Rotavirus gastroenteritis and rehydration

Rotavirus is a virus that infects the enterocytes (the absorptive cells lining the small intestine). The gut then absorbs less water and salt, so the child passes watery stools, often with vomiting and fever. It spreads very easily from child to child by the faecal-oral route (germs passed from stool to mouth), which explains an outbreak in a nursery.

In a healthy child the illness is self-limiting, meaning it settles by itself as the immune system clears the virus, usually within a few days. There is therefore nothing to cure, and the task is to replace what is lost. The real danger is dehydration (too little water in the body) together with loss of electrolytes (salts such as sodium and potassium), and children can become dehydrated more quickly than adults.

Management is supportive care: treatment that keeps the child well while the body recovers, without targeting the virus. Assess how dehydrated the child is, then offer oral rehydration solution (a measured mix of water, salts and sugar that the gut can absorb) in frequent small sips, even when the child is vomiting. Breast or bottle feeds carry on. Intravenous fluids (given into a vein) are kept for a child who cannot keep fluids down or is severely dehydrated.

Antibiotics do not act on a virus, so they are kept for suspected or proven bacterial infection. Loperamide is an antimotility drug (it slows the gut so stools are passed less often), but it is not suitable for young children and does nothing to replace the water and salts already lost.