Treatment of Diarrhea in a 1-Year-Old Child
The best treatment for a 1-year-old with diarrhea is immediate oral rehydration therapy (ORT) using reduced osmolarity oral rehydration solution (ORS), combined with continued feeding and early nutritional support. 1
Immediate Assessment
Rapidly assess hydration status by examining:
- Skin turgor and capillary refill time 1, 2
- Mucous membranes (dry vs moist) 1, 2
- Mental status (alert vs lethargic/irritable) 1, 2
- Weight loss (most reliable indicator if baseline weight available) 2
Classify dehydration severity:
- Mild: 3-5% fluid deficit 1, 2
- Moderate: 6-9% fluid deficit 1, 2
- Severe: ≥10% fluid deficit with shock or altered mental status 1, 2
Rehydration Protocol
For Mild Dehydration (3-5%)
Administer 50 mL/kg of ORS over 2-4 hours 1, 2
For Moderate Dehydration (6-9%)
Administer 100 mL/kg of ORS over 2-4 hours 1, 2
For Severe Dehydration (≥10%)
Immediately give 20 mL/kg IV boluses of lactated Ringer's or normal saline until pulse, perfusion, and mental status normalize, then transition to ORS 1, 2
Managing Concurrent Vomiting
If the child is vomiting, do not allow ad libitum drinking as this worsens vomiting 1. Instead:
- Give 5 mL of ORS every 1-2 minutes using a spoon or syringe 3, 1, 2
- Gradually increase volume as tolerated 3, 1
- Simultaneous correction of dehydration typically lessens vomiting frequency 3
Replacing Ongoing Losses
After initial rehydration:
- Give 10 mL/kg of ORS for each watery stool 1, 2
- Give 2 mL/kg of ORS for each vomiting episode 1, 2
- Continue until diarrhea and vomiting resolve 1, 2
Nutritional Management
Resume age-appropriate diet during or immediately after rehydration is completed 1, 2. This is critical as early refeeding shortens diarrhea duration 3.
For a 1-year-old:
- If breastfed: Continue breastfeeding on demand throughout the entire episode without interruption 1, 2
- If formula-fed: Resume full-strength formula immediately upon rehydration 1, 2
- Offer solid foods including starches, cereals, yogurt, fruits, and vegetables 1, 2
- Avoid foods high in simple sugars and fats 1
Zinc Supplementation
Administer zinc supplementation, as it reduces diarrhea duration in children 6 months to 5 years of age 1, 2. This is particularly important if the child shows any signs of malnutrition 1, 2.
Medications to AVOID
Absolutely do NOT use antimotility drugs (loperamide) in children under 18 years of age—these are contraindicated 1, 2. They do not prevent dehydration and can cause serious harm 1.
Do NOT use ondansetron in children under 4 years of age 2. At 1 year old, this child is too young for antiemetic therapy 2.
Do NOT routinely use antibiotics 1, 2. Consider antibiotics only if:
- Bloody diarrhea (dysentery) is present 1, 2
- High fever occurs 1
- Watery diarrhea persists >5 days 1, 2
- Stool cultures indicate a specific treatable pathogen 1, 2
Reassessment and Warning Signs
Reassess hydration status after 2-4 hours of rehydration 1, 2. If still dehydrated, restart the rehydration protocol 2.
Instruct parents to return immediately if:
- Decreased urine output develops 3, 1
- Child becomes irritable or lethargic 3, 1
- Intractable vomiting prevents oral intake 1, 2
- Condition worsens 2
Common Pitfalls to Avoid
Do not use cola drinks or other inappropriate beverages for rehydration—they contain too little sodium and excessive sugar, which worsens diarrhea 4. Only use commercially available ORS 3.
Do not withhold food during or after rehydration—early refeeding is essential and reduces morbidity 3, 1.
Do not allow a thirsty child to drink large volumes rapidly—this is a common mistake that worsens vomiting 1.
Home Management Education
Parents should keep ORS at home and begin administration at the first sign of diarrhea 3, 2. Since morbidity and mortality from diarrhea in the United States usually occur in the first year of life, this education is particularly critical for parents of 1-year-olds 3.