Doctors Revision

IMCI · Age: 2 months - 5 years

Persistent Diarrhoea

Classification for a child whose diarrhoea has lasted 14 days or more but who currently has NO signs of dehydration. Requires specific dietary advice and follow-up.

View images for Persistent Diarrhoea (Google Images, opens in a new tab)
On this page

Care priority and warning signs

Care priority

Routine Management / Dietary Counselling

Red flags

  • Development of dehydration.
  • Significant weight loss or failure to gain weight.
  • Signs of specific nutrient deficiencies.
  • Refusal to eat.

Assessment

  • Ask: Does the child have diarrhoea?
  • Ask: For how long? (Response is 14 days or more).
  • Assess for Dehydration: Confirm NO DEHYDRATION (Not enough signs for Some or Severe Dehydration).

Classification

  • Diarrhoea for 14 days or more AND No Dehydration -> PERSISTENT DIARRHOEA

Key features

  • Diarrhoea duration of 14 days or more.
  • Absence of signs of dehydration.
  • Management focuses on nutritional rehabilitation and investigating potential underlying causes.

Management

Non-pharmacological management

  • Advise the mother on feeding a child with PERSISTENT DIARRHOEA:
  • If still breastfeeding: Breastfeed more frequently and longer, day and night.
  • If taking other milk: Replace with fermented milk products (e.g., yoghurt) OR Replace half the milk with nutrient-rich semisolid food (e.g., porridge).
  • For other foods: Ensure adequate energy intake. Give small, frequent meals (at least 6 times/day). Use foods rich in energy and nutrients. Mix foods well.
  • Give foods rich in potassium (e.g., bananas, coconut water).
  • Ensure adequate fluid intake using ORS or recommended home fluids after loose stools.
  • Check for HIV Infection (refer to HIV assessment algorithm page 8).

Pharmacological treatment

  • Give multivitamins and minerals (including zinc) for 10 days (or longer per local guidelines). Ensure Zinc dose is 10mg (<6m) or 20mg (>=6m) daily.

Follow-up

  • Follow up in 5 days.
  • At follow-up (Day 5):
  • Ask: Has diarrhoea stopped? How many stools per day?
  • Assess feeding and check for dehydration.
  • If diarrhoea has not stopped: Do a full reassessment. Treat dehydration if present. Refer to hospital for assessment (including for ART if HIV+).
  • If diarrhoea has stopped: Tell mother to follow usual age-appropriate feeding recommendations. Complete 10 days of zinc.

Counselling points

  • Explain the importance of special feeding during persistent diarrhoea.
  • Provide specific, practical advice on recommended foods and feeding frequency based on local availability and child's age.
  • Explain how to give multivitamins and zinc.
  • Advise on giving extra fluids.
  • Advise when to return immediately (danger signs, signs of dehydration).
  • Advise on follow-up visit in 5 days.

Differential diagnosis

  • Severe Persistent Diarrhoea (if dehydration develops)
  • Secondary lactose intolerance
  • Cow's milk protein allergy
  • Other food intolerances/allergies
  • Giardiasis
  • Cryptosporidiosis
  • Malnutrition
  • HIV infection

Complications

  • Malnutrition
  • Micronutrient deficiencies
  • Dehydration (if fluid/feeding advice not followed)
  • Increased susceptibility to other infections

Prevention

  • Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
  • Good nutrition, Vitamin A.
  • Measles vaccination.
  • Handwashing, safe water/sanitation.
  • Early identification and management of HIV infection.

References

IMCI Chart Booklet - Page 3, Page 22, Page 26 (Feeding Recs), Page 8 (HIV)

For learning and professional reference. Use current local guidance and clinical judgement.

Browse imci entries
Scroll to Top