Juice Is Best for Treating Mild Gastroenteritis with Minimal Dehydration in Children — Physician’s First Watch

Medical News |
May 2, 2016

Juice Is Best for Treating Mild Gastroenteritis with Minimal Dehydration in Children

By John D. Cowden, MD, MPH

Dr. Cowden is an associate editor with NEJM Journal Watch Pediatrics and Adolescent Medicine, from which this story was adapted. Full coverage is available to subscribers at the link below.

For children with mild gastroenteritis and minimal dehydration, dilute apple juice for initial hydration followed by fluids of the child's choice is superior to electrolyte maintenance solution, a JAMA study finds.

Researchers randomized some 650 children (aged 6-60 months) with gastroenteritis and minimal dehydration to receive either half-strength apple juice for initial hydration followed by fluids of the child's choice, or apple-flavored electrolyte maintenance solution.

The treatment failure rate was lower in the juice group (17% vs. 25%). In addition, fewer children in the juice group received IV rehydration at the index visit (1% vs. 7%) and within 7 days (3% vs. 9%). Although effective in all age groups, juice/preferred fluids was most beneficial in children aged 24 months and older.

Comment: Use of special oral rehydration solution in cases of mild gastroenteritis may not only be unnecessary but could lead to worse outcomes than use of more readily available and cheaper fluids, such as apple juice. Evidence supporting a less restrictive approach to rehydrating mildly dehydrated children should be welcomed by clinicians and parents alike.

Reader Comments (4)

JESSE PARR Physician, Pediatrics/Adolescent Medicine, .Texas

As someone who has treated diarrhea caused by apple juice consumption for years, and bearing in mind that physiology demonstrates that a glucose-electrolyte mix is best for rehydration, I am concerned that this advice will be used inappropriately on folks who are actually dehydrated and I am skeptical.

Maruh Arthur Rosa Dias Physician, Pediatric Subspecialty, São Paulo, Brazil

I suppose it is a good idea to use apple juice for gastroenteritis with minimal dehydration in children. They accept very well apple juice, instead other juices and sometimes it is not necessary endovenous
liquid.

Joseph Weatherly DO Physician, Family Medicine/General Practice

Great question Tim. I wonder if the other reason that any juice appears non-inferior is that ...anything will work to keep them hydrated. Popsicle, Juice, Water or ORS. It may be more about enticing them to keep their intake up rather than actual depletion of electrolytes etc as most of these children had no signs of "dehydration" which leads me to think this was typically an "early" intervention with a good correlation to what we get as far as nurse calls from concerned mothers looking for re-hydration. I am not surprised that basically any oral intake was sufficient to keep mild GE patients out of the hospital when compared to ORS. This is a trend in healthcare.

Tim Miller, DO Physician, Family Medicine/General Practice

How is this study broken down?

Pedialyte?
Walmart Brand ORS?
ORS made at home with diluted flavoring?

Maybe the real reason is that Pedialyte tastes terrible. Offer your child Pedialyte and see if they take it the next time. The universal answer is no followed by whining resistance. Offer your child the Walmart brand and they say no; but when asked what it tastes like they will say "Strawberry yogut" (while my other child asks for that yummy strawberry drink). My first child was vomitting up to 12 x per hour and the Walmart brand ORS kept them out of the hospital... Which brings me to my last point, a lot of the time it is the parent not recognizing and acting early enough to keep their child more hydrated... In all, educating parents and expressing our dissatisfaction with the taste of ORS to the manufacturers is the real solution...

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