Gastroenterology Book

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Management of Moderate Diarrhea under age 2 yearsAka: Management of Persistent Diarrhea under age 2 years

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  1. See Also
    1. Diarrhea in Children
    2. See Diarrhea Management in Children
    3. See Management of Mild Diarrhea under age 2 years
    4. See Pediatric Diarrhea Fluid Replacement
    5. See Oral Rehydration Solution
  2. Step 1: Start with clear fluids for 24 hours
    1. Administer as much fluids as tolerated
    2. Oral Rehydration Solution is preferable
      1. Pedialyte
      2. Rehydrate
      3. Infalyte
      4. Homemade cereal based ORS
      5. WHO-ORS packs
    3. Alternative fluids may be tried
      1. Gatorade at half strength
      2. Jell-O water at half strength
        1. One pack per quart of water
      3. Weak broth
        1. One cube bullion in one quart water
        2. Consider mixing 1:1 with apple juice
    4. Avoid potentially harmful solutions
      1. Popsicle (Choke Hazard)
      2. Kool-Aid or soda (lack salt)
      3. Boiled skim milk or concentrate (too much salt)
  3. Step 2: Soy formula after 24 hours of clear fluids
    1. Consider skipping to Step 3 below (bovine formula)
    2. Consider Soy formula (milk for age >1 year) for 7 days
      1. Isomil
      2. ProSobee
    3. Start with half strength formula for first day
    4. Child over 4-5 months may also use:
      1. Applesauce
      2. Strained Bananas or Carrots
      3. Avoid other solids
  4. Step 3: Introduce solids for children over age 5 months
    1. Introduce age appropriate foods
    2. Sample Menu of foods that will not worsen Diarrhea
      1. Day 1
        1. Saltines
        2. White toast with honey
        3. Rice
        4. Applesauce
        5. Bland soups
      2. Day 2
        1. Lean meats
        2. Soft boiled eggs
        3. Noodles
      3. Day 3
        1. Soft fruits and vegetables
          1. Pears
          2. Carrots
          3. potatoes
        2. Cheese
        3. Cottage cheese
        4. Yogurt
      4. Day 4
        1. Regular diet
        2. Avoid milk and ice cream
  5. Step 4: Bovine products after 7 days of Soy
    1. Age <1 year
      1. Consider starting bovine formula in lieu of Step 2
      2. Gadually return to bovine formula
      3. Consider bovine formula and soy formula 1:1 for 1 day
    2. Age >1 year
      1. Consider starting cow's milk in lieu of Step 2
      2. Gradually return to cow's milk
      3. Consider cow's milk and soy milk 1:1 for 1 day
    3. Advance other foods when tolerating bovine products
  6. Step 5: If Watery stools recur
    1. Return to Step 2 and switch back to soy formula
    2. Use constipating solids
    3. Retry half-strength bovine formula every 3 to 4 days
    4. Rocovering child normally has 2-3 mushy stools per day

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