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Published on: November 9, 2016
Parents' attitudes toward oral rehydration therapy in children with mild-to-moderate dehydration
Vered Nir1, Erez Nadir, Yaffa Schechter
1Department of Pediatrics, Hillel Yaffe Medical Center, 38100 Hadera, Israel.
Insights
Parents often expect intravenous (IV) fluids for dehydrated children, contradicting guidelines for oral rehydration therapy. Educating parents is crucial for implementing evidence-based dehydration treatment in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pediatrics
- Healthcare Management
Background:
- Current guidelines recommend oral rehydration as the first-line treatment for mild-to-moderate dehydration, followed by nasogastric tube rehydration.
- Both oral and nasogastric rehydration methods are significantly underutilized in clinical practice.
- Parental expectations can influence treatment decisions in pediatric emergency care.
Purpose of the Study:
- To investigate parental attitudes and expectations regarding different rehydration methods for pediatric dehydration.
- To identify factors influencing parental acceptance or refusal of oral rehydration and nasogastric tube insertion.
- To compare parental expectations with established clinical guidelines for dehydration management.
Main Methods:
- A questionnaire-based study was conducted with 100 parents of children presenting with gastroenteritis and suspected dehydration in an emergency department.
- Parents were surveyed about their preferences and expectations for rehydration treatments, including intravenous (IV) fluids, oral rehydration, and nasogastric tube insertion.
- Data analysis explored correlations between previous treatment experiences, perceived dehydration severity, and parental attitudes towards rehydration methods.
Main Results:
- A significant majority of parents (75%) expected their child to receive IV fluids.
- 49% of parents would refuse oral rehydration, and 75% would refuse nasogastric tube insertion.
- Parental preference for IV fluids was higher among those whose children had prior IV treatment. Acceptance of oral rehydration varied based on perceived dehydration indicators, with diarrhea being a stronger predictor of acceptance than clinical appearance or vomiting.
Conclusions:
- Parental expectations regarding dehydration treatment frequently diverge from current evidence-based guidelines.
- There is a substantial gap between recommended rehydration strategies and parental preferences in pediatric emergency departments.
- Targeted educational interventions for parents are necessary to promote the understanding and acceptance of oral and nasogastric rehydration, thereby improving adherence to clinical guidelines.
Objective:
According to current guidelines, the first line of treatment for mild-to-moderate dehydration is oral rehydration; the second line is rehydration through a nasogastric tube. Both methods are widely underused. This study was conducted to evaluate parents' attitudes towards rehydration methods used in pediatric emergency departments.
Design:
100 questionnaires were distributed to parents of children who visited emergency room due to gastroenteritis and suspected dehydration.
Results:
75 of the parents expected their child to get IV fluids. 49 of them would refuse to consider oral rehydration. 75 of the parents would refuse to consider insertion of nasogastric tube. Parents whose children were previously treated intravenously tended to be less likely to agree to oral treatment. Parents were more prone to decline oral rehydration if the main measurement of dehydration was the child's clinical appearance, clinical appearance with vomiting, or child's refusal to drink and were more likely to agree if the main measurement was diarrhea, diarrhea with clinical appearance, or clinical personnel opinion.
Conclusions:
This is the first study to examine parents' expectations. We found that in the majority of cases, parents' expectations contradict current guidelines. Efforts should be taken to educate parents in order to allow full implementation of the guidelines.
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