What is the recommended management for Acute Gastroenteritis (AGE) in children?

Management of Acute Gastroenteritis (AGE) in Children

For children with acute gastroenteritis, oral rehydration therapy should be the primary treatment, with early reintroduction of normal feeding, while probiotics are not recommended for children in North America.

Assessment of Dehydration

• Dehydration severity is best assessed by:
  • Percentage of weight loss from normal body weight (most accurate method)
  • Clinical signs (appear when child has lost ≥4% of body weight) 1
  • Key signs: decreased peripheral perfusion, abnormal skin turgor, and abnormal respiratory pattern 1

Rehydration Therapy

Oral Rehydration

• First-line treatment for mild to moderate dehydration 2, 3
• Use low-osmolarity oral rehydration solution (ORS) with:
  • 65-70 mEq/L sodium
  • 75-90 mmol/L glucose
  • Commercial options: Pedialyte, CeraLyte, Enfalac Lytren 2
• Administration protocol:
  • Initial phase: 100 ml/kg during first 4 hours
  • Maintenance: 50-100 ml after each liquid stool 2
• For mild illness: half-strength apple juice followed by child's preferred liquids is as effective as commercial ORS for preventing hospitalization 3

Intravenous Fluids

• Indicated only for:
  • Severe dehydration
  • Shock
  • Altered mental status
  • Failure of oral rehydration therapy
  • Ileus (intestinal obstruction) 2
• Use isotonic fluids (lactated Ringer's or normal saline) at 10 ml/kg/h over 3 hours 2

Nutrition Management

• Continue breastfeeding throughout rehydration and illness 2
• Resume normal formula immediately after initial rehydration phase for formula-fed infants 2
• Early feeding is recommended rather than gradual reintroduction:
  • Reduces stool output and diarrhea duration by approximately 50% 2
  • Bland diet including bananas, rice, applesauce, and toast (BRAT diet) is appropriate 2
  • Avoid foods high in simple sugars and high-fat foods 2

Medication Use

• Avoid probiotics in children with acute infectious gastroenteritis in North America 4

  • Despite studies from other countries showing benefit, high-quality studies from the US and Canada showed no benefit 4
  • The American Gastroenterological Association (AGA) suggests against probiotic use in this population (conditional recommendation, moderate quality evidence) 4

• Avoid unnecessary medications:

  • Antibiotics are generally not indicated as viral causes predominate 2
  • Antidiarrheals should be avoided as they don't reduce diarrhea volume/duration and may cause serious side effects 2, 1
  • Exception: Ondansetron may be used if needed to prevent vomiting and improve tolerance of oral rehydration 3

Prevention and Control

• Implement proper hand hygiene and infection control measures 2
• Rotavirus vaccination significantly reduces AGE-related hospitalizations and costs 5
  • Between 2008-2013, AGE-related hospitalizations declined by 382,000 cases
  • Approximately $1.228 billion in medical costs were averted 5

Warning Signs Requiring Immediate Medical Attention

• Persistent vomiting preventing ORS intake
• High stool output (>10 mL/kg/hour)
• Bloody diarrhea
• Worsening dehydration despite treatment
• Lethargy or altered mental status 2

Monitoring During Treatment

• Monitor urine output (target ≥0.5 ml/kg/h)
• Track vital signs, especially blood pressure and heart rate
• Monitor electrolytes, particularly sodium levels 2

Special Considerations

• Households with children under 5 years have significantly higher AGE incidence (IRR 12.20,95% CI 11.08-13.45) 6
• Lower socioeconomic status is associated with higher AGE incidence 6