Norovirus In Children: Symptoms, Causes, And Diagnosis

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An infection due to norovirus in children leads to acute gastroenteritis, which is the inflammation of the stomach and intestinal lining. Gastroenteritis is the most common symptom of norovirus infection in children. The virus spreads easily in public places such as schools, restaurants, and hospitals (1).

This contagious infection may affect a child more than once. As per the Centers for Disease Control and Prevention, nearly 200 million children under the age of five years are infected by the norovirus each year (2). Since norovirus spreads via the fecal-oral route, its spread can be terminated by following a few simple steps.

Read on to learn more about these preventive measures, the symptoms, risk factors, and treatment for norovirus infection in children.

How Long Does The Norovirus Infection Last?

Generally, the infection caused by norovirus lasts for 4-5 days in a child. However, once your child tests positive with the symptoms of norovirus, they are contagious (3).

Even after recovery, your child could be a carrier of the virus for up to two weeks, making them contagious to others (3). Although it may not be life-threatening, the virus may lodge itself within the intestine and cause irritable bowel syndrome for a few days. Hence, as a precaution, your child must maintain exceptional personal hygiene for at least two weeks after their recovery to avoid contamination.

Norovirus Symptoms In A Child

Norovirus has an incubation period of 12 to 48 hours (4). The symptoms of the infection are similar to that of any other gastrointestinal disease. Diarrhea is the predominant sign. The virus, after its entry, destroys the function of the intestinal lining and leads to malabsorption of water. This results in secretory diarrhea followed by severe to moderate dehydration. If severe, it can cause severe dehydration. A few other symptoms may include (3):

You may contact your healthcare provider if your child shows the following additional symptoms (3)(5).

  • Bloody diarrhea
  • Vomiting with green or red discharge
  • Abdominal pain
  • Insomnia
  • Reduced intake of liquids or inability to consume liquids
  • Excessive irritability

Causes And Risk Factors For Norovirus Infection

Norovirus often affects those with a compromised immune system (4). Also, it spreads quickly in crowded areas. Children are physically near each other in schools and healthcare centers, so they are more susceptible to catching this stomach bug.

This virus spreads through the following ways (4).

  • Sharing a utensil or cutlery with other ill people
  • Eating or drinking contaminated food and water (especially when the food handler is infected)
  • Maintaining close contact with infected people
  • Consuming raw or undercooked meat, especially seafood
  • Swimming in an unclean and contaminated pool
  • Not maintaining proper personal hygiene after contacting a person infected with norovirus
  • Consuming improperly washed raw fruits and vegetables
  • Touching nose, mouth, and eyes with unclean hands

An asymptomatic carrier of norovirus could release the virus in their stools for up to two weeks after their recovery (3). As this virus spreads easily via the fecal-oral route, improper personal hygiene by such asymptomatic carriers could result in an outbreak. Similarly, dirty diapers from an infected baby could also be the reason for the spread in some cases.

How Is Norovirus Infection Diagnosed?

Norovirus infection is mostly diagnosed based on the symptoms since it is a short-term illness. But sometimes, your pediatric gastroenterologist may test your child’s stool sample to confirm their speculation (4). Blood tests may also be conducted to check for infection markers and rule out other problems.

Complications Of Norovirus Infection

As vomiting and diarrhea are the predominant symptoms of a norovirus infection, severe dehydration is a common complication. Decreased urinary output, tearless crying, dry mouth, and dizziness are a few severe signs of dehydration that warrant prompt medical attention (6).

Treatment For Norovirus In Children

Norovirus infection recedes on its own within two to three days with proper bed rest. However, since dehydration is inevitable, it is recommended you give your child plenty of fluids, especially oral rehydration solutions. (6).

Avoid providing any fluids up to 30 minutes after a vomiting and diarrhea episode. Start with clear liquids such as water, oral rehydration solution (ORS), juices, broths, ice chips, or Jello-O. Gradually increase the quantity of liquids. If your child accepts fluids for 12 hours, gradually include soft and bland food into their diet (7).

Abstain from giving your child any anti-diarrheal or anti-vomiting pills unless suggested by a doctor. In norovirus infection, the more these microorganisms are discarded from the body (through diarrhea), the higher the recovery rate. Also, since it is a viral disease, antibiotics are not effective.

Prevention Of Norovirus Infection In Children

Norovirus causes a transmissible disease. Hence, one can restrict the spread of norovirus by taking a few preventive measures. Here are the safety measures to follow during a norovirus outbreak (7) (8).

  1. Teach your children to wash their hands regularly with soap and water, especially after defecation. If there’s no access to water, they may use hand sanitizers.
  1. Avoid cooking any food if you are unwell with a gastrointestinal infection. You and your child must also abstain from consuming food prepared by an ill person.
  1. Clean the common contamination surfaces with a bleach-based cleaner.
  1. Wash your hands properly with soap and water after changing a baby’s diaper.
  1. Clean raw fruits and vegetables properly before consumption.
  1. Avoid eating food cooked unhygienically, especially food cooked in unhygienic restaurants.
  1. Abstain from eating undercooked or raw seafood, especially oysters.
  1. Seal a baby’s diapers carefully and discard them is a locked cover. It would be best if you also used gloves while changing the diaper.
  1. Avoid sending your children to school during the infection and three days after the symptoms reduce.
  1. Refrain from traveling during an outbreak or if you seem symptomatic.
  1. Teach your children to avoid putting their fingers in their mouths.
  1. Wash all the clothes, linens, and utensils used by a norovirus-infected person before reusing them.
  1. Do not send your child to swimming pools during an outbreak season. Also, prevent them from visiting a pool if they’ve recently suffered from diarrhea.

Infection due to norovirus in children may last for around five days and cause various symptoms. Though seen throughout the year, a norovirus outbreak is usually more common between November and April (9). If you notice any symptoms of norovirus infection in your child, seek medical attention. Also, give plenty of fluids and ensure they get proper rest and a healthy diet to help relieve their symptoms. It is worth remembering that prevention is the best way to reduce viral transmission. Hence, practice good hygiene and safety measures while cooking to prevent infection.

Key Pointers

  • Norovirus is an extremely contagious virus that causes a gastrointestinal infection, which lasts four to five days in a child.
  • Its incubation period is 12 to 48 hours, and common symptoms are diarrhea, vomiting, low-grade fever, chills, fatigue, and body ache.
  • Close contact with an infected person, eating/drinking contaminated food/water, and consuming raw/undercooked meat are ways the virus spreads.
  • The infection self-limits within two to three days with proper bed rest and sufficient hydration using oral rehydration solutions.
  • Maintaining optimum hygiene, cleaning raw fruits and veggies before eating, and sanitizing contaminated surfaces can help prevent the infection.

References:

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Dr. Mubina Agboatwalla

(MBBS, DCH, MCPS)
Dr. Mubina Agboatwalla is a well-known pediatrician, practicing paediatrics since the last 20 years in Karachi Pakistan. She is the head of the department of Pediatrics in Karachi Liaquat Hospital, as well as her private practice in three specialist clinics in Pediatrics. She is also a Public Health Specialist specializing in preventive health including nutrition, breastfeeding and infectious diseases especially... more

Sindusha MS

Sindusha is a clinical nutritionist with over two years of experience in diverse fields of nutrition. She did her Masters in Food Science and Nutrition and has qualified UGC-NET. She interned as a quality control analyst and as a dietitian during her graduation. She was a part of several community nutrition projects and a phytochemical-based nutrition study during the same... more