IMNCI: Diarrhoea

This presentation includes classification and management of diarrhoea based on IMNCI.

1. IMNCI: Diarrhoea Dr. Ramya S

2. DIARRHOEA A young infant is considered to have diarrhoea if the stools have changed from usual pattern and are many and watery (more water than faecal matter).

3. Determine the level of dehydration Depending on the degree of dehydration, an infant with diarrhoea may be lethargic or unconscious or look restless/irritable. Only infants who cannot be consoled and calmed should be considered restless or irritable Infant ’ s general condition .

4. Determine the level of dehydration. Sunken eyes.

5. Determine the level of dehydration. Check elasticity of skin using the skin pinch test . When released, the skin pinch goes back either very slowly ( longer than 2 seconds) , or slowly (skin stays up even for a brief instant), or immediately . Elasticity of skin

6. Locate the area on the child's abdomen halfway between the umbilicus and the side of the abdomen; then pinch the skin using the thumb and first finger. Place your hand in such a way that when the skin is pinched, the fold of skin will be in a line up and down the child's body and not across the child's body.

7. Sick young infant upto 2 months Two of the following signs: Classify Treatment Movement only when stimulated or no movement at all Sunken eyes Skin pinch goes back very slowly SEVERE DEHYDRATION If no other severe classification give fluid as per PLAN C or If infant has another severe classification, Refer URGENTLY with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding

8. Two of the following signs: Classify Treatment Restless and irritable Sunken eyes Skin pinch goes back slowly SOME DEHYDRATION Give fluid and breastmilk as per PLAN B If infant has any severe classification, Refer URGENTLY with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding Advise mother when to return Follow-up in 2 days if not improving

9. Signs Classification Treatment Not enough signs to classify as some or severe dehydration NO DEHYDRATION Give fluids to treat diarrhea at home and continue breastfeeding as per PLAN A . Advise mother when to return immediately Follow up in 2 days if not improving

10. Two of the following signs: Classify Treatment Lethargic or unconscious Not able to drink or drinking poorly Sunken eyes Skin pinch goes back very slowly SEVERE DEHYDRATION If no other severe classification give fluid as per PLAN C or If child has another severe classification, Refer URGENTLY with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding Sick child 2 months upto 5 years

11. Two of the following signs: Classify Treatment Restless, irritable Drinks eagerly, thirsty Sunken eyes Skin pinch goes back slowly SOME DEHYDRATION Give fluid, zinc supplements and food as per PLAN B If child has any severe classification, Refer URGENTLY with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding Advise mother when to return Follow-up in 5 days if not improving

12. Signs Classification Treatment Not enough signs to classify as some or severe dehydration NO DEHYDRATION Give fluid, zinc supplements and food to treat diarrhea at home as per PLAN A . Advise mother when to return immediately Follow up in 5 days if not improving

13. Signs Classify Treatment Dehydration present SEVERE PERSISTENT DIARRHOEA Treat dehydration before referral unless the child has another severe classification Refer to hospital If diarrhea present for 14 days or more

14. Signs Classify Treatment No de-hydration PERSISTENT DIARRHOEA Advise the mother on feeding a child who has PERSISTENT DIARRHOEA Give multi-vitamins and minerals including Zinc for 14 days Follow-up in 5 days

15. Sign Classify Treatment Blood in stool DYSENTERY Give Ciprofloxacin for 3 days Follow-up in 3 days

16. 17 NO DEHYDRATION: PLAN A- TREAT DIARRHOEA AT HOME

17. Extra fluid Age Extra fluid to be given Up to 2 yrs 50 to 100 ml after each loose stool 2 yrs or more 100 to 200 ml after each loose stool

18. Zinc supplementation (2 months to 5 yrs ) Age Dose (Zinc 20 mg tab ) 2 to 6 months ½ tablet daily for 14 days 6 months or more 1 tablet daily for 14 days

19. SOME DEHYDRATION: PLAN B- TREAT WITH ORS Amount of ORS to be given during first 4 hrs: Weight < 6 kg 6- < 10 kg 10 - < 12 kg 12 – 19 kg Age Up to 4 months 4 to 12 months 12 months up to 2 yrs 2 to 5 yrs In ml 200-450 450-800 800-960 960-1600

20. 21 The approximate amount of ORS required (in ml) can also be calculated by multiplying the child ’ s weight (in kg) times 75.

21. SEVERE DEHYDRATION: PLAN C- Intravenous fluid Give 100 ml/kg Ringer Lactate divided as follows: Age First give 30 ml/kg in Then give 70 ml/kg in Infants (under 12 months) 1 hr 5 hrs Children (12 months up to 5 yrs ) 30 min 2 ½ hrs

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23. Thank you