Pediatr Ann. 2026 Aug;55(8):e323-e327. doi: 10.3928/19382359-20260609-05. Epub 2026 Aug 1.
ABSTRACT
Pediatric acute gastroenteritis remains a leading global cause of mortality and malnutrition, accounting for 1.7 billion annual cases. Despite its prevalence, management remains variable. This article advocates for a transition from unstructured clinical “gestalt” to evidence-based frameworks in order to improve outcomes. Diagnostic evaluation should prioritize validated tools, like the Clinical Dehydration Scale and the Gorelick Scale, as physician intuition often lacks precision. Laboratory diagnostics and polymerase chain reaction testing should be reserved for severe cases or patients with high risk to avoid over testing. Management emphasizes oral rehydration therapy as the gold standard for mild-to-moderate dehydration, supported by single-dose ondansetron to reduce intravenous (IV) fluid reliance and hospitalization. Antimicrobials are indicated only for specific pathogens (eg, Shigella, Vibrio cholerae) or immunocompromised hosts. Finally, there is discussion on systemic health disparities-noting that children who are Black and not Hispanic and children who are Hispanic are statistically less likely to receive IV fluids or admission-underscoring the role of standardized guidelines in ensuring equitable, high-value care.
PMID:42644700 | DOI:10.3928/19382359-20260609-05
