Course Diarrhea and Dehydration

Dehydration is the most common complication of acute watery diarrhea in children. Assessment and treatment of this complication are discussed in Section III.

Watery diarrhea caused by organisms other than Vibrio cholerae is usually self-limited and requires no antibiotic therapy. It is important to note that antibiotics have the potential to prolong the disruption of intestinal homeostasis and delay the recovery of normal bowel flora. Therefore, the Integrated Management of Childhood Illness (IMCI) recommends use of oral antimicrobials only for children with bloody diarrhea (amoebic or bacterial dysentery), cholera, and giardiasis. Treatment for these infections is discussed later in this section.

Antidiarrheal or antiemetic medications are not recommended to treat acute diarrhea, since they reduce intestinal motility, lengthen the course of the disease, prolong the contact of the causal pathogen with the intestinal mucosa, and can worsen systemic symptoms.

Nutrition is also an important issue in children with diarrhea. It is widely recognized that fasting does not modify the outcome or severity of the diarrheal disease. Therefore, in a child with diarrhea and normal hydration status breastfeeding (or bottle feeding with usual milk or formula if the infant is not breastfed), as well as feeding with age-appropriate food should be continued. A lactose-reduced or lactose-free diet provides no benefit to children with acute diarrhea.

In children with dehydration, feeding should be resumed as soon as normal hydration is achieved through any rehydration therapy appropriate for the severity of the dehydration. Remember that malnourished children are at higher risk of diarrhea due to intestinal mucosa alteration. The diarrheal illness in these patients can last longer because of the reduced enterocyte turnover. Thus, reduced food intake only worsens the degree of malnutrition prior to the episode of acute diarrhea.

Patients with diarrhea but no signs of dehydration usually have a fluid deficit less than 5% of their body weight. Although these children lack distinct signs of dehydration, they should be given more fluid than usual to prevent dehydration from developing. Table 1 shows the classification of diarrhea without dehydration or blood in stools according to the IMCI strategy. 

TABLE 1. Classification of children with diarrhea without dehydration or blood in stools