Management of Diarrhea in Infants

Initial Assessment

• The Centers for Disease Control and Prevention recommends determining the degree of dehydration using clinical signs such as capillary refill time, skin turgor, mucous membranes, mental status, and pulse 1
• Capillary refill time is the most reliable predictor of dehydration in infants this age 1
• Weigh the infant to establish baseline and calculate fluid deficit 3

Rehydration Protocol

• For mild dehydration (3-5% deficit), administer 50 mL/kg of ORS over 2-4 hours 1, 3, 2
• For moderate dehydration (6-9% deficit), administer 100 mL/kg of ORS over 2-4 hours 1, 3, 2
• For severe dehydration (≥10% deficit), this is a medical emergency requiring immediate IV rehydration 1, 2
• Administer 20 mL/kg boluses of Ringer's lactate or normal saline until pulse, perfusion, and mental status normalize 1

Ongoing Loss Replacement

• After initial rehydration, replace continuing losses with 10 mL/kg of ORS for each watery stool 1, 3, 2
• Replace continuing losses with 2 mL/kg of ORS for each episode of vomiting 1, 3, 2

Feeding Management

• The American Academy of Pediatrics recommends continuing breastfeeding throughout the entire episode 6, 4, 5, 3, 2
• Never stop breastfeeding during diarrhea or rehydration 6, 4, 5, 3, 2

Reassessment and Monitoring

• Reassess hydration status after 2-4 hours, and if rehydrated, transition to maintenance phase 1, 3, 2
• Instruct caregivers to return immediately if the infant continues passing many watery stools, develops fever, shows increased thirst or sunken eyes, appears to be worsening, develops bloody diarrhea, shows signs of intractable vomiting, or has high stool output (>10 mL/kg/hour) 6, 4, 5, 2

What NOT to Do

• Avoid using cola drinks or soft drinks, as they contain inadequate sodium and excessive osmolality that worsens diarrhea 6
• Avoid using antidiarrheal medications, as they are contraindicated in children and do not prevent dehydration 2
• Do not delay feeding until diarrhea stops, as there is no justification for "bowel rest" 6, 4, 5