What is the treatment for diarrhea in toddlers?

From the Guidelines

For treating diarrhea in toddlers, the most effective approach is to focus on preventing dehydration through oral rehydration solutions like Pedialyte, given in small, frequent sips, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. This method is not only safer but also more physiologic than IV fluids, avoiding the risks of phlebitis and IV infiltrates, as noted in the management of acute diarrhea in children 1. Key considerations include:

• Continuing to feed the child their normal diet, which helps in the recovery process
• Avoiding sugary drinks, dairy products, and greasy foods that can worsen symptoms
• Considering the use of probiotics such as Culturelle Kids or Florastor Kids to help restore gut bacteria balance, typically given once daily as directed on packaging
• Avoiding over-the-counter anti-diarrheal medications like loperamide (Imodium) in young children due to the risk of serious side effects, as strongly advised against by the 2017 guidelines 1 Monitoring for signs of dehydration is crucial, including decreased urination, dry mouth, no tears when crying, unusual drowsiness, or sunken eyes. It's also important to note that diarrhea in toddlers is commonly caused by viral infections that must run their course, with symptoms typically improving within 3-7 days. Contacting a healthcare provider is necessary if diarrhea persists beyond 2-3 days, contains blood or mucus, is accompanied by high fever (over 102°F or 39°C), or if the child shows signs of dehydration.

From the FDA Drug Label

Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions The safety and effectiveness of loperamide hydrochloride in pediatric patients with chronic diarrhea have not been established

Treatment for diarrhea in toddlers is not recommended with loperamide hydrochloride due to the risks of respiratory depression and serious cardiac adverse reactions in pediatric patients less than 2 years of age 2.

From the Research

Treatment Options for Diarrhea in Toddlers

• Oral rehydration therapy is a major advance in the management of acute infectious diarrhea in children, effective for treating diarrhea of any etiology in patients of any age 3
• Optimal management of acute infectious diarrhea includes rapid rehydration, early refeeding with a mixed diet, continuation of lactose-containing foods unless clinical signs of lactose intolerance develop, and a staged laboratory evaluation 3
• Loperamide is an antidiarrheal medication that can be used to control diarrhea symptoms, working by decreasing peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes 4

Oral Rehydration Solutions

• The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea, resulting in decreased mortality associated with acute diarrheal illnesses in children 5
• Various modifications to the standard ORS have been derived, including hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids 5
• The standard World Health Organization ORS (WHO-ORS) has been shown to be effective in decreasing morbidity and mortality due to improved hydration status 5

Combination Therapy

• A study comparing oral rehydration therapy plus loperamide versus loperamide alone in the treatment of traveler's diarrhea found equivalent clinical responses between the two groups 6
• The study suggested that administration of loperamide plus ORT offered no benefit over administration of loperamide alone in cases where subjects were encouraged to drink ad libitum 6

Limitations of Oral Rehydration Solutions

• A novel hypothesis suggests that glucose-based ORS may not appreciably reduce diarrheal stool volume and may even exacerbate a net secretory state, particularly for pathogens that affect glucose transport 7
• The hypothesis proposes that modern food science initiatives should focus on ORS formulations that replace water and electrolytes while also reducing stool volume and duration of diarrhea 7