Can oral rehydration solutions be given to a 6-month-old with 8 episodes of diarrhea per day?

From the Guidelines

Yes, oral rehydration solutions (ORS) can and should be given to a 6-month-old infant experiencing 8 episodes of diarrhea per day. ORS is the first-line treatment for preventing and treating dehydration in infants with diarrhea, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. For a 6-month-old, offer small amounts (1-2 teaspoons) of ORS every 1-2 minutes, gradually increasing as tolerated. Commercial pediatric ORS products like Pedialyte, Infalyte, or WHO-formulated solutions are appropriate.

Key Considerations

• Continue breastfeeding or formula feeding alongside ORS.
• The total daily fluid requirement should be approximately 150-200 mL/kg of body weight, with additional ORS (about 10 mL/kg) after each diarrheal episode.
• ORS works by providing a balanced mixture of sodium, glucose, and water that enhances intestinal absorption even during diarrhea.
• The glucose facilitates sodium absorption, which pulls water into the bloodstream.
• If the infant shows signs of severe dehydration (lethargy, sunken eyes, decreased urination), seek immediate medical attention as intravenous fluids may be necessary, as outlined in the guidelines 1. Some studies have shown that ORS can be successfully used in infants with mild to moderate dehydration, with no significant differences in duration of diarrhea or amount of fluid ingested among different sodium concentrations 1. Additionally, administering small volumes of ORS (5-10 mL) every 1-2 minutes can help prevent vomiting and ensure successful rehydration 1. However, the most recent and highest quality study, the 2017 Infectious Diseases Society of America clinical practice guidelines 1, recommends reduced osmolarity oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea.

From the Research

Oral Rehydration Solutions for Infants

• Oral rehydration solutions (ORS) can be given to a 6-month-old infant with 8 episodes of diarrhea per day, as they are effective in treating dehydration caused by acute diarrhea 2, 3, 4.
• The World Health Organization (WHO) recommends an ORS with a sodium concentration of 90 mmol/L, which is effective in treating dehydration and preventing hypernatremia 2.
• Low osmolarity ORS has been shown to improve outcomes and reduce hospitalization in children with acute diarrhea 3.
• Zinc supplementation in addition to ORS has been found to reduce the incidence and prevalence of diarrhea, as well as the severity and duration of episodes 3, 5.

Considerations for Infant Care

• It is essential to continue regular feeding habits and add complementary liquids to prevent dehydration and malnutrition 2, 6.
• The use of a single solution for oral rehydration and maintenance therapy has been found to be effective in infants with mild to moderate dehydration caused by acute diarrhea 6.
• ORS can be used in conjunction with other treatments, such as zinc supplementation, to provide optimal care for infants with diarrhea 5.

Treatment Guidelines

• The WHO-ORS formula, which contains sodium 90 mmol/L, glucose 111 mmol/L, chloride 80 mmol/L, potassium 20 mmol/L, and citrate 10 mmol/L, is recommended for the treatment of dehydration caused by acute diarrhea 2.
• The use of ORS with a sodium concentration of 90 mmol/L reduces the risk of hypernatremia and is suitable for cases of hyponatremic dehydration 2.
• Zinc supplementation should be considered in addition to ORS to reduce the severity and duration of diarrhea episodes 3, 5.