Classifying diarrhoea
There are three classification tables for classifying diarrhoea:
All children with diarrhoea are classified for dehydration.
Diarrhoea is for 14 days or more, the child should be classified
for persistent diarrhoea.
A child has blood in the stool, the child should be classified as
having dysentery
There are three possible classifications of dehydration in a
child with diarrhoea:
Severe dehydration
Some dehydration
No dehydration
Classification of dehydration in a child
Treatment for dehydration:
Treatment for severe dehydration
• Referral to next health center or hospital for with
severe dehydration giving sips of ORS during the
trip.
Treatment for Some dehydration (Plan B is for
children with some dehydration)
• Although this is not as serious as ‘severe dehydration’
it is still important that you treat a child who has
‘some dehydration’ in order to prevent his situation
becoming worse
Plan B: Treatment of a child with some dehydration
Give in clinic recommended amount of ORS over 4-hour period
DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS
AGE Up to 4 Months 4 -12 months 12 m-2y 2 -5 y
Weight in kg <6 6-10 10-12 12-19
ORS in ml
200-400 400-700 700-900 900-1400
Use the child’s age only when you do not know the weight. The
approximate amount of ORS required (in ml) can also be calculated by
multiplying the child’s weight (in kg) times 75.
● If the child wants more ORS than shown, give more.
● For infants under 6 months who are not breastfed, also give 100–200
ml clean water during his period.
SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.
● Give frequent small sips from a cup or cup and spoon (one spoon every
1–2 minutes).
● If the child vomits, wait 10 minutes. Then continue, but more slowly.
●Continue breastfeeding whenever the child wants
AFTER 4 HOURS:
Reassess the child and classify the child for dehydration.
Select the appropriate plan to 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 enough ORS packets to complete rehydration. Also
give her a box of 10 packets Of ORS as recommended in Plan
A. Explain the 4 Rules of Home Treatment; these are:
1. Give extra fluids
2 .Give zinc supplements
3. Continue feeding
4. When to return
Treatment for no dehydration
child with diarrhea, even if classified as having no
dehydration, still needs extra fluid to prevent
dehydration occurring
Plan A: Treatment for a child with diarrhea but no
dehydration
Counsel the mother on the 4 Rules of Home Treatment
Give Extra Fluids, Give Zinc Supplements,
Continue Feeding, When to Return
Plan A: Treatment for a child with diarrhoea but no
dehydration
Counsel the mother on the 4 Rules of Home Treatment
Give Extra Fluids, Give Zinc Supplements, Continue Feeding,
When to Return
1 Give extra fluids (as much as the child will take):
Tell the mother:
– To breastfeed frequently and for longer at each feed.
– If the child is exclusively breastfed, give ORS in addition to
breast milk.
– If the child is not exclusively breastfed, give one or more of the
following:
ORS solution, food-based fluids (such as soup, rice water and
yoghurt drinks), or clean water.
It is especially important to give ORS at home when:
– The child has been treated with Plan B or Plan C
during this visit.
– The child cannot return to a clinic if the diarrhoea gets
worse.
● Teach the mother how to mix and give ORS.
● Give the mother 2 packets of ORS to use at home.
● Show the mother how much fluid to give in addition
to the usual fluid intake
Up to 2 years 50 to 100 ml after each
loose stool
2 years or more 100 to 200 ml after each
loose stool
• Tell the mother to:
– Give frequent small sips from a cup.
– If the child vomits, wait 10 minutes. Then continue,
but more slowly.
– Continue giving extra fluid until the diarrhoea stops .
2 Give zinc supplements:
Tell the mother how much zinc to give:
Up to 6 months 1/2 tablet for 10 days
6 months or more 1 tablet for 10 days
Show the mother how to give Zinc supplements
– Infants — dissolve tablet in a small amount of expressed breast
milk, ORS or clean water in a cup;
– Older children — tablets can be chewed or dissolved in a small
amount of clean water in a cup.
3 Continue feeding
4 Tell her when to return
