Acute
gastroenteritis remains a common illness among infants and children throughout the world. Among children in the United States, acute
diarrhea accounts for >1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths/year. In developing countries,
diarrhea is a common cause of mortality among children aged <5 years, with an estimated 2 million deaths annually.
Oral rehydration therapy (ORT) includes
rehydration and maintenance fluids with
oral rehydration solutions (
ORS), combined with continued age-appropriate nutrition. Although ORT has been instrumental in improving health outcomes among children in developing countries, its use has lagged behind in the United States. This report provides a review of the historical background and physiologic basis for using ORT and provides recommendations for assessing and managing children with acute
diarrhea, including those who have become dehydrated. Recent developments in the science of
gastroenteritis management have substantially altered case management. Physicians now recognize that
zinc supplementation can reduce the incidence and severity of diarrheal disease, and an
ORS of reduced osmolarity (i.e., proportionally reduced concentrations of
sodium and
glucose) has been developed for global use. The combination of
oral rehydration and early
nutritional support has proven effective throughout the world in treating acute
diarrhea. In 1992, CDC prepared the first national guidelines for managing childhood
diarrhea (CDC. The management of acute
diarrhea in children:
oral rehydration, maintenance, and nutritional
therapy. MMWR 1992;41[No. RR-16]), and this report updates those recommendations. This report reviews the historical background and scientific basis of ORT and provides a framework for assessing and treating infants and children who have acute
diarrhea. The discussion focuses on common clinical scenarios and traditional practices, especially regarding continued feeding. Limitations of ORT, ongoing research in the areas of
micronutrient supplements, and functional foods are reviewed as well. These updated recommendations were developed by specialists in managing
gastroenteritis, in consultation with CDC and external consultants. Relevant literature was identified through an extensive MEDLINE search by using related terms. Articles were then reviewed for their relevance to pediatric practice, with emphasis on U.S. populations. Unpublished references were sought from the external consultants and other researchers. In the United States, adoption of these updated recommendations could substantially reduce medical costs and childhood hospitalizations and deaths caused by
diarrhea.