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100 years ago when I was a little doctor-in-training, a bunch of studies came out demonstrating that oral rehydration therapy is actually better than IV fluids for kids who are mildly to moderately dehydrated in several ways. Kids who got fluid by mouth were more likely to recover more quickly and the parents reported a higher satisfaction with their ER visit. Taking fluid in by mouth not only avoids the pain, discomfort and time of an IV, but it might actually help the poor little diarrhea-ravaged intestines get better faster. So why are kids still getting IV fluids?

The problem is that oral rehydration therapy (ORT) is not just giving a kid a can of soda.  A dehydrated kid is a thirsty kid and if you let him gulp liquid, there is a good chance he’s just going to puke it right back out. Moreover, when a kid is just feeling cruddy, it’s okay to drink whatever he prefers. But when he’s actually dehydrated, using a specific fluid containing both salt and sugar, such as Pedialyte, helps the body take in water using specific fluid channels that are more effective in taking up liquid. Therefore, ORT is a real procedure: 1 teaspoon every 5 minutes for one hour, then double it until he can drink freely. If he throws up, stop, wait 30 minutes and try again. Bigger kids can start with 2 teaspoons. Do NOT let him gulp the whole cup. Using this method, a kid will be absorbing the fluid even if he continues to vomit intermittently and the tiny amount is less likely to make him get sick all over the rug.

Of course, this is a lot of work and parents can get discouraged. But I would argue that ORT is something you can do at home, thereby avoiding a visit to a crowded ER. Your pediatrician will be more than happy to provide encouragement over the phone and can also guide you as to when ORT just isn’t working and it’s time to head into the hospital. Even in the ER we might want to keep trying ORT but can add in a dose of anti-vomiting medicine to help you along. So don’t just assume that a trip to the ER means IV fluids.

I’ll stop here because I could go on and on about the signs of dehydration and more about both prevention and treatment. But that’s for another day. I’ll leave you with this: I don’t care how few wet diapers he’s had or how little she’s had to drink if she’s active and alert and her mouth is wet and her eyes bright and shiny. She won’t get an IV from me because you can’t hydrate a watermelon. Or at least that is what I teach the residents.

Dr. Lara Zibners, Jan 15, 2010

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While in Ohio I got together with several old friends and colleagues, all of whom are pediatricians, most of them emergency medicine specialists. Do you remember my last email when I said that we should be wiping the gums of a baby before he even has teeth? Oh well, can I tell you what a grand time my friends had making fun of that one! Never mind that the pediatric dentists taught me that. And that Eva’s pediatrician also instructed me to do so. No, my buddies thought it was so hilarious that they started calling people “Gum Wipers” as an insult. (As in, “Lara, you’re such a Gum Wiper. I can’t believe you measure Eva’s formula to the exact milliliter.” I don’t by the way. Just an example. “Gum Wiper” is apparently synonymous with “super uptight.”)

Why am I telling you this? Because it’s a fantastic example of how medicine is an art. And how different doctors may have different ways of doing things. There are very few times when a rule about raising kids is hard and fast. Putting healthy infants on their backs to sleep and strapping them into a car seat are a couple of them. But whether you wipe your kids gums or use a certain diaper cream or start green vegetables before yellow, chances are your kid is going to be okay. So that is my Happy New Year message to all of you: enjoy your children and don’t sweat the small stuff. Have confidence and do your best; it will most likely turn out fine. And now I’m off to wipe my child’s gums…

From The Mouth of Babes:
Said the 2 year old little boy of a friend of mine: “Pee comes out your penis. Poop comes out your butt. That’s all you need.” Well, it’s not everything, but it’s a good place to start.

Dr. Lara Zibners, Jan 05, 2010

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