As you know, foodborne illnesses are quite common. Per the Centers for Disease Control and Prevention, approximately 40 million children per year develop foodborne illness. That number may actually be far higher as many of the kids have very mild symptoms, such as mild nausea or vomiting, and never even seek care. So keep that in mind when evaluating children who come in with simple signs of gastroenteritis such as nausea, vomiting, and diarrhea.
Symptoms tend to develop within 6 hours of food ingestion. Ingestion of undercooked meats or eggs, for example, infected by bacteria will quickly produce the symptoms of foodborne illness. Typically, those include nausea and vomiting, as I had mentioned. Severe abdominal cramping may occur. Diarrhea may be bloody in the case of bacterial illnesses such as Escherichia coli or Salmonella species.
Fortunately, complications from foodborne illnesses are very rare. Patients may develop dehydration, and therefore treatment is centered around encouraging hydration for children. It is important to encourage parents to use electrolyte solutions, such as Pedialyte® (Abbott Nutrition; Columbus, Ohio), to maintain hydration through the acute illness.
In most cases, illnesses will resolve within 24 hours and children do not even need to seek care. In rare cases, however, the disease may become quite severe with severe dehydration leading to decreased urine output and an inability to keep up with their losses. In those cases, it would be important for you to refer the patient to the emergency department to receive intravenous hydration through the acute phase of the illness.
In rare cases patients may develop hemolytic uremic syndrome (HUS), a severe complication more often associated with E coli foodborne illness, although it can occur from other species of bacteria as well. HUS can be quite severe with complications that may include renal failure, thrombocytopenia, and anemia. Symptoms of HUS typically occur 5 days after resolution of the diarrhea and include altered mental status, petechiae, purpura, and lack of urine output. It is important to promptly refer those patients to the emergency department so they can be treated properly and receive the care necessary to avoid some severe complications.
One question that often comes up is that of antibiotic therapy. Because many foodborne illnesses are bacterial in origin but self-limited, antibiotics are often not necessary and treatment can be focused solely on hydration. In some cases, such as that of norovirus, the etiology is viral and no antibiotic treatment is necessary. So, for the child with suspected foodborne illness, focus on hydration, look to avoid severe dehydration, monitor for signs of HUS, and remember that there is no need for antibiotics in treatment of these patients.
Thank you. This is Rakesh Mistry from The Children’s Hospital of Philadelphia.