What is the recommended treatment for diarrhea in infants under 1 year old?

Treatment of Diarrhea in Infants Under 1 Year Old

Reduced osmolarity oral rehydration solution (ORS) is the first-line treatment for diarrhea in infants under 1 year old, with continued breastfeeding or age-appropriate feeding during the illness. 1

Rehydration Therapy Based on Dehydration Severity

Assessment of Dehydration

Determine the level of dehydration before initiating treatment:

• Mild dehydration (<5% fluid deficit): Slightly dry mucous membranes, normal to slightly decreased urine output
• Moderate dehydration (6-9% fluid deficit): Dry mucous membranes, decreased skin turgor, sunken eyes/fontanelle
• Severe dehydration (≥10% fluid deficit): Very dry mucous membranes, poor skin turgor, sunken eyes/fontanelle, altered mental status, shock

Treatment Protocol

For Mild to Moderate Dehydration

1. Administer ORS:

   • Mild dehydration: 50 mL/kg over 4 hours 1
   • Moderate dehydration: 100 mL/kg over 4 hours 1
   • Technique for vomiting infants: Give small volumes (5-10 mL) every 1-2 minutes using a spoon or syringe 1

2. Replace Ongoing Losses:

   • 10 mL/kg ORS for each watery stool
   • 2 mL/kg ORS for each episode of vomiting 1

For Severe Dehydration

1. Begin immediate IV rehydration with isotonic fluids (Ringer's lactate or normal saline) 1
   • Give 20 mL/kg boluses until pulse, perfusion, and mental status normalize 1
   • Once stabilized, transition to oral rehydration to complete fluid replacement 1

Nutritional Management

1. Continue breastfeeding throughout the diarrheal episode (strong recommendation) 1

2. For formula-fed infants:

   • Resume full-strength formula immediately after initial rehydration 1
   • Consider lactose-free or lactose-reduced formula if signs of lactose intolerance develop (worsening diarrhea with formula reintroduction) 1

3. Avoid high sugar drinks, carbonated beverages, and fruit juices as they may worsen diarrhea 1

Medication Considerations

1. Antimotility drugs (e.g., loperamide):

   • NEVER give to children under 18 years (strong recommendation) 1

2. Antibiotics:

   • Not routinely indicated for most cases of acute diarrhea 1
   • Consider only for:
     • Bloody diarrhea (dysentery)
     • High fever with diarrhea persisting >5 days
     • Specific identified pathogens requiring treatment 1

3. Probiotics:

   • May be offered to reduce symptom severity and duration (weak recommendation) 1
   • Specific strains and dosing should be based on manufacturer guidance

4. Zinc supplementation:

   • Recommended for infants 6 months to 5 years in countries with high zinc deficiency prevalence or in malnourished infants 1
   • Not routinely recommended for well-nourished infants in developed countries

Home Management Instructions

1. Early ORS administration at home at first sign of diarrhea 1
2. Continue breastfeeding or formula feeding 1
3. Replace fluid losses with ORS after each loose stool 1
4. Monitor for warning signs requiring medical attention:
   • Increased irritability or lethargy
   • Decreased urine output
   • Intractable vomiting
   • Persistent diarrhea
   • Blood in stool
   • Signs of dehydration (dry mouth, sunken eyes, decreased tears)

Common Pitfalls to Avoid

1. Do not withhold feeding during diarrheal episodes - early refeeding reduces severity and duration 1
2. Do not use sports drinks, sodas, or juices as rehydration solutions - they have inappropriate electrolyte content and high sugar content 1
3. Do not routinely prescribe antibiotics for uncomplicated diarrhea 1
4. Do not use antidiarrheal medications in infants - they are contraindicated and potentially dangerous 1
5. Do not delay rehydration - early intervention prevents progression to severe dehydration 1

Remember that proper hydration management is the cornerstone of diarrhea treatment in infants, with continued feeding being essential for recovery and prevention of nutritional deficits.