What are the recommended medications and treatments for diarrhea in children?

Recommended Medications and Treatments for Diarrhea in Children

The cornerstone of treatment for diarrhea in children is oral rehydration therapy using reduced osmolarity oral rehydration solution (ORS), not antimotility drugs which are contraindicated in children under 18 years of age. 1, 2

Assessment of Dehydration

• Evaluate the degree of dehydration by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time 3, 2
• Categorize dehydration as:
  • Mild (3-5% fluid deficit)
  • Moderate (6-9% fluid deficit)
  • Severe (≥10% fluid deficit, shock, or pre-shock) 3, 2
• Weighing the child is essential to establish a reference point and monitor treatment effectiveness 3

Rehydration Strategy

• For mild dehydration (3-5% fluid deficit):
  • Administer 50 ml/kg of ORS over 2-4 hours 3, 2
• For moderate dehydration (6-9% fluid deficit):
  • Administer 100 ml/kg of ORS over 2-4 hours 3, 2
• For severe dehydration (≥10% fluid deficit):
  • Immediate intravenous rehydration with isotonic fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 1, 2
  • Once stabilized, transition to oral rehydration 1
• Nasogastric administration of ORS may be considered in children who cannot tolerate oral intake or refuse to drink adequately 1

Maintenance and Ongoing Losses

• After rehydration, replace ongoing losses:
  • 10 ml/kg of ORS for each watery stool 3, 2
  • 2 ml/kg of ORS for each episode of vomiting 2
• Continue maintenance fluids until diarrhea and vomiting resolve 1

Nutrition During Diarrhea

• Continue breastfeeding throughout the diarrheal episode 1, 3, 2
• Resume age-appropriate diet during or immediately after rehydration 1, 2
• Avoid prolonged fasting or dietary restrictions, as they can worsen nutritional status 1, 2

Adjunctive Therapies

• Antimotility drugs (e.g., loperamide):
  • Contraindicated in children under 18 years of age 1, 4
  • Can cause serious adverse effects including respiratory depression and cardiac events in young children 4
• Antiemetics:
  • Ondansetron may be given to children >4 years of age to facilitate oral rehydration when vomiting is present, but only after adequate hydration is achieved 1, 2
• Probiotics:
  • May be offered to reduce symptom severity and duration in immunocompetent children 1, 2
• Zinc supplementation:
  • Recommended for children 6 months to 5 years of age who live in countries with high zinc deficiency prevalence or who show signs of malnutrition 1, 3, 2
  • Reduces the duration of diarrhea 1, 2

Follow-up and Monitoring

• Reassess hydration status after 2-4 hours of rehydration 3
• If the child remains dehydrated, reassess the fluid deficit and restart rehydration 3
• Monitor for signs of improvement or deterioration 2

Common Pitfalls to Avoid

• Do not use antimotility drugs in children under 18 years - these can cause serious adverse effects including respiratory depression and cardiac events 1, 4
• Do not delay rehydration - prompt rehydration is essential to prevent complications 1, 2
• Do not restrict diet unnecessarily - early reintroduction of appropriate foods helps recovery 1, 2
• Do not use "adult" oral rehydration solutions - children require specific electrolyte compositions 5, 6
• Do not use antibiotics routinely - most cases of acute diarrhea are viral and self-limiting 7