Oral Rehydration Therapy for Children

Initial Rehydration Therapy

• For a child with mild to moderate dehydration, the American Academy of Pediatrics recommends administering 50-100 mL/kg of ORS over 3-4 hours, with a total of 1000-2000 mL for a 20kg child 1, 3
• For a child with severe dehydration, the American Academy of Pediatrics recommends intravenous rehydration until vital signs normalize, then transitioning to oral rehydration 1, 3

Maintenance and Ongoing Loss Replacement

• The World Health Organization recommends 120-240 mL ORS for each diarrheal stool or vomiting episode in children over 10kg, including 20kg children, with a maximum daily amount of up to approximately 1L/day 1, 2, 3
• The Centers for Disease Control and Prevention recommends administering small, frequent volumes of ORS if vomiting is present 4

Type of ORS to Use

• The American Academy of Pediatrics recommends using low-osmolarity ORS for all age groups 1, 3
• The World Health Organization recommends avoiding apple juice, sports drinks, soft drinks, or commercial beverages due to inappropriate electrolyte content and high osmolality 1, 3, 5

Important Clinical Considerations

• The American Academy of Pediatrics recommends assessing hydration status after 3-4 hours of therapy to determine if rehydration is adequate 5
• The World Health Organization recommends continuing age-appropriate feeding during diarrheal illness, without delaying feeding until diarrhea stops, and offering food every 3-4 hours 1, 5

Special Situations

• The American Academy of Pediatrics recommends considering nasogastric administration of ORS at 15 mL/kg/hour for children who cannot tolerate oral intake but are not in shock 1, 5
• The Centers for Disease Control and Prevention recommends starting with small volumes (5 mL) and gradually increasing as tolerated for children with vomiting 4

Pitfalls to Avoid

• The American Academy of Pediatrics recommends avoiding anti-diarrheal medications in children with acute diarrhea 4, 5
• The World Health Organization recommends not restricting fluids, as adequate hydration is essential for recovery, and not using inappropriate fluids such as sports drinks, juices, and sodas 1, 3