What medication can be given to a child with diarrhea?

Medication for Diarrhea in Children

Do not give antimotility drugs (like loperamide) to children under 18 years of age with acute diarrhea—these medications are contraindicated and can cause serious adverse effects including respiratory depression and cardiac complications. 1

Primary Treatment: Oral Rehydration Solution (ORS)

The cornerstone of treating diarrhea in children is oral rehydration therapy with reduced osmolarity ORS (containing 50-90 mEq/L sodium), not pills or antimotility medications. 1, 2

Rehydration Based on Severity

Assess dehydration level by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time: 1, 3

• Mild dehydration (3-5% fluid deficit): Give 50 mL/kg ORS over 2-4 hours 1
• Moderate dehydration (6-9% fluid deficit): Give 100 mL/kg ORS over 2-4 hours 1
• Severe dehydration (≥10% fluid deficit, shock): Requires immediate IV fluids (lactated Ringer's or normal saline) until vital signs normalize, then transition to ORS 1

Ongoing Loss Replacement

• Replace each watery stool with 10 mL/kg of ORS 3, 2
• Replace each vomiting episode with 2 mL/kg of ORS 3, 2

Adjunctive Medications (Limited Role)

Antiemetics (For Vomiting Only)

Ondansetron may be given to children over 4 years of age to facilitate oral rehydration when vomiting prevents adequate fluid intake, but only after the child is adequately hydrated. 1 This is not a treatment for diarrhea itself—it only helps the child tolerate ORS when vomiting is problematic.

Zinc Supplementation

Oral zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age who live in countries with high zinc deficiency prevalence or show signs of malnutrition. 1, 3 This is particularly relevant in developing countries but less commonly needed in well-nourished children in developed nations.

Probiotics

Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent children with infectious or antimicrobial-associated diarrhea, though evidence is moderate. 1

Critical Contraindications

Loperamide (Imodium)

• Absolutely contraindicated in children under 2 years of age due to risks of respiratory depression and serious cardiac adverse reactions 4
• Should not be given to any child under 18 years with acute diarrhea per IDSA guidelines 1
• The FDA label confirms contraindication in children under 2 years, with postmarketing reports of cardiac arrest, syncope, and respiratory depression in this age group 4

Nutrition During Illness

• Continue breastfeeding throughout the diarrheal episode 1, 3
• Resume age-appropriate diet during or immediately after rehydration—early refeeding does not prolong diarrhea and may reduce its duration 1
• Do not unnecessarily restrict diet or prolong fasting, as this worsens nutritional status 3

Common Pitfalls to Avoid

• Never use antimotility medications in children—the risk of serious adverse effects including respiratory depression, cardiac complications, and paralytic ileus far outweighs any potential benefit 1, 4
• Avoid allowing thirsty children to drink large volumes of ORS rapidly (ad libitum)—this can worsen vomiting; instead give small volumes (5-10 mL) every 1-2 minutes using a spoon or syringe 2
• Do not fail to replace ongoing losses during maintenance—this leads to recurrent dehydration 3, 2

When to Seek Immediate Medical Attention

• Bloody diarrhea (dysentery) 2
• Severe dehydration with shock 2
• Intractable vomiting preventing oral rehydration 2
• High stool output (>10 mL/kg/hour) 2