What is the management for diarrhea in an infant under 6 months?

Management of Diarrhea in Infants Under 6 Months

The primary treatment for diarrhea in infants under 6 months is oral rehydration therapy (ORT) with small, frequent volumes of oral rehydration solution (ORS), starting with 5 mL every minute, while continuing breastfeeding or appropriately diluted formula feeding to prevent dehydration and maintain nutrition. 1

Assessment of Dehydration

Assess the infant for signs of dehydration:

• Weight loss (percentage of body weight)
• Decreased skin turgor (prolonged skinfold)
• Sunken eyes
• Dry oral mucosa
• Altered neurologic status/lethargy
• Decreased urine output (fewer wet diapers)
• Tachycardia 2

Severity of dehydration can be categorized as:

• Mild: ~3-5% weight loss
• Moderate: ~5-9% weight loss
• Severe: >10% weight loss 2

Management Algorithm

1. For Non-Dehydrated Infants with Diarrhea:

• Prevention of dehydration:
  • Administer ORS: 50-100 mL after each loose stool 3
  • Continue breastfeeding on demand 3, 1
  • If formula-fed, dilute formula with equal volume of clean water until diarrhea stops 3
  • Increase fluid intake with appropriate home fluids 3

2. For Mild to Moderate Dehydration:

• Rehydration phase:

  • Administer ORS at 50-100 mL/kg over 3-4 hours 3
  • For vomiting infants, start with 5 mL every minute via spoon or syringe, gradually increasing volume 1
  • Continue breastfeeding throughout rehydration 3, 1

• Maintenance phase:

  • Replace ongoing losses with 10 mL/kg ORS after each loose stool 3
  • Replace vomit losses with 2 mL/kg ORS after each episode 1
  • Continue breastfeeding on demand 3
  • For formula-fed infants, resume diluted formula after initial rehydration 3

3. For Severe Dehydration:

• Initial management:

  • Immediate medical attention is required
  • IV fluid therapy at 20 mL/kg of isotonic crystalloid solution 4
  • If IV access unavailable, nasogastric ORS at 15 mL/kg/hour 3
  • Reassess hydration status frequently

• After stabilization:

  • Transition to oral rehydration when mental status improves
  • Continue nutritional management as above 3

Nutritional Management

• For breastfed infants:

  • Continue breastfeeding on demand throughout the illness 3, 1

• For formula-fed infants:

  • Initially dilute formula with equal volume of clean water 3
  • Resume full-strength formula as soon as rehydration is achieved 1
  • Consider lactose-free or lactose-reduced formula if symptoms worsen with regular formula 3

Warning Signs Requiring Medical Attention

Instruct parents to seek immediate medical care if:

• Persistent vomiting
• High fever
• Blood in stool
• Signs of worsening dehydration (sunken eyes, decreased urination)
• Lethargy or decreased responsiveness
• Diarrhea lasting >5 days 3, 1

Important Considerations

• Avoid inappropriate medications:

  • Antibiotics are not indicated unless there's dysentery, high fever, or diarrhea lasting >5 days 3
  • Antidiarrheal medications and antimotility drugs should not be used in infants 5
  • Antiemetics are not recommended for vomiting in infants 5

• Home management education:

  • Teach parents proper ORS preparation and administration
  • Emphasize the importance of continued feeding
  • Explain warning signs requiring medical attention 1

• Prevention of spread:

  • Proper hand hygiene
  • Appropriate cleaning of bottles, toys, and surfaces 1

By following this approach, most infants with diarrhea can be successfully managed with oral rehydration and appropriate feeding, preventing the complications of dehydration while maintaining adequate nutrition.