Food poisoning in children: help and treatment

Food poisoning in children is an acute health disorder resulting from the consumption of contaminated food or water. There are two main mechanisms: foodborne toxic infections (intestinal infections – viral, bacterial, parasitic) and foodborne intoxications (pre-existing toxins in the food: staphylococcal enterotoxin, botulinum toxin, histamine in "mackerel" poisoning, shellfish biotoxins). Symptoms most often include watery diarrhea, vomiting, abdominal cramps, fever, and, in younger children, dehydration quickly develops. [1]

The disease burden is high: the World Health Organization estimates that unsafe food causes approximately 600 million cases of illness and approximately 420,000 deaths annually; up to 30% of deaths occur in children under five years of age, and approximately 125,000 children die annually. This emphasizes the importance of prevention, early recognition of "red flags," and proper rehydration. [2]

In children, the etiology is shifted toward viral gastroenteritis (often norovirus), but bacterial agents (Salmonella, Campylobacter, Shigella, Shiga toxin-producing E. coli) remain the leading causes of severe/bloody diarrhea. Seafood and home-canned foods add the risk of marine toxins and botulism with neurological symptoms. [3]

Current management relies on assessment of the degree of dehydration, oral rehydration as first-line therapy, selective administration of antiemetics (to enable the child to drink), targeted diagnostics (including multiplex stool PCR), and caution with antibiotics if Shiga toxin-E. coli is suspected. [4]

Code according to ICD-10 and ICD-11

In ICD-10, intestinal food poisonings are classified in block A05. "Other bacterial food poisonings": A05.0 - staphylococcal intoxication, A05.1 - botulism, A05.2-A05.4 - C. perfringens/B. cereus/proteus, etc.; A05.9 - unspecified. For toxic effects of seafood, section * T61 is used (poisonous seafood, histamine poisoning, etc.). Infectious gastroenteritis is coded according to the causative agent (e.g., A04., A02.*, etc.). [5]

In ICD-11, bacterial food poisonings are classified in 1A10-1A1Z (e.g., 1A10 - staphylococcal intoxication, 1A11 - botulism, 1A12-1A13 - C. perfringens/B. cereus, 1A1Z - unspecified). Infectious gastroenteritis (e.g., 1A06 - campylobacter gastroenteritis) is coded separately, and detail (severity, complications, agent) is achieved post-coordination. [6]

Table 1. Coding examples (children)

Clinical situation	ICD-10 (example)	Comment	ICD-11 (example)
Staphylococcal "vomiting" intoxication	A05.0	Short incubation, vomiting	1A10
Foodborne botulism	A05.1	Neurological symptoms	1A11
C. perfringens/B. cereus	A05.2-A05.3	Diarrhea/vomiting	1A12-1A13
Campylobacter gastroenteritis	A04.5	Fever, pain, blood	1A06
Nonbacterial marine toxins	T61.0-T61.8	Ciguatera, "scumbroyd"	Toxin/Exposure Code [7]

Epidemiology

WHO estimates the global burden of foodborne diseases to be approximately 600 million cases and approximately 420,000 deaths annually; approximately 125,000 deaths occur in children under 5 years of age. This reflects the particular vulnerability of childhood and the need for access to safe water/food and proper home rehydration. [8]

In the European Union in 2023 (joint EFSA/ECDC report), campylobacteriosis and salmonellosis remained the most frequent zoonoses; the number of outbreaks was approximately 5,691, with cases and hospitalizations higher than in 2022. For children, this means a stable risk of “classic” bacterial diarrhea, especially with eggs/poultry/undercooked meat. [9]

Outbreaks are often associated with shared tables/buffets, temperature control issues (the "danger zone" is 4-60°C), and cross-contamination in the kitchen. Infection detection is also increasing thanks to multiplex PCR and stratified surveillance. [10]

In young children, viral gastroenteritis (including norovirus) plays a leading role in outpatient practice; however, it is bacterial agents that most often cause bloody diarrhea and require laboratory testing and monitoring for complications. [11]

Reasons

Causes are divided into infectious (viruses - norovirus; bacteria - Salmonella, Campylobacter, Shigella, STEC; parasites - Giardia, Cryptosporidium, Cyclospora) and non-infectious (prepared toxins in food: staphylococcal enterotoxin, Clostridium perfringens, Bacillus cereus, botulinum toxin, histamine, shellfish toxins). In children, viral causes are more common, but it is invasive bacteria that cause severe forms. [12]

Chronology helps narrow the field: hours - most often intoxications (staphylococcus, B. cereus emetic, histamine); 12-48 hours - viruses and many bacteria; days-weeks - parasitoses. "Voming" scenarios without fever are typical of a prepared toxin, and blood/tenesmus - for invasive bacteria. [13]

Marine toxins produce a combination of gastrointestinal and neurological symptoms (ciguatera - "cold/heat inversion," paresthesia; histamine - hot flashes, itching, tachycardia). Botulism begins with neurological symptoms and can quickly progress to respiratory failure. [14]

For children, household sources are important: undercooked poultry/minced meat, raw eggs and dough, unpasteurized dairy products, prepared salads, and meals with a broken cold chain. These are also points of application for prevention. [15]

Risk factors

Age <5 years, low body weight, concomitant chronic diseases, and immunodeficiency increase the risk of severe dehydration and dehydration. In infants, the "window" to clinically significant dehydration is very short. [16]

Travel, street food, ice, and raw greens in areas with unsafe water increase the risk. Outbreaks of norovirus in groups (kindergarten, school, and camps) are common among schoolchildren. [17]

Kitchen factors: non-compliance with temperature control (long-term storage at 4-60°C), cross-contamination (sharing cutting boards/knives for raw and cooked foods), poor hand hygiene. Pasteurization and thorough cooking significantly reduce the risk. [18]

Some risks are associated with seafood (histamine from cooling disorders, shellfish biotoxins from red tides) and home canning (botulism).[19]

Table 2. What increases the risk in a child

Category	Examples
Vulnerable groups	<5 years, immunodeficiency, low body weight
Eating habits	Raw/undercooked poultry, eggs, unpasteurized dairy
Storage conditions	"Danger Zone" 4-60°C, buffets/festivals
Special risks	Seafood (histamine/biotoxins), home-canned food (botulism) [20]

Pathogenesis

In infectious causes, the leading mechanisms are secretory diarrhea (enterotoxins increase water/electrolyte secretion) and invasive mucosal inflammation (Shigella, Campylobacter, Salmonella, STEC), which causes pain, fever, and blood/mucus in the stool. Intense secretion and mucosal damage quickly lead to fluid deficiency in children. [21]

In cases of intoxication, the clinical manifestations are determined by the toxins present: staphylococcal toxin causes vomiting through activation of the enteric nervous system, histamine causes vasomotor reactions (flushing, itching, tachycardia), and botulinum toxin blocks neuromuscular transmission (ptosis, diplopia, weakness). Mollusk neurotoxins act on ion channels. [22]

The key to recovery is restoring fluid and electrolyte balance. The mechanism of effectiveness of oral rehydration solution is based on the combined transport of sodium and glucose into enterocytes, which improves water absorption even during diarrhea. This is the universal physiological basis of ORS. [23]

Some children may experience post-infectious sequelae following an infection: transient lactase deficiency, post-infectious irritable bowel syndrome, and, less commonly, reactive arthritis (after Salmonella/Campylobacter) or Guillain-Barré syndrome (after Campylobacter). This explains the "lingering" complaints following an acute episode. [24]

Symptoms

The main symptoms are watery diarrhea, vomiting, cramping pain, and sometimes fever. In viral infections, sudden, repeated vomiting and short-term fever are most common; in invasive bacterial infections, fever, severe pain, blood/mucus in the stool, and painful urge to urinate (tenesmus) are common. [25]

Children quickly develop signs of dehydration: sparse and dark urine, dry tongue and lips, sunken eyes/fontanelles, drowsiness, crying without tears, and dizziness. Young children can suddenly "deflate" within hours, especially when vomiting and diarrhea are combined. [26]

Specific symptoms suggest a toxin: hot flashes, itching, headache, tachycardia 30-120 minutes after eating fish - histamine; numbness, cold/heat "inversion", paresthesia - ciguatera; ptosis, double vision, "nasal voice", weakness - botulism (requires immediate assistance). [27]

Red flags: blood in the stool, fever >39°C (102.5°F), vomiting so frequent that the child cannot drink, signs of dehydration, diarrhea lasting >3 days, severe pain/lethargy/confusion. These signs require urgent evaluation by a physician. [28]

Forms and stages

In practice, the following are distinguished: (1) food intoxications (ready-made toxins; violent onset, mainly vomiting); (2) food toxic infections (viral, bacterial, parasitic); (3) chemical poisoning (pesticides, heavy metals, mycotoxins). The clinician relies on incubation, dominant symptoms and epidemiological anamnesis to select tests and initial tactics. [29]

By severity: mild (thirst, but no signs of dehydration), moderate (dry mucous membranes, infrequent urine output, tachycardia), severe (lethargy/drowsiness, cold extremities, hypotension, anuria). The gradation determines whether ARS can be treated at home or whether infusion therapy is required. [30]

In children, cases are further divided into uncomplicated (watery diarrhea, no blood/high fever) and complicated (blood, severe pain, neurological symptoms, dehydration, young age/immunodeficiency). For the latter, the hospitalization threshold is low. [31]

Table 3. Clinical clues by form

Signs	More likely
Very short incubation (hours), vomiting >> diarrhea	Intoxication (staphylococcus, B. cereus emetic, histamine)
Blood in stool, fever, tenesmus	Invasive bacteria (Shigella, Salmonella, Campylobacter, STEC)
Neurology (ptosis/double vision/paresthesia)	Botulism or marine biotoxins
Long-term, no fever, bloating	Parasitosis (Giardia/Cryptosporidium) [32]

Complications and consequences

The main acute complications are dehydration, electrolyte imbalances (hyponatremia/hypokalemia), and acute renal failure with severe fluid deficit. These complications develop rapidly in infants, so educating parents about the signs of dehydration is critical. [33]

Some pathogens are characterized by delayed consequences: hemolytic uremic syndrome after STEC (several days after onset), Guillain-Barré syndrome and reactive arthritis after Campylobacter/Salmonella, post-infectious irritable bowel syndrome. Monitoring and early recognition are required. [34]

Marine toxins can cause prolonged neurological symptoms (ciguatera - weeks/months), while botulism can cause respiratory failure. Any neurological symptoms after an ingestion episode warrant emergency referral. [35]

Repeated mild episodes in children increase the risk of nutritional deficiencies; zinc has been shown to reduce the duration of diarrhea and the number of subsequent episodes in the coming months. [36]

When to see a doctor

Immediately - if there is blood in the stool, fever >39 °C, uncontrollable vomiting (unable to drink), signs of dehydration (rare/very dark urine, dry mouth, crying without tears, drowsiness/fainting), diarrhea >3 days, “acute abdomen” or neurological symptoms. [37]

If a child is under 6 months old, has chronic illnesses, is receiving immunosuppression, or has recently traveled, the threshold for seeking medical attention is even lower. In these groups, complications develop more quickly and are more severe. [38]

Suspected STEC (bloody stool, severe abdominal pain with little or no fever) is a reason for early presentation: Shiga toxin testing and monitoring for signs of hemolytic uremic syndrome are required. [39]

If you experience symptoms after eating fish/shellfish or canned food (hot flashes/paresthesia/ptosis/double vision), go to the hospital immediately: this could be histamine intoxication, ciguatera, or botulism. [40]

Table 4. Red flags in a child - what to do

Sign	Action
Bloody stool, high fever	See a doctor immediately, get a stool test, rehydrate
Vomiting interferes with drinking	Emergency department; IV rehydration may be given
Signs of dehydration	Immediate rehydration (IV/tube), monitoring
Neurology after eating/canned food/seafood	Emergency medical services, toxicological assessment [41]

Diagnostics

In mild, uncomplicated cases, laboratory tests are not required: it is more important to assess hydration and educate parents on proper rehydration. Indications for testing include: blood/fever, severe or protracted course, immunodeficiency, early age, and suspected outbreak. Basic electrolyte, creatinine, and hematocrit testing are performed, along with stool analysis. [42]

A modern tool is multiplex stool PCR (GIP panels): they rapidly detect a broad spectrum of viruses/bacteria/parasites and help avoid unnecessary antibiotics and imaging, as well as improve isolation measures. If STEC is suspected, Shiga toxin/gene testing is mandatory, differentiating between O157 and other STEC. Results are always interpreted in the context of clinical findings. [43]

Cultures are needed for heavy/bloody stools, suspected outbreaks, and for antibiograms. CT/ultrasound is used only for acute abdomen, toxic megacolon, and signs of perforation/ischemia—these are rare scenarios with diarrhea. [44]

Table 5. For whom and what tests

Scenario	What to prescribe	For what
Blood/fever, severe	Electrolytes/creatinine, PCR/stool culture	Identify the pathogen, assess dehydration
Suspected STEC	Shiga toxin (or genes) test	Determine the risk of HUS and tactics (without antibiotics)
Outbreak (several cases)	PCR panel/culture + notification to the SES	Epidemiological surveillance, targeted measures
Neurology after fish/canned food	Toxicological assessment	Eliminate botulism/biotoxins [45]

Differential diagnosis

Foodborne illnesses are distinguished from non-infectious diarrhea (drug-induced, intolerance-related) by their acute onset, epidemiological history, and systemic manifestations (fever, vomiting). Antibiotic-associated diarrhea ( Clostridioides difficile ) less often begins with vomiting, but more often after a course of antibiotics.

In acute abdomen (local "dagger" pain, muscle tension, lack of stool/gas), consider surgical pathology (appendicitis, intussusception, torsion) - here diarrhea may be absent or quickly turn into constipation; ultrasound/CT is required as indicated.

Bloody stool without pronounced diarrhea in a teenager may be due to inflammatory bowel disease or ischemic colitis (rare in children) - anamnesis/age, laboratory tests, calprotectin, and endoscopy as indicated help.

In travellers, it is important to differentiate invasive bacterial forms (dysentery) from secretory ones: this determines the choice of antibiotic and the acceptability of loperamide as an adjuvant in older adolescents. [46]

Treatment

1) Rehydration is the foundation.

• Children with mild to moderate dehydration are given oral rehydration solution (ORS): 50-100 ml/kg over 2-4 hours to replenish the deficit + an additional 10 ml/kg for each loose stool and 2 ml/kg for each episode of vomiting. Give frequently and little by little (a teaspoon/syringe of 5 ml every 1-2 minutes) with a gradual increase. If fluid intake is refused, nasogastric rehydration is acceptable; in severe dehydration, intravenous crystalloids. Nutrition is resumed early (age-appropriate diet/breastfeeding). [47]

2) Symptom control.

• Paracetamol for fever/pain (use caution with NSAIDs). Ondansetron as a single dose in children ≥6 months in the emergency department reduces vomiting and increases the success of oral rehydration; home repeat doses are discussed individually. Antidiarrheals (loperamide) are not recommended in young children; in adolescents, they are acceptable for short periods and only for watery diarrhea without blood/fever. [48]

3) Antibiotics - strictly as indicated.

• Not prescribed empirically for uncomplicated watery diarrhea. Indications: dysentery/severe course/vulnerable patients/sepsis. In regions with resistance, azithromycin is more often the drug of choice; fluoroquinolones are undesirable in children. If STEC is suspected, antibiotics and antidiarrheals are contraindicated (risk of hemolytic uremic syndrome). Based on PCR/culture results, therapy is de-escalated. [49]

4) Zinc and nutrition.

• WHO/UNICEF recommend zinc 10 mg/day (<6 months) or 20 mg/day (≥6 months) for 10-14 days - this reduces the duration of diarrhea and subsequent episodes. Maintaining/resumption of normal nutrition (including breast milk) accelerates mucosal recovery. [50]

5) Special scenarios.

• Marine toxins are treated symptomatically (rehydration, antihistamines for histamine); if botulism is suspected, urgent hospitalization and antitoxin as indicated are required. In cases of uncontrollable vomiting/inability to drink, intravenous rehydration is recommended. Outbreaks require notification of epidemiological services and testing of contacts. [51]

Table 6. Treatment components (brief “cheat sheet”)

Situation	What to do	What to avoid
Watery diarrhea without blood	ORS, early feeding, zinc (children)	Antibiotics "just in case"
Uncontrollable vomiting/does not drink	Ondansetron, ORS divided; if unsuccessful - intravenous/nasogastric	Delayed rehydration
Dysentery/sepsis	ORS/IV + targeted antibiotic	Loperamide
Suspected STEC	ORS, observation on HUS	Antibiotics and antidiarrheals [52]

Prevention

Home prevention revolves around four steps: Clean - Separate - Cook - Chill. Wash hands and surfaces; use separate cutting boards/knives for raw and cooked foods; cook to a safe temperature; cool quickly and store at ≤4°C, avoiding the "danger zone" of 4-60°C. These principles are also included in the recommendations of EFSA/ECDC/national agencies. [53]

Give children only pasteurized dairy products; eggs and meat should be cooked thoroughly; fish/seafood should be purchased from trusted vendors and kept refrigerated (this reduces the risk of histamine intoxication). Do not try raw dough with eggs. [54]

In groups (kindergarten/school), hand hygiene, proper cleaning after episodes of vomiting/diarrhea, and exclusion of children with acute diarrhea until recovery are important. During norovirus outbreaks, recommendations for surface disinfection and isolation are followed. [55]

When traveling, use safe water (bottled/boiled), avoid ice of unknown origin and raw salads; hot dishes should be "hot." Teach your child basic hygiene - this reduces the risk. [56]

Table 7. Safe cooking temperatures (minimum in the center of the product)

Product	Temperature
Chicken/turkey (parts/whole), ground poultry	≥74 °C (165 °F)
Minced meat (beef/pork/lamb)	≥71 °C (160 °F)
Steaks/cutlets/fish	≥63 °C (145 °F); in fish - "layered"
Reheating prepared meals/leftovers	≥74 °C (165 °F) [57]

Forecast

In most cases, with proper rehydration, childhood diarrhea resolves within 1-3 days without sequelae. The severity of the outcome depends on age, degree of dehydration, etiology (invasive bacteria/toxins), and the time it takes to seek help. [58]

The prognosis is worse for STEC (risk of hemolytic uremic syndrome), botulism (respiratory failure), and listeria in infants/immunocompromised individuals. Rapid re-routing and supportive care are critical. [59]

Preventive measures (hygiene, safe preparation, clean-separate-cook-refrigerate), early ORS, zinc and gentle symptom management reduce hospitalizations and recurrent episodes. [60]

FAQ

1) What is the difference between "intoxication" and "food poisoning" in a child?
Intoxication is a ready-made toxin in the product (staphylococcus, histamine); incubation lasts for hours, with vomiting predominating. Food poisoning is the proliferation of a pathogen in the intestines (viruses/bacteria/parasites); incubation lasts from 12-48 hours or longer, with diarrhea and fever most often present. [61]

2) When are antibiotics needed?
Only for dysentery/severe cases/vulnerable children and after careful diagnosis; the drug of choice is often azithromycin. If STEC is suspected, do not use antibiotics or antidiarrheals (risk of HUS). [62]

3) What should you give your child to drink?
Oral rehydration solution (not juices/sodas); a guideline is 50-100 ml/kg over 2-4 hours + 10 ml/kg for each loose bowel movement and 2 ml/kg for vomiting. Give frequently (5 ml every 1-2 minutes), and resume feeding early. [63]

4) Is zinc necessary?
Yes: 10 mg/day (<6 months) or 20 mg/day (≥6 months) for 10-14 days - reduces the duration of diarrhea and the risk of subsequent episodes. [64]

5) What are the most alarming signs of dehydration in children?
Infrequent/very dark urine, crying without tears, dry tongue/mouth, lethargy/drowsiness, dizziness, sunken eyes/fontanelles - these are reasons to immediately rehydrate and be evaluated by a doctor. [65]