From the Guidelines
The treatment for recurrent diarrhea in a toddler should focus on oral rehydration therapy, using solutions like Pedialyte, and avoiding anti-diarrheal medications due to potential dangerous side effects, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
Key Components of Treatment
- Oral rehydration therapy is the cornerstone of treatment, using solutions like Pedialyte or homemade mixtures (1/2 teaspoon salt, 6 teaspoons sugar in 1 liter of clean water) offered frequently in small amounts.
- Continue regular feeding with a BRAT diet (bananas, rice, applesauce, toast) and avoid dairy products temporarily.
- Probiotics such as Lactobacillus GG or Saccharomyces boulardii may help restore gut flora, typically given as 1-2 capsules daily for 5-7 days.
- Zinc supplementation (10mg daily for 10-14 days) can reduce diarrhea duration and severity.
Important Considerations
- Avoid anti-diarrheal medications in young children as they can cause dangerous side effects, such as ileus, abdominal distension, and lethargy, as noted in the guidelines 1.
- Seek medical attention if the child shows signs of dehydration (decreased urination, dry mouth, no tears when crying), has bloody stools, high fever above 102°F (39°C), or if diarrhea persists beyond 5-7 days.
- Recurrent episodes warrant medical evaluation to identify potential causes such as food allergies, lactose intolerance, or infections.
Prevention
- Hand hygiene and proper food handling are essential preventive measures as toddlers' developing immune systems make them vulnerable to gastrointestinal infections.
- The use of reduced osmolarity oral rehydration solution (ORS) is recommended as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause, as stated in the guidelines 1.
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 Pediatric patients may be more sensitive to CNS effects, such as altered mental status, somnolence, and respiratory depression, than adults.
The treatment for recurrent diarrhea in a toddler cannot be determined with loperamide, as it is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions 2.
From the Research
Treatment for Recurrent Diarrhea in Toddlers
- The treatment for recurrent diarrhea in toddlers typically involves oral rehydration therapy to replace lost fluids and electrolytes 3, 4.
- A glucose-based or cereal-based oral rehydration solution can be used for rapid rehydration and maintenance of hydration 4.
- Early refeeding with a mixed diet and no interruption of breast feeding is also recommended 4.
- Lactose-containing foods can be continued unless clinical signs of lactose intolerance develop 4.
- Some studies suggest that rice-based oral rehydration solutions may be effective in reducing stool output and time to rehydrate in children with acute diarrhea 5, 6.
- However, other studies have found that L-glutamine-containing, glucose-free oral rehydration solutions may not offer greater clinical benefit than standard glucose-based rehydration solutions 7.
- The use of a single solution for oral rehydration and maintenance therapy, such as Pedialyte or Infalyte, has been shown to be effective in infants with mild to moderate dehydration caused by acute diarrhea 3.