Pediatricians hate treating kids for diarrhea.
The theory is that if you give children medications to slow down the diarrhea, that any infectious organism in the colon will have more time to multiply, will overgrow, and will, in turn, worsen the infection.
When children come in with diarrhea, they’re miserable, their parents are miserable, and they just want some help to feel better. Unfortunately, there’s not much on the market for treating diarrhea in children aside from probiotics or antibiotics in certain cases. Imodium elixir has dosing guidelines for kids, but many doctors shy away from recommending it. The goal is to use Oral Rehydration Therapy to get more in the mouth than comes out the other end.
Ditto for vomiting. Emetrol may help and is over the counter, but is essentially glorified sugar water. The only other medications to treat vomiting in children are prescription meds. Even the number of available prescription antiemetic medications has been narrowed considerably. Many pediatricians do not like giving children antiemetic medications unless children are dehydrated because there is a risk of “side effects” (although this study suggests otherwise, as does this Cochrane review). By the way, the “side effects” argument was the same one that pediatricians used to get most children’s cold medications taken off the market.
Here’s one About.com article on treating vomiting and diarrhea in kids.
One pediatrician on staff intermittently raises hell during medical staff meetings because emergency physicians have the gall to give children medications to treat diarrhea and vomiting. He repeatedly suggests that the ED docs “read up on” treatment of vomiting and diarrhea.
With a run on gastroenteritis in the community, this same pediatrician apparently thinks that vomiting and diarrhea of less than one day’s duration are impending emergencies. When parents are asked why what prompted them to bring their kids in for evaluation of diarrhea, they repeatedly say that they called the pediatrician and were told to go to the emergency department.
Because we aren’t supposed to give medications for vomiting or for diarrhea in children who are not dehydrated, I am now making it a habit to call the pediatrician when patients arrive – to let him know they got there and to ask what he wants me to do in the ED. I also call when the patients are discharged to let him know I have told them to follow up in the office tomorrow to make sure that they still aren’t dehydrated.
Kind of feel bad when we keep waking him up in the middle of the night for multiple patients – especially after being called by the parents as well, but through our conscientiousness, I’m hopeful that he will give the ED a better review during the next medical staff meeting.