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Management of Acute Diarrhoea in Children

Essential elements:
• rehydration therapy,
• zinc supplementation, and
• continued feeding

Rehydration
Assess the hydration status as per the table below: (classify as no, some or severe dehydration present)
classification of dehydration
Rehydration in case of severe dehydration
• Rapid IV rehydration – followed by oral rehydration therapy
• Ringer’s lactate (RL) (a.k.a Hartmann’s solution) is recommended.
• If RL is not available, normal saline can be used
• Recommended amount is 100ml/kg of fluid: the rate of iv administration should be decided by the age of the child as given below:
iv re-hydration in children
aRepeat if the radial pulse is still very weak or not detectable

Rehydration in case of SOME dehydration:
• In the first 4 hours, give the child the following approximate amounts of ORS solution, according to the child’s weight (or age if the weight is not known), as shown in the chart below
ORS amounts in some dehydration
• Remember, if the child wants more to drink, he/she should be given more
• Demonstrate the mother how to give the ORS solution,
• One teaspoonful every 1–2 minutes if the child is under 2 years
• Frequent sips from a cup for an older child.
• If the child vomits, wait 10 minutes; then, resume giving ORS solution more slowly (e.g. a spoonful every 2–3 minutes).
• If the child’s eyelids become puffy, stop ORS solution and give plain water or breast milk.
• Advise breastfeeding mothers to continue to breastfeed whenever the child wants.
Reassess the child after 4 hours, checking for signs of dehydration. (Important: Reassess the child before 4 hours if the child is not taking the ORS solution or seems to be getting worse.) —
• If there is no dehydration, teach the mother the four rules of home treatment
• If still there is SOME DEHYDRATION, repeat the above treatment
4 rules of home treatment are:
1. Give extra fluid
2. Give zinc supplements for 10 – 14 days
3. Continue feeding
4. Teach her when to return

In case of NO dehydration
• Recommend extra fluids at home to prevent dehydration.
• Explain the mother that it is important that the child needs to receive an appropriate diet for their age, including continued breastfeeding.
• Explain the 4 rules of home treatment

• If the mother cannot stay for 4 hours, show her how to prepare ORS solution and give her enough ORS packets to complete the rehydration at home plus enough for 2 more days.

Antibiotics should NOT be used routinely.
Antibiotics should be considered in cases of:
• bloody diarrhoea (probable shigellosis),
• suspected cholera with severe dehydration, and
• Serious parenteral infections such as pneumonia.
Antiprotozoal drugs are rarely indicated.
CAUTION:
“Antidiarrhoeal” drugs and anti-emetics should not be given to young children with acute or persistent diarrhoea (or dysentery):
• they do NOT prevent dehydration or
• they do NOT improve nutritional status and
• some have dangerous, sometimes fatal, side-effects

sugar - salt solution for rehydration: http://www.ihatepsm.com/blog/sugar-salt-solution-rehydration
4 rules of home treatment for diarrhoea: http://www.ihatepsm.com/blog/4-rules-home-treatment-diarrhea-children
'Pinch test' for assessment of dehydration: http://www.ihatepsm.com/blog/6-steps-%E2%80%98skin-pinch%E2%80%99-test-a...
Reference:
• WHO, 2005 : Pocket Book of Hospital Care for Children; GUIDELINES FOR THE MANAGEMENT OF COMMON ILLNESSES WITH LIMITED RESOURCES; available on file:///C:/Users/Lenovo/Documents/books/child%20care/WHO%20child%20mgmt%20module.pdf accessed on 19 July 2016