Acute diarrhoea in infants: oral rehydration is crucial.

(1) Dehydration is the most immediate complication of acute diarrhoea. Infants still die by dehydration, or suffer severe repercussions. (2) Thirst is an early sign of dehydration in an infant. Other signs are delayed capillary filling, absence of tears, mucosal dryness and a "sickly" appearance. Fever or vomiting in the first 24 hours facilitate dehydration. Weight loss is the main clinical index of the degree of dehydration. (3) Oral rehydration with glucose-electrolyte solution is as effective as intravenous rehydration. It must start immediately dehydration occurs. Infants with signs of severe dehydration must be hospitalised. (4) Oral rehydration of a vomiting infant is feasible, by giving a teaspoonful of solution every one or two minutes. (5) A dehydrated infant rarely refuses oral rehydration solutions. (6) Beverages such as cola drinks are inappropriate for rehydration, as they contain too little sodium and are excessively hyperosmolar, which may worsen the diarrhoea. Rice gruel is better. (7) Antidiarrhoeal drugs do not prevent dehydration. (8) Feeding must be resumed as soon as dehydration has been corrected, as it shortens the course of diarrhoea. Continuing maternal breast-feeding reduces the severity of diarrhoea. Lactose-free "milk" has no demonstrated benefit. (9) Those in charge of an infant with diarrhoea must know how to prevent severe dehydration, which can occur very rapidly. Fluid intake must always be increased in an infant with diarrhoea. Sachets of powder for oral rehydration should be kept at home. Their prescription and dispensing should be accompanied by written instructions.