Treatment for a 2-Year-Old with Diarrhea
The primary treatment for a 2-year-old with diarrhea is oral rehydration solution (ORS), continued feeding, and increased fluid intake, while avoiding antidiarrheal medications which are contraindicated in young children. 1
Rehydration Therapy
For Children Without Dehydration
- Oral Rehydration Solution (ORS):
- Give 50-100 mL (¼ to ½ large cup) of ORS after each loose stool 1
- Demonstrate to parents how to mix and administer ORS
- Provide a 2-day supply of ORS for home use
For Children With Dehydration
Assess dehydration level based on:
- Mental status (irritability, lethargy)
- Thirst
- Sunken eyes
- Decreased urine output
- Skin turgor
For moderate dehydration:
- Administer ORS at approximately 25 mL/kg in the first few hours 2
- Children who can tolerate this volume are more likely to be successfully managed at home
For severe dehydration:
- May require supervised rehydration in a healthcare setting
- In extreme cases, nasogastric tube administration at 15 mL/kg/hour may be needed 1
Nutritional Management
Continue breast-feeding if the child is being breast-fed 1
For non-breast-fed children:
- Continue regular diet appropriate for age
- Offer food every 3-4 hours 1
- Recommended foods include:
- Starches (rice, potatoes, crackers, bananas)
- Cereals
- Yogurt
- Fruits and vegetables 1
- Avoid foods high in simple sugars (soft drinks, undiluted apple juice, presweetened cereals) 1
- Avoid foods high in fat as they can delay gastric emptying 1
After diarrhea stops, provide one extra meal each day for a week to aid recovery 1
Additional Fluid Intake
- Increase normal fluid intake using locally available fluids that help prevent dehydration:
- Cereal-based gruels
- Soup
- Rice water 1
- Avoid soft drinks due to high osmolality 1
Medication Considerations
- Antimicrobial drugs are contraindicated for routine treatment of uncomplicated, watery diarrhea 1, 3
- Antidiarrheal agents like loperamide are contraindicated in children with acute diarrhea 1, 3
- Antibiotics should only be considered when:
- Dysentery (bloody diarrhea) is present
- High fever is present
- Watery diarrhea lasts more than 5 days
- Specific pathogens are identified requiring treatment (e.g., Shigella, amebic dysentery) 1
Managing Vomiting
- For children with vomiting:
- Administer small, frequent volumes of ORS (e.g., 5 mL every minute)
- Use a spoon or syringe with close supervision
- Gradually increase the amount as tolerated 1
- Correction of dehydration often reduces vomiting frequency
When to Seek Medical Care
Advise parents to return to the clinic if the child:
- Continues to pass many stools
- Is very thirsty
- Has sunken eyes
- Has a fever
- Becomes irritable or lethargic
- Has decreased urine output
- Develops intractable vomiting
- Does not show general improvement 1