These include rotavirus, enteric adenovirus, Norwalk-like viruses, astrovirus and other small round viruses. Bacteria and parasites also cause a significant portion of infantile and childhood diarrheal disease. Forty percent of cases are idiopathic. 5 y. Children attending day care centers may have rates 3 times higher. Norwalk virus is a more common virus in school age and adolescent age children.
Outbreaks occur yearly in schools, camps and other group settings.
Infants and small children are at higher risk for significant volume depletion. Risk is greater if history reveals limited parental resources, history of prematurity, inadequate prenatal care, and presence of high fever or other significant symptoms. Assessment of volume depletion by history and physical examination guides the therapy of patients with uncomplicated gastroenteritis. Pertinent questions related to etiological factors will help differentiate viral gastroenteritis from invasive bacterial disease, food poisoning, appendicitis, urinary infections and other diseases. Urine output may be difficult to determine if all diapers are soiled by watery stool.