Simpler is better: children with diarrhea, vomiting often OK to drink what they want, study shows

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Girl drinks apple juice

If a child with a stomach ailment wants to have apple juice, a Canadian study suggests it might be better than trying to force her to drink electrolyte solutions. (Jessica Rinaldi/Reuters)

Parents should feel free to give young children with minimal dehydration apple juice or a favourite beverage instead of an electrolyte solution when they’re recovering from vomiting and diarrhea, says a Canadian doctor who put both approaches to a test.

Nearly 650 children aged six months to five years who went to the emergency department at the Hospital for Sick Children in Toronto with gastroenteritis or intestinal infection were randomly assigned to drink either diluted apple juice or a standard apple-flavoured electrolyte solution as a control.

When the children left emergency, investigators asked the parents to continue giving the diluted apple or preferred fluids or the electrolyte solution, depending on their group. A research nurse called daily until the child was free of symptoms for a day and then again after a week.

Of the 644 children who completed follow-up, those who had dilute apple juice experienced treatment failure less often (17 per cent) than those in the control group who were given electrolytes (25 per cent), Dr. Stephen Freedman, an associate professor of pediatrics at the University of Calgary and his co-authors said in Saturday’s issue of JAMA.

Children often don’t like electrolyte solution

“I’ve bought commercially available electrolyte solutions in the past and often seen first-hand the challenges of getting a child to want to drink them,” said Freedman, who is also an adjunct scientist at Sick Kids.

Some children don’t like the way the electrolyte solution tastes. In hospital, when children refuse to drink it, staff may resort to an IV, Freedman said.

In the study, fewer children in the apple juice group needed intravenous rehydration (2.5 per cent compared with nine per cent).

The findings challenge the recommendation to routinely give electrolyte solutions when diarrhea starts, an approach Freedman called somewhat dogmatic. It was based on evidence from developing countries where mortality and dehydration is high, but hadn’t been tested much in high-income countries where most children don’t need immediate electrolyte maintenance.

Anecdotally, Freedman said doctors at Canadian hospitals are trying the juice approach when a child won’t take the electrolyte solution.

More important to just get them to drink

“I think this will enable physicians to take a more patient-centred approach,” Freedman said. “Sometimes it’s more important we promote the successful consumption of liquids than being rigid on what we’re allowing them to consume.”

If parents have significant concerns about a child developing dehydration, then they should be brought in for an evaluation to be reassured if they feel they can’t manage it at home, he said. In some cases, a child may need more treatment.

The Canadian Paediatric Society’s Caring for Kids website says signs of dehydration include:

  • Decreased urination (fewer than four wet diapers in 24 hours in infants or no urine for over eight hours in older children).
  • Increased thirst.
  • Absence of tears.
  • Dry skin, mouth and tongue.
  • Faster heartbeat.
  • Sunken eyes.
  • Grayish skin.
  • Sunken soft spot (fontanelle) on a baby’s head.

Officially, the American Academy of Pediatrics endorses rehydration solution or electrolytes even in children without evidence of dehydration.

Children under six months of age, those weighing less than 8 kg, who had significant dehydration or history of heart, lung, kidney or chronic gastrointestinal disease were excluded from the study.

The study was funded by the Physician Services Incorporated Foundation.


Simpler is better: children with diarrhea, vomiting often OK to drink what they want, study shows

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