Diarrhea is characterized by loose, watery, and frequent bowel movements (at least 3 times a day). Diarrhea causes 1.5 to 2 million deaths annually and is dubbed the second leading cause of child mortality among children younger than five years. Diarrheal illness is classified intothree categories such as acute watery diarrhea, invasive diarrhea, or chronic persistent diarrhea (present for more than 14 days). Based on these categories, an approach to managing child diarrhea is framed along with etiology, clinical assessment, treatment, and prevention-related issues.

The treatment for a child with diarrheal symptoms includes classification of illness, replacement of deficit electrolytes, appropriate nutrition, and preventing related co-morbidities. Based on physical signs and symptoms, the dehydration degree should be evaluated and fluid management should be performed. Fluid management is divided into two steps i.e., replacement and maintenance. Replacement replenishes the deficient water and electrolyte composition while maintenance therapy balances the ongoing loss of water and electrolyte and is performed till the patient urinates and all the symptoms are not resolved respectively.In malnourished children, treatment is an arduous task because of the risk of fluid overload during rehydration. Malnourished patients should be prescribed broad-spectrum antibiotics and nutrition therapy. Nutritional therapy can also be used by others to prevent the development of nutritional deficiency and chronic enteropathy. 

In cases of acute diarrhea, antibiotics are used in suspected cases of cholera. Whereas, invasive diarrhea also follows the same approach of fluid management but with an additional empirical antibiotic therapy targeted against Shigella species. In resource-limited nations, the prevention strategy includes breastfeeding until six months, intake of safe food and water, adherence to hygienic practices, use of latrines, and, WHO suggested administration of rotavirus vaccine for infants and an oral cholera vaccine in the endemic areas.

Harris JB et al., Wolters Kluwer, Nov 11, 2021