Advice for the 11-Month-Old Sibling
Reassure the family that with proper hand hygiene, the risk of transmission to the 11-month-old can be minimized, and emphasize that handwashing with soap and water after diaper changes, before food preparation, and before eating is the single most critical preventive measure. 1
Key Preventive Measures
Hand Hygiene (Most Critical)
- All household members must wash hands with soap and water after using the toilet, after changing diapers, before and after food preparation, before eating, and after handling any soiled items 1, 2
- Alcohol-based hand sanitizers are insufficient for gastroenteritis pathogens—soap and water are essential 3
- This is particularly critical given that morbidity and mortality from diarrhea in the United States occur predominantly in the first year of life 1
Diaper Changing and Environmental Hygiene
- Use gloves when changing diapers of the 11-month-old if they develop symptoms 2
- Clean and disinfect contaminated surfaces (changing tables, bathroom fixtures, toys) promptly with appropriate disinfectants 2, 3
- Maintain meticulous diaper changing practices to prevent fecal-oral transmission 1
Separation and Monitoring
- Ideally separate the 10-year-old from the 11-month-old sibling until at least 2 days after complete symptom resolution 2
- Monitor the infant closely for signs of gastroenteritis: increased stool frequency, watery stools, vomiting, decreased urine output, or behavioral changes 1
If the 11-Month-Old Develops Symptoms
Warning Signs Requiring Immediate Medical Attention
Parents should contact their physician or return to clinic immediately if the infant develops: 1, 2
- Irritability or lethargy
- Decreased urine output (fewer wet diapers)
- Dry mucous membranes or poor skin turgor
- Intractable vomiting
- Persistent diarrhea beyond 24 hours
- Fever
Home Management if Mild Symptoms Develop
- Begin oral rehydration solution (ORS) immediately at home—every household with young children should have ORS available 1, 2
- Replace each watery stool with 10 mL/kg of ORS and each vomiting episode with 2 mL/kg 2, 4
- Continue breastfeeding if applicable 2, 5
- Resume age-appropriate foods immediately after rehydration—do not restrict diet 1, 2
Important Caveats
Testing Considerations
- Do not routinely test for Clostridium difficile in children under 2 years of age, as asymptomatic colonization rates exceed 50% in this age group and positive tests may not indicate true infection 1
- Stool cultures are generally not needed for typical viral gastroenteritis unless bloody diarrhea, high fever, or symptoms persisting beyond 5 days occur 1, 2
What NOT to Do
- Never use antimotility agents (like loperamide) in the 11-month-old—these are absolutely contraindicated in children under 18 years 2, 6
- Do not use sports drinks or undiluted apple juice as primary rehydration fluids for moderate dehydration—use proper ORS formulations 2, 5
- Do not restrict diet or delay refeeding after rehydration 1, 2