Shigella Gastroenteritis (Infant/Toddler)

Outline of infant showing digestive system.

Shigella is an infection of the intestinal tract. It is caused by bacteria. It is more serious than common gastroenteritis or “stomach flu,” which is caused by a virus. It usually affects children between 2 to 4 years old. 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 is easily spread in daycare 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, they can get into his or her 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 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.

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.

  • 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 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.

  • 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.

  • 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.

Giving liquids and feeding

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 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 amounts of fluid at a time, especially if your child is vomiting. An ounce or two 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 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, 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 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. 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 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 babies 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, 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 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:

  • 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

  • Unusual drowsiness

  • New rash

  • Diarrhea lasts more than 10 days

  • Chest pain

  • Fever (see Fever and children, below)

Shigella often causes a fever. Unless otherwise advised by your healthcare provider, follow these general guidelines for when to call for a fever.

 

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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