Management of Chronic Diarrhea in Infants
Evaluation and Assessment
- The American Academy of Pediatrics recommends evaluating the degree of dehydration by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time 1
- Dehydration can be categorized as mild (3-5% fluid deficit), moderate (6-9% fluid deficit), or severe (≥10% fluid deficit, shock, or pre-shock) 2
- Weighing the infant is essential to establish a reference point and monitor the effectiveness of treatment 3
Rehydration Strategy
- For mild dehydration (3-5% fluid deficit), administer 50 ml/kg of oral rehydration solution (ORS) over 2-4 hours 3
- For moderate dehydration (6-9% fluid deficit), administer 100 ml/kg of ORS over 2-4 hours 3
- The World Health Organization recommends using an ORS containing 50-90 mEq/L of sodium for rehydration 3
Maintenance and Feeding
- After rehydration, replace ongoing losses with 10 ml/kg of ORS for each liquid stool and 2 ml/kg for each episode of vomiting 5
- The American Academy of Pediatrics recommends continuing breastfeeding on demand throughout the diarrheal episode 3
- For non-breastfed infants, quickly resume an appropriate formula after rehydration 3
Zinc Supplementation
- Zinc supplementation reduces the duration of diarrhea in children aged 6 months to 5 years with signs of malnutrition 5