Treatment of Food Poisoning in Children

Introduction to Treatment

The cornerstone of treating food poisoning in children is oral rehydration therapy with ORS solution, continued feeding without interruption, and avoidance of antimicrobial drugs and antidiarrheal agents in uncomplicated cases 1

Determine the degree of dehydration using clinical signs, with capillary refill time being the most reliable predictor in infants 1
Mild dehydration (3-5% deficit) is characterized by slightly decreased skin turgor and normal mental status 1, 2
Moderate dehydration (6-9% deficit) is characterized by decreased skin turgor, dry mucous membranes, and sunken eyes 1, 2
Severe dehydration (≥10% deficit) is characterized by very poor skin turgor, sunken eyes, altered mental status, and weak pulse, and is a medical emergency 1, 2

For mild dehydration, administer 50 mL/kg of ORS over 2-4 hours 1, 2
For moderate dehydration, administer 100 mL/kg of ORS over 2-4 hours 1, 2
For severe dehydration, immediate IV rehydration with 20 mL/kg boluses of Ringer's lactate or normal saline is required until pulse, perfusion, and mental status normalize 1
If IV access is unavailable, use nasogastric tube at 15 mL/kg body weight/hour 3, 4

After initial rehydration, replace continuing losses with 10 mL/kg of ORS for each watery stool 1, 2, 5
Replace continuing losses with 2 mL/kg of ORS for each episode of vomiting 1, 2
For children under 2 years, give 50-100 mL after each stool 4

Never stop feeding during diarrhea, as there is no justification for "bowel rest" 1
Breastfed infants should continue breastfeeding on demand throughout the entire episode without interruption 1, 2, 5
Formula-fed infants should resume full-strength formula immediately after rehydration 2
Children over 4-6 months should be given freshly prepared foods including cereal and beans or cereal and meat with vegetable oil added 3, 6, 4

Antimicrobial drugs are contraindicated for routine treatment of uncomplicated watery diarrhea, but are indicated for cholera, Shigella dysentery, amoebic dysentery, and acute giardiasis 3, 1, 6

Antidiarrheal agents are absolutely contraindicated in children and may produce adverse effects including respiratory depression, cardiac arrest, and death 3, 1, 2
Soft drinks and colas should be avoided as they contain inadequate sodium and excessive osmolality that worsens diarrhea 3, 4, 1

Instruct caregivers to return immediately if the child continues passing many watery stools, develops fever, shows increased thirst or sunken eyes, appears to be worsening or develops altered mental status, develops bloody diarrhea, shows signs of intractable vomiting, or has high stool output (>10 mL/kg/hour) 3, 4, 1, 2, 6

Do not dilute formula or delay full-strength feeding, as this worsens nutritional outcomes and prolongs diarrhea 2, 6
Do not use stimulants, steroids, or purgatives, as these are not indicated and may cause harm 3
Do not withhold plain water, as children should consume plain water as often as they wish during rehydration 3, 4