What is the significance of mucous and blood in stools in pediatric patients with viral gastroenteritis (viral inflammation of the stomach and intestines)?

From the Guidelines

Blood and mucus in stools during pediatric viral gastroenteritis is uncommon but can occur in severe cases, and parents should seek medical attention promptly if their child has bloody stools, especially if accompanied by high fever, severe abdominal pain, or signs of dehydration. The presence of blood and mucus in stools should prompt consideration of other diagnoses such as bacterial infection (like Shigella, Salmonella, or E. coli), inflammatory bowel disease, or intussusception 1. Management focuses on maintaining hydration with oral rehydration solutions like Pedialyte, given in small frequent amounts, as recommended by the Centers for Disease Control and Prevention 1. Continue age-appropriate nutrition as tolerated, avoiding sugary drinks and dairy temporarily if they worsen symptoms. Antipyretics like acetaminophen (10-15 mg/kg every 4-6 hours) can be used for fever, and most cases resolve within 5-7 days 1. However, persistent bloody diarrhea beyond this timeframe requires medical evaluation for possible stool culture and further treatment. It is essential to note that rotavirus infection, a common cause of viral gastroenteritis, typically presents with acute onset of fever and vomiting followed by watery diarrhea, and severe disease tends to occur most often in children between 3 and 24 months of age 1. In any case, the key to managing pediatric viral gastroenteritis with blood and mucus in stools is to ensure proper hydration, monitor for signs of dehydration, and seek medical attention if symptoms worsen or persist. Some key points to consider include:

• The importance of oral rehydration solutions in managing dehydration
• The need to avoid sugary drinks and dairy if they worsen symptoms
• The use of antipyretics like acetaminophen for fever management
• The potential for other diagnoses, such as bacterial infections or inflammatory bowel disease, if symptoms persist or worsen
• The typical presentation and course of rotavirus infection, a common cause of viral gastroenteritis in children.

From the Research

Mucous and Blood in Stools in Pediatric Viral Gastroenteritis

• The presence of blood and mucus in stools can be an indicator of the cause of gastroenteritis in children, with bacterial infections more likely to present with these symptoms than viral infections 2.
• A study found that blood and mucus in the stool, as well as a high C-reactive protein level, were more significantly associated with bacterial gastroenteritis than viral gastroenteritis 2.
• However, it is also noted that the diagnostic value of etiologic tests, including bacterial stool cultures and viral antigen tests, is low when based on clinical characteristics of acute gastroenteritis in pediatric patients 2.
• In cases of viral gastroenteritis, vomiting is a more common symptom than blood or mucus in the stool 2.
• The management of pediatric viral gastroenteritis typically involves oral rehydration therapy, with the goal of preventing dehydration and electrolyte imbalance 3, 4.
• In some cases, ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 3, 4.
• Laboratory tests, including stool microbiological tests, are not routinely needed for children with mild illness and a likely diagnosis of viral gastroenteritis 4, 5.