What is the treatment for food poisoning in an infant?

Treatment of Food Poisoning in Infants

The cornerstone of treating food poisoning (acute gastroenteritis) in infants is immediate oral rehydration therapy with oral rehydration solution (ORS), continued feeding without interruption, and avoidance of antidiarrheal medications which are contraindicated in this age group. 1, 2

Immediate Assessment of Dehydration Severity

Assess the infant's hydration status by examining:

• Skin turgor and capillary refill time 2
• Mucous membranes (dry indicates dehydration) 2, 3
• Mental status (lethargy is concerning) 2
• Presence of tears (absent tears indicate dehydration) 3
• Weight loss (the most reliable clinical indicator) 2, 3

Categorize dehydration as:

• Mild: 3-5% fluid deficit 2
• Moderate: 6-9% fluid deficit 2
• Severe: ≥10% fluid deficit with shock or pre-shock 2

Rehydration Protocol

For Mild Dehydration (3-5% deficit):

• Administer 50 mL/kg ORS over 2-4 hours 2
• Give 50-100 mL ORS after each loose stool 1, 2
• Replace vomiting losses with 2 mL/kg ORS per episode 1, 2

For Moderate Dehydration (6-9% deficit):

• Administer 100 mL/kg ORS over 2-4 hours 2
• Continue replacement of ongoing losses as above 1

For Severe Dehydration (≥10% deficit):

• Hospitalize immediately and administer 20 mL/kg boluses of normal saline or Ringer's lactate IV rapidly, repeating as needed until pulse, perfusion, and mental status normalize 1, 2
• If IV access is delayed, use nasogastric tube at 15 mL/kg/hour 1, 2

Managing Vomiting During Rehydration

Give small, frequent volumes of ORS (5 mL every minute) using a spoon or syringe 1, 2. This approach is feasible even in vomiting infants and often reduces vomiting frequency as dehydration corrects 1, 3. For infants ≥6 months with persistent vomiting, ondansetron 0.15 mg/kg intramuscular (maximum 16 mg) may be considered 1.

Feeding Management: Critical for Recovery

Breastfed Infants:

Continue breastfeeding on demand throughout the entire illness without any interruption 1, 2. Breast milk reduces stool output and severity compared to ORS alone 2, 3.

Formula-Fed Infants:

Immediately resume full-strength, lactose-free or lactose-reduced formula after rehydration 1, 2. This approach reduces both stool output and duration of diarrhea by approximately 50% compared to gradual reintroduction 2.

If lactose-free formula is unavailable, use full-strength lactose-containing formula under supervision 1. True lactose intolerance is diagnosed only by worsening diarrhea upon reintroduction, not by stool pH <6.0 or reducing substances >0.5% alone 1.

Older Infants (>4-6 months):

Resume feeding as soon as appetite returns with energy-rich, easily digestible foods including starches, cereals, yogurt, fruits, and vegetables 1. Avoid foods high in simple sugars and fats 1.

Medications: What NOT to Use

Antidiarrheal agents including loperamide are absolutely contraindicated in infants due to risks of respiratory depression, cardiac arrest, and death 2.

Antibiotics are not indicated unless the infant has:

• Dysentery (bloody diarrhea) 1
• High fever 1
• Watery diarrhea lasting >5 days 1
• Confirmed bacterial pathogen requiring specific treatment 1

Red Flags Requiring Immediate Medical Attention

Instruct caregivers to return immediately or call 911 if the infant develops:

• Irritability or lethargy 1, 2
• Decreased urine output 1
• Intractable vomiting (unable to keep down even small amounts) 1
• Sunken eyes or very poor skin turgor 1, 2
• >3 episodes of vomiting with moderate-to-severe lethargy 1

Common Pitfalls to Avoid

Do not dilute formula or delay full-strength feeding as this worsens nutritional outcomes and prolongs diarrhea 2.

Do not use cola drinks or other inappropriate beverages for rehydration as they contain too little sodium and excessive sugar, which may worsen diarrhea 3.

Do not diagnose lactose intolerance based solely on laboratory findings without clinical worsening 1, 2.

Do not withhold food until diarrhea stops—early feeding (within 6-24 hours) shortens the duration of illness 1, 4.

Home Management and Prevention

Keep ORS packets at home for immediate use when diarrhea begins 3. Parents should be educated at the first newborn visit about recognizing dehydration and initiating ORS immediately 1. Handwashing and proper hygiene are essential for preventing spread 1.