

Rehydration

›Rehydration strategy

›Oral rehydration solution for mild to moderate dehydration

›50 mL per kg over 4 hours for mild dehydration

›100 mL per kg over 4 hours for moderate dehydration

›Additional 10 mL per kg per stool

›IV fluids for severe dehydration or failed ORS

›Isotonic crystalloid

›Transition to deficit replacement and maintenance after stabilization

›Hypernatremia precautions

›Slow correction planning

›Sodium monitoring frequency per protocol

Antiemetic and symptom control

›Symptom control options

›Ondansetron for vomiting limiting ORS

›0.15 mg per kg PO once

›Maximum single dose 8 mg

›Antidiarrheals avoidance

›Loperamide avoidance in young children

›Avoid in bloody diarrhea or systemic toxicity

Targeted antimicrobials

›Antibiotic decision logic

›Avoid empiric antibiotics in suspected Shiga toxin producing E coli

›Bloody diarrhea without fever pattern concern

›HUS risk consideration

›Empiric antibiotics when severe dysentery with systemic toxicity

›Local resistance and protocol dependent selection

›Stool testing before antibiotics when feasible

›Suspected cholera context

›Profuse watery diarrhea with travel or outbreak context

›Public health notification pathway

Monitoring and reassessment loop

›Reassessment loop

›Vital signs reassessment after fluids

›Mental status reassessment

›Urine output monitoring

›Ongoing losses replacement planning

›Repeat electrolytes when IV rehydration ongoing

17Disposition/dispo24

ICU criteria

›ICU level care criteria

›Shock requiring ongoing boluses or vasoactive support

›Severe altered mental status

›Severe electrolyte derangements with ECG changes

›Severe acidosis with clinical instability

Inpatient admission criteria

›Admission criteria

›Severe dehydration

›Persistent inability to tolerate oral intake

›Failed ED oral rehydration pathway

›Suspected HUS

›Surgical abdomen concern

›Immunocompromised child with significant symptoms

›Social concerns limiting safe home care

Observation pathway criteria

›Observation criteria

›Moderate dehydration improving with ORS

›Need for serial reassessment

›Pending stool study with significant symptoms

Discharge criteria

›Discharge readiness

›Normal or improving vital signs

›Tolerating oral fluids

›Improving hydration exam

›Reliable caregiver

›Clear return precautions

›Follow up plan established

18Discharge Instructions/di24

Copy discharge instructions

›Home care summary

›Most childhood diarrhea is from a stomach infection and improves over a few days

›Focus on fluids to prevent dehydration

›Fluids and diet

›Use oral rehydration solution in small frequent sips

›Continue breastfeeding or usual formula

›Avoid juice and soda until better

›Medications

›Use acetaminophen for fever if needed

›Do not use anti diarrhea medicines unless told by a clinician

›If ondansetron prescribed take only as directed

›Follow up

›See your primary care clinician within 24 to 48 hours if not improving

›Earlier follow up for infants or children with medical complexity

›Return to emergency care now

›Trouble staying awake

›Blue lips or trouble breathing

›No urine for 8 hours

›Very dry mouth or no tears

›Blood in stool

›Green vomiting

›Severe belly pain

›Fever in an infant under 3 months

›Worsening weakness or dizziness

19References/r18

Guidelines and key sources

›Acute gastroenteritis in children guideline ESPGHAN ESPID 2014

›Oral rehydration as first line for mild to moderate dehydration

›Antiemetic use supports ORS success in selected patients

›NICE guideline Diarrhoea and vomiting caused by gastroenteritis under 5 years 2009 updated

›Dehydration assessment guidance

›Safety net and return precautions emphasis

›WHO guideline on diarrhoea treatment in children latest consolidated guidance

›ORS standards

›Dehydration classification framework

›IDSA clinical practice guideline for infectious diarrhea 2017

›Stool testing indications

›Empiric antibiotics cautions in suspected STEC

›CDC clinical overview of norovirus and acute gastroenteritis infection control

›Outbreak context considerations

›Supportive care emphasis

›Project instructions source

›Formatting and structure requirements

›Evidence labeling expectations

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Diarrhea In The ChildAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

546 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx83

HPI

›Diarrhea history

›Duration

›Frequency per day

›Volume

›Baseline stool pattern

›Nocturnal stools

›Blood

›Mucus

›Melena

›Color

›Watery

›Greasy

›Tenesmus

›Incontinence

›Hydration and output

›Oral intake

›Breastfeeding tolerance

›Formula intake

›Vomiting

›Urine output

›Wet diapers per day

›Tears

›Exposure context

›Sick contacts

›Daycare outbreaks

›Recent travel

›Recent swimming

›Well water

›Farm exposure

›Reptile exposure

›Undercooked foods

›Unpasteurized dairy

›Fever pattern

›Maximum temperature

›Antipyretic response

›Baseline status

›Weight trajectory

›Recent weight loss

›Growth concerns

›Developmental baseline

Onset

›Onset features

›Sudden onset

›Gradual onset

›Post exposure onset timing

Provocation/Palliation

›Modifiers

›Worse with oral intake

›Worse with specific foods

›Improvement with fasting

›Improvement with ORS

Quality

›Stool quality descriptors

›Watery

›Bloody

›Mucoid

›Greasy

›Foul smelling

Region/Radiation

›Pain location pattern

›Diffuse abdominal pain

›Periumbilical pain

›RLQ pain

›Colicky episodic pain

Severity

›Severity indicators

›Dehydration symptoms

›Inability to keep fluids down

›Functional limitation

›Lethargy

Timing

›Course

›Constant

›Intermittent

›Worsening

›Improving

›Recurrent episodes

Associated symptoms

›Associated symptoms set

›Vomiting

›Abdominal pain

›Fever

›Rash

›Respiratory symptoms

›Dysuria

›Headache

›Myalgias

›Joint pain

›Recent antibiotics

›Recent hospitalization

02Alarm Features/alarm35

High risk history

›High risk history triggers

›Age under 3 months

›Prematurity

›Immunocompromised state

›Chronic kidney disease

›Chronic cardiac disease

›Chronic lung disease

›Complex medical device dependence

›Recent international travel

›Known exposure to Shiga toxin producing E coli

›Ingestion of high risk foods

Vital sign danger thresholds

›Vital sign danger patterns

›Hypotension for age

›Persistent tachycardia for age

›RR elevation with work of breathing

›Fever with toxicity

›Hypothermia in infant

High risk exam findings

›High risk exam findings set

›Altered mental status

›Severe dehydration signs

›Poor perfusion

›Capillary refill over 3 seconds

›Mottling

›Cyanosis

›Peritoneal signs

›Bilious emesis

›Abdominal distension

›Palpable abdominal mass

›Petechiae or purpura

›Neck stiffness

Immediate escalation triggers

›Escalation logic

›If shock signs then resuscitation pathway

›If bilious emesis or peritonitis then urgent surgical consult

›If bloody diarrhea with pallor or oliguria then HUS evaluation pathway

›If severe lethargy then immediate glucose check and resuscitation pathway

03Medications/meds19

Current and recent meds

›Medication exposure review

›Recent antibiotics

›Recent laxatives

›Recent magnesium containing products

›Recent sorbitol containing products

›Recent NSAIDs

›Acid suppression therapy

›Immunosuppressants

›Chemotherapy

OTC and supplements

›Non prescription agents

›Antidiarrheals

›Probiotics

›Herbal products

›Zinc supplementation

Medication risks and contraindications

›Medication hazards

›Loperamide avoidance in children with dysentery

›Bismuth salicylate avoidance in children

›Antibiotic associated diarrhea risk

›C difficile risk with recent antibiotics

04Diet/diet13

Recent intake pattern

›Intake and exposures

›Breastfeeding continuation

›Formula concentration changes

›New foods

›Excess fruit juice

›Sugar alcohol exposure

›High lactose intake after gastroenteritis

Hydration pattern

›Hydration details

›ORS use

›Water only intake

›Sports drinks

›Soda

›Caffeinated beverages

05Review of Systems/ros25

›GI symptoms

›Vomiting

›Abdominal pain

›Distension

›Blood in stool

›Constipation history

›Weight loss

›GU symptoms

›Urine output reduction

›Dysuria

›Flank pain

Respiratory

›Respiratory symptoms

›Cough

›Rhinorrhea

›Dyspnea

Neuro

›Neuro symptoms

›Lethargy

›Irritability

›Seizure

›Headache

Skin and MSK

›Skin and MSK symptoms

›Rash

›Petechiae

›Arthralgia

›Myalgia

06Collateral History and Family History/chafh14

Collateral source

›Collateral and reliability

›Caregiver historian reliability

›Daycare report

›Public health notification

Family history

›Familial conditions

›Inflammatory bowel disease

›Celiac disease

›Primary immunodeficiency

›Hemolytic uremic syndrome history

Household exposures

›Household context

›Sick contacts at home

›Food shared exposure

›Pets and animal contact

›Water source

07Risk Factors/rf18

Patient factors

›Patient risk profile

›Age under 6 months

›Prematurity

›Malnutrition

›Chronic disease

›Immunocompromised state

›Incomplete immunizations

Exposure risks

›Infectious exposure risks

›Daycare attendance

›Recent travel

›Untreated water exposure

›Farm or petting zoo exposure

›Reptile exposure

›Recent antibiotics

Complication risks

›Complication risk profile

›Prior dehydration hospitalization

›Limited caregiver support

›Barriers to oral rehydration at home

08Differential Diagnosis/ddx60

Life threatening

›Life threatening causes

›Sepsis (A41.9)

›Toxic appearance

›Hypotension for age

›Hypovolemic shock (R57.1)

›Poor perfusion

›Altered mental status

›Intussusception (K56.1)

›Colicky pain

›Lethargy

›Bloody stool

›Volvulus with malrotation (K56.2)

›Bilious vomiting

›Distension

›Hemolytic uremic syndrome (D59.3)

›Bloody diarrhea

›Pallor

›Oliguria

›Diabetic ketoacidosis (E10.10)

›Polyuria history

›Kussmaul breathing

Common

›Common causes

›Viral gastroenteritis (A08.4)

›Watery diarrhea

›Sick contacts

›Foodborne bacterial gastroenteritis (A05.9)

›Fever

›Abdominal cramping

›Antibiotic associated diarrhea (K52.1)

›Recent antibiotic exposure

›Non bloody diarrhea

›Functional toddler diarrhea (K59.1)

›Normal growth

›Excess juice intake

›Lactose intolerance after infection (E73.9)

›Worse with dairy

›Bloating

Less common

›Less common causes

›Giardiasis (A07.1)

›Foul smelling greasy stool

›Untreated water exposure

›C difficile infection (A04.7)

›Recent antibiotics

›Recent hospitalization

›Appendicitis (K35.80)

›RLQ tenderness

›Anorexia

›Inflammatory bowel disease (K50.90)

›Weight loss

›Nocturnal stools

›Celiac disease (K90.0)

›Growth faltering

›Chronic diarrhea

Key mimics and pitfalls

›Mimics and pitfalls

›Overflow diarrhea from constipation (K59.00)

›Stool withholding history

›Palpable stool burden

›UTI in young child with fever (N39.0)

›Fever without source

›Poor feeding

09Past Medical History/pmh16

Relevant conditions

›Chronic and prior conditions

›Prior dehydration episodes

›Prior hospitalization for gastroenteritis

›Congenital heart disease

›Chronic kidney disease

›Diabetes mellitus

›Inflammatory bowel disease

Surgeries and devices

›Surgical and device history

›Abdominal surgery history

›Short bowel syndrome

›Gastrostomy tube

›Central venous catheter

Baseline function

›Baseline status

›Baseline oral intake

›Baseline urine output pattern

›Baseline weight percentile trend

10Physical Exam/exam46

General and vitals

›General status

›Appearance

›Toxicity

›Consolability

›Work of breathing

›Vital sign interpretation

›HR for age

›BP for age

›RR for age

›Temperature

›Oxygen saturation

Hydration and perfusion

›Hydration assessment

›Mental status

›Eyes

›Tears

›Mucous membranes

›Skin turgor

›Capillary refill

›Peripheral pulses

›Extremity temperature

›Fontanelle in infants

HEENT

›HEENT findings

›Sunken eyes

›Dry mouth

›Otitis media signs

›Pharyngeal erythema

Abdomen

›Abdominal exam

›Distension

›Tenderness localization

›Guarding

›Rebound

›Bowel sounds

›Hepatosplenomegaly

›Mass

Skin and MSK

›Skin and MSK findings

›Rash

›Petechiae

›Purpura

›Signs of poor perfusion

›Joint swelling

Neuro

›Neuro status

›Alertness

›Lethargy

›Tone

›Irritability

›Seizure activity evidence

11Lab Studies/labs35

Point of care

›Bedside labs

›Glucose

›Hypoglycemia threshold 3.0 mmol/L

›Hyperglycemia trigger for DKA workup

›Capillary ketones when DKA concern

›Elevated ketones support DKA pathway

›Normal ketones support alternate diagnosis

Basic labs for dehydration or toxicity

›Dehydration and severity labs

›Electrolytes

›Sodium risk pattern

›Potassium risk pattern

›Urea and creatinine

›Prerenal azotemia pattern

›Baseline comparison when known

›Venous blood gas

›Metabolic acidosis pattern

›Severe acidosis triggers escalation

Infection and complication labs

›Infection complication labs

›CBC

›Leukocytosis support bacterial infection context

›Anemia and thrombocytopenia support HUS concern

›Blood culture when sepsis concern

›Higher yield in toxic or immunocompromised child

›Lower yield in mild gastroenteritis without red flags

Stool studies

›Stool testing indications

›Stool culture or multiplex PCR

›Bloody diarrhea

›Severe illness

›Outbreak public health needs

›Ova and parasites

›Persistent diarrhea over 14 days

›Travel exposure

›C difficile testing

›Recent antibiotics

›Recent hospitalization

12Imaging/img28

Scoring Systems

›Clinical severity tools

›Clinical Dehydration Scale

›Mild to moderate dehydration stratification

›Use with overall clinical judgment

›Gorelick dehydration scale

›Dehydration risk stratification

›Limited accuracy in some age groups

MRI

›MRI use cases

›IBD complications evaluation

›Perianal disease evaluation

›Avoid in unstable child

›Sedation risk consideration

›CT indications and cautions

›Complication concern

›Perforation concern

›Abscess concern

›Radiation risk discussion

›Contrast nephrotoxicity risk in dehydration

Ultrasound

›Ultrasound pathways

›Intussusception evaluation

›Target or donut sign

›Enema reduction pathway coordination

›Appendicitis evaluation

›Non compressible appendix

›Secondary signs

›Hydronephrosis when UTI concern

›Febrile infant pathway alignment

›Dehydration confounders

13Special Tests/spec14

Bedside tests

›Bedside diagnostics

›Urinalysis

›Febrile child without source

›Dehydration ketonuria confounder

›Stool occult blood testing

›Supports inflammatory diarrhea context

›Limited specificity

Procedural diagnostics

›Procedural and consult driven tests

›Air or contrast enema for intussusception

›Diagnostic and therapeutic

›Perforation risk awareness

›Lumbar puncture when meningitis concern

›Toxic appearance with neuro signs

›Local protocol dependent thresholds

14ECG/ecg11

When to obtain

›ECG indications

›Severe dehydration with electrolyte abnormalities

›Potassium abnormality concern

›Arrhythmia symptoms

High risk patterns

›ECG red flags

›QT prolongation

›Risk increased with electrolyte derangements

›Medication contribution review

›Wide QRS

›Hyperkalemia concern

›Immediate escalation pathway

15Assessment/ax19

Working diagnosis and severity

›Acute diarrhea syndrome

›Acute gastroenteritis likely (A09)

›Inflammatory diarrhea consideration (A09)

›Antibiotic associated diarrhea consideration (K52.1)

›Dehydration severity

›No dehydration

›Mild dehydration

›Moderate dehydration

›Severe dehydration

Complications to rule out

›High consequence complications

›Shock physiology

›HUS risk

›Surgical abdomen

›DKA risk when hyperglycemia pattern

Diagnostic uncertainty

›Alternative diagnoses

›UTI in young child with fever

›Appendicitis

›Intussusception

›IBD flare

16Plan/plan44

Approach to the critical patient

›First 5 minutes workflow

›Airway and breathing support if altered mental status

›Oxygen for hypoxemia

›Cardiac monitoring if shock or severe electrolyte concern

›IV or IO access if shock or severe dehydration

›Isotonic fluid bolus if shock

›20 mL per kg

›Reassess after each bolus

›Glucose check if lethargy or altered mental status

›Broad sepsis pathway if toxic with concern for bacterial source

Rehydration

›Rehydration strategy

›Oral rehydration solution for mild to moderate dehydration

›50 mL per kg over 4 hours for mild dehydration

›100 mL per kg over 4 hours for moderate dehydration

›Additional 10 mL per kg per stool

›IV fluids for severe dehydration or failed ORS

›Isotonic crystalloid

›Transition to deficit replacement and maintenance after stabilization

›Hypernatremia precautions

›Slow correction planning

›Sodium monitoring frequency per protocol

Antiemetic and symptom control

›Symptom control options

›Ondansetron for vomiting limiting ORS

›0.15 mg per kg PO once

›Maximum single dose 8 mg

›Antidiarrheals avoidance

›Loperamide avoidance in young children

›Avoid in bloody diarrhea or systemic toxicity

Targeted antimicrobials

›Antibiotic decision logic

›Avoid empiric antibiotics in suspected Shiga toxin producing E coli

›Bloody diarrhea without fever pattern concern

›HUS risk consideration

›Empiric antibiotics when severe dysentery with systemic toxicity

›Local resistance and protocol dependent selection

›Stool testing before antibiotics when feasible

›Suspected cholera context

›Profuse watery diarrhea with travel or outbreak context

›Public health notification pathway

Monitoring and reassessment loop

›Reassessment loop

›Vital signs reassessment after fluids

›Mental status reassessment

›Urine output monitoring

›Ongoing losses replacement planning

›Repeat electrolytes when IV rehydration ongoing

17Disposition/dispo24

ICU criteria

›ICU level care criteria

›Shock requiring ongoing boluses or vasoactive support

›Severe altered mental status

›Severe electrolyte derangements with ECG changes

›Severe acidosis with clinical instability

Inpatient admission criteria

›Admission criteria

›Severe dehydration

›Persistent inability to tolerate oral intake

›Failed ED oral rehydration pathway

›Suspected HUS

›Surgical abdomen concern

›Immunocompromised child with significant symptoms

›Social concerns limiting safe home care

Observation pathway criteria

›Observation criteria

›Moderate dehydration improving with ORS

›Need for serial reassessment

›Pending stool study with significant symptoms

Discharge criteria

›Discharge readiness

›Normal or improving vital signs

›Tolerating oral fluids

›Improving hydration exam

›Reliable caregiver

›Clear return precautions

›Follow up plan established

18Discharge Instructions/di24

Copy discharge instructions

›Home care summary

›Most childhood diarrhea is from a stomach infection and improves over a few days

›Focus on fluids to prevent dehydration

›Fluids and diet

›Use oral rehydration solution in small frequent sips

›Continue breastfeeding or usual formula

›Avoid juice and soda until better

›Medications

›Use acetaminophen for fever if needed

›Do not use anti diarrhea medicines unless told by a clinician

›If ondansetron prescribed take only as directed

›Follow up

›See your primary care clinician within 24 to 48 hours if not improving

›Earlier follow up for infants or children with medical complexity

›Return to emergency care now

›Trouble staying awake

›Blue lips or trouble breathing

›No urine for 8 hours

›Very dry mouth or no tears

›Blood in stool

›Green vomiting

›Severe belly pain

›Fever in an infant under 3 months

›Worsening weakness or dizziness

19References/r18

Guidelines and key sources

›Acute gastroenteritis in children guideline ESPGHAN ESPID 2014

›Oral rehydration as first line for mild to moderate dehydration

›Antiemetic use supports ORS success in selected patients

›NICE guideline Diarrhoea and vomiting caused by gastroenteritis under 5 years 2009 updated

›Dehydration assessment guidance

›Safety net and return precautions emphasis

›WHO guideline on diarrhoea treatment in children latest consolidated guidance

›ORS standards

›Dehydration classification framework

›IDSA clinical practice guideline for infectious diarrhea 2017

›Stool testing indications

›Empiric antibiotics cautions in suspected STEC

›CDC clinical overview of norovirus and acute gastroenteritis infection control

›Outbreak context considerations

›Supportive care emphasis

›Project instructions source

›Formatting and structure requirements

›Evidence labeling expectations

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.