Summer is the high incidence of pediatric diarrhea, which is a headache for many parents. Most of the pediatric diarrhea starts very quickly, frequent diarrhea will make the body of water and nutrients are rapidly lost, resulting in acute dehydration. Treatment of pediatric diarrhea should not be emergency to stop diarrhea, pay attention to timely supplementation of water to prevent severe dehydration. Master these four principles to effectively prevent dehydration and malnutrition. Acute diarrhea: need to know the purpose of treatment and program ① purpose of treatment: no dehydration in children, prevention of dehydration; some dehydration in children, treatment of dehydration; diarrhea and continue to feed after the prevention of nutritional problems. ②To reduce the duration and severity of diarrhea and the number of diarrhea episodes in the future through zinc supplementation. (iii) Therapeutic program: achieve therapeutic goals by choosing a therapeutic program. Non-dehydrated children need more fluids and salt to replace water and electrolyte loss due to diarrhea. Otherwise, signs of dehydration may develop. Mothers should be taught how to give their children more fluids than usual at home to prevent dehydration, to continue feeding to prevent malnutrition, and the importance of these measures. Mothers should also know when to bring their children for follow-up appointments. These are summarized in the four principles of the treatment plan. Principle 1: Give the child more fluids than usual to prevent dehydration 1. What fluids to give: In all cases, home rehydration should include at least one saline fluid (see below). The child should be given clean water to drink. Fluids that the child drinks regularly, that the mother thinks are appropriate for the child with diarrhea, and that can be given more often on the advice of the doctor should also be recommended. 2. Appropriate fluids: Most of the fluids that children normally drink can be used. Appropriate fluids can be divided into two groups: (1) salted fluids, such as ORS fluids, salted beverages (e.g., salted rice soup or salted yogurt), and salted vegetable or chicken broth. Tip: Mothers can be taught to make drinks or soups with about 3 g/L of salt for their children with diarrhea; it may take several attempts to persuade mothers to accept this. Home-made solutions containing 3 g/L table salt (a level teaspoonful) and 18 g/L table sugar (sucrose) also work well. However, recipes are often forgotten, ingredients are unavailable, or insufficient amounts are added, so they are generally not recommended. ② Salt-free liquids, such as: clean water, water in which grains are cooked (e.g., unsalted rice broth), unsalted soups, unsalted yogurt, fresh coconut water, light tea (unsweetened), and unsweetened fresh fruit juices. 3. Unsuitable fluids: Potentially dangerous fluids should be avoided in children with diarrhea. Of particular note: some sugary drinks can cause osmotic diarrhea and hypernatremia. Examples include: commercially available carbon dioxide drinks, commercially available fruit juices, and sweetened teas. Irritating, diuretic or laxative fluids should also be avoided, e.g. coffee, certain medicinal teas or preparations. 4. Amount of fluid to be given: The general principle is: children or adult patients should be given as much as they are willing to drink until the diarrhea stops. For reference, after each loose stool, give: Children under 2 years of age: 50 to 100 mL (1/4 to 1/2 large cup) of fluid; Children 2 to 10 years of age: 100 to 200 mL (half to one large cup) of fluid; Older children and adults: as much as they want. Principle 2: Give children zinc supplements for 10 to 14 days (10 to 20 mg/day), regardless of the formula used, either as a zinc syrup or in tablets. Zinc supplements at the onset of diarrhea can reduce the duration and severity of diarrhea and the risk of dehydration. Zinc supplementation for 10 to 14 days can completely replace the zinc lost during diarrhea and reduce the risk of diarrhea recurrence in children within 2 to 3 months. Principle 3: Continue to feed the child to prevent malnutrition During and after diarrhea, continue to give the infant the foods he or she normally eats. Foods should never be reduced, and foods that the child normally eats should never be diluted. Breastfeeding should be continued. The goal is to give the child nutritious food that he or she can tolerate. Most children with diarrhea and loose stools regain their appetite after rehydration, while children with hemorrhagic diarrhea have a poor appetite during the recovery period. These children should be encouraged to eat normally. TIP: After eating, children absorb sufficient nutrients to continue to grow and gain weight. Continued feeding also accelerates the return of normal bowel function, including the ability to digest and absorb many nutrients. In contrast, children on restricted or diluted diets lose weight, have a longer duration of diarrhea, and have slower recovery of bowel function. 1. What foods to give: What foods to give should be based on the child’s age, food preferences and eating habits prior to the illness; cultural practices are also important. In general, the foods suitable for children with diarrhea are the same as those needed by healthy children. Here are some specific recommendations: Milk ① Breastfed babies should be nursed on demand, regardless of age. Encourage mothers to increase the frequency and duration of breastfeeding. Non-breastfed infants should be fed at least every 3 hours with milk (or infant formula), using a cup whenever possible. Tip: Special formulas advertised for children with diarrhea are expensive and unnecessary and should not be routinely consumed. Clinically significant milk intolerance is rare. (iii) Breastfeeding should be increased in mixed-feeding infants under 6 months of age. As the child’s condition improves and breastfeeding increases, other foods should be reduced (liquids other than mother’s milk should be given, and cups should be used rather than bottles). This usually lasts for about a week. The infant may switch to exclusive breastfeeding. Tip: Routine testing of the pH value of the baby’s stool or its reducing substances is of no value. Such tests are too sensitive and often indicate a decrease in lactose absorption, and such results are not clinically relevant. It is more important to monitor the clinical response of the child (e.g., weight gain, improvement in general condition). Cow’s milk intolerance is clinically significant when milk feeding rapidly causes massive diarrhea and signs of dehydration reappear or worsen. If the child is younger than 6 months of age or is able to eat softer foods, grains, vegetables, and other foods should be given in addition to cow’s milk. If the child is older than 6 months and has not been given such foods, they should be offered during an episode of diarrhea or as soon as possible after the diarrhea stops. TIP: Recommended foods should be culturally acceptable, readily available, high in energy, and provide adequate amounts of essential micronutrients. These foods should be well cooked, mashed or ground so that they are easily digested; fermented foods are also easily digested. Milk should be mixed with cereals. If possible, 5 to 10 mL of vegetable oil should be added to each serving. Meat, fish, or eggs should be given to children when available. Consumption of foods rich in potassium, such as bananas, fresh coconut milk, and fresh fruit juices, is beneficial. Note: Most staple foods do not provide enough calories per unit of body weight for infants and young children and can be improved by adding some vegetable oil. 2. Amount and Frequency of Food Offered Children should be fed every 3 or 4 hours (6 times a day). Children tolerate small frequent feedings better than large frequent feedings. After the diarrhea stops, continue to give energy-rich foods and eat more often than usual every day for at least two weeks. If the child is malnourished, additional meals should be given until the child’s height and weight return to normal. The mother should take the child to the doctor immediately if the child shows signs of dehydration or other problems, such as: the onset of profuse watery stools; repeated vomiting; extreme thirst; poor eating or drinking; fever; blood in the stools; or if the child has not improved in three days.