How to Prescribe Pedialyte for Oral Rehydration
Prescribe Pedialyte based on the child's degree of dehydration: 50 mL/kg over 2-4 hours for mild dehydration (3-5% fluid deficit) and 100 mL/kg over 2-4 hours for moderate dehydration (6-9% fluid deficit), starting with small volumes like 5 mL every minute if vomiting is present. 1, 2
Initial Rehydration Dosing by Severity
Mild Dehydration (3-5% fluid deficit)
- Administer 50 mL/kg of Pedialyte over 2-4 hours 1, 2
- Start with very small volumes (one teaspoon or 5 mL) using a spoon, syringe, or medicine dropper, then gradually increase as tolerated 1, 2
- Reassess hydration status after 2-4 hours; if still dehydrated, reestimate the deficit and restart rehydration 1
Moderate Dehydration (6-9% fluid deficit)
- Administer 100 mL/kg of Pedialyte over 2-4 hours 1, 2
- Use the same gradual approach with small initial volumes 1
- If the child cannot drink but is not in shock, consider nasogastric administration at 15 mL/kg/hour 2
Severe Dehydration (≥10% fluid deficit, shock)
- Do not use oral rehydration—this is a medical emergency requiring immediate IV therapy 1, 2
- Administer 20 mL/kg boluses of isotonic crystalloid (Ringer's lactate or normal saline) until pulse, perfusion, and mental status normalize 1, 2
- Once stabilized, transition to oral Pedialyte for remaining deficit 2
Special Consideration for Vomiting
When vomiting is present, start with 5 mL every minute and gradually increase the amount as tolerated—simultaneous correction of dehydration often lessens vomiting frequency 1, 2
Replacement of Ongoing Losses
During Active Diarrhea/Vomiting
- For children <10 kg: Give 60-120 mL of Pedialyte after each diarrheal stool or vomiting episode 2
- For children >10 kg: Give 120-240 mL of Pedialyte after each diarrheal stool or vomiting episode 2
- Alternative calculation: 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode 1, 2
Age-Based Maintenance Volumes
Practical Administration Instructions
Step-by-Step Approach
- Begin with 5 mL (one teaspoon) every 1-2 minutes using a spoon or syringe 1, 2
- Gradually increase volume as the child tolerates without vomiting 1
- Continue for the calculated 2-4 hour rehydration period 1, 2
- Monitor for signs of adequate rehydration: improved skin turgor, moist mucous membranes, increased urine output 2
Feeding During and After Rehydration
- Breastfed infants: Continue nursing on demand throughout rehydration 1, 2
- Formula-fed infants: Resume full-strength formula immediately after rehydration is complete 1
- Older children: Offer age-appropriate foods within 3-4 hours after rehydration 2, 3
Critical Pitfalls to Avoid
Do NOT Use These Alternatives
- Never prescribe apple juice, Gatorade, or commercial soft drinks for rehydration—they have inappropriate electrolyte content and excessive osmolality that can worsen diarrhea 2
- Only use commercially available oral rehydration solutions like Pedialyte 2
When to Escalate Care
Instruct parents to return immediately if the child develops: 1
- Increased lethargy or irritability
- Decreased urine output
- Intractable vomiting despite small-volume administration
- Persistent diarrhea after 5 days
- Signs of worsening dehydration
Sodium Content Considerations
Pedialyte contains 45 mEq/L of sodium, which is lower than the WHO-recommended 75-90 mEq/L for rehydration but is effective for mild to moderate dehydration commonly seen in the United States 4, 5. This lower sodium concentration is appropriate for viral diarrhea (the most common cause in developed countries) and can be used as a single solution for both rehydration and maintenance phases 5, 6.