Shigella Gastroenteritis (Infant/Toddler)

Shigella is an infection of the intestinal tract. It is caused by bacteria. It's more serious than common gastroenteritis or stomach flu, which is caused by a virus. It usually affects children between ages 2 and 4. Shigella infections cause diarrhea. Diarrhea is the passing of loose watery stools 3 or more times a day.

Symptoms of shigella infection include:

• Belly pain and cramping.
• Nausea and vomiting.
• Fever and chills.
• Bloody stools.

Shigella is very contagious. It spreads easily in day care centers and among household members. The bacteria are passed in the stool. Other children may be infected if they touch anything exposed to the diarrhea of the infected child. This could be diapers, clothing, toys, toilets, or food. Once the bacteria are on a child's hands, it can get into their mouth or nose. This will cause infection.

Illness begins 2 to 3 days after exposure. It may last 1 to 2 weeks if untreated. Antibiotics are sometimes used to treat this type of infection. The illness may last about 1 week if treated with an antibiotic. Shigella bacteria remain in the stool up to 4 weeks after the symptoms are gone. The infection can be passed to others during that time.

The main danger from this illness is dehydration. This is the loss of too much water and minerals from the body. When this occurs, your child's body fluids must be replaced. This can be done by giving your child oral rehydration solution. Oral rehydration solution is available at pharmacies and most grocery stores. Do not give sports drinks because they may contain too much sugar and not enough electrolytes.

Follow all instructions given by your child's doctor.

If giving medicines to your child:

• Don't give over-the-counter diarrhea medicines unless your child's doctor tells you to.
• If antibiotics were prescribed, make sure your child takes them every day until they're finished. Don't stop giving them if your child feels better. Antibiotics must be taken as a full course.
• You can use acetaminophen to control pain and fever. Or you can use other medicine as prescribed.
• Don't give aspirin or products containing aspirin to anyone younger than age 19 who has a fever. This may cause liver or brain damage due to a life-threatening condition called Reye syndrome.

To prevent the spread of illness:

• Remember that washing hands with soap and clean, running water or using alcohol-based sanitizer is the best way to prevent the spread of infection.
• Wash your hands before and after caring for your sick child.
• Clean the toilet after each use. Then wash your hands.
• Dispose of soiled diapers in a sealed container.
• Keep your child out of day care until your child's doctor says it's okay. This is usually when stool is contained in the diaper or the toilet-trained child doesn't have accidents, and bowel movements are no more than 2 over what is typical for your child.
• Wash your hands before and after preparing food.
• Wash your hands after using cutting boards, countertops, and knives that have been in contact with raw foods.
• Keep uncooked meats away from cooked and ready-to-eat foods.
• Teach all household members how to wash their hands.

The main goal while treating vomiting or diarrhea is to prevent dehydration. This is done by giving your child small amounts of liquids often.

If your baby is breastfed:

• For diarrhea. Keep breastfeeding. Feed your child more often than usual. If diarrhea is severe, give oral rehydration solution between feedings. As diarrhea decreases, stop giving oral rehydration solution and resume your normal breastfeeding schedule.
• For vomiting. After 2 hours with no vomiting, restart breastfeeding. Spend half the usual feeding time on each breast every 1 to 2 hours. If your child vomits again, reduce feeding time to 5 minutes on 1 breast only, every 30 to 60 minutes. Switch to the other breast with each feeding. Some milk will be absorbed even when your child vomits. As vomiting stops, resume your regular breastfeeding schedule.

If your baby is bottle-fed:

• Give small amounts of fluid at a time, especially if your child is vomiting. One or 2 ounces every 30 minutes may improve symptoms.
• For diarrhea. Give full-strength formula or milk. If diarrhea is severe, give oral rehydration solution between feedings. If giving milk and the diarrhea isn't getting better, stop giving milk. In some cases, milk can make diarrhea worse. Try soy or lactose-free formula. Don't give apple juice, soda, sports drinks, or other sweetened drinks. Drinks with sugar can make diarrhea worse. If your child starts doing worse with food, go back to clear liquids.
• For vomiting. After 2 hours with no vomiting, try giving regular formula or milk. If at any time the child starts to vomit again, go back to small amounts of clear liquids. Start with small amounts and increase the amount as tolerated.
• If your child is doing well after 24 hours, resume a regular diet and feeding schedule.

If your child is on solid food:

• Keep in mind that liquids are more important than food right now. Give small amounts of liquids at a time, especially if your child is having stomach cramps or vomiting.
• For diarrhea. If you're giving milk to your child and the diarrhea isn't going away, stop the milk. In some cases, milk can make diarrhea worse. If that happens, use oral rehydration solution instead. If diarrhea is severe, give oral rehydration solution between feedings.
• For vomiting. Start with oral rehydration solution at room temperature. Give 1 teaspoon (5 ml) every 5 minutes. Even if your child vomits, continue to give oral rehydration solution. Much of the liquid will be absorbed, despite the vomiting. After 2 hours with no vomiting, start with small amounts of milk or formula and other fluids. Increase the amount as tolerated. Don't give your child plain water, milk, formula, or other liquids until vomiting stops. As vomiting decreases, try giving larger amounts of oral rehydration solution. Space this out with more time in between. Continue this until your child is making urine and is no longer thirsty (has no interest in drinking). After 4 hours with no vomiting, restart solid foods. After 24 hours with no vomiting, resume a normal diet.
• You can resume your child's normal diet over time as they feel better. Don't force your child to eat, especially if they're having stomach pain or cramping. Don't feed your child large amounts at a time, even if they're hungry. This can make your child feel worse. You can give your child more food over time if they can tolerate it. For babies age 4 months or older, you can give cereal, mashed potatoes, applesauce, mashed bananas, or strained carrots during this time. For children age 1 or older, you can add crackers, white bread, rice, and other complex starches, lean meats, yogurt, fruits, and vegetables. Low-fat diets are easier to digest than high-fat diets.
• If the symptoms come back, return to a simple diet or clear liquids.

Follow up with your child's doctor, or as advised. If a stool sample was taken or cultures were done, call the doctor for the results as instructed.

Call 911 if your child has any of these symptoms:

• Trouble breathing
• Confusion
• Unusual or extreme drowsiness or loss of consciousness
• Trouble walking
• Rapid heart rate
• Stiff neck
• Seizure

Contact your child's doctor or get medical care right away if any of these occur:

• Belly pain that gets worse
• Constant lower right belly pain
• Repeated vomiting after the first 2 hours on liquids
• Occasional vomiting for more than 24 hours
• More than 8 diarrhea stools within 8 hours
• Continued severe diarrhea for more than 24 hours
• Blood or black material in vomit or stool
• Refusal to drink or feed
• Dark urine or no urine for 4 to 6 hours, no tears when crying, sunken eyes, or dry mouth
• Fussiness or crying that can't be soothed
• New rash
• Diarrhea lasts more than 10 days
• Chest pain
• Fever (see Fever and children, below)
• New symptoms

Shigella often causes a fever. Unless otherwise advised by your child's doctor, follow these general guidelines for when to call about a fever.

Use a digital thermometer to check your child's temperature. Don't use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 months, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The doctor may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.
• Mouth (oral). Don't use a thermometer in your child's mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker's directions for correct use. Insert it gently. Label it and make sure it's not used in the mouth. It may pass on germs from the stool. If you don't feel okay using a rectal thermometer, ask the doctor what type to use instead. When you talk with any doctor about your child's fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child's doctor may give you different numbers for your child. Follow your doctor's specific instructions.

Fever readings for a baby under 3 months old:

• First, ask your child's doctor how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher
• Armpit: 101°F (38.3°C) or higher

Contact the doctor in these cases:

• Repeated temperature of 104°F (40°C) or higher in a child of any age
• Fever of 100.4° (38°C) or higher in baby younger than 3 months
• Fever that lasts more than 24 hours in a child under age 2
• Fever that lasts for 3 days in a child age 2 or older