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Advice for Patients
January 5, 2009

Escherichia coli O157 and Children

Author Affiliations

Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Pediatr Adolesc Med. 2009;163(1):96. doi:10.1001/archpediatrics.2008.535

Escherichia coli is a common bacterium that is normally present in the human intestine. There are many different types, or strains, of E coli that infect many types of animals and most strains are harmless. A few strains can cause illness. These strains are often found in animals such as cattle, goats, and sheep and do not cause illness in these animals. The most common cause of E coli infection in humans is ingesting contaminated food or water or having contact with infected animals.

The strain of E coli that causes the most serious illness in humans is a strain called E coli O157:H7, sometimes called E coli O157. The people most at risk for infection with this strain of E coli are the very young and very old, but anyone can become ill if infected. Rates of E coli O157 have gone down in recent decades; there are around 70 000 infections with E coli O157 each year in the United States. The most important risk factor for this illness is bloody diarrhea.


  • Severe stomach cramps

  • Diarrhea (often bloody)

  • Vomiting

  • Mild fever


E coli infections are diagnosed by laboratory testing of stool specimens (feces). Most laboratories will identify whether a dangerous strain of E coli such as O157 is present in the stool. Fortunately, most people recover from this illness in about a week and are treated with supportive measures such as rest and fluids. Antibiotics and antidiarrheal medicines are not used to treat this infection and may actually increase the risk of complications.

The most serious illness caused by E coli O157 is called hemolytic uremic syndrome (HUS), in which a person becomes anemic because of breakdown of red blood cells (hemolytic) and has kidney problems (uremic). Signs of this illness include fatigue, appearing pale, and decreased urination. If you are concerned that your child might have HUS, you should see a doctor quickly; people with HUS need to be hospitalized since their kidneys may stop working. Most people with HUS recover but some have permanent kidney damage or die.


A research article in this month's Archives describes an outbreak of E coli in young children after visiting a petting zoo. The study discovered that young children who visited the petting zoo and who had frequent hand-to-mouth behaviors, such as using pacifiers or sippy cups, were at increased risk of becoming infected with E coli. The study also found that using alcohol-based hand-sanitizing gels did not protect against infection with E coli, while washing hands with soap and water did protect children against infection.

  • •:Wash your hands and your children's hands frequently with soap and water after using the bathroom, changing diapers, and before preparing or eating food. If you or your children have any contact with animals, wash hands thoroughly with soap and water right after. Wash fruits and vegetables before eating.

  • •: Cook all meats thoroughly. Use a thermometer to ensure meats have been cooked to at least 160°F/70°C.

  • •: Teach your children to avoid swallowing water when swimming in any location.

  • •: avoid touching, stepping, or falling in manure. Pay extra attention to toddlers who may fall down frequently. Avoid hand-to-mouth behaviors. Do not let children use pacifiers or sippy cups while in a petting zoo.

  • •, maintain strict hand washing, especially after using the bathroom or changing diapers, to avoid passing the infection to other family members.

For more information

Centers for Disease Control and Prevention: http://www.cdc.gov/nczved/dfbmd/disease_listing/stec_gi.html

Inform yourself

To find this and other Advice for Patients articles, go to the Advice for Patients link at http://archpediatrics.com.

Source: Centers for Disease Control and Prevention

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The Advice for Patients feature is a public service of Archives of Pediatrics & Adolescent Medicine. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child's medical condition, Archives of Pediatrics & Adolescent Medicine suggests that you consult your child's physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.