What is the treatment for pediatric viral gastroenteritis?

Treatment of Pediatric Viral Gastroenteritis

The cornerstone treatment for pediatric viral gastroenteritis is oral rehydration therapy (ORT), which should be used as first-line therapy for both mildly and moderately dehydrated children to prevent dehydration and its complications. 1, 2

Assessment of Dehydration

Before initiating treatment, assess the degree of dehydration:

• Mild dehydration: No decrease in oral intake or urine output, minimal or no vomiting
• Moderate dehydration: Decreased urine output, dry mucous membranes, decreased skin turgor, sunken eyes
• Severe dehydration: Altered mental status, tachycardia, delayed capillary refill, cool extremities

Rehydration Protocol

Mild to Moderate Dehydration

• First-line treatment: Oral rehydration therapy using low-osmolarity ORS 1, 3

  • Commercial preparations: Pedialyte, CeraLyte, Enfalac Lytren
  • WHO formula: 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water 1
  • Administration: 50-100 mL/kg over 3-4 hours

• Alternative approach: Half-strength apple juice followed by preferred liquids for mild dehydration 4

• If vomiting persists: Consider ondansetron to improve ORS tolerance 1, 4

  • Nasogastric tube administration if child cannot tolerate oral intake 1

Severe Dehydration or ORT Failure

• Intravenous fluid therapy: 20 mL/kg boluses of isotonic crystalloid (normal saline or Ringer's lactate) 1
  • Can repeat to total of 40-60 mL/kg in first hour if needed
  • Transition to ORT once stabilized

Nutritional Management

• Continue breastfeeding throughout the diarrheal episode 1, 5
• Resume regular age-appropriate diet during or immediately after rehydration 1
• Early feeding reduces stool output and duration of diarrhea by approximately 50% 1
• Recommended foods: Bananas, rice, applesauce, and toast (BRAT diet) 1
• Avoid: Foods high in simple sugars and high-fat foods 1

Medication Considerations

• Antibiotics: Generally not indicated for viral gastroenteritis 1, 4
• Antimotility drugs (e.g., loperamide): Should not be given to children under 18 years 1
• Probiotics: American Gastroenterological Association suggests against use in children with acute infectious gastroenteritis in North America 1

Monitoring During Treatment

• Urine output: Target ≥0.5 mL/kg/h 1
• Vital signs: Especially blood pressure and heart rate 1
• Electrolytes: Particularly sodium levels 1

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 1

Special Considerations

• Immunocompromised children: May experience severe, prolonged, and sometimes fatal rotavirus diarrhea 2
• Premature infants: Increased risk for hospitalization from diarrheal disease 2
• Malnourished children: At risk for cycle of diarrhea and malnutrition 2

Prevention

• Hand hygiene: Proper handwashing with soap 2, 1
• Rotavirus vaccination: Significantly reduces AGE-related hospitalizations 1
• Environmental cleaning: Use detergents for cleaning surfaces and laundering fecally contaminated linens 2

Clinical Outcomes

ORT has been shown to be as effective as intravenous fluid therapy for rehydration of moderately dehydrated children, with the advantages of quicker initiation of therapy and potentially lower hospitalization rates 3, 6. For every 25 children treated with ORT, only one would fail and require intravenous therapy 6.