From the Guidelines
For a 1-year-old with viral gastroenteritis, treatment should focus on preventing dehydration through oral rehydration therapy, without the use of antimotility or antinausea agents, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The primary goal is to prevent dehydration by offering small, frequent sips of oral rehydration solutions like Pedialyte, and continuing breastfeeding or formula if applicable.
- Resume a normal diet as tolerated, avoiding dairy temporarily if it worsens symptoms.
- Medication is generally not recommended for viral gastroenteritis in young children - avoid antidiarrheals like loperamide (Imodium) as they can be harmful in this age group, according to the guidelines 1.
- Anti-emetics are rarely needed and should only be used under medical supervision, with consideration of guidelines that suggest their use may be facilitated in children >4 years of age 1. Key points to monitor include signs of dehydration, such as decreased urination, dry mouth, absence of tears when crying, unusual drowsiness, or sunken eyes/fontanelle.
- Viral gastroenteritis is self-limiting, typically resolving within 3-7 days, and the focus on hydration is crucial because young children dehydrate quickly, as noted in a study on viral agents of gastroenteritis 1. Seek immediate medical attention if the child shows signs of severe dehydration, persistent vomiting, bloody diarrhea, high fever, or if symptoms worsen or persist beyond a week.
From the Research
Treatment for Viral Gastroenteritis in Children
- The management of viral gastroenteritis in children typically involves oral rehydration therapy (ORT) with fluids containing physiological concentrations of glucose and electrolytes 2.
- ORT is as effective as intravenous (IV) fluid therapy for rehydration in children with mild-to-moderate dehydration 2, 3.
- Measurements of serum electrolytes, creatinine, and glucose are usually not necessary and should only be considered in a subset of children with severe dehydration who require hospitalization and IV therapy 2.
Use of Ondansetron
- Judicious use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization 2, 4.
- Ondansetron has been shown to improve tolerance of oral fluids and reduce hospital admission rates in children with dehydration secondary to vomiting from acute viral gastritis 4.
- A study found that ondansetron use decreased the need for intravenous fluids, reduced hospitalizations, and shortened illness duration in pediatric patients with acute gastroenteritis 5.
Oral Rehydration Solutions
- Pedialyte and Gatorade are commonly used oral rehydration solutions, but there is limited evidence to support their use 6.
- A study found that Gatorade and a New Oral Rehydration Solution (N-ORS) were as effective as Pedialyte in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 6.
- The choice of oral rehydration solution may depend on factors such as palatability and the presence of hypokalemia or hyponatremia 6.
Education and Quality Improvement
- Educating healthcare providers on the safety and utility of ondansetron and oral rehydration therapy can improve treatment outcomes for pediatric patients with acute gastroenteritis 5.
- Standardized oral rehydration instructions and trainee-led educational approaches can also promote evidence-based practice and improve patient outcomes 5.