Certain clinical findings may indicate that a child with vomiting and/or diarrhea does not have simple viral gastroenteritis.


Patient selection: pediatric patient (< 5 years for the guideline, but findings should apply to older pediatric patients as well) with vomiting and/or diarrhea


Findings suggesting a diagnosis other than viral gastroenteritis:

(1) fever (>= 38°C if an infant < 3 months old; >= 39° if >= 3 months old)

(2) tachypnea and/or shortness of breath

(3) decreased level of consciousness

(4) neck stiffness

(5) severe or localized abdominal pain

(6) abdominal distention

(7) rebound tenderness over the abdomen

(8) non-blanching rash

(9) bulging fontanelle in an infant

(10) bile-colored vomit

(11) stool with blood, mucus and/or white blood cells


Historical findings which should prompt a careful evaluation of the patient:

(1) past history of bowel obstruction

(2) past history of abdominal surgery

(3) immunocompromised status


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