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Care priority and warning signs
Care priority
Treat at Clinic (Plan B)
Red flags
- Development of signs of severe dehydration.
- Inability to take ORS.
- Persistent vomiting.
- Presence of another severe classification requiring referral.
Assessment
- Ask: Does the young infant have diarrhoea?
- Look/Feel: Look at the infant's general condition. Is the infant Restless, irritable?
- Look/Feel: Look for sunken eyes.
- Look/Feel: Pinch the skin of the abdomen. Does it go back Slowly?
Classification
- Two or more of the following signs: (Restless, irritable) OR (Sunken eyes) OR (Skin pinch goes back slowly) -> SOME DEHYDRATION
Key features
- Requires TWO or more of the following signs: Restless/irritable, Sunken eyes, Skin pinch goes back slowly.
- Absence of signs of severe dehydration.
- Requires supervised administration of ORS over 4 hours (Plan B).
Management
Non-pharmacological management
- Supervise ORS administration in clinic.
- Continue breastfeeding frequently alongside ORS.
- After 4 hours, reassess hydration.
Pharmacological treatment
- TREAT WITH PLAN B (Young Infant Version - Page 43):
- Give recommended amount of ORS over 4-hour period in the clinic. Amount for infant < 6kg (Birth up to 4 months): 200-450 ml. (Approximate amount in ml = weight in kg x 75). Use standard ORS (new low osmolarity ORS preferred).
- Show the mother how to give ORS: frequent small sips from a cup (or syringe/dropper).
- If infant vomits, wait 10 minutes, then continue ORS more slowly.
- Continue breastfeeding whenever the infant wants.
- Also give 100-200 ml clean water during this period IF using standard osmolarity ORS (not needed if using low osmolarity ORS).
- After 4 hours: Reassess dehydration. Select appropriate plan (A, B, or C).
- If mother must leave before 4 hours: Show how to prepare ORS. Give enough packets to complete rehydration + 2 more for Plan A. Explain how much to give to finish 4-hour treatment. Explain Plan A rules.
- If infant has any severe classification: Refer URGENTLY. Give frequent sips of ORS on the way. Advise continued breastfeeding.
- Zinc is NOT routinely recommended for infants under 2 months in this guideline (Zinc starts at 2 months in Plan A/B on page 16).
Pre-referral treatment
- If referring due to co-existing severe classification: Give frequent sips of ORS on the way. Keep infant warm. Give other needed pre-referral treatments.
Follow-up
- If hydration improves and discharged on Plan A: Follow up in 3 days if not improving (Page 48).
- Advise immediate return if signs worsen.
Counselling points
- Explain the infant needs special fluids (ORS) for dehydration.
- Show how much ORS to give over 4 hours.
- Show how to give ORS (sips, what to do if vomits).
- Emphasize continuing frequent breastfeeding.
- Explain home care (Plan A) if infant is discharged.
- Advise when to return immediately (danger signs, signs of worsening dehydration).
Differential diagnosis
- Severe Dehydration (Young Infant)
- No Dehydration (Young Infant)
- Irritability due to other causes (colic, hunger, infection)
Complications
- Progression to severe dehydration
- Electrolyte imbalance
- Treatment failure due to vomiting or inadequate intake
Prevention
- Exclusive breastfeeding.
- Handwashing.
- Safe water/sanitation.
- Prompt management of diarrhoea.
References
IMCI Chart Booklet - Page 35, Page 43 (Plan B - Young Infant)