Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting

Rebecca A. Carson, DNP, CPNP-PC/AC; Shawna S. Mudd, DNP, CPNP-AC; P. Jamil Madati, MD

Disclosures

J Pediatr Health Care. 2016;30(6):610-616. 

In This Article

Abstract and Introduction

Abstract

Acute gastroenteritis (AGE) is a common illness in childhood that usually can be treated in the outpatient setting. Inaccurate assessment or delayed treatment of AGE can lead to an increased risk for invasive interventions. A literature search was conducted using PubMed, CINAHL Plus, the Cochrane Library, and Embase. Results of the query were refined to narrow the focus of relevant studies for the provider caring for dehydrated children in the outpatient setting. Use of clinical dehydration scales to assess the level of dehydration and early initiation of oral rehydration therapy promote optimal patient outcomes. Oral rehydration therapy remains the best means of rehydrating, and ondansetron is a safe and effective adjunct to help children with persistent vomiting. The purpose of this practice guideline is to identify best practices for AGE in children older than 6 months with symptoms for less than 7 days who are being cared for in the outpatient setting.

Introduction

Acute gastroenteritis (AGE) is one of the most common childhood illnesses in the United States, accounting for more than 1.7 million outpatient visits each year (Freedman, Thull-Freedman, Rumantir, Atenafu, & Stephens, 2013). Up to 16% of emergency department (ED) visits are attributed to AGE, defined as three or more episodes of diarrhea and/or vomiting and possibly accompanied by other symptoms including fever, nausea, or abdominal pain that results from gastrointestinal inflammation (Fox, Richards, Jenkins, & Powell, 2012). The primary treatment goals for children with viral AGE are rehydration and prevention of complications due to dehydration from fluid loss from ongoing diarrhea and/or vomiting (Farthing et al., 2013).

Nationally recognized recommendations for AGE are oral rehydration therapy (ORT) as the primary treatment while avoiding unnecessary laboratory tests, diagnostic imaging, and medications (Centers for Disease Control and Prevention [CDC], 2003; Cincinnati Children's Hospital Medical Center, 2011). Most children have only mild or moderate dehydration associated with AGE, and the success rate of ORT as a treatment method is approximately 96% (Nir, Nadir, Schechter, & Kline-Kremer, 2013). Despite recommendations that pediatric patients with mild to moderate dehydration receive ORT as the mainstay of treatment, many providers unnecessarily order laboratory tests, diagnostic imaging, and intravenous fluids that do not provide prognostic value or shorten the self-limited illness (Kharbanda et al., 2013). The purpose of this clinical practice guideline is to describe current evaluation and management of pediatric patients with AGE in the outpatient setting.

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