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Care priority and warning signs
Care priority
Home Management (Plan A)
Red flags
- Development of signs of dehydration.
- Increased stool frequency/volume.
- Poor feeding.
- Development of any danger sign.
Assessment
- Ask: Does the young infant have diarrhoea?
- Confirm absence of TWO or more signs of Some or Severe Dehydration (Infant is not lethargic/unconscious, not restless/irritable; eyes are not sunken; 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.
- Management focuses on preventing dehydration at home (Plan A).
- Exclusive breastfeeding is the mainstay; ORS/water used supplementally.
Management
Non-pharmacological management
- Treat with Plan A (Young Infant Version - Page 43):
- Advise mother to continue breastfeeding frequently and for longer at each feed, day and night.
- Give extra fluids: Advise giving ORS or clean water in addition to breastmilk.
- Show how much extra fluid to give after each loose stool (approx 50-100 ml for <2 years, though this is from the 2m-5y chart - give small frequent amounts appropriate for infant size).
- Teach how to mix and give ORS (give 2 packets for home use).
- Advise mother when to return immediately.
Pharmacological treatment
- Zinc is NOT routinely recommended for infants under 2 months in this guideline.
Follow-up
- Follow up in 3 days IF not improving (Page 48).
- Advise immediate return if signs of dehydration or danger signs develop.
Counselling points
- Explain the 2 Rules of Home Treatment for young infants: 1. Give Extra Fluid (primarily frequent, longer breastfeeding; supplement with ORS/water). 2. When to Return.
- Emphasize continued frequent and longer breastfeeding.
- Teach how to prepare and give ORS.
- Explain signs requiring immediate return: develops danger signs (stopped feeding, convulsions, lethargy etc.), becomes very thirsty, develops sunken eyes, blood in stool.
Differential diagnosis
- Some Dehydration (Young Infant)
- Normal stool pattern for breastfed infant
Complications
- Dehydration (if feeding/fluid advice not followed)
- Malnutrition (less common if breastfeeding maintained)
Prevention
- Exclusive breastfeeding.
- Handwashing.
- Safe water/sanitation.
References
IMCI Chart Booklet - Page 35, Page 43 (Plan A - Young Infant), Page 48 (Follow-up Diarrhoea)