What is the recommended treatment for acute gastritis in an 8-year-old male?

Treatment of Acute Gastritis in an 8-Year-Old Male

For acute gastritis in an 8-year-old, initiate oral rehydration solution (ORS) immediately using small, frequent volumes (5-10 mL every 1-2 minutes), assess hydration status clinically, resume age-appropriate diet during or after rehydration, and avoid antimotility agents, antiemetics (unless vomiting prevents ORS intake), and unnecessary medications. 1, 2

Immediate Assessment and Rehydration

Evaluate dehydration severity through specific clinical signs:

• Mild dehydration (3-5% fluid deficit): Slightly dry mucous membranes, normal vital signs 1
• Moderate dehydration (6-9% fluid deficit): Loss of skin turgor with tenting, dry mucous membranes, decreased urine output 1
• Severe dehydration (≥10% fluid deficit): Severe lethargy or altered consciousness, prolonged skin tenting (>2 seconds), cool extremities with poor perfusion, rapid deep breathing 1

For mild to moderate dehydration, administer low-osmolarity ORS:

• Start with 5-10 mL every 1-2 minutes using a spoon or syringe to prevent triggering vomiting 1, 2
• For moderate dehydration specifically, give 100 mL/kg over 2-4 hours 1, 2
• Replace ongoing losses: 10 mL/kg ORS for each watery stool and 2 mL/kg for each vomiting episode 1
• Gradually increase volume as tolerated without triggering vomiting 1

For severe dehydration, initiate intravenous rehydration immediately:

• Use isotonic fluids (lactated Ringer's or normal saline) 1, 2
• Continue IV therapy until pulse, perfusion, and mental status normalize 1, 2
• Transition to ORS once patient improves 1

Nutritional Management

Resume age-appropriate diet immediately during or after rehydration:

• Early refeeding reduces severity and duration of illness 1, 2
• Do not restrict diet or use "clear liquids only" approach 1, 3
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice), high-fat foods, and caffeinated beverages as these can exacerbate symptoms 1, 2

Pharmacological Considerations

Ondansetron may be considered if vomiting prevents ORS intake:

• Give to children >4 years with significant vomiting to facilitate oral rehydration 1, 2
• A single oral dose reduces gastroenteritis-related vomiting and facilitates ORT without significant adverse events 4
• However, ondansetron has been loaded with warnings for potentially severe side effects, so use judiciously 5

Never administer antimotility agents:

• Loperamide should not be given to children <18 years with acute diarrhea due to serious adverse events including ileus and deaths 1, 2
• Antimotility agents do not demonstrate effectiveness in reducing diarrhea volume or duration 1

Avoid other unnecessary medications:

• Do not use adsorbents, antisecretory drugs, or toxin binders as they lack demonstrated effectiveness 1
• Metoclopramide is explicitly contraindicated in gastroenteritis management 1

Antimicrobial Therapy

Do not give empiric antibiotics for typical acute gastritis with watery diarrhea:

• 70% of acute gastroenteritis cases are viral and antibiotics provide no benefit 2
• Consider antimicrobials only for specific scenarios: bloody diarrhea with fever, suspected bacterial dysentery, or immunocompromised status 2

Monitoring and Red Flags

Monitor vital signs and clinical status every 2-4 hours:

• Assess capillary refill, skin turgor, mental status, and mucous membrane moisture 1
• Track urine output and daily weights to assess rehydration progress 1

Seek immediate medical escalation if:

• Altered mental status develops (severe lethargy, decreased consciousness, irritability) 1
• Prolonged skin tenting >2 seconds persists 1
• Bloody stools with fever and systemic toxicity appear 1
• Persistent vomiting despite small-volume ORS administration continues 1
• Absent bowel sounds on auscultation (absolute contraindication to oral rehydration) 1

Infection Control

Implement strict infection control measures:

• Practice proper hand hygiene after toilet use, before eating, and after handling soiled items 1, 2
• Use gloves and gowns when caring for the child 1, 2
• Clean and disinfect contaminated surfaces promptly 1, 2
• Separate ill child from well persons until at least 2 days after symptom resolution 1

Common Pitfalls to Avoid

• Do not delay rehydration while awaiting diagnostic testing - initiate ORS immediately 1
• Do not use inappropriate fluids like apple juice or sports drinks as primary rehydration solutions 1
• Do not unnecessarily restrict diet during or after rehydration 1, 2
• Do not underestimate dehydration severity - reassess after 2-4 hours and restart rehydration if still dehydrated 1
• Do not give antimotility drugs to any child with acute diarrhea 1, 2