What is the treatment plan for a child with diarrhea?

From the Guidelines

The treatment plan for a child with diarrhea should focus primarily on preventing dehydration through oral rehydration therapy, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal is to prevent dehydration and ensure the child receives adequate fluids and electrolytes.

• Give your child an oral rehydration solution like Pedialyte, Enfalyte, or a homemade solution (1 liter of clean water, 6 teaspoons of sugar, and 1/2 teaspoon of salt) in small, frequent sips, as suggested by the guidelines 1.
• Continue regular feeding as tolerated, avoiding sugary drinks, dairy products, and fatty or spicy foods which can worsen symptoms, and resume an age-appropriate usual diet during or immediately after the rehydration process is completed 1.
• Breastfeeding should continue if applicable, as human milk feeding is recommended throughout the diarrheal episode 1.
• Monitor for signs of dehydration such as decreased urination, dry mouth, sunken eyes, or lethargy.
• Most cases of childhood diarrhea are viral and self-limiting, typically resolving within 5-7 days without specific medication.
• Anti-diarrheal medications are generally not recommended for children as they can mask symptoms and prolong illness, and may even cause severe side effects, as reported in a study from Pakistan 1.
• Probiotics like Lactobacillus GG or Saccharomyces boulardii may help reduce the duration of diarrhea, as suggested by the guidelines 1.
• Oral zinc supplementation may be beneficial in reducing the duration of diarrhea in children 6 months to 5 years of age who reside in countries with a high prevalence of zinc deficiency or who have signs of malnutrition 1.
• Seek medical attention if your child shows signs of severe dehydration, has bloody diarrhea, high fever above 102°F (39°C), severe abdominal pain, or if diarrhea persists beyond 7 days.
• Handwashing and proper food handling are essential to prevent spread to other family members.

From the FDA Drug Label

Pediatric Use 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 Although loperamide hydrochloride has been studied in a limited number of pediatric patients with chronic diarrhea; the therapeutic dose for the treatment of chronic diarrhea in a pediatric population has not been established.

The treatment plan for a child with diarrhea is not established in the provided drug label for loperamide hydrochloride, especially for those less than 2 years of age due to contraindications and for those over 2 years, the therapeutic dose has not been established 2.

From the Research

Treatment Plan for a Child with Diarrhea

The treatment plan for a child with diarrhea involves a combination of oral rehydration therapy, dietary management, and in some cases, intravenous fluids. The goal of treatment is to prevent or treat dehydration, which is a major cause of morbidity and mortality in children with diarrhea.

• Oral Rehydration Therapy (ORT): ORT is the mainstay of treatment for children with mild to moderate dehydration due to diarrhea 3, 4, 5, 6. Commercially available oral rehydration solutions containing 45-75 mEq/l of Na+ are recommended for children with mild to moderate dehydration.
• Intravenous Fluids: Children with severe dehydration should receive intravenous fluids, 60-100 ml/kg of 0.9% saline in the first 2-4 hours to restore circulation 3. Once circulation is restored, ORT should be given in small quantities to replace losses of water and Na+ over 6-8 hours.
• Dietary Management: Age-appropriate diet should be started as soon as tolerated 3, 6. Breastfeeding should be continued for infants with diarrhea.
• ORS Tolerance Test: An ORS tolerance test can be used to assess the effectiveness of ORT in children with moderate dehydration 4. Children who tolerate ORS well can be discharged to continue oral rehydration treatment at home.
• Low Osmolarity Oral Rehydration Solutions: Low osmolarity oral rehydration solutions with osmolarities of 224-204 mosmol/l can be effective in treating acute diarrhea in young children 7.
• Probiotics: The use of probiotics such as Lactobacillus GG may be beneficial in reducing the duration of diarrhea and promoting weight gain 7.

Special Considerations

• Hyponatremic Dehydration: Hyponatremic dehydration is best treated with 0.9% saline and 0.45% saline alternately in a 1:1 ratio in 5% dextrose containing 20 mEq/l KCl over 24 hours 3.
• Hypernatremic Dehydration: Hypernatremic dehydration is best treated with 5% dextrose in 0.2% saline containing 20 mEq/l KCl over 2-3 days to avoid cerebral edema 3.
• Maintenance Hydration: Maintenance hydration is best treated with 5% dextrose in 0.2% saline containing 20 mEq/l KCl 3.