What is the treatment for diarrhea in a child?

From the Guidelines

For treating diarrhea in a child, the most effective approach is to focus on preventing dehydration through oral rehydration therapy, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.

Key Recommendations

• Give your child an oral rehydration solution like Pedialyte, Enfalyte, or a homemade solution (1 liter of clean water, 6 teaspoons of sugar, and 1/2 teaspoon of salt) in small, frequent sips.
• Continue regular feeding as tolerated, avoiding sugary drinks, dairy, and fatty foods which can worsen symptoms.
• If the child is vomiting, wait 15-30 minutes after vomiting before offering fluids again.
• Most cases of childhood diarrhea are viral and resolve within 5-7 days without medication.
• Anti-diarrheal medications like loperamide (Imodium) are not recommended for children.
• Probiotics such as Lactobacillus GG or Saccharomyces boulardii may help reduce the duration of diarrhea.

When to Seek Medical Attention

• Seek medical attention if your child shows signs of dehydration (decreased urination, dry mouth, no tears when crying, unusual drowsiness).
• Has bloody diarrhea, severe abdominal pain, high fever above 102°F (39°C), or if diarrhea persists beyond 7 days.
• Handwashing and good hygiene practices can prevent spread to other family members, as emphasized by the Centers for Disease Control and Prevention 1.

Rehydration Therapy

• Reduced osmolarity oral rehydration solution (ORS) is recommended as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
• Nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration, who cannot tolerate oral intake, or in children with normal mental status who are too weak or refuse to drink adequately 1.

From the FDA Drug Label

Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions The safety and effectiveness of loperamide hydrochloride in pediatric patients with chronic diarrhea have not been established Although loperamide hydrochloride has been studied in a limited number of pediatric patients with chronic diarrhea; the therapeutic dose for the treatment of chronic diarrhea in a pediatric population has not been established.

Loperamide hydrochloride is not recommended for the treatment of diarrhea in children less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions. For children over 2 years of age, the safety and effectiveness of loperamide hydrochloride for the treatment of diarrhea have not been established. Caution should be exercised when considering the use of loperamide hydrochloride in pediatric patients, especially those less than 6 years of age, due to the potential for dehydration and variability of response 2.

From the Research

Treatment for Diarrhea in Children

• The primary treatment for diarrhea in children is oral rehydration therapy (ORT) using oral rehydration solutions (ORS) 3, 4, 5, 6.
• ORS is effective in reducing the duration and severity of diarrhea, and it is recommended to use commercially available solutions rather than homemade ones 4, 6.
• Breastfeeding should not be interrupted, and lactose-free formulae should only be used in infants with severe, persistent, or recurrent diarrhea 3.
• Antibiotics and antidiarrheal agents are usually not indicated, except in cases of bacterial infection or severe sepsis 3, 4.
• Early reintroduction of milk, formula, or solid food is important, as well as instruction of parents in measures to minimize transmission of infectious agents 4.

Oral Rehydration Solutions (ORS)

• Low-osmolarity ORS (LORS) is recommended for the treatment of acute and persistent diarrhea in children under 10 years of age 7.
• LORS has been shown to decrease the duration of diarrhea, stool output, and ORS intake compared to standard ORS 7.
• The use of LORS is supported by the World Health Organization (WHO) recommendations 7.

Management of Acute Diarrhea

• Diagnosis and evaluation of dehydration should be fast and lead to premature correction of hypovolumic shock or accurate fluid management 5.
• Nasogastric tube or intravenous infusion may be used as an alternative to ORS in case of failure 5.
• Prevention of diarrhea includes respect of hygienic rules and anti-rotavirus vaccine 5.

Additional Considerations

• Racecadotril is the only drug with anti-diarrheal properties, with a reduction of stool output of 50% 3.
• Oral Rotavirus vaccine has been shown to dramatically reduce the number of severe cases of diarrhea with dehydration, and has been associated with a striking reduction of both morbidity and mortality 3.