What is the treatment for acute gastritis in children?

Treatment of Acute Gastritis in Children

The cornerstone of managing acute gastritis (gastroenteritis) in children is oral rehydration therapy with appropriate oral rehydration solution (ORS), early refeeding with age-appropriate diet, and avoidance of unnecessary medications. 1, 2

Initial Assessment

Evaluate hydration status through specific clinical signs rather than laboratory tests 1, 2, 3:

• Skin turgor (prolonged tenting >2 seconds indicates severe dehydration) 4
• Mental status (lethargy or altered consciousness) 4, 1
• Mucous membrane moisture (dry membranes suggest dehydration) 4, 1
• Capillary refill time (>2 seconds indicates poor perfusion) 4, 1
• Vital signs (tachycardia, rapid deep breathing suggesting acidosis) 4

Categorize dehydration severity 4, 1, 2:

• Mild: 3-5% body weight loss (50 mL/kg deficit)
• Moderate: 6-9% body weight loss (100 mL/kg deficit)
• Severe: ≥10% body weight loss (shock or near-shock state)

Rehydration Strategy by Severity

Mild to Moderate Dehydration (3-9%)

Administer ORS containing 50-90 mEq/L sodium 4:

• Mild dehydration: 50 mL/kg over 2-4 hours 4
• Moderate dehydration: 100 mL/kg over 2-4 hours 4

Critical technique to prevent vomiting: Use small volumes (5-10 mL) administered every 1-2 minutes via teaspoon, syringe, or medicine dropper, gradually increasing as tolerated 4. A common pitfall is allowing thirsty children to drink large volumes ad libitum from a cup or bottle, which frequently triggers vomiting 4.

For children who refuse ORS or continue vomiting: Consider nasogastric administration via feeding tube with continuous slow infusion 4, 2.

Severe Dehydration (≥10%)

This is a medical emergency requiring immediate IV rehydration 4:

• Administer 20 mL/kg boluses of Ringer's lactate or normal saline until pulse, perfusion, and mental status normalize 4, 2
• May require two IV lines or alternate access (venous cutdown, femoral vein, intraosseous infusion) 4
• Once consciousness returns to normal, transition to ORS for remaining deficit 4, 2

Replacement of Ongoing Losses

During both rehydration and maintenance phases, replace ongoing losses 4:

• 10 mL/kg for each watery/loose stool 4
• 2 mL/kg for each vomiting episode 4
• Continue ORS replacement until diarrhea and vomiting resolve 1, 2

Nutritional Management

Early refeeding is essential—fasting or "gut rest" is contraindicated 4, 1, 2:

• Breastfed infants: Continue nursing on demand throughout illness 4, 1, 2, 3
• Formula-fed infants: Resume full-strength, lactose-free or lactose-reduced formula immediately upon rehydration 4
• Older children: Resume age-appropriate diet during or immediately after rehydration 4, 1, 2

The traditional approach of withholding food for 24 hours reduces enterocyte renewal, increases intestinal permeability, and worsens nutritional outcomes 4.

Pharmacological Management

Antiemetics

Ondansetron (0.15 mg/kg per dose) may be given to children >4 years with significant vomiting to facilitate oral rehydration 1, 2, 3. This is particularly useful for children who have failed initial oral rehydration attempts 5. A randomized controlled trial demonstrated that ondansetron reduced the need for IV hydration from 54.5% to 21.6% (difference of 32.9%) in children who initially failed oral rehydration 5.

Antimotility Agents

Loperamide and other antimotility agents are contraindicated in all children <18 years with acute diarrhea 1, 2, 3. These agents do not reduce diarrhea volume or duration and may cause complications 1.

Antibiotics

Antimicrobial agents have limited usefulness since viral agents are the predominant cause 1. Antibiotics should only be considered for specific cases: bloody diarrhea, recent antibiotic use, exposure to certain pathogens, recent foreign travel, or immunodeficiency 1.

Adjunctive Therapies

Zinc supplementation (10-20 mg daily) reduces diarrhea duration in children 6 months to 5 years in areas with high zinc deficiency prevalence or in malnourished children 2, 3.

Probiotics may reduce symptom severity and duration 1, 3, though current data are insufficient to support routine use in outpatient settings 6.

Fluids to Avoid

Do not use apple juice, sports drinks (Gatorade), or commercial soft drinks as primary rehydration solutions 1, 2. These contain high simple sugar content and can exacerbate diarrhea through osmotic effects 1.

Common Pitfalls to Avoid

• Delaying rehydration while awaiting diagnostic testing 1
• Using inappropriate fluids instead of proper ORS 1, 2
• Allowing ad libitum drinking from cups/bottles instead of small frequent volumes 4
• Unnecessarily restricting diet during or after rehydration 1, 2
• Administering antimotility drugs to children 1, 2
• Using adsorbents, antisecretory drugs, or toxin binders (these are ineffective) 1

Infection Control

Implement strict hand hygiene and contact precautions 1, 2, 3:

• Hand hygiene after toilet use, diaper changes, before food preparation and eating 1, 2, 3
• Use gloves and gowns when caring for children with diarrhea 1, 2
• Separate ill children from well children until at least 2 days after symptom resolution 1