Management of childhood gastroenteritis in the community

Good evidence-based research exists for the management of gastroenteritis. However, we encountered local anecdotal evidence of wide variations in the management of gastroenteritis. In order to assess the prevailing practice in gastroenteritis management in primary care, in the Tees Health region, an anonymous questionnaire study involving general practitioners (GPs) and health visitors (HVs) was perform ed. Three case scenarios were presented in the questionnaire, involving a b reast-fed infant, a formula-fed infant and a four-y-old child all with diar rhoea and vomiting, but able to tolerate oral fluids and not ill enough to need hospital admission. Most GPs (78.6%) and HVs (80.5%) advised continuation of breast-feeding, th ough the practice of giving advice to stop breast-feeding, starve the child and substitute inappropriate fluids such as flat coke, was still common. F or infants who were bottle-fed, this inappropriate advice was given much mo re commonly (only 25.6% and 52.8% of GPs and HVs, respectively gave advice to continue bottle-feeding). This was even more true for the four-y-old, fo r whom advice to continue with a normal diet was very much the exception (7 .7% of GPs and 19.5% of HVs). Advice given to parents of children with gastroenteritis was inconsistent a nd, in many cases, inappropriate, This has implications for clinical govern ance. There is an urgent need for the development and implementation of loc al guidelines.