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TOPIC : DIARHEAIN CHILDREN

LEARNING OBJECTIVES:

AT the end of this session learners should able to

 Define diarrhea

 Classification of diarrhea

 Common causes of diarrhea

 Management and treatment of plan A,B and C.

 Sign and symptoms for diarrhea

DIARRHEA: Described loose watery stool that occur more frequently than usual or
passage of unusually loose or watery stools at least 3 times in a 24 hour period •

Acute diarrhea: < 2 weeks • chronic diarrhea: > 2 week,

The most common causes diarrhea include

1. Viruses
2. Bacteria
3. Parasites

Other

Medication \antibiotic
Infections: Infections from viruses, bacteria, or parasites sometimes lead to chronic diarrhea.
After an infection, some children have problems digesting carbohydrates, such as lactose, or
proteins, such as milk or soy proteins. These problems can cause prolonged diarrhea often for up
to 6 weeks after an infection. Also, some bacteria and parasite infections that cause diarrhea do
not go away quickly without treatment
Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth
and development can result in other health problems.
These problems may include
 Failure to thrive in infants •
 Slowed growth and short stature •
 Weight loss •
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 Irritability or mood changes •

 Delayed puberty •
 Dental enamel defects of the permanent teeth •
Anemia, a condition in which red blood cells are fewer or smaller than normal, which prevents
the body’s cells from getting enough oxygen

Lactose intolerance. Lactose intolerance is a condition in which people have digestive

symptoms such as bloating, gas, and diarrhea after consuming milk or milk products. Lactose is
a sugar found in milk or milk products. Lactase, an enzyme produced by the small intestine,
breaks down lactose into two simpler forms of sugar: glucose and galactose. The bloodstream
then absorbs these simpler sugars. Some children have a lactase deficiency, meaning the small
intestine produces low levels of lactase and cannot digest much lactose.

Dietary fructose intolerance. Dietary fructose intolerance is a condition in which people have
digestive symptoms such as bloating, gas, and diarrhea after consuming foods that contain
fructose. Fructose is a sugar found in fruits, fruit juices, and honey. Fructose is also added to
many foods and soft drinks as a sweetener called high fructose corn syrup. Fructose
malabsorption causes dietary fructose intolerance. The small intestine absorbs fructose, and,
when a person consumes more fructose than the small intestine can absorb, fructose
malabsorption results. Unabsorbed fructose passes to the colon, where bacteria break down the
fructose and create fluid and gas. The amount of fructose that a child’s small intestine can
absorb varies. The capacity of the small intestine to absorb fructose increases with age. Some
children may be able to tolerate more fructose as they get older.
Another

Types of diarrhea:

Acute and chronic

Acute :

Water diarrhea, Bloody diarrhea or dysentery and cholera

Chronic: Persistence diarrhea more than 14 days

Examination
Look for:
■ signs of some dehydration or severe dehydration

Restlessness or irritability
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– Lethargy or reduced level of consciousness

– Sunken eyes
– Skin pinch returns slowly or very slowly
– Thirsty or drinks eagerly, or drinking poorly or not able to drink
-poor urinary output
-Rapid pulse and respiration
-Cold extremities [severe dehydration]

■ Blood in stool
■ signs of severe malnutrition
■ Abdominal mass
■ abdominal distension

Plan A: management

• If there is no dehydration, teach the mother the four rules of home treatment:
i) Give extra fluid.
( (ii) Give zinc supplements for 10–14 days.
(iii) Continue feeding.
(iv) Return if the child develops any of the following signs:

– drinking poorly or unable to drink or breastfeed

– develops a general danger sign
– becomes sicker
– develops a fever

I. GIVE THE EXTRA FLUID(as much as child will take)

I. Breast feeding frequently

II. If the child exclusive breast feeding give ORS ,or clean water
III. If not child breast feeding give one of the fallowing food based fluid(soup rice
water, and younger drinks )or ORS
 Teach The Mother How To Mix ORS And Give The Mother 2 Packets of ORS To
Use At Home
 Show Mother How Much Fluid To Give In Additional
Up to two years: 50 to 100ml after each loose stool
2 years or more : 100 to 200ml after each loose stool

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2. GIVE ZINC ( Age two months up 5years )

 Tell the mother how much zinc to give(20mg tab)
2months up to 6 months ----1\2 tablet daily for 14 days
6 months or more ----1 tablet daily for 14 days
 Show The Mother how To Give Zinc Supplements
 Infants: dissolved tablets in small amounts of expressed breast
milk.ORS or clean water in a cup
 Older children: tablets can be chewed in small amounts clean water in
a cup
3. CONTINUE FEEDING (exclusive breast feeding if ageless then 6 months)
4. WHEN TO RETURN:

PLAN B: treat some dehydration ORS in the clinic ,give recommendation of ORS over 4
hour period

AGE Up to 4 4 months up to 12 12mounths 2years up to 5years

months months up to 2years

WEIGTH <6—kg 6--<10kg 10--<12kg 12—<20kg

Amount of fluid 200-450 800-450 800-960 960-1600

(ml)over 4 hour

Use the Child’s age only when you do not know weight . The approximately amount of
ORS required in(ml)can also be

Calculated by multiplying the child’s weight in kg times 75

 If the wants more ORS than shown give more

 For infants below 6 months who are not breast fed . also give 100-200ml
water during the period

 SHOW THE MOTHER HOW TO GIVE ORS

 Give frequent small sips from a cup

 If the child vomiting , weight 10 minutes then continue –but more slowly

 Continue breast feeding whenever the child wants

 AFTER 4 HOURS

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 The child and classify the child for dehydration

 Select appropriate plan continue treatment

 Begin feeding the child in clinic

 IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT

 Show her how to prepare ORS solution at home

 Show her how much ORS to give to finish 4- hour treatment at home .

 Give her instruction how to prepare salts and sugar solution for use at home

 Explain 4 Rules of Home Treatment

1. Give extra fluid.

2. Give zinc supplements for 10–14 days.
3. Continue feeding .
4. When to Return

PLAN C:TREATMENT FOR SEVERE DEHYDRATION QUICKLY

Treat severe dehydration quickly
➞ DIARRHOEA TREATMENT PLAN C

_ Start IV fluid immediately. If the child can drink, give

ORS by mouth while the drip is being set up. Give

100 ml/kg Ringer’s lactate solution (or, if not available,

Normal saline), divided as follows:

Age First give 30 Then give 70
ml/kg in: ml/kg in:
Infants 1hour 5 hours
(< 12 months)
Children 30minute
(12 months to 5 years 2.5 hour

A repeat once if radial pulse is still weak or not detectable

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■ Reassess the child every 15–30 min. If hydration

status not improving, give the IV drip more rapidly. .Also watch for over-hydration.
_ Also give ORS (about 5 ml/kg per h) as soon as the
child can drink: usually after 3–4 h (infants) and
1–2 h (children).a■ Reassess an infant after 6 h and a child after 3 h.
Classify dehydration. Then choose the appropriate plan (A, B or C) to continue treatment.
_ Refer urgently to hospital for IV treatment. If the child can drink, give the mother ORS
solution, and show her how to give frequent sips during the trip.
_ Start rehydration by tube (or mouth) with ORS solution: give 20 ml/kg per h for 6 h (total, 120
ml/kg).
■ Reassess the child every 1–2 h:
– If there is repeated vomiting or increasing abdominal
distension, give the fluid more slowly.
– If hydration status is not improving after 3 h, send
the child for IV therapy.
■ After 6 h, reassess the child and classify dehydration.
Then, choose the appropriate plan (A, B or C)to continue treatment.
Note: If possible, observe the child for at least 6 h after
rehydration to be sure the mother can maintain hydration by
giving the child ORS solution by mouth.
Refer urgently to hospital for IV or nasogastric treatment.

Complications of Dehydration:
Complications of dehydrations may occur because of dehydration, and/or because of underlying
disease or situation that causes the fluid loss.

Infection
Low birth weight..
Malnutrition..
Kidney failure..
Coma…
Shock…
Death …..
Electrolyte malformation or imbalance…

Renal signs: {Acute Renal failure}

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