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Care priority and warning signs
Care priority
Home Management (Plan A)
Red flags
- Development of signs of dehydration (thirst, restlessness, sunken eyes, slow skin pinch).
- Increased stool frequency/volume.
- Inability to keep up with fluid intake.
- Development of any danger sign.
Assessment
- Ask: Does the child have diarrhoea?
- Ask: For how long?
- Ask: Is there blood in the stool?
- Confirm absence of TWO or more signs of Some or Severe Dehydration (Child is not lethargic/unconscious, not restless/irritable; eyes are not sunken; drinks normally, not thirsty; skin pinch goes back immediately).
Classification
- Not enough signs to classify as Some or Severe Dehydration -> NO DEHYDRATION
Key features
- Absence of sufficient signs for Some or Severe Dehydration classification.
- Management focuses on preventing dehydration and providing nutritional support at home (Plan A).
Management
Non-pharmacological management
- Treat with Plan A: Home Care to prevent dehydration and malnutrition.
- Counsel mother on the 4 Rules of Home Treatment:
Pharmacological treatment
- 1. Give Extra Fluid: As much as the child will take. Tell mother: Breastfeed frequently and longer. If exclusively breastfed, give ORS or clean water in addition. If not exclusively breastfed, give ORS or food-based fluids (soup, rice water, yoghurt drinks). Give after each loose stool: Age < 2 years: 50-100 ml. Age 2 years or more: 100-200 ml. Teach how to mix and give ORS (give 2 packets to use at home).
- 2. Give Zinc Sulphate: Give 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of EBM, ORS or clean water.
- 3. Continue Feeding: Continue usual feeding practices. (Exclusive breastfeeding if <6m).
- 4. When to Return: Advise mother to return immediately if child develops any danger sign (becomes sicker, not able to drink/breastfeed, develops fever) OR signs of dehydration (drinking poorly, becomes very thirsty, sunken eyes) OR has blood in stool.
Follow-up
- Follow-up in 5 days ONLY IF not improving (e.g., diarrhoea persists, feeding problems).
- Advise immediate return if danger signs or signs of dehydration develop.
Counselling points
- Explain the 4 Rules of Home Treatment clearly.
- Teach how to prepare and give ORS solution.
- Teach how to give Zinc supplement for the full 10 days.
- Emphasize continuing feeding and giving extra fluids.
- Clearly explain the signs that require immediate return to the clinic.
Differential diagnosis
- Some Dehydration (mild)
- Toddler's diarrhoea (chronic non-specific diarrhoea, usually no dehydration)
Complications
- Dehydration (if fluid intake is inadequate)
- Malnutrition (if feeding is stopped or inadequate)
Prevention
- Exclusive breastfeeding for 6 months.
- Use of safe water and sanitation.
- Handwashing with soap.
- Appropriate complementary feeding.
- Measles vaccination.
- Rotavirus vaccination (if available).
- Prompt use of ORS and Zinc at the start of diarrhoea.
- Continued feeding during diarrhoea.
References
IMCI Chart Booklet - Page 3, Page 16 (Plan A, Zinc), Page 30