Treatment of Gastritis in an 18-Month-Old Child
For an 18-month-old with gastritis, prioritize supportive care with oral rehydration therapy using low-osmolarity oral rehydration solution (ORS), continue age-appropriate feeding without dietary restrictions, and consider a 2-4 week trial of extensively hydrolyzed protein or amino acid-based formula to exclude milk protein allergy as a contributing factor. 1, 2
Initial Assessment and Hydration Management
Evaluate hydration status clinically by assessing skin turgor, mucous membrane moisture, mental status, capillary refill time, and vital signs to categorize dehydration as mild (3-5%), moderate (6-9%), or severe (≥10%). 2, 3
For mild to moderate dehydration, administer low-osmolarity ORS as first-line treatment until clinical dehydration is corrected, then continue ORS to replace ongoing losses. 2
For severe dehydration (≥10% fluid deficit or signs of shock), initiate intravenous isotonic fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize, then transition to ORS. 2, 3
Nutritional Management
Resume age-appropriate diet immediately during or after rehydration rather than restricting foods or prolonged fasting. 1, 2
Offer starches (rice, potatoes, noodles, crackers, bananas), cereals (rice, wheat, oat), soup, yogurt, vegetables, and fresh fruits. 1
Avoid foods high in simple sugars including soft drinks, undiluted apple juice, Jell-O, and presweetened cereals, as these exacerbate symptoms through osmotic effects. 1, 2
Avoid high-fat foods as they may delay gastric emptying and worsen tolerance. 1
Addressing Potential Milk Protein Allergy
This is a critical consideration, as milk protein allergy can mimic gastritis symptoms in this age group.
Trial an extensively hydrolyzed protein or amino acid-based formula for 2-4 weeks in formula-fed infants with gastritis symptoms, as approximately 25% may have underlying milk protein sensitivity. 1
If the child improves on this trial, milk protein allergy is the likely underlying cause rather than primary gastritis. 1
Pharmacologic Considerations
Acid Suppression Therapy
Proton pump inhibitors (PPIs) or H2 receptor antagonists can be used to manage gastritis or gastroesophageal reflux if symptoms persist despite dietary modifications. 1
PPIs should be dosed approximately 30 minutes before meals for optimal effectiveness, and metabolism differs in children compared to adults. 1
Be aware of risks: acid suppression may increase risk of community-acquired pneumonia, gastroenteritis, and candidemia in young children. 1
H2 antagonists are effective but can cause tachyphylaxis within 6 weeks with long-term use. 1
Medications to Avoid
Do NOT use antimotility agents (loperamide) in children under 18 years, as they can cause serious side effects including ileus, drowsiness, and potentially fatal abdominal distention. 1, 2, 3
Do NOT use adsorbents (kaolin-pectin), antisecretory drugs, or toxin binders, as they do not reduce diarrhea volume or duration and may interfere with appropriate therapy. 1, 2
Avoid chronic antacid therapy due to associated risks in children. 1
Antiemetic Use (If Vomiting is Prominent)
Ondansetron may be considered in children over 4 years to facilitate oral rehydration when vomiting is significant, though this child at 18 months is below the typical recommended age. 2
For younger children with vomiting, administer small volumes of ORS (5-10 mL) every 1-2 minutes, gradually increasing as tolerated. 3
When Antimicrobial Therapy is Indicated
Antimicrobials have limited usefulness since viral agents predominate in gastroenteritis. 1, 2
Consider antimicrobial therapy only if:
Stool cultures should be performed if bloody diarrhea or white blood cells on methylene blue stain are present. 1
Common Pitfalls to Avoid
Do not delay rehydration while awaiting diagnostic testing; initiate ORS promptly. 2
Do not use inappropriate fluids like apple juice or sports drinks as primary rehydration solutions for moderate to severe dehydration. 2
Do not unnecessarily restrict diet during or after rehydration; early refeeding improves outcomes. 1, 2
Do not rely on the "BRAT diet" exclusively (bananas, rice, applesauce, toast) for prolonged periods, as it provides inadequate energy and protein. 1
Do not use diluted formulas for extended periods, as this results in inadequate nutrition. 1