What is the treatment for acute gastritis in pediatric patients?

Treatment of Acute Gastritis in Pediatric Patients

Primary Treatment Approach

The cornerstone of managing acute gastritis (acute gastroenteritis) in children is oral rehydration therapy with low-osmolarity oral rehydration solution (ORS), combined with continued age-appropriate feeding and no dietary restrictions. 1, 2

Assessment of Dehydration Severity

Evaluate dehydration using clinical examination focusing on:

• Mild dehydration (3-5% fluid deficit): Increased thirst, slightly dry mucous membranes 1
• Moderate dehydration (6-9% fluid deficit): Loss of skin turgor, skin tenting when pinched, dry mucous membranes 1
• Severe dehydration (≥10% fluid deficit): Severe lethargy or altered consciousness, prolonged skin tenting (>2 seconds), cool/poorly perfused extremities, decreased capillary refill, rapid deep breathing 1

The four-item Clinical Dehydration Scale provides objective severity grading based on physical findings. 3 Obtain an accurate body weight for monitoring treatment effectiveness. 1

Rehydration Protocol by Severity

Mild Dehydration (3-5% deficit)

• Administer 50 mL/kg of low-osmolarity ORS over 2-4 hours 1
• Give small volumes initially (5-10 mL every 1-2 minutes) using a teaspoon, syringe, or medicine dropper, gradually increasing as tolerated 1
• Common pitfall: Allowing the thirsty child to drink large volumes ad libitum from a cup or bottle leads to vomiting; controlled small-volume administration is essential 1

Moderate Dehydration (6-9% deficit)

• Administer 100 mL/kg of low-osmolarity ORS over 2-4 hours using the same small-volume technique 1
• If the child cannot tolerate oral intake or refuses to drink, consider nasogastric administration of ORS 1
• For persistent vomiting, ondansetron may be used to improve tolerance of oral rehydration, though routine use requires caution given cardiac safety warnings 3, 2

Severe Dehydration (≥10% deficit, shock, altered mental status)

• Immediate intravenous rehydration with isotonic crystalloid (lactated Ringer's or normal saline) in 20 mL/kg boluses until pulse, perfusion, and mental status normalize 1
• Continue IV rehydration until the child awakens, has no aspiration risk, and shows no evidence of ileus 1
• Transition to ORS for the remaining fluid deficit once the child can tolerate oral intake 1

Maintenance and Ongoing Loss Replacement

After rehydration is complete:

• Resume age-appropriate normal diet immediately with no dietary modifications 1, 2
• Continue breastfeeding throughout the illness without interruption 1, 2
• Children on lactose-containing formula can typically tolerate the same product; diluted formula offers no benefit 1
• Replace ongoing losses with ORS: 60-120 mL for children <10 kg per diarrheal stool/vomiting episode (up to ~500 mL/day); 120-240 mL for children >10 kg per episode (up to ~1 L/day) 1

Adjunctive Therapies

Consider active therapies that reduce duration and severity:

• Specific probiotics (Lactobacillus GG or Saccharomyces boulardii) 2
• Diosmectite or racecadotril 2
• Antiemetic and antidiarrheal medications are generally not indicated and may cause complications 4
• Antibiotics should only be given in exceptional cases 2

Critical Pitfalls to Avoid

• Do not use popular beverages (apple juice, Gatorade, commercial soft drinks) for rehydration—they are inadequate and inappropriate 1
• Do not withhold food or use "clear liquids only" approach—this is outdated and nutritionally harmful 1, 4
• Do not delay oral rehydration waiting for laboratory results in mild-moderate cases—stool tests are not routinely needed when viral gastroenteritis is likely 3
• Do not use hypotonic solutions for initial rehydration in severe dehydration as they worsen electrolyte imbalances 5

Hospitalization Criteria

Reserve hospitalization for:

• Failure of oral rehydration therapy plus antiemetic 3
• Severe dehydration with signs of shock 1, 3
• Altered mental status or inability to protect airway 1
• Ileus preventing oral intake 1

Most cases can be successfully managed in outpatient settings with proper oral rehydration technique. 2