Salmonella Gastroenteritis (Baby/Toddler)

Salmonella is a kind of bacteria that is carried by some animals. This includes chickens, turkeys, cows, pigs, turtles, lizards, iguanas, dogs, and cats. People can get it by eating food that comes from an infected animal. This includes raw eggs and raw or undercooked meat. It can also be passed by food or water that has come in contact with the feces of an infected animal or person.

This infection occurs most often in children under 5. Children with immune system problems are at higher risk for more severe illness.

A salmonella infection can cause symptoms, such as:

  • Nausea

  • Vomiting

  • Abdominal cramps or pain

  • Diarrhea, sometimes with blood

  • Fever

  • Headache

Symptoms appear within 2 days of exposure. They usually go away after 3 to 7 days.

Antibiotics are sometimes given to treat this illness. Mild symptoms will get better without any antibiotic treatment. More severe illness or those at high risk will need antibiotics.

The main danger from this illness is dehydration. This is the loss of too much water and minerals from the body. When this occurs, body fluids must be replaced. This can be done with oral rehydration solution (ORS). This is available at drugstores and most grocery stores. Don't use sports drinks. They are not appropriate for babies or toddlers.

Home care

Follow all instructions given by your child’s healthcare provider.

If giving medicines to your child:

  • Don’t give over-the-counter diarrhea medicines unless your child’s healthcare provider tells you to. These can make the illness last longer.

  • If antibiotics were prescribed, make sure your child takes them every day until they are finished. Don’t stop giving them if your child feels better. Antibiotics must be taken as a full course.

  • You can use acetaminophen or ibuprofen to control pain and fever. Or, you can use other medicine as prescribed.

  • Don’t give aspirin to anyone under 18 years of age who has a fever. This may cause liver damage and a life-threatening condition called Reye syndrome.

To prevent the spread of illness:

  • Remember that washing with soap and water and 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 or the diaper change area after each use. Dispose of soiled diapers in a sealed container.

  • Keep your child out of day care until your child's healthcare provider says it's OK.

  • Teach your child to wash his or her hands after using the toilet and before meals. This is very important if your child is in day care.

  • Make sure your child avoids contact with the feces of reptiles (turtles, lizards, and iguanas), birds, dogs, and cats. Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.

  • Wash your hands before and after preparing food. Keep in mind that people with diarrhea or vomiting should not prepare food for others.

  • Wash your hands after using cutting boards, counter tops, and knives that have been in contact with raw foods.

  • Wash and then peel fruits and vegetables.

  • Keep uncooked meats away from cooked and ready-to-eat foods.

  • Wash all cooking utensils (including cutting boards) after they touch raw food.

  • Use a food thermometer when cooking. Cook poultry to at least 165°F (74°C). Cook ground meat (beef, veal, pork, lamb) to at least 160°F (71°C). Cook fresh beef, veal, lamb, and pork to at least 145°F (63°C).

  • Don’t serve raw or undercooked eggs (poached or sunny side up), poultry, meat, or unpasteurized milk and juices to your child.

  • Don't eat foods prepared with unpasteurized milk.

Giving liquids and feeding

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

If your baby is breastfed, continue breastfeeding. Breastmilk usually contains all the fluids and electrolytes he or she needs. 

If your baby is breastfed:

  • For diarrhea: Breastfeed your child more often than usual. If diarrhea is severe, give ORS between feedings. As diarrhea decreases, stop giving ORS 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 one 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, frequent amounts of fluid at a time, especially if your child is vomiting. An ounce or two (30 to 60 mL) every 30 minutes may improve symptoms. Start with 1 teaspoon (5 mL) every 5 minutes and increase gradually as tolerated.

  • For diarrhea: Give full-strength formula or milk. If diarrhea is severe, give ORS between feedings. If giving milk and the diarrhea is not getting better, stop giving milk. In some cases, milk can make diarrhea worse. Try soy or rice formula. Don't give apple juice, soda, 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 are giving milk to your child and the diarrhea is not going away, stop the milk. Most children can tolerate milk even though they have diarrhea. However, in some cases, milk can make diarrhea worse. If that happens, use ORS instead. If diarrhea is severe, give ORS between feedings.

  • For vomiting: Begin with ORS at room temperature. Give 1 teaspoon (5 ml) every 5 minutes. Even if your child vomits, continue to give ORS. 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 ORS. 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 he or she feels better. Don’t force your child to eat, especially if he or she is having stomach pain or cramping. Don’t feed your child large amounts at a time, even if he or she is hungry. This can make your child feel worse. You can give your child more food over time if he or she can tolerate it. For a baby over 4 months, 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, crackers, 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, go back to a simple diet or clear liquids.

Follow-up care

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

Call 911

Call 911 if your child has any of these symptoms:

  • Trouble breathing

  • Confusion

  • Extreme drowsiness or trouble walking

  • Loss of consciousness

  • Rapid heart rate

  • Stiff neck

  • Seizure

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Abdominal pain that gets worse

  • Constant lower right abdominal 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

  • Unable to eat or drink

  • Blood in vomit or stool

  • Refusal to drink or feed

  • Dark urine or no urine for 6 hours, no tears when crying, sunken eyes, or dry mouth

  • Fussiness or crying that cannot be soothed

  • Unusual drowsiness

  • New rash

  • Diarrhea lasts more than 1 week

  • Fever (see Fever in children, below)

Fever and children

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 years, 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 provider 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 he or she is 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 OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

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

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider 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

Call the healthcare provider 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

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