Management of Acute Gastroenteritis in Children

Assessment and Treatment

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend oral rehydration solution (ORS) as the initial treatment for children with mild to moderate dehydration from acute gastroenteritis 1, 2
Children with mild dehydration (3-5% fluid deficit) should receive 50 mL/kg of ORS over 2-4 hours, while those with moderate dehydration (6-9% fluid deficit) should receive 100 mL/kg of ORS over 2-4 hours 4, 6
The World Health Organization recommends reduced osmolarity ORS (total osmolarity <250 mmol/L) for rehydration 1, 8
Ongoing losses should be replaced with ORS: 10 mL/kg for each watery stool and 2 mL/kg for each episode of vomiting 7
Children who are alert and able to take oral fluids, with no signs of severe dehydration or altered mental status, are suitable for home management with ORS 1, 2, 5

Antimotility drugs (loperamide) should not be given to children under 18 years with acute diarrhea 1, 9
Antiemetics (ondansetron) may be considered for children over 4 years to facilitate oral rehydration if vomiting is severe 9
Breastfeeding should be continued throughout the illness if applicable 1, 7
Normal diet should be resumed immediately after rehydration; food should not be withheld 1, 3

Parents should seek immediate medical attention if the child becomes unable to tolerate oral fluids, signs of dehydration worsen, diarrhea becomes bloody, or fever increases significantly 5