00:02
So if you see a child with
vomiting and/or diarrhea,
what are key things you want to ask?
First is obviously fever.
00:10
Children with infectious diarrhea
typically may have a fever.
00:14
Ask about blood or mucus in the stool.
00:16
This may tip you off if this is bacterial
as opposed to a viral pathogen.
00:22
Most bacterial gastroenteritis
requiring treatment is bloody.
00:28
Ask about exposure to
farm animals or reptiles.
00:31
This is actually a really
important question
because a common cause of salmonella
in children is reptile pets
and a common cause of E. coli,
especially the variety that
causes hemolytic uremic syndrome,
is from farm animal exposure.
00:49
Petting zoos are a big
problem in the United States
if children don’t wash their hands with
alcohol after they pet the animals.
00:58
Suspicious foods are
always a potential cause
and we hear about
outbreaks all the time.
01:03
For example, E. coli in spinach,
this happens periodically
and so when such a thing
happened, you might ask
about suspicious or
also undercooked foods,
things like uncooked eggs, which
might show up in raw cookie dough.
01:17
Ask about recent travel.
01:18
Recent travel’s important because
there are some causes of diarrhea
that are unusual in
the United States
that may be more prevalent
in developing countries.
01:27
And of course, as about
recent antibiotic use
because C. diff is a possibility as well
as the antibiotic-associated diarrhea.
01:37
So on exam, critically important
to look for signs of dehydration.
01:42
Tenting is rare and is only at
extreme ends of dehydration.
01:47
Mostly, you’re going to look at mucus
membranes and see if they’re moist.
01:50
See if the child is making
tears when they cry.
01:53
Look for sings of systemic infection.
01:55
Is there something else going on.
01:57
The abdominal exam is critical especially,
especially looking for rebound guarding,
things like that where the child doesn’t
want you pressing on their abdomen.
02:07
In babies, this can be tricky.
02:09
The baby, if you’re careful, will seem to
resist you if you squeeze on their belly.
02:15
But in a crying baby who doesn’t want
to be examined in the first place,
this can be a challenge.
02:20
A perianal inspection is
important on children
especially if you’re concerned
about inflammatory bowel disease.
02:27
Sometimes, a rectal tag or fissure
is the best clue you have that
the child has Crohn’s disease.