Shigella Gastroenteritis (Child)

Front view of boy showing digestive tract.

Shigella is an infection of the intestinal tract. It is cause by bacteria. It is more serious than common gastroenteritis or "stomach flu" caused by a virus. Shigella infections cause loose watery stools (diarrhea). Stools might be bloody. Your child may have abdominal pain and cramping. Other symptoms of shigella infection include nausea, vomiting, and fever.

Shigella is very contagious. It is easily spread in daycare centers and among household members. The bacteria are passed in the stool. Other children and adults may be infected if they touch anything exposed to the diarrhea of the infected child and then touch their nose or mouth. This could be diapers, clothing, toys, toilets, or food. Once the bacteria are on a child's hands, they can get into his or her mouth or nose. This will cause infection. Therefore, good hand washing is essential to prevent spread of the illness.

Illness starts 2 to 4 days after exposure. It may last 1 to 2 weeks if untreated. It is diagnosed with a stool culture. This may take several days to result.  Antibiotics are sometimes used to treat this type of infection. Your healthcare provider will advise you if your child needs antibiotics. Your child will likely feel better within one week of treatment. However, shigella bacteria remain in the stool up to 4 weeks after the symptoms are gone. The infection can still 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. In more severe cases, your child may need treatment for dehydration in the hospital.

Home care

Follow all instructions given by your child’s health care provider.

If giving medicines to your child:

  • Don’t give over-the-counter diarrhea medicines unless your child’s healthcare provider tells you to.

  • If antibiotics were prescribed, make sure your child takes them every day until they are finished or you are told to stop, even if your child feels better. 

  • Use other medicine as prescribed. Unless told otherwise, you can give your child acetaminophen or ibuprofen to control pain and fever. (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.)

  • Your child's healthcare provider may prescribe an oral antiemetic medicine if vomiting persists despite dietary precautions.

To prevent the spread of illness:

  • Good handwashing with soap and water 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.

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

  • 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, countertops, and knives that have been in contact with raw foods.

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

Giving liquids and food

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

  • Keep in mind that liquids are more important than food right now. Give your child small amounts of liquids at a time, especially if the 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. In some cases, milk can make diarrhea worse. If that happens, use oral rehydration solution instead. Do not give apple juice, soda, sports drinks, or other sweetened drinks. Drinks with sugar can make diarrhea worse.

  • 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 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. Foods you can give include cereal, mashed potatoes, applesauce, mashed bananas, crackers, dry toast, rice, oatmeal, bread, noodles, pretzels, soups with rice or noodles, and cooked vegetables.

  • 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 loss of consciousness

  • Trouble walking

  • Rapid heart rate

  • Stiff neck

  • Seizure

When to seek medical advice

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

  • Symptoms worsen after 3 days of treatment

  • Diarrhea lasts more than one week on antibiotics

  • More than 8 diarrhea stools within 8 hours

  • 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

  • Continued severe diarrhea for more than 24 hours

  • Blood in vomit or stool

  • Reduced oral intake

  • Signs of dehydration: Very dark urine, no urine for 8 hours, no tears when crying, sunken eyes, or dry mouth

  • Fussiness or crying that cannot be soothed

  • Unusual drowsiness

  • New rash

  • Fever (see Fever and children, below)

Shigella often causes a fever. Unless advised otherwise by your child's healthcare provider, call your provider right away based on these guidelines:

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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