In a child with acute gastroenteritis presenting with vomiting and watery diarrhea, what is the initial management step?

• A. Begin loperamide
• B. Identify etiologic agent
• C. Start oral rehydration fluid for a maximum 48 hours
• D. Increase dietary fat

Answer: (C)

Oral rehydration therapy is the first and most important step when a child has acute gastroenteritis with vomiting and watery diarrhea. The goal is to restore fluid and electrolyte balance quickly to prevent dehydration, which is the main danger in these illnesses. An oral rehydration solution uses a glucose–sodium mechanism that enhances water absorption in the gut, allowing rehydration to be achieved with minimal invasiveness. Begin with small, frequent sips or small volumes as tolerated, and continue ORS for up to 48 hours while monitoring hydration status. If dehydration persists or the child cannot tolerate oral fluids, escalate to intravenous fluids.

Antidiarrheal agents like loperamide are not appropriate as initial therapy in young children because they don’t address dehydration and can cause adverse effects; identifying the etiologic agent isn’t necessary right away since most acute gastroenteritis is self-limited and managed supportively; and increasing dietary fat does not help and can worsen diarrheal symptoms. After rehydration starts, resume age-appropriate feeding.