Rehydration In Kids: Which Is Safest?

gastroenteritis diarrhea dehydration children rehydrationWhat’s the best treatment if you or your child have a stomach infection and get  slightly dehydrated from a couple days of diarrhea and poor eating? I see a lot of such gastroenteritis in the summertime, mostly due to more bacterial food poisoning. Overall, most mild infections in children are caused by a virus and not bacteria. Sometimes this infection can be very severe, but the great percentage are mild and don’t require any antibiotics or hospitalizations. I worry mostly about babies and toddlers because they can quickly dehydrate after a couple of days of severe diarrhea and not keeping up with fluids and foods. That’s why my top priority when talking with parents is not to offer antibiotics but to educate them about proper hydration at home.

The basics of hydration include continuing to eat normal foods if possible, and certainly continue breast-feeding. As for fluid supplements, many parents feel that their child automatically needs intravenous hydration at their local hospital, but in reality the great majority can be treated orally, and at home. The American Academy of Pediatrics has an official position paper on gastroenteritis which states, “oral rehydration was found to be as effective as intravenous therapy in rehydrating children with mild to moderate dehydration and is the therapy of first choice in these patients.” A 2006 meta-analysis by the Cochrane Collaboration assembling data from the best studies also confirmed “no clinically important differences between oral rehydration therapy and intravenous therapy”.

So what is the best way to get this oral rehydration when at home? There are many home remedies and traditional recipes used by parents, but the best treatment remains the official WHO-approved Oral Rehydration Salts, which are sold over the counter in all pharmacies worldwide, including here in China. Some companies package this into premade solutions such as Pedialyte in the USA. The official WHO-ORS has been exhaustively studied across the world to provide the proper balance of water, sugar and salts, and has proven an invaluable life saver for millions of children, especially in developing countries. This WHO-ORS has a very specific concentration (osmolarity) of 245 mOsm/L along with glucose 13.5 g/L, sodium 75 mEq/L and a couple of other electrolytes. This balance is crucial to correct dehydration as well as to give people ideal amounts of salts and sugars. For example, pure water is definitely not the best treatment as it has none of the sodium salts and sugar which are critical to replenish your body’s cells.



What about sports drinks and sodas? Gatorade and other sports drinks specifically advertise that they can replenish your essential nutrients — what’s the actual data showing if these are helpful, especially with gastroenteritis? The medical consensus is that none of these options are ideal. This is because they usually contain a lot of sugar and other ingredients which make their osmolarity much higher than a normal body can handle, and this higher osmolarity actually pulls more liquid from your cells — making your dehydration and watery diarrhea worse, not better. A 2010 review article offers easy to read comparisons between WHO-ORS and Coke, Pocari, Gatorade and other common brands. Coke’s osmolarity is very high at 650 mOsm/L, and some sports drinks go as high as 1,076. The popular Japanese drink Pocari Sweat is closer to ORS with osmolarity of 326 but still has more glucose and, just as importantly, much less sodium. Sodium is the most critical mineral to keep our bodies hydrated, and any major imbalance of sodium, whether too high or too low, can cause great harm. The standard WHO-ORS has 75 millequivalents per liter of this essential mineral, while Pocari only has 21 mEq/L, and Coke even less with 2.

With homemade remedies, many parents use clear liquids such as chicken soup or juices, yet these also may cause some problems when compared to WHO-ORS. For example, everyone’s favorite sickness food, chicken soup, often has an enormous amount of sodium which again could cause more harm than help. Chicken broth usually has 250 mEq/L compared to the recommended 75. Apple juice is another favorite but its osmolarity is so high, at 700, that it usually makes diarrhea much worse. Plus it contains very little of the needed sodium. Even ginger ale has too high osmolarity and also too little sodium, making this yet another poor choice for hydration.

The take-home message for parents is that you should not reach for water, sports drinks, teas or juices as a first choice when you or your child are throwing up and having diarrhea. My Academy of Family Practice has more specific advice, from their article on management of acute gastroenteritis in children:

“The time-honored “clear liquids” most often used by parents or recommended by physicians in the past are not appropriate for use in oral rehydration therapy. Drinks such as colas, ginger ale, apple juice and even commercial sports drinks (e.g., Gatorade) are inappropriately high in carbohydrates and osmolality. They can cause osmotic worsening of diarrhea, and their low sodium content may contribute to the development of hyponatremia. Tea should not be used because of its low sodium content, and chicken broth is contraindicated because of its high sodium content. Furthermore, food should not be arbitrarily withheld because continued feeding or the early resumption of feeding improves outcome.”

 


This article was originally printed in my monthly column in Beijing Kids magazine. You can click here to read the rest of my “The Doc Is In” columns. A Chinese version was printed in the New York Times China edition.




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2 thoughts on “Rehydration In Kids: Which Is Safest?”

  1. I like this homemade version I found online, originally from “The Washington Manual: Outpatient Medicine Survival Guide”. LW&W, 2003. I also made a similar version when I was in Labor, during my home births, they called it on the birthing groups LaborAide!

    “Recipe for home made oral rehydration solution

    Gather the following items: table salt (sea salt is even better), baking soda, sugar, orange juice (100% juice), water (filtered is preferred), large container that can measure 1 liter of fluid.

    Measure one half teaspoon (1/2 tsp) of salt into the container. Add one teaspoon (1 tsp) of baking soda (NOT baking powder!)Add eight teaspoons (8 tsp) of sugar. Measure in eight ounces (8 oz) of orange juice. Add water up to the one liter (1 L) mark to dilute the above ingredients. Stir or swirl to combine

    Once the above oral rehydration solution has been made it should be administered to the individual with diarrhea as a means to prevent dehydration. It is often necessary to take very small sips of the ORS frequently, rather than attempting to imbibe a glass of this concoction. It is not necessary to restrict water as long as the child or adult with diarrhea is drinking the oral rehydration solution as well. As always, individuals should contact their health care provider with any concerns or questions regarding treatment of adults or children with diarrhea.”

    We often don’t have white sugar in the house, so I have used a combination of date sugar and even plain molasses, too. I think it is even better, because of the additional trace minerals present. If no OJ, you can substitute for the OJ a small amount of fresh lemon juice to make it lemonadey. The critical portion is the potassium salt and it’s available in most stores. Get the China Salt brand of low-sodium salt, it’s potassium salt.

    1. Thanks for this valuable recipe! I’m fine with this approach, it’s a lot better than Gatorade, juices, etc. The Washington Manual is a very solid reference…

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