“Her mum told me to ring — she’s had the runs and been sick, and she’s just sleeping a lot.”

In children under 5 with gastroenteritis, the decision is not about the diagnosis but about dehydration and safety. NICE CG84 lists reduced urine output and altered responsiveness among symptoms of clinical dehydration, and altered responsiveness (lethargy or irritability) is a red-flag feature, so a child described as unusually sleepy with few wet nappies needs a face-to-face assessment the same day. Telephone assessment depends on converting vague words into data: count wet nappies, ask the parent to check the child while on the phone, and ask about colour, breathing, hands and feet and a rash. Red flags for other diagnoses include bilious vomiting, blood in the stool (HUS, intussusception), abdominal distension, high fever and a non-blanching rash. Interim management is oral rehydration solution little and often; avoid fruit juice and carbonated drinks; antidiarrhoeal drugs are not used in young children. The communication challenge is the parent who accepts a next-day appointment because of real barriers — the safe GP explains why, then helps solve the barrier (family, timing, a duty-clinician visit) rather than lowering the standard of care. Children should stay off nursery until 48 hours after the last episode (UKHSA).