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Am Fam Physician. 1998;58(6):1413

In 1996, the American Academy of Pediatrics (AAP) revised guidelines for the management of acute gastroenteritis in children. Oral rehydration solution, even in the presence of vomiting, is the cornerstone of treatment. Recent evidence in the literature indicates that unrestricted diets are not ill-advised in the presence of mild diarrhea, and there is no need to avoid lactose. Shamir and colleagues analyzed results from a multiple-choice questionnaire given to Israeli physicians to examine their knowledge and their implementation of the revised AAP guidelines.

The 17-item questionnaire consisted of three parts: demographic information, knowledge about the management of acute gastroenteritis in infants and children, and information about the pediatrician's own treatment practices.

Eighty-seven pediatricians completed the questionnaire. Overall, they were aware of 73 percent of the current AAP recommendations about treatment of acute gastroenteritis in children, but actually followed only 60 percent of the guidelines' recommendations in their practices. Most of the physicians (83 percent) knew that oral rehydration solutions should be used for dehydration in patients with acute gastroenteritis, but only 69 percent knew that these solutions were useful for both mild and moderate dehydration. Almost all of the physicians surveyed (93 percent) knew that oral rehydration solution was better than other clear liquids for the management of acute gastroenteritis, and 86 percent knew it could be used even if the patient was vomiting. However, although the current AAP guidelines recommend continuing full-strength feeds in an infant with acute gastroenteritis, 67 percent of those surveyed did not recommend this practice. The so-called BRAT (banana, rice, apple and toast) diet was recommended by 83 percent of pediatricians, even though this diet has a low calorie content. Fifty-five percent of pediatricians believe that milk products should be avoided.

The authors conclude that awareness of the revised AAP guidelines for management of acute gastroenteritis has not translated to following the guidelines in clinical practice. Further education about the guidelines is needed.

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