How to treat diarrhea in babies and children? (Zinc can help!)

by Mr. Pharmacist April 15, 2021

Most of the times, diarrhea in children is will stop on its own and is non-life-threatening but they are more susceptible to the adverse effects of dehydration and should be looked at attentively.

The treatment of diarrhea in children needs to aim at correcting dehydration with rehydration solutions given by mouth. Oral rehydration solutions available at the pharmacy are easy to buy and effective and safe.

Sadly, they are use too little and may be due to the inconvenience of administration, unacceptable taste or a preference by some professionals for an IV solution instead. While fruit juices have not traditionally been recommended for rehydration due to concerns they may cause diarrhea (osmotic diarrhea effect), there is more reliable scientific information that oral rehydration with half-diluted apple juice followed by preferred fluids can be considered for children with mild gastroenteritis and minimal dehydration. So definitely try it!

Breastfeeding should be continued during episodes of diarrhea, and ORS should be offered. If a child is not being breastfed, age-appropriate foods should be given as well as oral solutions and you should start them as soon as diarrhea begins and keep going until diarrhea is less frequent.

Guidelines for Oral Solution in Children

Age	Amount of Oral Rehydration Solution to aim for
0-6 months	30-90 mL every hour
6-24 months	90-125 mL every hour
>2years	125-250 mL every hour

Even if a child refuses the liquid by the cup or bottle, the solution could to be given by a medicine dropper or small teaspoon.

If the child vomits, continued the solution with a spoon, giving 15 mL every 10-15 minutes until vomiting stops, then start again with the regular amount (see chart above). If vomiting does not stop after 4-6 hours, please proceed to the emergency for more in depth assessment.

Early refeeding should begin within 6 hours of beginning oral solutions. For infants who are formula-fed, start with small, frequent feedings of the child's usual formula. If the diarrhea persists for 2 days, switch to a soy-based or lactose-free formula as lactose intolerance may be suspected.

For older children, early refeeding with age-appropriate, previously tolerated foods is recommended. After 24-48 hours, the child's normal diet can resume. It may take 7-10 days for stools to become completely formed. Restricting a child to a complex carbohydrate diet (e.g., BRATT diet: bananas, rice, applesauce, tea and toast) is inappropriate.

For dehydrating, persistent diarrhea, the use of hypo-osmolar solution (e.g. Gastrolyte®, Pedialyte®, Hydralyte®) is beneficial and superior to the older iso-osmolar WHO solution. Hypo-osmolar oral solutions results in a shorter period of diarrhea, less stool output and less need for maintenance therapy.

In addition to hypo-osmolar solutions, the WHO and UNICEF recommend supplementation with Zinc 20 mg daily for 10-14 days for infants >6 months of age and 10 mg per day for infants <6 months of age. Zinc supplementation decreases both the severity and the duration of acute or persistent diarrhea in children. (Email Mister Pharmacist for references from the WHO and J Pediatr 2011)

Supplementing with a combination of micronutrients and vitamins is not superior to zinc alone.

The addition of zinc and prebiotics to oral solutions limits the duration of diarrhea in children.