From the Guidelines
For a 3-year-old boy with 2-3 episodes of vomiting and diarrhea, the primary treatment should focus on preventing dehydration through oral rehydration therapy (ORT) with a reduced osmolarity oral rehydration solution (ORS), as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
Treatment Approach
The treatment approach should involve:
- Starting with small, frequent sips of an oral rehydration solution like Pedialyte, offering 5-15 ml every 5-10 minutes and gradually increasing as tolerated.
- Continuing breastfeeding if applicable.
- After 4-6 hours of successful rehydration, reintroducing a BRAT diet (bananas, rice, applesauce, toast) or other bland foods like crackers and clear broths, then gradually returning to a normal diet within 24 hours.
- Avoiding dairy products, fatty foods, and sugary drinks during this time as they may worsen symptoms.
Medication
Medication is generally not recommended for viral gastroenteritis in children this age, as most cases are self-limiting and resolve within 3-5 days. Anti-diarrheal medications are contraindicated in young children 1.
Monitoring and Follow-up
Parents should seek immediate medical attention if the child shows signs of severe dehydration (decreased urination, excessive sleepiness, dry mouth, sunken eyes), high fever (>102°F/39°C), bloody stools, persistent vomiting, or if symptoms worsen or last beyond 3 days. This approach works because it replaces lost fluids and electrolytes while allowing the gastrointestinal tract to recover naturally from what is likely a viral infection, as supported by the guidelines 1 and evidence from the Centers for Disease Control and Prevention 1.
From the Research
Treatment Options for Gastroenteritis in Children
- Oral rehydration therapy (ORT) is an effective and inexpensive treatment for dehydration associated with gastroenteritis in children, as shown in a study published in 2006 2.
- Intravenous rehydration therapy (IVT) may be necessary in some cases, but it is associated with a higher risk of complications such as phlebitis 2.
- The use of ondansetron, a selective serotonin receptor antagonist, has been shown to improve the success of ORT in children with vomiting and dehydration secondary to gastroenteritis 3, 4, 5.
Efficacy of Ondansetron in Treating Gastroenteritis
- A randomized controlled trial published in 2008 found that ondansetron significantly reduced the need for intravenous hydration in children with acute gastroenteritis who failed initial ORT 3.
- An economic analysis published in 2010 found that the routine administration of ondansetron to children with dehydration and vomiting secondary to gastroenteritis resulted in significant monetary savings compared to a no-ondansetron policy 4.
- A study published in 2013 found that the addition of ondansetron to an established ORT protocol reduced the rates of intravenous fluid administration and admissions in children with gastroenteritis 5.
Improving Ondansetron Use and Oral Rehydration Instructions
- A quality improvement project published in 2022 found that educating pediatricians and residents on the safety and utility of ondansetron, and implementing standardized oral rehydration instructions, increased the use of ondansetron and improved patient outcomes 6.
- The project also found that trainee-led educational approaches and senior resident ownership of teaching and data collection were effective in sustaining the impact of the intervention 6.