From the Guidelines
For a 2-year-old with watery diarrhea, the most effective treatment is to offer frequent small amounts of oral rehydration solution (ORS) like Pedialyte, which replaces lost electrolytes and fluids, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The goal is to prevent dehydration by providing ORS in small amounts, such as 1-2 tablespoons (15-30 ml) every 15-20 minutes, gradually increasing as tolerated.
- Continue breastfeeding or formula if applicable, as this will help maintain the child's nutrition and hydration status.
- Avoid giving plain water alone, as it lacks necessary electrolytes, and sugary drinks, juices, and sports drinks, which can worsen diarrhea.
- Offer a regular diet with easily digestible foods like bananas, rice, applesauce, toast, and yogurt to help the child recover from the illness.
- Probiotics may help reduce the duration of diarrhea, and children's formulations are available over-the-counter.
- It is essential to monitor for signs of dehydration, including decreased urination, dry mouth, no tears when crying, unusual drowsiness, or sunken eyes, and seek immediate medical attention if the child shows these signs, has bloody diarrhea, high fever above 102°F (38.9°C), severe abdominal pain, or if diarrhea persists beyond 2-3 days. The use of ORS is supported by multiple studies, including those from the Centers for Disease Control and Prevention 1, which emphasize the importance of oral rehydration therapy in treating acute diarrhea in children.
- Nasogastric administration of ORS may be considered in infants and children who cannot tolerate oral intake or are too weak to drink adequately, as stated in the 2017 guidelines 1.
- Intravenous fluids, such as lactated Ringer's and normal saline solution, should be administered in cases of severe dehydration, shock, or altered mental status, and failure of ORS therapy, as recommended by the guidelines 1.
From the FDA Drug Label
Pediatric Patients 2 to 12 Years of Age: In pediatric patients 2 to 5 years of age (20 kg or less), the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) should be used; for ages 6 to 12, either loperamide hydrochloride capsules or Imodium A-D liquid may be used For pediatric patients 2 to 12 years of age, the following schedule for capsules or liquid will usually fulfill initial dosage requirements: Recommended First Day Dosage Schedule Two to five years (13 to 20 kg): 1 mg three times daily (3 mg total daily dosage) Six to eight years (20 to 30 kg): 2 mg twice daily (4 mg total daily dosage) Eight to twelve years (greater than 30kg): 2 mg three times daily (6 mg total daily dosage) Recommended Subsequent Daily Dosage Following the first treatment day, it is recommended that subsequent loperamide hydrochloride capsules doses (1 mg/10 kg body weight) be administered only after a loose stool The total daily dosage should not exceed recommended dosages for the first day.
The treatment for watery diarrhea in a 2-year-old child is 1 mg of loperamide three times daily (3 mg total daily dosage), using the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) 2. Patients should receive appropriate fluid and electrolyte replacement as needed.