Gastroentérite

Le référentiel médical TREKK est une collection des meilleures ressources et évidences sur divers sujets. La collection est constituée par une équipe de synthèse des connaissances à l’Alberta Research Centre for Health Evidence (ARCHE) et par une équipe de spécialistes qui contribuent au contenu médical TREKK.

L’équipe de synthèse utilise un cadre hiérarchique des données probantes en forme de pyramide « 4S » (voir le modèle “4S” Hierarchy of evidence), pour répondre aux besoins des parties prenantes. Pour ce faire, l’équipe effectue à priori une recherche de la littérature à partir des bases de données scientifiques (Cochrane Library, PubMed, TRIP Database) et des moteurs de recherche internet (Google, Google Scholar). Les résultats sont organisés en 5 volets de présentation :

1. Recommandations de base
2. Lignes directrices sur la pratique clinique et algorithmes
3. Survols et résumés des revues systématiques
4. Revues systématiques
5. Études clés

Ressources pour parents et familles, si applicable

En collaboration avec l’équipe de synthèse des connaissances, les spécialistes qui contribuent au contenu TREKK sélectionnent les items pertinents, présentés ci-dessous. Le référentiel médical TREKK n’est pas conçu comme liste exhaustive du sujet, mais plutôt comme liste sélectionnée par un consensus d’experts : c’est une liste de ressources fondées sur des données probantes à date, pertinentes, et utilisables au Service général des urgences médicales. Les ressources à libre accès sont privilégiées (c’est-à-dire, disponibles à tous, gratuites, et sans abonnement nécessaire).

Pour en savoir plus sur l’élaboration de nos référentiels, cliquez ici.

Un grand merci aux spécialistes cliniques et à l’Équipe de synthèse des connaissances qui ont dirigé le développement de ce référentiel médical.

Dr. Stephen Freedman Professor Department of Pediatrics, Cumming School of Medicine, University of Calgary Professor Department of Emergency Medicine, University of Calgary Professor in Child Health and Wellness, Alberta Children’s Hospital Foundation

Samantha Guitard Evidence Synthesis Scientist, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

Cliquez ici pour voir les ressources TREKK élaborées pour professionnels de la santé, parents, et familles.

1. Children’s Hospital of Philadelphia. Dehydration Clinical Pathway—Emergency Department and Inpatient. 2023. https://www.chop.edu/clinical-pathway/dehydration-clinical-pathway
2. The Royal Children’s Hospital Melbourne. Gastroenteritis. 2020. https://www.rch.org.au/clinicalguide/guideline_index/Gastroenteritis/
3. Kim YJ, Park KH, Park DA, Park J, Bang BW, Lee SS, et al. Guideline for the Antibiotic Use in Acute Gastroenteritis. Infect Chemother. 2019;51(2):217-43. https://pubmed.ncbi.nlm.nih.gov/31271003/
4. Hartman S BE, Loomis E, Russell HA. Gastroenteritis in children. American Family Physician. 2019;99(3):159-65. https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html
5. Cincinnati Children’s Hospital Medical Center. Prevention and management of acute gastroenteritis (AGE) in children aged 2 months to 18 years. 2018. http://www.guideline.gov/content.aspx?f=rss&id=35123
6. Cheng A. Emergency department use of oral ondansetron for acute gastroenteritisrelated vomiting in infants and children. Canadian Pediatric Society. 2018. https://cps.ca/en/documents/position/oral- ondansetron
7. Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Shamir R, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 2014;58(4):531-9. https://pubmed.ncbi.nlm.nih.gov/24614141/
8. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132-52. https://pubmed.ncbi.nlm.nih.gov/24739189/
9. Services AH. Alberta Health Services Acute Childhood Vomiting & Diarrhea Pathway. 2011. https://calgarypaeds.org/wp-content/uploads/2014/12/DV-pathway-Oct-25-2011.pdf
10. Excellence NIfHaC. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. 2009. https://www.nice.org.uk/guidance/cg84
11. King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(Rr-16):1-16. https://pubmed.ncbi.nlm.nih.gov/14627948/

1. Imdad A, Rani U. Oral Rehydration Salt Solutions for Children: A Review. Pediatr Review. 2025;46(7):355-365. https://pubmed.ncbi.nlm.nih.gov/40588279/
2. Freedman SB. TREKK Talk: Gastroenteritis 2014. https://www.youtube.com/watch?v=DIkAfNv46fA.
3. ARCHE. Evidence Summary: Gastroenteritis. 2014. https://trekk.ca/system/assets/assets/attachments/27/original/Evidence_Summary_Gast roenteritis.pdf.
4. Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L. Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries. Evid Based Child Health. 2013;8(4):1123-37. https://pubmed.ncbi.nlm.nih.gov/23877938/.

1. Ali AA, Naqvi SK, Hasnain Z, Zubairi MB, Sharif A, Salam RA, et al. Zinc supplementation for acute and persistent watery diarrhoea in children: A systematic review and meta-analysis. J Glob Health. 2024;14:04212. https://pubmed.ncbi.nlm.nih.gov/39641338/
2. Zubairi MB, Naqvi SK, Ali AA, Sharif A, Salam RA, Hasnain Z, et al. Low-osmolarity oral rehydration solution for childhood diarrhoea: A systematic review and meta-analysis. J Glob Health. 2024;14:04166. https://pubmed.ncbi.nlm.nih.gov/39641334/
3. Barot KS, Vaghasiya KN, Suhagiya GH, Singh AP, Nadeem S, Qureshi AN, et al. Comparing the Efficacy of Ondansetron, Domperidone, and Metoclopramide in Treating Vomiting in Pediatric Patients With Acute Gastroenteritis: A Network Meta-Analysis. Cureus. 2024;16(8):e67902. https://pubmed.ncbi.nlm.nih.gov/39328710/
4. Weghorst A, Lawrence J, Jansen D, Holtman GA, Sanci LA, Berger MY, et al. Enablers and Barriers to Home Management for Children with Gastroenteritis: Systematic Review. J Pediatr. 2024;14:200115. https://pubmed.ncbi.nlm.nih.gov/39950054/
5. Khales P, Razizadeh MH, Ghorbani S, Moattari A, Sarvari J, Saadati H, et al. Human adenoviruses in children with gastroenteritis: a systematic review and meta‑analysis. BMC Infect Dis. 2024;24(1):478. https://pubmed.ncbi.nlm.nih.gov/38724898/
6. Octavius GS, Imanuelly M, Wibowo J, Heryadi NK, Widjaja M. Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta‑analysis. Clin Exp Pediatr. 2023;66(11):477-484. https://pubmed.ncbi.nlm.nih.gov/37321576/
7. Florez ID, Sierra J, Perez-Gaxiola G. Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children. Cochrane Database Syst Rev. 2023;5(5):CD013640. https://pubmed.ncbi.nlm.nih.gov/37196992/
8. Huang R, Xing HY, Liu HJ, Chen ZF, Tang BB. Efficacy of probiotics in the treatment of acute diarrhea in children: a systematic review and meta-analysis of clinical trials. Transl Pediatr. 2021;10(12):3248-60 https://pubmed.ncbi.nlm.nih.gov/35070839/.
9. Grigsby A, Herron J, Hunter BR. Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis. Cjem. 2019;21(5):638-45. https://pubmed.ncbi.nlm.nih.gov/30698123/
10. Iro MA, Sell T, Brown N, Maitland K. Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis. BMC Pediatr. 2018;18(1):44. https://pubmed.ncbi.nlm.nih.gov/29426307/.
11. Florez ID, Veroniki AA, Al Khalifah R, Yepes-Nuñez JJ, Sierra JM, Vernooij RWM, et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS One. 2018;13(12):e0207701. https://pubmed.ncbi.nlm.nih.gov/30517196/.
12. Falszewska A, Szajewska H, Dziechciarz P. Diagnostic accuracy of three clinical dehydration scales: a systematic review. Arch Dis Child. 2018;103(4):383-8. https://pubmed.ncbi.nlm.nih.gov/29089317/.
13. Grisaru S, Xie J, Samuel S, Hartling L, Tarr PI, Schnadower D, et al. Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin-Producing Escherichia Coli: A Systematic Review And Metaanalysis. Jama Pediatr. 2017;171(1):68-76 https://pubmed.ncbi.nlm.nih.gov/27893870/.
14. Grisaru S, Xie J, Samuel S, Freedman SB. Iatrogenic Dysnatremias in Children with Acute Gastroenteritis in High-Income Countries: A Systematic Review. Front Pediatr. 2017;5:210. https://pubmed.ncbi.nlm.nih.gov/29057220/.
15. Goldenberg JZ, Yap C, Lytvyn L, Lo CKF, Beardsley J, Mertz D, et al. Probiotics for the prevention of Clostridium difficile‑associated diarrhea in adults and children. Cochrane Database of Systematic Reviews. 2017(12). https://doi.org//10.1002/14651858.CD006095.pub4.
16. Cohen R, Raymond J, Gendrel D. Antimicrobial treatment of diarrhea/acute gastroenteritis in children. Arch Pediatr. 2017;24(12s):S26-s9. https://pubmed.ncbi.nlm.nih.gov/29290231/.
17. Freedman SB, Xie J, Neufeld MS, Hamilton WL, Hartling L, Tarr PI, et al. Shiga ToxinProducing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta- analysis. Clin Infect Dis. 2016;62(10):1251-8. https://pubmed.ncbi.nlm.nih.gov/26917812/.
18. Schnadower D, Finkelstein Y, Freedman SB. Ondansetron and probiotics in the management of pediatric acute gastroenteritis in developed countries. Curr Opin Gastroenterol. 2015;31(1):1-6. https://pubmed.ncbi.nlm.nih.gov/25333367/.
19. Freedman SB, Vandermeer B, Milne A, Hartling L. Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a metaanalysis. J Pediatr. 2015;166(4):908-16.e1-6. https://pubmed.ncbi.nlm.nih.gov/25641247/.
20. Freedman SB, Pasichnyk D, Black KJ, Fitzpatrick E, Gouin S, Milne A, et al. Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis. PLoS One. 2015;10(6):e0128754. https://pubmed.ncbi.nlm.nih.gov/26075617/.
21. Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews. 2011(9). https://doi.org//10.1002/14651858.CD005506.pub5.
22. Hartling L, Bellemare S, Wiebe N, Russell KF, Klassen TP, Craig WR. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database of Systematic Reviews. 2006(3). https://doi.org//10.1002/14651858.CD004390.pub2.

1. Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025;393(3):255-266. https://pubmed.ncbi.nlm.nih.gov/40673584/
2. Bizot E, Bonacorsi S, Labe P, Pinhas Y, Cointe A, Ferroni A, et al. Use of gastrointestinal syndromic multiplex molecular assays and detection of Escherichia coli pathotypes in pediatric wards. J Clin Microbiol. 2025;63(4):E0107324. Https://Pubmed.ncbi.nlm.nih.gov/40008873/
3. Satyesh S, Meena RK, Shah D, Saha R, Gupta P. Intramuscular Versus Oral Ondansetron for Management of Children with Acute Dehydrating Diarrhea and Vomiting: A Randomized Controlled Trial. Indian Pediatr. 2025;62(6):414-420. Https://Pubmed.ncbi.nlm.nih.gov/40172592/
4. Fonseca-Romero P, Brintz BJ, Vierkant DM, Bard JD, Cohen DM, Festekjian A, et al. Etiologies of Bloody Diarrhea in Children Presenting With Acute Gastroenteritis to US Emergency Departments. Open Forum Infect Dis. 2024;11(12):Ofae692. Https://Pubmed.ncbi.nlm.nih.gov/39691289/
5. Bardhan PK, Das R, Nahar B, Haque MA, Sobi RA, Sultana AA, et al. Assessing safety and efficacy of a novel glucose-free amino acid oral rehydration solution for watery diarrhea management in children: a randomized, controlled, phase III trial. EClinicalMedicine. 2024;72:102630. https://pubmed.ncbi.nlm.nih.gov/38800804/
6. Pavia AT, Cohen DM, Leber AL, Daly JA, Jackson JT, Selvarangan R, et al. Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Clin Infect Dis. 2024;78(3):573-581. https://pubmed.ncbi.nlm.nih.gov/38097379/
7. Freedman SB, Finkelstein Y, Pang XL, Chui L, Tarr PI, VanBuren JM, et al. Pathogen-Specific Effects of Probiotics in Children With Acute Gastroenteritis Seeking Emergency Care: A Randomized Trial. Clin Infect Dis. 2022;75(1):55-64. https://pubmed.ncbi.nlm.nih.gov/34596225/
8. Weghorst AAH, Bonvanie IJ, Holtman GA, de Boer MR, Berger MY. Course of uncomplicated acute gastroenteritis in children presenting to out-of-hours primary care. BMC Prim Care. 2022;23(1):125. https://pubmed.ncbi.nlm.nih.gov/35606695/.
9. Powell EC, Roskind CG, Schnadower D, Olsen CS, Casper TC, Tarr PI, et al. Oral Ondansetron Administration in Children Seeking Emergency Department Care for Acute Gastroenteritis: A Patient- Level Propensity-Matched Analysis. Ann Emerg Med. 2022;79(1):66-74. https://pubmed.ncbi.nlm.nih.gov/34389195/.
10. Patel PV, Wallach T, Rosenbluth G, Heyman M, Verstraete S. Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis. BMJ Open Qual. 2022;11(1). https://pubmed.ncbi.nlm.nih.gov/35347066/.
11. Levine AC, O’Connell KJ, Schnadower D, VanBuren TJM, Mahajan P, Hurley KF, et al. Derivation of the Pediatric Acute Gastroenteritis Risk Score to Predict Moderate-toSevere Acute Gastroenteritis. J Pediatr Gastroenterol Nutr. 2022;74(4):446-53. https://pubmed.ncbi.nlm.nih.gov/35129163/.
12. Burstein B, Rogers S, Klassen TP, Freedman SB. Trends in Management of Children With Acute Gastroenteritis in US Emergency Departments. JAMA Netw Open. 2022;5(5):e2211201. https://pubmed.ncbi.nlm.nih.gov/35536583/.
13. Almutairi MK, Al-Saleh AM, Al Qadrah BH, Sarhan NT, Alshehri NA, Shaheen NA. Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration. Int J Pediatr Adolesc Med. 2022;9(1):2731. https://pubmed.ncbi.nlm.nih.gov/35573064/.
14. Freedman SB, Xie J, Lee BE, Ali S, Pang XL, Chui L, et al. Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care Due to Vomiting in the Absence of Diarrhea. Clin Infect Dis. 2021;73(8):1414-1423. Https://Pubmed.ncbi.nlm.nih.gov/33993272/
15. Schnadower D, Roskind CG, VanBuren JM, Powell EC, Norris JG, Tarr PI, et al. Factors Associated With Nonadherence in an Emergency Department-based Multicenter Randomized Clinical Trial of a Probiotic in Children With Acute Gastroenteritis. J Pediatr Gastroenterol Nutr. 2021;72(1):24-8. https://pubmed.ncbi.nlm.nih.gov/32804911/.
16. Santos J, Musta V, Luca CM, Belei OA, Cambrea SC. Randomized, placebo-controlled trial of xyloglucan and gelose for the treatment of acute diarrhea in children. Expert Rev Gastroenterol Hepatol. 2021;15(3):325-31. https://pubmed.ncbi.nlm.nih.gov/33028102/.
17. Poonai N, Powell EC, Schnadower D, Casper TC, Roskind CG, Olsen CS, et al. Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Netw Open. 2021;4(4):e216433. https://pubmed.ncbi.nlm.nih.gov/33871616/.
18. Jové-Blanco A, Solís-García G, Torres-Soblechero L, Escobar-Castellanos M, MoraCapín A, Rivas- García A, et al. Video discharge instructions for pediatric gastroenteritis in an emergency department: a randomized, controlled trial. Eur J Pediatr. 2021;180(2):56975. https://pubmed.ncbi.nlm.nih.gov/33029683/.
19. Freedman SB, Roskind CG, Schuh S, VanBuren JM, Norris JG, Tarr PI, et al. Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States. Pediatrics. 2021;147(6). https://pubmed.ncbi.nlm.nih.gov/34016656/.
20. Bonvanie IJ, Weghorst AA, Holtman GA, Russchen HA, Fickweiler F, Verkade HJ, et al. Oral ondansetron for paediatric gastroenteritis in primary care: a randomised controlled trial. Br J Gen Pract. 2021;71(711):E728-E35. Https://Pubmed.ncbi.nlm.nih.gov/34426397/
21. Nabower AM, Hall M, Burrows J, Dave A, Deschamp A, Dike CR, et al. Trends and Variation in Care and Outcomes for Children Hospitalized With Acute Gastroenteritis. Hosp Pediatr. 2020;10(7):547-54. https://pubmed.ncbi.nlm.nih.gov/32493708/.
22. Vanderkooi OG, Xie J, Lee BE, Pang XL, Chui L, Payne DC, et al. A prospective comparative study of children with gastroenteritis: emergency department compared with symptomatic care at home. Eur J Clin Microbiol Infect Dis. 2019;38(12):2371-9. https://pubmed.ncbi.nlm.nih.gov/31502119/.
23. Tarr GAM, Chui L, Lee BE, Pang XL, Ali S, Nettel-Aguirre A, et al. Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children With 9 Potential Bacterial Enteropathogens. Clin Infect Dis. 2019;69(7):1173-82. https://pubmed.ncbi.nlm.nih.gov/30517612/.
24. Sunderland N, Westbrook J, Urwin R, Knights Z, Taitz J, Williams H, et al. Appropriate management of acute gastroenteritis in Australian children: A population-based study. PLoS One. 2019;14(11):e0224681. https://pubmed.ncbi.nlm.nih.gov/31697706/.
25. Freedman SB, Soofi SB, Willan AR, Williamson-Urquhart S, Ali N, Xie J, et al. Oral Ondansetron Administration to Nondehydrated Children With Diarrhea and Associated Vomiting in Emergency Departments in Pakistan: A Randomized Controlled Trial. Ann Emerg Med. 2019;73(3):255-65. https://pubmed.ncbi.nlm.nih.gov/30392735/.
26. Zhuo R, Parsons BD, Lee BE, Drews SJ, Chui L, Louie M, et al. Identification of Enteric Viruses in Oral Swabs from Children with Acute Gastroenteritis. J Mol Diagn. 2018;20(1):56-62. https://pubmed.ncbi.nlm.nih.gov/29056575/.
27. Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’Connell KJ, et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. N Engl J Med. 2018;379(21):2002-14. https://pubmed.ncbi.nlm.nih.gov/30462938/.
28. Maragkoudaki M, Chouliaras G, Moutafi A, Thomas A, Orfanakou A, Papadopoulou A. Efficacy of an Oral Rehydration Solution Enriched with Lactobacillus reuteri DSM 17938 and Zinc in the Management of Acute Diarrhoea in Infants: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2018;10(9). https://pubmed.ncbi.nlm.nih.gov/30200394/.
29. Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Willan AR, Poonai N, et al. Multicenter Trial Of A Combination Probiotic For Children With Gastroenteritis. N Engl J Med. 2018;379(21):2015-26 https://pubmed.ncbi.nlm.nih.gov/30462939/.
30. Freedman SB, Johnson DW, Nettel-Aguirre A, Mikrogianakis A, Williamson-Urquhart S, Monfries N, et al. Assessing Dehydration Employing End-Tidal Carbon Dioxide in Children With Vomiting and Diarrhea. Pediatr Emerg Care. 2018;34(8):564-9. https://pubmed.ncbi.nlm.nih.gov/28538608/.
31. Zhuo R, Cho J, Qiu Y, Parsons BD, Lee BE, Chui L, et al. High genetic variability of norovirus leads to diagnostic test challenges. J Clin Virol. 2017;96:94-8. https://pubmed.ncbi.nlm.nih.gov/29035762/.
32. Geurts D, de Vos-Kerkhof E, Polinder S, Steyerberg E, van der Lei J, Moll H, et al. Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department. Eur J Pediatr. 2017;176(2):17381. https://pubmed.ncbi.nlm.nih.gov/27933399/.
33. Freedman SB, Xie J, Nettel-Aguirre A, Lee B, Chui L, Pang XL, et al. Enteropathogen detection in children with diarrhoea, or vomiting, or both, comparing rectal flocked swabs with stool specimens: an outpatient cohort study. Lancet Gastroenterol Hepatol. 2017;2(9):662-9. https://pubmed.ncbi.nlm.nih.gov/28712662/.
34. Freedman SB, Eltorki M, Chui L, Xie J, Feng S, MacDonald J, et al. Province-Wide Review of Pediatric Shiga Toxin-Producing Escherichia coli Case Management. J Pediatr. 2017;180:184-90.e1. https://pubmed.ncbi.nlm.nih.gov/27745751/.
35. Whitney RE, Santucci K, Hsiao A, Chen L. Cost-effectiveness of point-of-care testing for dehydration in the pediatric ED. Am J Emerg Med. 2016;34(8):1573-5. https://pubmed.ncbi.nlm.nih.gov/27289438/.
36. Verbakel JY, Lemiengre MB, De Burghgraeve T, De Sutter A, Aertgeerts B, Shinkins B, et al. Should all acutely ill children in primary care be tested with point-of-care CRP: a cluster randomised trial. BMC Med. 2016;14(1):131. https://pubmed.ncbi.nlm.nih.gov/27716201/.
37. Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, et al. Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial. PLoS One. 2016;11(11):e0165441. https://pubmed.ncbi.nlm.nih.gov/27880811/.
38. Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. Jama. 2016;315(18):1966-74. https://pubmed.ncbi.nlm.nih.gov/27131100/.
39. Bahm A, Freedman SB, Guan J, Guttmann A. Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population-Based Cohort Study. Acad Emerg Med. 2016;23(5):599-609 https://pubmed.ncbi.nlm.nih.gov/26824763/.
40. Allen CH, Goldman RD, Bhatt S, Simon HK, Gorelick MH, Spandorfer PR, et al. A randomized trial of Plasma-Lyte A and 0.9 % sodium chloride in acute pediatric gastroenteritis. BMC Pediatr. 2016;16:117. https://pubmed.ncbi.nlm.nih.gov/27480410/.
41. Freedman SB, Sherman PM, Willan A, Johnson D, Gouin S, Schuh S. Emergency Department Treatment of Children With Diarrhea Who Attend Day Care: A Randomized Multidose Trial of a Lactobacillus helveticus and Lactobacillus rhamnosus Combination Probiotic. Clin Pediatr (Phila). 2015;54(12):1158-66. https://pubmed.ncbi.nlm.nih.gov/25669920/.
42. Freedman SB, Hall M, Shah SS, Kharbanda AB, Aronson PL, Florin TA, et al. Impact of increasing ondansetron use on clinical outcomes in children with gastroenteritis. JAMA Pediatr. 2014;168(4):321- https://pubmed.ncbi.nlm.nih.gov/24566613/.
43. Freedman SB, Thull-Freedman JD, Rumantir M, Atenafu EG, Stephens D. Emergency department revisits in children with gastroenteritis. J Pediatr Gastroenterol Nutr. 2013;57(5):612-8. https://pubmed.ncbi.nlm.nih.gov/23820403/.
44. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006;354(16):1698-705. https://pubmed.ncbi.nlm.nih.gov/16625009/.
45. Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. 2005;115(2):295-301. https://pubmed.ncbi.nlm.nih.gov/15687435/.
46. Friedman JN, Goldman RD, Srivastava R, Parkin PC. Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr. 2004;145(2):201-207. https://pubmed.ncbi.nlm.nih.gov/15289767/
47. Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99(5):E6. https://pubmed.ncbi.nlm.nih.gov/9113963/

1. Freedman SB, Crocco A. Emergency Medicine Cases Podcast: Dilute Apple Juice for Gastroenteritis. https://emergencymedicinecases.com/dilute-apple-juice-pediatric-gastroenteritis/.
2. Jarvis AF, Freedman SB. Emergency Medicine Cases Podcast: Pediatric gastroenteritis, constipation & bowel obstruction 2012. http://emergencymedicinecases.com/episode-19-part-2-pediatric- gastroenteritis-acuteconstipation-bowel-obstruction/.