Emergency department study supports giving dehydrated children fluids by mouth

Therapy is quicker, less invasive than IV therapy

Oral rehydration therapy, or giving fluids by mouth, is equally effective as giving intravenous fluids to young children dehydrated by common stomach and intestinal inflammations, according to a new study by emergency medicine physicians. Because oral therapy can be started more quickly and is less painful for the child than IV treatment, the researchers say it should be the preferred treatment for children with moderate dehydration.

The research, performed in the emergency department of The Children’s Hospital of Philadelphia, supports previous recommendations by expert groups such as the American Association of Pediatrics and the World Health Organization. The study appears in the February issue of Pediatrics.

Gastroenteritis, an inflammation of the stomach and intestine, causes stomach pain, diarrhea, fever and vomiting in young children, especially during the winter months. The loss of fluids may cause a potentially dangerous dehydration, resulting in some 10 percent of hospitalizations in American children under age five.

Busy hospital emergency departments, such as The Children’s Hospital of Philadelphia, see hundreds of children each year with this condition, frequently caused by infection with rotavirus. “Our study shows that oral rehydration therapy is as effective as intravenous fluid therapy in rehydrating moderately dehydrated children,” said Philip Spandorfer, M.D., a pediatric emergency physician at The Children’s Hospital of Philadelphia and primary researcher on the study. “Currently, the majority of pediatric emergency physicians continue to use I.V. therapy for these children, both because they believe parents and referring physicians expect it, and because they believe oral therapy is time-consuming.”

There are many benefits to oral rehydration therapy (ORT) that make it more desirable than intravenous fluid therapy (IVF). Patients treated with ORT do not require intravenous access, a potentially painful and difficult procedure in young children. Also, parents who learn to administer ORT correctly have acquired a skill that can be used at home for ongoing and future illnesses.

A randomized controlled clinical trial was performed in the emergency department at Children’s Hospital from December 2001 through April 2003. Seventy-three children between 8 weeks and 3 years were enrolled in the study. Of the 73 patients, 36 were randomized to receive oral rehydration therapy (ORT) and 37 were randomized to receive intravenous fluid therapy (IVF). Less than one third of the group that received ORT required hospitalization, whereas almost half of the IVF group was hospitalized. Patients in the ORT group received small amounts of fluid (Pedialyte) over a period of four hours. After instruction, parents provided the fluid (Pedialyte) to their children.

Half of the participants in both groups were rehydrated successfully in four hours. The time required to start therapy was less in the ORT group, at just under 20 minutes compared to 41 minutes in the IVF group. Physicians also obtained 72-hour post-ED visit information through a follow-up phone call to all participants. Researchers used sham I.V.s so that treating physicians did not know which children were in each group.

“By the end of the study, we realized that most families prefer to start with the oral rehydration therapy for treatment of moderate dehydration,” said Dr. Spandorfer. “It is our hope that this study may support greater adoption of ORT by emergency physicians.”

Dr. Spandorfer’s co-authors were Evaline Alessandrini, M.D., M.S.C.E.; Mark D. Joffe, M.D.; Russell Localio, M.S.; and Kathy N. Shaw, M.D. All are from the Division of Emergency Medicine at The Children’s Hospital of Philadelphia.