What is the management for a child with diarrhea lasting 7 days?

Management of Diarrhea Lasting 7 Days in Children

For a child with diarrhea persisting for 7 days, immediately assess hydration status and initiate oral rehydration therapy (ORS) while continuing age-appropriate feeding; additionally, consider stool cultures and specific pathogen testing since diarrhea lasting >5 days warrants investigation for infectious agents requiring targeted treatment. 1

Initial Assessment

Evaluate the child's hydration status by examining:

• Skin turgor (pinched skin returns slowly when dehydrated) 2
• Mucous membranes (dry indicates dehydration) 2
• Mental status (lethargy or irritability suggests significant dehydration) 2
• Capillary refill time (>2 seconds is abnormal) 2
• Pulse quality and perfusion 2
• Body weight to establish baseline and monitor treatment effectiveness 1

Categorize dehydration severity:

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

Rehydration Protocol Based on Severity

Mild Dehydration (3-5% deficit)

• Administer 50 mL/kg of ORS containing 50-90 mEq/L sodium over 2-4 hours 2
• Use small volumes initially (one teaspoon) via spoon, syringe, or medicine dropper, gradually increasing as tolerated 1
• Reassess hydration status after 2-4 hours 2

Moderate Dehydration (6-9% deficit)

• Administer 100 mL/kg of ORS over 2-4 hours using the same technique 2
• If child is vomiting, give small volumes (5-10 mL) every 1-2 minutes, gradually increasing 2

Severe Dehydration (≥10% deficit)

• This is a medical emergency requiring immediate IV rehydration 2
• Administer 20 mL/kg boluses of Ringer's lactate or normal saline until pulse, perfusion, and mental status normalize 1
• Once consciousness returns, transition to oral rehydration for remaining deficit 1

Replacement of Ongoing Losses

Critical: During both rehydration and maintenance phases, replace ongoing losses:

• 10 mL/kg of ORS for each watery/loose stool 1, 2
• 2 mL/kg of ORS for each vomiting episode 1, 2

Nutritional Management

Infants

• Breastfed infants: Continue nursing on demand throughout the illness 1, 2
• Formula-fed infants: Resume full-strength, lactose-free or lactose-reduced formula immediately after rehydration 1
• If lactose-free formula unavailable, use full-strength lactose-containing formula under supervision, watching for worsening diarrhea 1

Older Children

• Resume age-appropriate diet immediately upon rehydration 2
• Early refeeding is essential to prevent nutritional deterioration 1

Special Considerations for 7-Day Duration

Since diarrhea has persisted beyond 5 days, specific pathogen investigation is warranted:

• Obtain stool cultures and microscopy 1
• Consider parasitic causes (Giardia, Cryptosporidium) requiring specific treatment 1
• Evaluate for bacterial pathogens that may need antimicrobial therapy 1

Adjunctive Therapies

• Zinc supplementation: Recommended for children 6 months to 5 years with signs of malnutrition or in zinc-deficient populations, as it reduces diarrhea duration 3, 2
• Ondansetron: May be used in children >4 years with persistent vomiting to facilitate oral rehydration, but only after adequate hydration is achieved 2

Critical Pitfalls to Avoid

• Do NOT allow ad libitum drinking of large ORS volumes in thirsty children, as this worsens vomiting 2
• Do NOT use antimotility drugs (contraindicated in children <18 years) 2
• Do NOT routinely use antibiotics unless specific pathogen identified or bloody diarrhea present 1
• Do NOT use antiemetics, antidiarrheals, or spasmolytics routinely—they are unnecessary and potentially harmful 4

Warning Signs Requiring Immediate Medical Attention

• Bloody diarrhea (dysentery) suggesting invasive bacterial infection 2
• Intractable vomiting preventing successful oral rehydration 2
• High stool output (>10 mL/kg/hour) 2
• Signs of glucose malabsorption (increased stool output with ORS administration) 2
• Persistent lethargy or irritability 1
• Decreased urine output 1

Follow-Up

• Reassess hydration status every 2-4 hours during active rehydration 2
• Instruct parents to return if symptoms worsen or new warning signs develop 1
• For children who tolerate <25 mL/kg of ORS during observation, consider admission for IV therapy 5