If your child is under 4 months of age, call the child's doctor.

When restarting fluid, give Pedialyte (or similar commercially prepared oral electrolyte solution) in small, frequent amounts. Increase amounts as much as the child desires and tolerates during the first 24 to 48 hours. Continue until there has been no vomiting for 24 hours, and until diarrhea slows to 12 or less stools per 24 hours. Glucose-electrolyte solutions such as Pedialyte must be distinguished from other popular but nonphysiologic liquids that have been used inappropriately to treat children with diarrhea. These beverages and fluids which include cola beverages, apple juice, chicken broth and popular sports drinks have inappropriate electrolyte concentrations for use for rehydration. These later solutions are not recommended to treat children with diarrhea. Also, contrary to earlier advice, continued feeding does not necessarily need to be withheld. Children who have diarrhea and are not dehydrated should continue to be fed age-appropriate diets. Children who require rehydration should be fed age-appropriate diets as soon as they have been rehydrated.

Sometimes intravenous fluids are required for rehydration. Instances of severe dehdration or refusal to take Pedialyte will sometimes make this a necessity. Some practical techniques exist to induce reluctant children to drink glucose-electrolyte solutions (ie. Pedialyte). Administering the solution in small amounts at first may allow the child to get accustomed to the taste. Some solutions, including Pedialyte, have flavors added that do not alter their basic composition but may make them more palatable. These glucose-electrolyte solutions can be frozen into, and even purchased as an ice-pop form, which may appeal to some children. All children who are severely dehydrated or in a state of shock or near shock require immediate and vigorous IV therapy. Children who are moderately dehydrated and who cannot retain oral liquids because of persistent vomiting also should receive fluids by the IV route. Administration of oral rehydrating fluids is labor intensive, requiring parents or other care givers who can administer small amounts of fluid at frequent intervals. If this is not possible, IV therapy may be necessary.

A variety of early feeding regimens have been studied, including human milk, diluted and full-strength animal milk and animal milk formulas, diluted and full-strength lactose-free formulas, and staple food diets with milk. These studies have demonstrated that unrestricted diets do not worsen the course or symptoms of mild diarrhea and can decrease stool output compared to Pedialyte alone. Studies from developed countries on early refeeding show that the duration of diarrhea may be reduced by nearly half a day. Although these beneficial effects are modest, of major importance is the added benefit of improved nutrition with early feeding.

The question of which foods are best for refeeding has been an issue of continuing study. Although agreement is not universal, experts suggest that certain foods, including complex carbohydrates (rice, wheat, potatoes, bread, and cereals), lean meats, yogurt, fruits, and vegetables, are better tolerated. Fatty foods or foods high in simple sugars (including tea, juices, and soft drinks) should be avoided. Note that this is not the classic BRAT diet, which consists of bananas, rice, applesauce, and toast. Although these foods can be tolerated, this limited diet is low in energy density, protein, and fat. Modifying the BRAT diet with other sources of protein, and fat can correct this shortcoming.

Complicated problems: If your child vomits for more than 3 or 4 days, has green vomit, or has blood in vomit or diarrhea, call your doctor. A child who is not urinating at least every 6 to 8 hours needs to be promptly examined. Any severe abdominal pain needs to be evaluated. If diarrhea does not improve in 5 to 7 days and completely clear within 10 or 12 days, your child should be examined.

Perianal rash from diarrhea may be treated with sitz baths, soaking in warm water in a clean tub for 20 to 30 minutes 3 times daily. After the bath apply A&D ointment, Vaseline or Desitin ointment.

Reference: Pediatrics; Volume97, Number 3 ,March, 1996