II. Indications: Urgent or emergent evaluation for red flag symptoms and signs

  1. Fever
    1. Age <3 months: Temperature > 100.4 F (38 C)
    2. Age >3 months: Temperature > 104 F (40 C)
  2. Caregiver report of dehydration signs
    1. See Pediatric Dehydration
    2. Decreased tearing (sensitive parent reported marker for dehydration)
    3. Decreased fluid intake
    4. Decreased Urine Output
      1. Age <1 year old: last urine >8 hours earlier
      2. Age >1 year old: last urine >12 hours earlier
    5. Dry mucous membranes
    6. Cyanosis
    7. Poor peripheral perfusion
  3. Mental status changes
    1. Lethargy
    2. Excessive irritability or inconsolable crying
    3. Altered Level of Consciousness
  4. Ill appearance
    1. Toxic appearance
    2. Tachypnea
    3. Petechiae
  5. Failure of Oral Rehydration Solution
    1. Persistent Vomiting
    2. Failure to improve with Oral Rehydration Solution
  6. Inflammatory Diarrhea signs
    1. Tenesmus
    2. Bloody Diarrhea
  7. Vomiting characteristics
    1. Bilious Vomiting
    2. Bloody Vomiting (Hematemesis)
  8. High-risk child
    1. Younger than 6 months of age or less than 17 pounds (7-8 kg)
    2. Premature Infant
    3. Chronic comorbidity
  9. Moderate to severe Diarrhea
    1. More than 10 stools per day
    2. Substantial volume
    3. Prolonged course longer than 2 weeks
  10. References
    1. (2003) King MMWR Recomm Rep 52(RR-16): 1-16 [PubMed]
    2. Van Den Bruel (2010) Lancet 375(9717): 834-45 [PubMed]

III. Indications: Routine clinical evaluation

  1. Recurrent Diarrhea or persistent Diarrhea >2 weeks
    1. Suggests parasitic Diarrhea
  2. Inflammatory Diarrhea (Bacterial Diarrhea)
    1. Flecks or streaks of blood in stool
    2. Diarrhea for longer than 1 week
      1. Not indicated for only persistent soft stools
      2. Also consider Lactose-Free Diet
    3. Mucus or pus in stool
    4. Fever for longer than 72 hours
    5. Stool Incontinence

IV. Management: Home recommendations

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