From the Guidelines
For a 2-year-old with gastroenteritis and moderate dehydration, oral rehydration therapy (ORT) with a reduced osmolarity oral rehydration solution (ORS) is the first-line treatment, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The treatment should begin with an ORS like Pedialyte, giving 50-100 mL/kg over 3-4 hours.
- Offer small amounts (5-15 mL) every 5-10 minutes using a spoon or syringe to prevent vomiting, as suggested by the Centers for Disease Control and Prevention 1.
- Continue breastfeeding if applicable, and resume a regular age-appropriate diet once the child can tolerate fluids.
- Avoid sugary drinks, juices, and sodas as they can worsen diarrhea. Signs of improvement include:
- Moist mucous membranes
- Tears when crying
- Normal urination
- Improved energy levels Medications are generally not recommended for viral gastroenteritis in young children, but zinc supplementation (10 mg daily for 10-14 days) may reduce the duration and severity of diarrhea. Seek immediate medical attention if the child shows signs of severe dehydration (lethargy, no tears, dry mouth, decreased urination), persistent vomiting, bloody diarrhea, high fever, or if symptoms worsen. Rehydration works by replacing lost fluids and electrolytes, allowing the body to recover while the infection resolves naturally, typically within 3-7 days. It's worth noting that nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration, who cannot tolerate oral intake 1. However, isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered when there is severe dehydration, shock, or altered mental status and failure of ORS therapy 1.
From the Research
Treatment for Gastroenteritis with Moderate Dehydration
The treatment for gastroenteritis with moderate dehydration in a 2-year-old child involves:
- Oral rehydration therapy (ORT) as the mainstay of treatment, which is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 2, 3, 4, 5
- The use of oral rehydration solutions, which are recommended for moderate dehydration 2, 4
- Ondansetron may be prescribed if needed to prevent vomiting and improve tolerance of oral rehydration solutions 2, 6, 5
- 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, 6
Key Considerations
- 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
- Laboratory testing is not routinely needed for children with mild illness, and no single laboratory value has been found to be accurate in predicting the degree of dehydration 2, 6
- Antiemetic and antidiarrheal medications are generally not indicated and may contribute to complications, although ondansetron has been shown to be effective in decreasing the rate of vomiting and improving the success rate of oral hydration 4, 6, 5