What is the recommended Pedialyte (oral rehydration solution) dosing for a 7-month-old infant weighing 9 kg with mild to moderate dehydration?

Pedialyte Dosing for a 7-Month-Old, 9 kg Infant

Rehydration Phase (If Dehydrated)

For mild to moderate dehydration, administer 450-900 mL of Pedialyte (50-100 mL/kg) over 3-4 hours. 1, 2, 3

Specific Dosing by Dehydration Severity:

• Mild dehydration (3-5% fluid deficit): Give 450 mL (50 mL/kg × 9 kg) over 2-4 hours 1, 3
• Moderate dehydration (6-9% fluid deficit): Give 900 mL (100 mL/kg × 9 kg) over 2-4 hours 1, 3

Administration Technique:

• Start with very small volumes using a teaspoon, syringe, or medicine dropper (approximately 5 mL initially) 1, 3, 4
• Gradually increase the amount as tolerated 1, 3
• If vomiting is present, give small frequent volumes every 1-2 minutes 4
• Reassess hydration status after 3-4 hours to determine if rehydration is adequate 2, 3

Alternative Route if Oral Fails:

• If the infant cannot tolerate oral intake but is not in shock, consider nasogastric administration at 135 mL/hour (15 mL/kg/hour × 9 kg) 3, 4
• Severe dehydration (≥10% fluid deficit, shock, altered mental status) requires immediate IV rehydration with 20 mL/kg boluses of isotonic crystalloid until vital signs normalize, then transition to oral rehydration 1, 3

Maintenance Phase (After Rehydration or If No Dehydration)

Replace ongoing losses with 60-120 mL of Pedialyte for each diarrheal stool or vomiting episode, up to approximately 500 mL/day maximum. 1, 3

Ongoing Loss Replacement:

• Since this infant weighs <10 kg, give 60-120 mL Pedialyte per diarrheal stool 1, 3
• Give 60-120 mL Pedialyte per vomiting episode 1, 3
• Alternative calculation: 90 mL (10 mL/kg × 9 kg) for each watery stool and 18 mL (2 mL/kg × 9 kg) for each vomiting episode 1, 3
• Continue replacement as long as diarrhea or vomiting persists 1, 3

Important Clinical Considerations

Feeding During Illness:

• If breastfed, continue nursing on demand throughout the illness 1, 3
• If formula-fed, resume full-strength formula immediately after rehydration is achieved 1, 3
• Offer age-appropriate foods every 3-4 hours once rehydrated 2, 3

Product Selection:

• Use only commercially available oral rehydration solutions like Pedialyte, which contain appropriate low-osmolarity formulations 1, 3
• Do not use apple juice, Gatorade, sports drinks, or commercial soft drinks due to inappropriate electrolyte content and high osmolality that can worsen diarrhea 1, 2, 3

Critical Pitfalls to Avoid

• Never use anti-diarrheal medications in infants with acute diarrhea 2, 3
• Do not restrict fluids or delay feeding until diarrhea stops 2
• Do not use diluted formula, as it provides no benefit 1
• If dehydration persists after the initial 3-4 hour rehydration period, reassess the fluid deficit and restart rehydration therapy 1, 3
• Seek immediate medical attention if the infant shows signs of severe dehydration, severe lethargy, inability to drink, or worsening clinical status 3