What is the treatment for diarrhea in an infant?

From the Guidelines

For treating diarrhea in an infant, the most effective approach is to prevent dehydration by continuing to feed the baby and replacing lost fluids with reduced osmolarity oral rehydration solution (ORS) as the first-line therapy. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, ORS is recommended for mild to moderate dehydration in infants. It is essential to continue breastfeeding or formula feeding during the diarrheal episode, as recommended by the same guidelines 1. For mild cases, provide oral rehydration solutions like Pedialyte in small, frequent amounts (about 1-2 teaspoons every 5-15 minutes).

Some key points to consider when treating diarrhea in infants include:

• Continuing the baby's regular diet unless advised otherwise by a healthcare provider
• Avoiding over-the-counter anti-diarrheal medications, which can be dangerous for infants
• Watching for signs of dehydration, such as fewer wet diapers, dry mouth, sunken eyes, or unusual fussiness
• Practicing good hygiene by washing hands thoroughly after diaper changes
• Contacting a doctor immediately if the baby shows signs of dehydration, has bloody stools, high fever, severe abdominal pain, or if diarrhea persists beyond 24 hours in an infant under 3 months or beyond a few days in older infants.

It is also important to note that nasogastric administration of ORS may be considered in infants with moderate dehydration who cannot tolerate oral intake 1. Additionally, human milk feeding should be continued in infants throughout the diarrheal episode, and resumption of an age-appropriate usual diet is recommended during or immediately after the rehydration process is completed 1.

From the FDA Drug Label

For full term infants and children up to 5 years of age, 100 mcg zinc/kg/day (0.1 mL/kg/day) is recommended. The answer to the treatment for diarrhea in infants is zinc supplementation. The recommended dosage is 100 mcg zinc/kg/day for full-term infants. 2

From the Research

Treatment for Diarrhea in Infants

• The primary treatment for diarrhea in infants is oral rehydration with a glucose-electrolyte solution, which is as effective as intravenous rehydration 3.
• Oral rehydration should start immediately when dehydration occurs, and infants with signs of severe dehydration should be hospitalized 3.
• For vomiting infants, oral rehydration is feasible by giving a teaspoonful of solution every one or two minutes 3.
• Beverages like cola drinks are not suitable for rehydration due to their low sodium content and high hyperosmolarity, which can worsen diarrhea 3.
• Rice gruel is a better option for rehydration than other beverages 3.

Feeding and Nutrition

• Feeding should be resumed as soon as dehydration has been corrected, as it shortens the course of diarrhea 3.
• Continuing maternal breast-feeding reduces the severity of diarrhea 3.
• Lactose-free "milk" has no demonstrated benefit in treating diarrhea in infants 3.
• In cases of severe, persistent, or recurrent diarrhea, lactose-free formulae may be used, especially in infants under 3-4 months old 4.

Medications and Vaccines

• Antidiarrheal drugs do not prevent dehydration and are not recommended as a primary treatment 3.
• Racecadotril is the only drug with anti-diarrheal properties, reducing stool output by 50% 4.
• Oral antibiotics should only be used in cases of Shigella infection or bacterial infection with severe sepsis or underlying debilitating disease 4.
• The oral Rotavirus vaccine has been shown to dramatically reduce the number of severe cases of diarrhea with dehydration and has been associated with a reduction in morbidity and mortality 4.

Prevention and Management

• It is essential for caregivers to know how to prevent severe dehydration, which can occur rapidly in infants with diarrhea 3.
• Fluid intake should always be increased in infants with diarrhea, and sachets of powder for oral rehydration should be kept at home 3.
• Homemade oral rehydration solutions, plain water, or fizzy drinks should be avoided, and oral rehydration solutions should be used in accordance with written instructions 4.