What is the recommended treatment for chronic diarrhea in healthy children under five years of age?

Treatment of Chronic Diarrhea in Healthy Children Under Five Years of Age

The cornerstone of treatment for chronic diarrhea in healthy children under five years of age is oral rehydration therapy (ORT) using reduced osmolarity oral rehydration solution (ORS), along with continued feeding and appropriate nutritional management. 1, 2

Assessment and Rehydration

• Evaluate the degree of dehydration clinically by assessing skin turgor, mucous membranes, mental status, pulse, and capillary refill time 2
• Categorize dehydration as mild (3-5% fluid deficit), moderate (6-9% fluid deficit), or severe (≥10% fluid deficit) 2
• For mild dehydration, administer 50 mL/kg ORS over 2-4 hours; for moderate dehydration, give 100 mL/kg ORS over 2-4 hours 2
• Severe dehydration requires immediate intravenous rehydration with isotonic fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 1
• Nasogastric administration of ORS may be considered in children who cannot tolerate oral intake or refuse to drink adequately 1

Maintenance and Nutrition

• After rehydration, administer maintenance fluids and replace ongoing losses with ORS until diarrhea resolves 1
• Replace each watery stool with 10 mL/kg of ORS and each episode of emesis with 2 mL/kg of ORS 2
• Continue breastfeeding throughout the diarrheal episode in infants 1, 2
• Resume age-appropriate usual diet during or immediately after the rehydration process 1, 2
• Early reintroduction of normal feeding is essential rather than prolonged periods of fasting or diluted formulas 2, 3

Adjunctive Therapies

• Antimotility drugs such as loperamide should NOT be given to children under 18 years of age with diarrhea due to risk of serious adverse effects 1, 4
• Antinausea and antiemetic agents (e.g., ondansetron) may be given to facilitate oral rehydration in children over 4 years of age with vomiting, but only after adequate hydration is achieved 1, 2
• Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent children with infectious or antimicrobial-associated diarrhea 1, 2
• Oral zinc supplementation reduces the duration of diarrhea in children 6 months to 5 years of age who reside in countries with high zinc deficiency prevalence or who have signs of malnutrition 1, 2

Prevention and Hygiene Measures

• Hand hygiene should be performed after using the toilet, changing diapers, before and after preparing food, before eating, and after handling garbage or soiled items 1
• Infection control measures including use of gloves and hand hygiene with soap and water or alcohol-based sanitizers should be followed in the care of children with diarrhea 1
• Appropriate food safety practices are recommended to avoid cross-contamination of foods or cooking surfaces 1

Common Pitfalls to Avoid

• Delaying rehydration therapy or using inappropriate fluids (sports drinks, sodas, juices) instead of proper ORS 5, 6
• Unnecessarily restricting diet or prolonging fasting, which can worsen nutritional status and prolong diarrhea 2, 3
• Using antimotility medications in children under 18 years, which can lead to serious adverse effects including respiratory depression and cardiac complications 1, 4
• Failing to replace ongoing fluid losses during the maintenance phase, which can lead to recurrent dehydration 1
• Inadequate volume of ORS during initial rehydration - children who tolerate at least 20-25 mL/kg of ORS during initial treatment are more likely to succeed with oral rehydration therapy 6