Zinc Dose for a 1-Year-Old Child with Acute Diarrhea
For a 1-year-old child with acute diarrhea, give 10 mg of elemental zinc daily for 10-14 days, as this is the recommended dose for infants under 6 months to children transitioning to the higher dose at 6 months of age. 1, 2
Age-Specific Dosing Algorithm
Since your patient is 1 year old (12 months), the dosing depends on weight and regional context:
Standard Recommendation (Most Settings)
- Children 6 months to 5 years should receive 20 mg of elemental zinc daily for 10-14 days when they have acute diarrhea, particularly in zinc-deficient populations or those with signs of malnutrition 1, 3
- This recommendation comes from the Infectious Diseases Society of America and World Health Organization, supported by evidence showing zinc reduces diarrhea duration by approximately 10-27 hours 1, 2
Weight-Based Dosing for Precision
- For pediatric patients weighing 10 kg and above (typical for a 1-year-old), the dose is 50 mcg/kg daily, up to a maximum of 3 mg/day for parenteral nutrition contexts 4
- However, for oral supplementation in acute diarrhea, the 20 mg daily dose is standard regardless of exact weight within the 6 months to 5 years age range 1, 5
Critical Context: When to Use Zinc
Zinc supplementation is strongly indicated when:
- The child resides in a country with high zinc deficiency prevalence 1, 2
- The child shows signs of malnutrition or stunted growth 1, 5
- The child has watery diarrhea that may benefit from adjunctive therapy beyond oral rehydration 2, 5
Important caveat: The American Academy of Pediatrics does not routinely recommend zinc for all infants with diarrhea in well-nourished populations, but does support its use in zinc-deficient settings 2
Administration Details
- Duration: Continue for the full 10-14 days even if diarrhea resolves earlier 1, 3
- Timing of benefit: Zinc shows minimal effect in the first 3 days but demonstrates a 38% reduction in continued diarrhea risk after day 3 5
- Greatest benefit: Children with stunted growth show more pronounced reductions in duration and severity compared to those with normal growth 5
Common Pitfall to Avoid
Never use zinc as a substitute for oral rehydration therapy—rehydration remains the cornerstone of diarrhea management 1, 2. The zinc is adjunctive therapy only. Ensure the child receives:
- Appropriate ORS for rehydration (50-100 mL/kg over 2-4 hours depending on dehydration severity) 2
- Continued breastfeeding or age-appropriate diet 6, 2
- Replacement of ongoing stool losses with 10 mL/kg ORS per watery stool 2
Side Effect Management
- Vomiting within 30 minutes of zinc administration is common and may interfere with compliance 7
- This side effect appears dose-related, which is why lower doses (5-10 mg) are being studied, though the 20 mg dose remains the current standard for children over 6 months 7
- If vomiting occurs, consider administering zinc with food or dividing the dose, though this is not formally studied 7
Evidence Quality Note
The 20 mg dose for children 6 months to 5 years is supported by high-quality randomized controlled trials showing a 23% reduction in risk of continued diarrhea overall, with 39% reduction in episodes lasting more than 7 days when started within 3 days of onset 5. The recommendation carries strong endorsement from the Infectious Diseases Society of America with moderate-quality evidence 1.