What is the recommended zinc supplementation dose for a 1-year-old child weighing 10kg with acute diarrhea?

Zinc Supplementation for a 1-Year-Old Child with Diarrhea

Recommended Dose

For a 1-year-old child weighing 10 kg with acute diarrhea, give 10 mg of elemental zinc daily for 10-14 days. 1, 2, 3

This recommendation applies specifically because:

• The child is under 6 months of age threshold where the standard 20 mg dose is recommended 1
• However, at 1 year of age, the child falls into the category where 10 mg is the appropriate dose for infants under 6 months, though guidelines vary on the exact age cutoff 1, 2

Important Clarification on Dosing

The most recent high-quality guidelines provide nuanced age-based dosing:

• For infants under 6 months: 10 mg elemental zinc daily for 10-14 days 1, 2
• For children 6 months to 5 years: 20 mg elemental zinc daily for 10-14 days 4, 1

Since your child is 1 year old (12 months), the standard recommendation would actually be 20 mg daily for 10-14 days 4, 1, as this falls within the 6 months to 5 years age range where the higher dose has strong evidence for reducing diarrhea duration by approximately 10-27 hours 1

Evidence Supporting Lower Doses

Recent research demonstrates that lower zinc doses may be equally effective with fewer side effects:

• A 2020 multicenter trial showed that 5 mg and 10 mg doses were non-inferior to 20 mg for treating diarrhea, with significantly less vomiting (13.7% and 15.6% vs 19.3% respectively) 5
• The 10 mg dose reduced vomiting risk by 19% compared to 20 mg (relative risk 0.81) 5

Critical Context: This is NOT a Substitute for Rehydration

Zinc supplementation should never replace oral rehydration therapy (ORS), which remains the cornerstone of diarrhea management 2

For your 10 kg child with diarrhea:

• Assess dehydration severity first (skin turgor, mucous membranes, mental status) 2
• For mild dehydration (3-5% deficit): give 50 mL/kg ORS over 2-4 hours = 500 mL over 2-4 hours 2
• For moderate dehydration (6-9% deficit): give 100 mL/kg ORS over 2-4 hours = 1000 mL over 2-4 hours 2
• Replace each watery stool with 10 mL/kg of ORS = 100 mL per stool 2

Feeding During Illness

• Continue breastfeeding if applicable throughout the diarrheal episode 4, 2
• Resume age-appropriate usual diet immediately after rehydration 4, 2
• Do not restrict diet or prolong fasting, as this worsens nutritional status 2

Common Pitfalls to Avoid

• Never use antimotility drugs (like loperamide) in children under 18 years - these carry serious risks including respiratory depression 4, 2
• Do not delay or substitute zinc for proper rehydration therapy 2
• Zinc is most beneficial when started within 3 days of diarrhea onset 6

When Zinc is Most Beneficial

Zinc supplementation has the strongest evidence in:

• Children residing in countries with high zinc deficiency prevalence 4, 1
• Children with signs of malnutrition or stunted growth 4, 1, 6
• The benefit is greater in malnourished children, with reductions of 38% in continued diarrhea after day 3 6

Practical Administration

• Zinc can be given as dispersible tablets dissolved in water or breast milk 3
• The full 10-14 day course should be completed even after diarrhea resolves, as this prevents recurrence for up to 2-3 months 3
• Zinc may cause mild gastrointestinal upset, but lower doses (10 mg vs 20 mg) significantly reduce vomiting 5