From the Guidelines
For a 12-month-old with diarrhea and viral gastroenteritis, the primary treatment should focus on preventing dehydration through oral rehydration therapy, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The treatment approach should prioritize the use of oral rehydration solutions (ORS) like Pedialyte, Enfalyte, or a homemade solution (1 liter of clean water, 6 teaspoons of sugar, and 1/2 teaspoon of salt) to replace lost fluids and electrolytes.
- Continue breastfeeding or formula feeding alongside rehydration fluids to maintain nutrition.
- Resume a normal diet as soon as possible, avoiding sugary drinks, dairy products, and fatty foods initially.
- Monitor for signs of dehydration, including decreased urination, dry mouth, sunken eyes, absence of tears when crying, unusual drowsiness, or irritability.
- Probiotics like Lactobacillus GG or Saccharomyces boulardii may help reduce the duration of symptoms, as suggested by various studies 1.
- Practice good hygiene by washing hands thoroughly after diaper changes to prevent the spread of infection.
- Seek immediate medical attention if the child shows signs of severe dehydration, bloody diarrhea, high fever above 102.2°F (39°C), persistent vomiting, or if symptoms worsen or last more than 5-7 days. It is essential to note that antidiarrheal medications are not recommended for children under 18 years of age with acute diarrhea, as they can be harmful 1.
- Loperamide, an antimotility agent, should not be given to children under 18 years of age with acute diarrhea, as it may increase the risk of adverse events, including ileus, abdominal distension, and lethargy 1.
- The use of antiemetic agents like ondansetron may be considered in children over 4 years of age to facilitate oral rehydration, but its routine use is not recommended in children under 4 years of age or in adults 1.
From the Research
Treatment for Diarrhea and Viral Gastroenteritis
The treatment for diarrhea and viral gastroenteritis in a 12-month-old infant involves:
- Oral rehydration therapy (ORT) as the mainstay of treatment for mild dehydration 2, 3, 4
- Oral rehydration solutions (ORS) to compensate for fluid loss due to diarrhea and vomiting 2, 3, 4
- Breastfeeding should not be interrupted 4
- Symptomatic treatments and antibiotics are not recommended 4
Evaluation of Dehydration
Dehydration is evaluated by:
- Recent history of fluid intake and output 2
- Physical examination findings, including the four-item Clinical Dehydration Scale 2
- Laboratory data points in select patients, although no single laboratory value has been found to be accurate in predicting the degree of dehydration 5
Management of Dehydration
Management of dehydration involves:
- Oral rehydration therapy for mild to moderate dehydration 2, 5, 3, 4
- Ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 2, 5
- Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy and patients with severe dehydration 2, 5
Prevention
Prevention of acute gastroenteritis includes: