A recent study described the courses of vomiting, diarrhea, fever, and clinical deterioration, in children with uncomplicated gastroenteritis at presentation. This study came as a 7-day prospective follow-up study in an out-of-hours primary care service. It analyzed the course of vomiting, diarrhea, and fever by generalized linear mixed modeling. 

Since young children (≤ 12 months) and children with severe vomiting are at increased risk of dehydration, the study describes potentially more complicated courses of these groups separately. It also describes the day(s) most frequently associated with deterioration and the symptoms present in children who deteriorated during follow-up.

The study included 359 children who presented with uncomplicated acute gastroenteritis to the out-of-hours primary care service. Among these, 8.6% developed a complicated illness and needed referral or hospitalization. 90% of children showed a reduction in all symptoms within five days. They showed a rapid decrease in vomiting and fever; however, diarrhea decreased somewhat slower, especially among children aged 6–12 months. Children who deteriorated during follow-up had a higher frequency of vomiting at presentation, while higher frequencies of vomiting along with fever during follow-up.

Thus this study describes that the frequency of vomiting, not its duration, is the more important predictor of deterioration. It is important to educate the parents about the typical symptom duration and advice them to focus on alarm symptoms. Clinicians should be vigilant for children with higher vomiting frequencies at presentation and during follow-up since these children are more likely to deteriorate.

Weghorst AAH, Bonvanie IJ, Holtman GA. et al. course of uncomplicated acute gastroenteritis in children presenting to out-of-hours primary care. BMC Prim. Care. 2022;23. https://doi.org/10.1186/s12875-022-01739-2