Treatment for Ileus in Children

Initial Management

The Infectious Diseases Society of America provides strong evidence (moderate quality) that isotonic IV fluids must be used when ileus is present, as oral rehydration therapy fails in this setting and can worsen abdominal distention 1, 2
Administer isotonic IV fluids such as lactated Ringer's solution or normal saline, and continue IV rehydration until pulse, perfusion, and mental status normalize and there is no evidence of ileus 1, 2, 3
Oral rehydration solutions are contraindicated in the presence of ileus 1, 2

Correct electrolyte abnormalities by monitoring and replacing potassium, sodium, and other electrolytes as needed, and check serum electrolytes if clinical signs suggest abnormalities 4, 5
Discontinue contributing medications, such as antimotility agents, anticholinergic, antidiarrheal, and opioid agents, as they aggravate ileus 2, 3

Clinical monitoring should include vital signs monitoring (pulse, perfusion, mental status) 2, 6
Assessment for return of bowel function (passage of flatus or stool) should be performed 3

For a child >10 kg body weight, initial fluid boluses of 20 mL/kg may be needed if signs of dehydration or shock are present 6
Maintenance fluids should be administered once rehydration is complete 2, 3
Never use antimotility drugs like loperamide in children with ileus or suspected ileus, as this can lead to paralytic ileus and severe complications 2