What supplements are recommended for a child with vomiting, such as from acute gastroenteritis?

Supplements for Vomiting in Pediatric Patients

Zinc supplementation is the only supplement recommended for children with vomiting from acute gastroenteritis, specifically for children 6 months to 5 years of age who live in areas with high zinc deficiency prevalence or show signs of malnutrition. 1, 2

Primary Management: Oral Rehydration, Not Supplements

The cornerstone of managing vomiting in pediatric gastroenteritis is not supplementation but rather oral rehydration solution (ORS) administered in small, frequent volumes. 1, 2, 3

• Administer 5-10 mL of ORS every 1-2 minutes using a spoon or syringe when vomiting is present, gradually increasing volume as tolerated. 1, 2
• This technique successfully rehydrates >90% of children with vomiting and diarrhea without any antiemetic medication. 2
• A common pitfall is allowing a thirsty child to drink large volumes of ORS ad libitum, which worsens vomiting. 1

Zinc Supplementation: The Evidence

Zinc is the only supplement with guideline-level evidence for reducing symptom duration in pediatric gastroenteritis. 1, 2

• Zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age. 1, 2
• This recommendation applies specifically to:
  • Children residing in countries with high zinc deficiency prevalence 1, 2
  • Children showing signs of malnutrition 1, 2
• The American Academy of Pediatrics and CDC support this recommendation based on evidence showing reduced illness duration. 1

Pharmacologic Adjuncts (Not Supplements)

While not supplements, ondansetron may be considered for children >4 years of age to facilitate oral rehydration when vomiting is significant, but only after adequate hydration is achieved. 1, 2

• Ondansetron reduces vomiting episodes (0.18 vs 0.65 episodes, P<0.001) and decreases need for IV rehydration (14% vs 31%). 4
• This is a medication, not a supplement, and should be prescribed by a healthcare provider. 1

What NOT to Use

Avoid the following, as they have no role in managing pediatric gastroenteritis: 1, 2

• Antimotility agents (loperamide) are absolutely contraindicated in all children <18 years of age. 1, 2
• Adsorbents, antisecretory drugs, or toxin binders do not demonstrate effectiveness in reducing diarrhea volume or duration. 2
• Metoclopramide has no role in gastroenteritis management and may worsen outcomes. 2
• Caffeinated beverages should be avoided as they worsen symptoms through stimulation of intestinal motility. 2

Nutritional Management

Continue breastfeeding throughout the diarrheal episode and resume age-appropriate diet during or immediately after rehydration. 1, 2, 3

• Early refeeding is recommended rather than fasting or restrictive diets. 2, 3
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice) as they exacerbate diarrhea through osmotic effects. 2

Warning Signs Requiring Medical Attention

Seek immediate care if the child develops: 1, 2

• Severe dehydration signs (altered mental status, prolonged skin tenting >2 seconds, poor perfusion) 2
• Intractable vomiting despite small-volume ORS administration 1, 2
• Bloody diarrhea with fever 2
• Decreased urine output, severe lethargy, or irritability 1