What is the best course of treatment for an 8-month-old infant with acute gastroenteritis, characterized by loose stools and vomiting, without fever or abdominal tenderness?

Management of Acute Gastroenteritis in an 8-Month-Old Infant

Immediate Treatment Approach

The current management plan is appropriate and should be continued: oral rehydration solution (ORS-75), zinc supplementation, continued breastfeeding, and close monitoring for dehydration signs. 1, 2

The presentation of watery, non-bloody diarrhea with vomiting in an 8-month-old infant without fever or systemic signs is consistent with viral gastroenteritis, which does not require antimicrobial therapy. 1

Core Treatment Components

Oral Rehydration Therapy

• Administer ORS-75 using small, frequent volumes (5-10 mL every 1-2 minutes) via spoon or syringe, gradually increasing as tolerated to prevent triggering more vomiting. 2
• Since the infant shows no signs of dehydration (clear breath sounds, normal activity, normal appetite), skip the rehydration phase and proceed directly to maintenance therapy with ongoing loss replacement. 1, 2
• Replace ongoing losses: give 10 mL/kg (approximately 80 mL for an 8-month-old) of ORS for each watery stool and 2 mL/kg (approximately 16 mL) for each vomiting episode. 1, 2

Zinc Supplementation

• Zinc sulfate supplementation is appropriate and should reduce diarrhea duration, particularly in areas with high zinc deficiency prevalence or in children with signs of malnutrition. 2
• Continue zinc supplementation throughout the diarrheal episode. 2

Nutritional Management

• Continue breastfeeding on demand without interruption, as this is a cornerstone of management. 1, 2, 3
• Resume age-appropriate solid foods immediately (if already introduced), as early refeeding reduces severity and duration of illness. 2, 3
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice, presweetened cereals) as these can exacerbate diarrhea through osmotic effects. 1, 2

Probiotics

• Lactobacillus clausii may reduce symptom severity and duration in both adults and children with acute gastroenteritis. 2
• This is a reasonable adjunctive therapy to the core management. 2

What NOT to Do

Avoid Harmful Medications

• Never administer antimotility agents (loperamide) to children under 18 years, as they do not reduce diarrhea volume or duration and carry serious risks including ileus, drowsiness, and even death. 1, 2
• Do not use adsorbents (kaolin-pectin), antisecretory drugs, or toxin binders, as available data do not demonstrate effectiveness and they shift focus away from appropriate fluid and nutritional therapy. 1, 2
• Antimicrobial therapy is not indicated for watery diarrhea with vomiting in a child less than 2 years of age, as this most likely represents viral gastroenteritis. 1

Avoid Inappropriate Fluids

• Do not use sports drinks, undiluted apple juice, or other high-sugar beverages as primary rehydration solutions. 2
• Avoid caffeinated beverages as they can worsen diarrhea through stimulation of intestinal motility. 2

Monitoring and Red Flags

Clinical Assessment Parameters

• Monitor for signs of dehydration every 2-4 hours: skin turgor, mucous membrane moisture, capillary refill, mental status, and urine output. 1, 2
• Mild dehydration (3-5% fluid deficit) presents with increased thirst and slightly dry mucous membranes. 1
• Moderate dehydration (6-9% fluid deficit) shows loss of skin turgor, skin tenting when pinched, and dry mucous membranes. 1

Warning Signs Requiring Immediate Medical Attention

• Severe dehydration (≥10% fluid deficit) constitutes a medical emergency: severe lethargy or altered consciousness, prolonged skin tenting (>2 seconds), cool and poorly perfused extremities, decreased capillary refill. 2
• Persistent vomiting despite small-volume ORS administration (5-10 mL every 1-2 minutes) indicates failure of oral rehydration therapy. 2
• Absent bowel sounds is an absolute contraindication to oral rehydration. 2
• Bloody stools with fever may indicate bacterial infection requiring immediate evaluation and stool culture. 2
• Altered mental status including severe lethargy or decreased consciousness. 2

Diagnostic Testing

Fecalysis Indication

• Stool microbiological tests are not routinely needed when viral gastroenteritis is the likely diagnosis in children with mild illness. 4
• The requested fecalysis is reasonable but should not delay treatment. 2
• Bloody diarrhea or presence of white blood cells on stool examination suggests bacterial infection requiring stool cultures. 1

Common Pitfalls to Avoid

• Do not delay rehydration therapy while awaiting diagnostic testing—rehydration should be initiated promptly. 2
• Do not unnecessarily restrict diet during or after rehydration, as early refeeding is beneficial. 2, 3
• Do not underestimate the importance of small-volume, frequent ORS administration—this technique successfully rehydrates >90% of children with vomiting and diarrhea without antiemetic medication. 2
• Infants are more prone to dehydration due to higher body surface-to-weight ratio, higher metabolic rate, and dependence on caregivers for fluid intake. 1, 2

Infection Control

• Practice proper hand hygiene after diaper changes, before food preparation, and before eating. 2
• Clean and disinfect contaminated surfaces promptly to prevent transmission. 2
• Separate the ill infant from well siblings until at least 2 days after symptom resolution. 2