Half-strength apple juice can help some kids get through stomach flu

When little kids have the stomach flu and need to drink fluids, half-strength apple juice – and whatever fluid the child prefers - can be as effective as expensive electrolyte solutions, researchers say.

The treatment of stomach flu, or gastroenteritis, usually focuses on replacing fluids lost through diarrhea or vomiting, but the electrolyte solutions are relatively expensive and kids often don't like the way they taste.

“In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration,” Dr. Steven D. Freedman from University of Calgary in Alberta, Canada told Reuters Health by email.

Freedman’s team studied 647 children ages six months to five years old who came to the emergency department with mild dehydration from stomach flu. Half the children were given half-strength apple juice followed by their favorite drink, and half received an apple-flavored electrolyte solution, the researchers reported in the Journal of the American Medical Association.

Twenty-five percent of the kids who drank the electrolyte solution still needed intravenous (IV) fluids or other additional treatment, compared to only about 17 percent of the kids who drank apple juice and their favorite drink.

Two-year-olds and older children responded best to apple juice, but even the younger group fared slightly better with apple juice than with the electrolyte solution. In addition, children treated with apple juice required fewer IV fluids and had lower hospitalization rates than children treated with the electrolyte solution.

"These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins," the researchers say.

But apple juice is not always the best treatment.

“Our study specifically excluded high-risk children, and such children should continue to receive electrolyte maintenance solution,” Freedman said. “This would include children younger than six months of age, those with moderate to severe dehydration, children receiving care in a region where severe disease and dehydration are common, and those at risk for electrolyte abnormalities.”

He also favors electrolyte solutions for children with other significant medical conditions.

Dr. Francois Angoulvant from Hopital Necker-Enfants Malades in Villejuif, France, who has studied this topic, told Reuters Health by email, “If a child more than two years of age with mild dehydration refuses to drink electrolyte maintenance solution, the use of half-strength apple juice/preferred fluids therapy is legitimate.”

He would not use half-strength apple juice in younger children, however. Dr. Ivan D. Florez from Universidad de Antioguia, Medellin, Colombia told Reuters Health by email that more information is needed before switching from electrolyte solution to apple juice.

"(People) should think of apple juice as a promising intervention that needs further studies," he said, adding that "these results are not applicable in low- and middle-income settings."