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Letter to the editor
Editor, – I refer to the article 'Oral rehydration therapy for acute gastroenteritis in children' by Dr E. O'Loughlin (Aust Prescr 1993;16:61-3).
Articles from paediatricians which appear in journals and similar articles written by paediatricians for popular magazines concerning the management of vomiting illnesses give advice based on the condition of children as usually first seen by the specialists or the hospital staff.
The fact that a specialist and/or a hospital are involved indicates the illness has progressed along the road to dehydration and needs significant intervention.
Because advice in magazines warns mothers of the lethal potential of dehydration, they take the hydration advice very seriously indeed. So every time the child vomits, they feed 30 mL or so of ORS which the irritated stomach - not realising the good intention - promptly returns, usually with interest. And rather than reduce fluid loss, the mother usually succeeds in increasing it.
This is the common general practice experience. After a lengthy uphill battle, I eventually convinced 'my mothers' to initially starve the vomiting baby or child. 'Nothing by mouth for 3 hours and then try a little water - if rejected wait another 3 hours and try again, but ring me at any stage if you are getting anxious.' Invariably, those who phoned in earlier would admit that the vomiting returned after 'giving in' because the child asked for something or was licking their lips.
It is difficult to know how successful one is in a general practice, but admissions were uncommon and only moderately sick.
I believe the initial advice in this illness should be to fast as the gastric irritability settles during the first day in most cases.