Clinical Guidelines for management of pediatric acute gastroenteritis (AGE)

Published October 09, 2024

Download Clinical Guidelines for Management of Pediatric Acute Gastroenteritis

Authored by: Mohsen Saidinejad, MD, MS, MBA

Overview

Children have a higher total body water content than adults, and therefore are more susceptible to dehydration. They also can lose electrolytes such as sodium and potassium. In most cases, dehydration is mild and isonatremic. Oral rehydration therapy (ORT), which contains, water, as well as electrolytes and a small carbohydrate component (e.g. Pedialyte, Gatorade, or the World Health Organization’s Oral Rehydration Solution) is highly effective to treat dehydration, especially from GI loses the first line treatment for mild to moderate dehydration. ORT can even be made from common items found in the house.

Children who have AGE, can often be successfully treated with a combination of antiemetics and oral hydration. The use of intravenous hydration should be limited to circumstances when severe dehydration is present, and the child cannot tolerate oral rehydration or has a compromise to functioning of their gastrointestinal system.

Important considerations for management of a child with acute gastroenteritis

Assess the child for the degree of dehydration based on signs and symptoms.

- Altered mental status
- Tachycardia
- Signs for shock (significantly delayed capillary refill)
- Poor skin turgor
- Dry oral mucosa and tongue
- Few or no tears when crying
- Sunken eyes
- For infants, sunken fontanelle
- Decreased urine output (e.g. no wet diaper or urination for 12 hours)
- Irritability and agitation

Check electrolytes including glucose and sodium to help with determining cause and type of dehydration.

Always encourage oral hydration if no contraindication is present.

Assess whether a child can tolerate oral hydration. If vomiting is present, use an antiemetic medication. If vomiting results in difficulty with oral hydration, consider smaller volume aliquots for hydration.

- For infants, use a teaspoon and feed 1-2 teaspoons (5-10 mL) aliquots. Toddlers can be given 1-2 tablespoon (15-30 mL) aliquots as tolerated. The key is to rehydrate slowly as the child tolerates. In cases where pharyngitis is limiting oral intake, consider an analgesic or other medicine to soothe the pain and discomfort.

Reserve intravenous hydration for a severely dehydrated child without ability to be orally hydrated

If a child requires intravenous hydration, consider timing for switching to oral hydration, when possible, to avoid access reliance on IV fluids.

PPN Hub site UCSF: clinical care pathway for acute gastroenteritis