Diarrhea in Children U5Y

Dr. Karwan Hawez

Family Medicine Specialist
College of Medicine
 Outline of the Lecture

• Aims and objectives.

• Clinical Case.
• Introduction.
• Assessment, classification, and Rx of diarrhea in
children age 2 months to 5years.
• Diarrhea in sick young infant (up to 2 months).
• Conclusion.
 Aims and Objectives
1. To know how to assess the child complaining of
diarrhea.

2. Also to classify a child with diarrhea.

3. To know the guidelines of Rx according to the

classification.
 Clinical Case Approach
• Afrah A. A. is a 14 months old. She weighs 12kg. Her
temp is 37.5.
• Afrah’s mother said that her child had dh for 3 weeks.
• Afrah does not have any general danger signs. She
does not have cough or difficult breathing.
• The health worker assessed her for dh. He noted she
has had dh for 21 days with blood in the stool. The
child is irritable throughout the visit with no sunken
eyes. She drinks eagerly and the skin pinch goes back
immediately.
How you approach to Afrah’s complain and how fill the
recording form for this patient according to IMCI.
 Introduction
Diarrhea is passage of liquid or watery stool for at
least 3 times during 24hrs.
Breastfeed infants usually pass semi-solid pasty and
yellow stools. Sometimes, they pass stool after each
breastfeed.
Blood in the stool is called dysentery, which can be
amebic or bacillary.
It is estimated that under 5 years children may
develop 1-12 episodes of dh/year, which will lead to
GF and complications.
 Introduction (cont.)
Diarrhea is caused by viruses, bacteria and protozoa.

The contributing factors are unclean water, dirty

hands when preparing meals or when eating them
and/or food spoilt by high temperature.

Dh leads to MN (GF and under weight). The degree of

weight loss is directly correlates with the duration of
dh (25gm wt loss for each day of dh).
 Diarrhea in children
of 2monhs to 5years
1. Assessment:
Does the child have diarrhea?
If Yes, Ask (Hx):
1. For how long?
2. Is there blood in the stool?
Look and Feel (exam):
1. General condition.
2. Sunken eyes.
3. Fluid intake.
4. Skin pinch.
5. Febrile and toxic.
 Diarrhea in children of
2monhs to 5years (cont.)
3) Rx of sever dehydration:
 If he child has no other sever classification: Give fluid
for sever dehydration (Plan C).
 If the child has another sever classification:
• Refer urgently to hospital with mother giving frequent sips
of ORS on the way.
• Advice the mother to continue breastfeeding.
 If there is cholera in your area, give AB for cholera.
 Diarrhea in children of
2monhs to 5years (cont.)
3. Rx of some dehydration
 Give fluid, food, and zinc for some dehydration (Plan B).
 If the child also has another sever classification:
• Refer urgently to hospital with mother giving frequent sips of
ORS on the way.
• Advice the mother to continue breastfeeding.
 If there is cholera in your area, give AB for cholera.
 Follow-up in 5 days if not improving.
 Advice the mother when to return immediately.
 Diarrhea in children
of 2monhs to 5years (cont.)
3. Rx of no dehydration:
 Give fluid, food, and zinc for no dehydration (Plan A).

If there is cholera in your area, give AB for cholera.

Follow-up in 5 days if not improving.

Advice the mother when to return immediately.

 Diarrhea in children
of 2monhs to 5years (cont.)
• Classification of diarrhea according to the
duration:
• If diarrhea is ≥ 14 days:
1. Dehydration present:
• Sever persistent diarrhea.

2. No dehydration:
• Persistent diarrhea.
 Rx of persistent diarrhea
1. Rx of sever persistent diarrhea:
• Rx dehydration before referral unless the child
has another sever classification.
• Refer to hospital.
2. Rx of persistent diarrhea:
• Advice the mother on feeding the child who has
persistent dh.
• Follow-up in 5 days.
 Classification and Rx according to
blood in the stool
1. Blood in the stool and toxic:

 Possible Shigilla Dysentery → Refer to hospital.

2. Blood in the stool:

 Dysentery → Rx for 10ds with an oral metronidazole.

 Follow-up in 2 days.
 Clinical Case Management
Name: Afrah. Age: 14ms. Weight: 12kg. Temp: 37.5
Ask: wt are the child’s problem? dh 21 days. Initial visit? √ F/Up visit?
Assess (circle all signs present) classify
Check for general danger signs yes No √
Not able to drink or breast feed lethargic or unconscious
Vomit every thing
Convulsions convulsing now
Assess Classify
Does the child have cough or difficult breathing? Yes No √
For how long? ……. Days count the breath in one min.
………… B/min Fast breathing
look for chest indrawing.
look and listen for strider.
look and listen for wheeze.
 Clinical Case Management (cont.)
Dose the child have diarrhea? Yes √ No
• For how long? 21ds Look at the child’s general danger conditions.
Is the child
• Is their blood in he stool? Yes Lethargic or unconscious
Restless or irritable
No sunken eyes some
drinking eagerly. Thirsty dehydration
Skin pinch goes back immediately
Sever persistent dh

Is the child febrile and toxic? Dysentery

 Clinical Case Management (cont.)
Classification of Afrah’s condition:
1. Afrah has 2 signs of some dehydration.
2. Afrah has some dehydration + dh for 21 ds;
so the 2nd classification is sever persistent dh.
3. Afrah has blood in the stool with fever but
not toxic; so the third classification is dysentery.
 Clinical Case Management (cont.)
1. Rx of sever persistent diarrhea:
• Rx dehydration before referral.
• Refer to hospital.

2. Rx of Afrah’s Dysentery: you did not Rx this

condition because you send Afrah to the hospital.
 Diarrhea in sick young infant
up to 2 months
The same as the age group of 2months to 5 years
except:

1. Any diarrhea lasting ≥14 days is classified as sever

persistent diarrhea (even without dehydration).

2. Any blood in the stool (even without fever) is

classified as bloody dh and should be referred.
 Conclusion
1. Diarrhea is a very common problem in children U5Y.
2. Things which are important in assessing a child with
diarrhea are, duration, blood in the stool, fever and
toxicity and the hydration status.
3. You should manage the child with diarrhea according to
the classification.
4. Do not give antimicrobial agents unless in dysentery
and cholera.
Thank You