From the Guidelines
For a one-year-old with a stomach virus, the primary focus should be on preventing dehydration by offering small amounts of oral rehydration solutions like Pedialyte frequently. This approach is supported by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. The guidelines emphasize the importance of fluid and electrolyte therapy, stating that ancillary treatment with antimotility, antinausea, or antiemetic agents can be considered once the patient is adequately hydrated, but their use is not a substitute for fluid and electrolyte therapy. Key points to consider in managing a one-year-old with a stomach virus include:
- Offering small, frequent amounts of oral rehydration solutions to prevent dehydration
- Continuing breastfeeding or formula if the child can keep it down
- Avoiding sugary drinks, juices, and sports drinks which can worsen diarrhea
- Not giving over-the-counter anti-diarrheal medications to young children as they can be dangerous, as highlighted by the guidelines which state that antimotility drugs like loperamide should not be given to children <18 years of age with acute diarrhea 1
- Considering acetaminophen (Tylenol) for fever, but only after consulting with a pediatrician for proper dosing based on the child's weight
- Following the BRAT diet (bananas, rice, applesauce, toast) when the child begins eating solids again
- Monitoring for signs of dehydration, such as fewer wet diapers, no tears when crying, or unusual drowsiness, and seeking immediate medical attention if these signs are present, or if the fever exceeds 102.2°F (39°C), if there's blood in the stool, or if symptoms persist beyond 2-3 days. It's also important to note that while ondansetron may be beneficial in reducing vomiting in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting 1, its use in a one-year-old would not be recommended based on the provided guidelines. Overall, the management of a one-year-old with a stomach virus prioritizes hydration, monitoring for complications, and supportive care, rather than the use of specific medications unless otherwise indicated by a healthcare provider.
From the Research
Treatment Options for One-Year-Old with Stomach Virus
- Oral rehydration therapy is the mainstay of treatment for mild dehydration in children with viral gastroenteritis, as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 2
- For moderate dehydration, oral rehydration solutions are recommended 2
- Ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 2, 3
- Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration 2
Management of Dehydration
- Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output 2
- The physical examination is the best way to evaluate hydration status, and the four-item Clinical Dehydration Scale can be used to determine severity of dehydration based on physical examination findings 2
- Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children 2
Medication and Oral Rehydration
- Ondansetron with intravenous rehydration improves tolerance of oral fluids after two hours and reduces the hospital admission rate when compared with intravenous rehydration with or without dexamethasone 3
- Oral rehydration solutions, such as Pedialyte, Gatorade, and New Oral Rehydration Solution (N-ORS), are effective in correcting dehydration and improving bowel symptoms in adults with viral gastroenteritis 4
- Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis can decrease the need for intravenous fluids, reduce hospitalizations, and shorten illness duration 5