From the Guidelines
Zinc supplementation is strongly recommended for children with diarrhea, particularly in countries with a high prevalence of zinc deficiency or in children with signs of malnutrition, as it reduces the duration of diarrhea. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, oral zinc supplementation is beneficial for children 6 months to 5 years of age. The recommended dose is 20 mg per day for children older than 6 months, or 10 mg per day for infants under 6 months. Treatment should continue for 10-14 days, even after diarrhea resolves. Zinc can be given as zinc sulfate, zinc acetate, or zinc gluconate tablets or syrup, and it should be administered with oral rehydration solution (ORS) for optimal management of diarrhea.
The benefits of zinc supplementation in children with diarrhea include:
- Reducing the duration and severity of diarrheal episodes
- Decreasing stool volume
- Lowering the risk of subsequent infections for 2-3 months
- Improving intestinal absorption of water and electrolytes
- Strengthening the immune response
- Helping repair the intestinal lining
Some key points to consider when administering zinc supplementation:
- Side effects are minimal but may include vomiting if taken on an empty stomach
- Giving zinc with food can help improve tolerance
- Zinc supplementation is particularly important in malnourished children and those with persistent diarrhea
It's worth noting that while probiotics may also be beneficial in reducing symptom severity and duration in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea 1, the strongest evidence supports the use of zinc supplementation in children with diarrhea, especially in developing countries where zinc deficiency is common. Additionally, oral rehydration therapy (ORT) is a crucial component of diarrhea management, and it can be used in conjunction with zinc supplementation to promote earlier treatment and prevention of dehydration 1.
From the Research
Role of Zinc in Treating Diarrhea
- Zinc plays a crucial role in modulating host resistance to infectious agents and reducing the risk, severity, and duration of diarrheal diseases 2.
- The WHO/UNICEF recommendations for zinc supplementation are based on meta-analyses of randomized, controlled intervention trials on children: 20 mg zinc/day for 10-14 days for children with acute diarrhea and 10 mg/day for infants under 6 months of age 2.
- Zinc supplementation reduces the duration and severity of acute and persistent diarrhea in children 3, 4, 5, 6.
- Effective forms of zinc supplementation include sulfate, gluconate, or acetate 2.
- Zinc treatment as an adjunct to oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children 6.
Benefits of Zinc Supplementation
- Decreases the proportion of diarrheal episodes which last beyond 7 days 4.
- Reduces the risk of hospitalization and all-cause mortality 4.
- Decreases diarrhoea morbidity and mortality when introduced and scaled-up in low-income countries 4.
- Reduces stool frequency and diarrhoea duration as well as respiratory infections in zinc deficient children 5.
- Reduces the proportion of diarrheal episodes lasting more than 7 days 6.