Oral Rehydration Therapy for Children with Vomiting and Diarrhea

Rehydration Approach

For a child with vomiting and diarrhea, the Centers for Disease Control and Prevention recommends administering small volumes (5-10 mL) of oral rehydration solution (ORS) every 1-2 minutes using a spoon or syringe, gradually increasing the amount as tolerated 1, 2
For mild dehydration (3-5% fluid deficit), the American Academy of Pediatrics suggests administering 50 mL/kg of ORS over 2-4 hours 3
For moderate dehydration (6-9% fluid deficit), the American Academy of Pediatrics recommends administering 100 mL/kg of ORS over 2-4 hours 3
For severe dehydration (≥10% fluid deficit) or shock, the American Academy of Pediatrics advises beginning with intravenous rehydration until vital signs normalize, then transitioning to oral therapy 3

The Centers for Disease Control and Prevention recommends administering small volumes (5 mL) of ORS every minute using a spoon or syringe under close supervision 1, 2
The Centers for Disease Control and Prevention suggests gradually increasing the volume of ORS as tolerated 1, 2
The Centers for Disease Control and Prevention advises never allowing a thirsty child to drink large volumes of ORS (ad libitum) from a cup or bottle, as this can worsen vomiting 1, 4
The Centers for Disease Control and Prevention notes that simultaneous correction of dehydration often lessens the frequency of vomiting 5
Over 90% of children with vomiting can be successfully rehydrated orally when using this small-volume, frequent administration approach, according to the Centers for Disease Control and Prevention 1

The World Health Organization recommends using ORS with a sodium concentration of 75-90 mEq/L for rehydration, especially with high purging rates (>10 mL/kg/hour) 6, 3
The World Health Organization suggests using ORS with a sodium concentration of 40-60 mEq/L for maintenance after rehydration 6
Commercially available products like Pedialyte (45 mEq/L sodium) or Ricelyte (50 mEq/L sodium) are appropriate for maintenance therapy, according to the World Health Organization 6
The Infectious Diseases Society of America advises avoiding inappropriate fluids such as apple juice, Gatorade, and commercial soft drinks for rehydration 7

The American Academy of Pediatrics recommends that breastfeeding should continue throughout the illness if applicable 7, 3
The American Academy of Pediatrics suggests resuming an age-appropriate diet during or immediately after rehydration 7
The American Academy of Pediatrics advises continuing with full-strength formula after rehydration for formula-fed infants, as diluted formula provides no benefit 7
The American Academy of Pediatrics recommends focusing on starches, cereals, yogurt, fruits, and vegetables for toddlers on solid foods 3, 2
The Centers for Disease Control and Prevention advises avoiding therapeutic starvation or "gut rest" as this can reduce enterocyte renewal and increase intestinal permeability 4

The Centers for Disease Control and Prevention recommends instructing parents to administer small, frequent volumes of ORS rather than large amounts 1, 5
The Infectious Diseases Society of America suggests replacing ongoing losses from each episode of vomiting or diarrhea with additional ORS 7
The Centers for Disease Control and Prevention advises monitoring for signs of worsening dehydration (decreased urine output, lethargy, persistent vomiting) 5
The Centers for Disease Control and Prevention recommends returning for medical care if the child becomes irritable or lethargic, has decreased urine output, develops intractable vomiting, or has persistent symptoms 5

The Centers for Disease Control and Prevention advises against allowing the child to drink large volumes of ORS at once, which can worsen vomiting 1, 4
The Infectious Diseases Society of America recommends avoiding inappropriate fluids like apple juice or sports drinks for rehydration 7
The Centers for Disease Control and Prevention advises against withholding food during or after rehydration 4, 7
The Centers for Disease Control and Prevention recommends recognizing when oral rehydration is inappropriate (severe dehydration with shock, intestinal ileus, or intractable vomiting) 1