On this page
Care priority and warning signs
Care priority
Refer URGENTLY (after treating dehydration if severe)
Red flags
- Signs of Severe Dehydration.
- Signs of severe malnutrition.
- Signs of associated sepsis or other severe infection.
Assessment
- Ask: Does the child have diarrhoea?
- Ask: For how long? (Response is 14 days or more).
- Assess for Dehydration (Look/Feel for signs of Some or Severe Dehydration - see IMCI_2M5Y_005 & 006 assessments).
Classification
- Diarrhoea for 14 days or more AND Dehydration present (Signs of Some or Severe Dehydration) -> SEVERE PERSISTENT DIARRHOEA
Key features
- Diarrhoea duration of 14 days or more.
- Presence of signs classifying as SOME DEHYDRATION or SEVERE DEHYDRATION.
- High risk for malnutrition and underlying infections (including HIV).
Management
Non-pharmacological management
- Treat dehydration first (Plan C if severe, Plan B if some) BEFORE referral, unless the child has another severe classification requiring immediate referral.
- If referring, keep child warm.
Pharmacological treatment
- Treat dehydration as per Plan C or Plan B.
- If child has another severe classification (e.g., Very Severe Febrile Disease), give pre-referral treatments for that condition (e.g., antibiotic, antimalarial).
Pre-referral treatment
- Stabilize hydration as much as possible (start Plan C or B).
- Give other essential pre-referral treatments if needed for co-existing severe classifications.
- Keep child warm.
- Advise mother to continue breastfeeding.
Follow-up
- To be managed at referral hospital, which will investigate cause and provide specialized feeding/treatment.
Counselling points
- Explain that the long duration of diarrhoea combined with dehydration is serious and requires hospital care.
- Explain any dehydration treatment being given.
- Advise mother to continue breastfeeding frequently.
- Advise on keeping child warm during transport.
- Write a detailed referral note mentioning duration of diarrhoea, dehydration status, and any treatments given.
Differential diagnosis
- Persistent Diarrhoea (without dehydration)
- Acute Diarrhoea with Dehydration
- Secondary lactose intolerance
- Cow's milk protein allergy
- Other food intolerances/allergies
- Post-enteritis syndrome
- Giardiasis
- Cryptosporidiosis (especially if HIV+)
- Other specific enteropathogens
- Malnutrition-associated gut changes
Complications
- Severe malnutrition
- Micronutrient deficiencies
- Severe dehydration and shock
- Sepsis
- Electrolyte imbalance
- Death
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, Pages 13, 16