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Guideline Synthesis

GUIDELINE SYNTHESIS

Management of Gastroenteritis in Pediatrics

Guidelines

American Academy of Pediatrics (AAP). Practice parameter: the management of acute gastroenteritis in young children. Pediatrics 1996 Mar;97(3):424-35.
Children's Hospital Medical Center (Cincinnati, OH) (CHMC). 1997-1998 Evidence based guidelines and recommendations for the community evaluation and medical management of children with acute gastroenteritis. Cincinnati (OH): Children's Hospital Medical Center (CHMC); 1997. 46 p.

INTRODUCTION

The formulation of the CHMC guidelines was based on review of more than 200 articles including the American Academy of Pediatrics practice parameter. Their review was supplemented with data and experiences gathered through the local resources at Cincinnati Children's Hospital and the surrounding communities.

	AAP (March 1996)	CHMC (1997)
OBJECTIVE AND SCOPE	To present current knowledge about optimal treatment of children with diarrhea, to prevent morbidity and mortality related to the disease and treatment of gastroenteritis in young children, and to promote the use of oral rehydration therapy.	To update current practices for evaluating and treating gastroenteritis to maximize the use of these newer therapies of proven efficacy
TARGET POPULATION	Children aged 1 month to 5 years with acute gastroenteritis who live in developed countries and who have no previously diagnosed disorders affecting major organ systems, including immunodeficiency	Infants aged 2 months to 5 years with acute gastroenteritis (diarrheal disease of recent onset not caused by chronic disease) with or without accompanying symptoms and signs, such as nausea, vomiting, fever, or abdominal pain
INTERVENTIONS AND PRACTICES CONSIDERED	Oral rehydration therapy (ORT) Intravenous rehydration therapy Early refeeding of appropriate foods Antidiarrheal agents	Oral rehydration solutions (ORS) Intravenous rehydration therapy Early refeeding of appropriate foods Anti-diarrheal agents Antimicrobial and antiemetic agents
EXCLUDED TOPICS	Antiemetic drugs	None excluded
COMPARISON OF RECOMMENDATIONS FOR MANAGEMENT OF GASTROENTERITIS IN YOUNG CHILDREN
Oral rehydration therapy (ORT)	ORT is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration.	For the child who is dehydrated consider preferential use of oral rehydration solutions with at least 45 mEq/L by mouth as alternative to intravenous therapies for replacing fluids lost due to diarrhea and vomitting.
Early refeeding of age-appropriate foods	Children who have diarrhea and are not dehydrated should continue to be fed age-appropriate diets. Children who require rehydration should be fed age-appropriate diets as soon as they have been rehydrated.	To prevent dehydration, continue to offer food and liquids that are part of the child's usual diet in quantities matching estimated fluid losses. Even when on IV or ORS, it is strongly recommended that refeeding using a usual diet be started at the earliest opportunity after rehydration, child is alert, and accepts the feedings.
Anti-diarrheal agents	As a general rule, pharmacologic agents should not be used to treat acute diarrhea. Anti-diarrheal agents, such as loperamide, anticholinergic agents, bismuth subsalicylate, adsorbants, and lactobacillus are not recommended; opiates are contraindicated. Although the committee did not evaluate the use of antiemetic drugs, their consensus opinion was that antiemetic drugs are not needed.	Anti-diarrheal agents and antiemetics are not recommended.
POTENTIAL BENEFITS
	Successful rehydration Decrease the number of emergency room visits and hospitalizations for rehydration Reduce or limit the use of pharmacologic agents in the management of acute gastroenteritis	Prevent or limit the severity of dehydration Prevent the need for IV therapies and hospitalizations Shorten the duration of illness and length of hospitalization
POTENTIAL HARMS
	None identified	None identified

Guideline Content Comparison

The American Academy of Pediatrics (AAP) and the Children's Hospital Medical Center (Cincinnati, OH) (CHMC) present recommendations for the management of acute gastroenteritis in young children.

Areas of Agreement

The AAP and CHMC agree that oral rehydration therapy (ORT) and early refeeding is the preferred treatment for children with mild to moderate dehydration. Although both groups emphasize ORT, they stress IV therapy is the appropriate approach for severely dehydrated children with altered mental status or in a state of shock or near shock. Both groups advocate age-appropriate feeding and fluid consumption to prevent dehydration in children with diarrhea. Both groups recommend against the use of anti-diarrheal or antiemetic agents.

Areas of Differences

There are no areas of significant differences between the recommendations from AAP and CHMC.

This Guideline Synthesis was prepared by ECRI on December 28, 1998. It was reviewed and verified by the Guideline Developers as of February 1, 1999.

Guideline Synthesis

GUIDELINE SYNTHESIS

Management of Gastroenteritis in Pediatrics

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