Treatment of Gastritis in Children

Initial Assessment and Hydration Management

The American Academy of Pediatrics recommends evaluating hydration status clinically by assessing skin turgor, mucous membrane moisture, mental status, capillary refill time, and vital signs to categorize dehydration as mild (3-5%), moderate (6-9%), or severe (≥10%) 3, 4
For mild to moderate dehydration, the Centers for Disease Control and Prevention suggests administering low-osmolarity ORS as first-line treatment until clinical dehydration is corrected, then continue ORS to replace ongoing losses 3
For severe dehydration (≥10% fluid deficit or signs of shock), the World Health Organization recommends initiating intravenous isotonic fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize, then transition to ORS 3, 4

The American Academy of Pediatrics recommends resuming age-appropriate diet immediately during or after rehydration rather than restricting foods or prolonged fasting 5, 3
The Centers for Disease Control and Prevention suggests offering starches (rice, potatoes, noodles, crackers, bananas), cereals (rice, wheat, oat), soup, yogurt, vegetables, and fresh fruits 5
The World Health Organization recommends avoiding foods high in simple sugars including soft drinks, undiluted apple juice, Jell-O, and presweetened cereals, as these exacerbate symptoms through osmotic effects 5, 3
The American Academy of Pediatrics suggests avoiding high-fat foods as they may delay gastric emptying and worsen tolerance 5

The American Academy of Pediatrics recommends trialing an extensively hydrolyzed protein or amino acid-based formula for 2-4 weeks in formula-fed infants with gastritis symptoms, as approximately 25% may have underlying milk protein sensitivity 1, 2
If the child improves on this trial, milk protein allergy is the likely underlying cause rather than primary gastritis 1

The American Academy of Pediatrics recommends using proton pump inhibitors (PPIs) or H2 receptor antagonists to manage gastritis or gastroesophageal reflux if symptoms persist despite dietary modifications 6, 2
The American Academy of Family Physicians suggests dosing PPIs approximately 30 minutes before meals for optimal effectiveness, and metabolism differs in children compared to adults 2
The Centers for Disease Control and Prevention warns that acid suppression may increase risk of community-acquired pneumonia, gastroenteritis, and candidemia in young children 2
The American Academy of Family Physicians notes that H2 antagonists are effective but can cause tachyphylaxis within 6 weeks with long-term use 2

The Centers for Disease Control and Prevention recommends avoiding antimotility agents (loperamide) in children under 18 years, as they can cause serious side effects including ileus, drowsiness, and potentially fatal abdominal distention 5, 3, 4
The World Health Organization suggests avoiding adsorbents (kaolin-pectin), antisecretory drugs, or toxin binders, as they do not reduce diarrhea volume or duration and may interfere with appropriate therapy 5, 3
The American Academy of Family Physicians recommends avoiding chronic antacid therapy due to associated risks in children 2

The American Academy of Pediatrics suggests considering ondansetron in children over 4 years to facilitate oral rehydration when vomiting is significant, though this child at 18 months is below the typical recommended age 3
For younger children with vomiting, the Centers for Disease Control and Prevention recommends administering small volumes of ORS (5-10 mL) every 1-2 minutes, gradually increasing as tolerated 4

The Centers for Disease Control and Prevention notes that antimicrobials have limited usefulness since viral agents predominate in gastroenteritis 5, 3
The World Health Organization recommends considering antimicrobial therapy only if bloody diarrhea is present, recent antibiotic use, exposure to day care centers where Giardia or Shigella is prevalent, or immunodeficiency 5
The Centers for Disease Control and Prevention suggests performing stool cultures if bloody diarrhea or white blood cells on methylene blue stain are present 5

The American Academy of Pediatrics recommends not delaying rehydration while awaiting diagnostic testing; initiate ORS promptly 3
The Centers for Disease Control and Prevention warns against using inappropriate fluids like apple juice or sports drinks as primary rehydration solutions for moderate to severe dehydration 3
The World Health Organization suggests not unnecessarily restricting diet during or after rehydration; early refeeding improves outcomes 5, 3
The American Academy of Pediatrics recommends not relying on the "BRAT diet" exclusively (bananas, rice, applesauce, toast) for prolonged periods, as it provides inadequate energy and protein 5
The Centers for Disease Control and Prevention warns against using diluted formulas for extended periods, as this results in inadequate nutrition 5

The American Academy of Pediatrics recommends reserving hospitalization for severe dehydration or shock, failure of oral rehydration therapy, altered mental status, ileus, or persistent vomiting preventing adequate oral intake 3, 4