What is the recommended treatment for food poisoning in children?

Treatment of Food Poisoning in Children

The cornerstone of treating food poisoning in children is oral rehydration therapy with ORS solution, continued feeding without interruption, and avoidance of antimicrobial drugs and antidiarrheal agents in uncomplicated cases. 1

Immediate Assessment of Dehydration Severity

Determine the degree of dehydration using clinical signs, with capillary refill time being the most reliable predictor in infants 1:

• Mild dehydration (3-5% deficit): Slightly decreased skin turgor, normal mental status 1, 2
• Moderate dehydration (6-9% deficit): Decreased skin turgor, dry mucous membranes, sunken eyes 1, 2
• Severe dehydration (≥10% deficit): Very poor skin turgor, sunken eyes, altered mental status, weak pulse—this is a medical emergency 1, 2

Weigh the child immediately to establish baseline and calculate fluid deficit 1, 2

Rehydration Protocol

For Mild Dehydration

• Administer 50 mL/kg of ORS over 2-4 hours 1, 2
• Use WHO-recommended ORS containing 50-90 mEq/L sodium 1, 3

For Moderate Dehydration

• Administer 100 mL/kg of ORS over 2-4 hours 1, 2
• If vomiting occurs, give small frequent volumes (5 mL every minute) using a spoon or syringe 2

For Severe Dehydration

• This requires immediate IV rehydration with 20 mL/kg boluses of Ringer's lactate or normal saline until pulse, perfusion, and mental status normalize 1
• If IV access is unavailable, use nasogastric tube at 15 mL/kg body weight/hour 4

Ongoing Loss Replacement

After initial rehydration, replace continuing losses 1, 2:

• 10 mL/kg of ORS for each watery stool 1, 2
• 2 mL/kg of ORS for each episode of vomiting 1, 2

For children under 2 years: 50-100 mL after each stool 4

Feeding Management: Critical Component

Never stop feeding during diarrhea—there is no justification for "bowel rest" 1:

• Breastfed infants: Continue breastfeeding on demand throughout the entire episode without interruption 1, 2, 5
• Formula-fed infants: Resume full-strength formula immediately after rehydration 2
• Children >4-6 months: Give freshly prepared foods including cereal and beans or cereal and meat with vegetable oil added 4
• Offer food every 3-4 hours, encouraging the child to eat as much as desired 4
• After diarrhea stops, give one extra meal daily for a week 4

Reassessment Timeline

Reassess hydration status after 2-4 hours 1, 5:

• If rehydrated, transition to maintenance phase with ongoing loss replacement 1
• If still dehydrated, continue rehydration in supervised setting 4

When Antimicrobials ARE Indicated

Antimicrobial drugs are contraindicated for routine treatment of uncomplicated watery diarrhea 4. Specific indications include only 4:

• Cholera
• Shigella dysentery
• Amoebic dysentery
• Acute giardiasis

Critical Contraindications

Antidiarrheal agents are absolutely contraindicated in children and may produce adverse effects including respiratory depression, cardiac arrest, and death 4, 1, 2

Avoid soft drinks and colas—they contain inadequate sodium and excessive osmolality that worsens diarrhea 4, 1

Red Flags Requiring Immediate Return

Instruct caregivers to return immediately if the child 4, 1, 2:

• Continues passing many watery stools
• Develops fever
• Shows increased thirst or sunken eyes
• Appears to be worsening or develops altered mental status
• Develops bloody diarrhea
• Shows signs of intractable vomiting
• Has high stool output (>10 mL/kg/hour)

Common Pitfalls to Avoid

• Do not dilute formula or delay full-strength feeding—this worsens nutritional outcomes and prolongs diarrhea 2
• Do not use stimulants, steroids, or purgatives—these are not indicated and may cause harm 4
• Do not withhold plain water—children should consume plain water as often as they wish during rehydration 4