assess and classify diarrhea
Diarrhea: is
the passage of unusually loose or watery stools, usually at least three times
in a 24 hours’ period. It is common in children, especially those between 6
months and 2 years of age. It is more common in babies under 6 months who are
drinking cow's milk or infant feeding formulas. Frequent passing of normal
stools is not diarrhea. The number of stools normally passed in a day varies
with the diet and age of the child. In many regions diarrhea is defined as
three or more loose or watery stools in a 24-hour period.
Mothers usually
know when their children have diarrhea. They may say that the child's stools
are loose or watery. Mothers may use a local word for diarrhea.
Babies who are
exclusively breastfed often have stools that are soft; this is not diarrhea.
The mother of a breastfed baby can recognize diarrhea because the consistency
or frequency of the stools is different from normal.
What are the Types of Diarrhea?
Most diarrheas
which were causes dehydration are loose or watery. Cholera is one example of
loose or watery diarrhea. Only a small proportion of all loose or watery
diarrheas is due to cholera.
If an episode
of diarrhea lasts less than 14 days, it is acute diarrhea. Acute
watery diarrhea causes dehydration and contributes to malnutrition. The death
of a child with acute diarrhea is usually due to dehydration.
If diarrhea
lasts 14 days or more, it is diarrhea become persistent.
Persistent contributes to deaths in children.
Up to 20% of
episodes of diarrhea often causes nutritional problems and Diarrhea with blood
in the stool, with or without mucus, is called dysentery. The most
common cause of dysentery is Shigella bacteria. Amoebic dysentery is not common
in young children. A child may have both watery diarrhea and dysentery.
4.1 ASSESS DIARRHOEA : A child with diarrhea is assessed for:
· How long the
child has had diarrhea?
· blood in the
stool to determine if the child has dysentery, and
· Signs of
dehydrtion.
|
ASK: LOOK AND FEEL: - For
how long?
. Look at the child’s general condition Is
the child: - Blood
in the stool?
- Lethargic or
unconscious? - Restless
and irritable?
. Look for sunken eyes. . Offer the child fluid. Is the child:
- Not able to drink or drinking poorly?
- Drinking eagerly, thirsty?
. Pinch the skin of the abdomen.
Does it go back - Very
slowly (longer than 2 seconds)? - Slowly?
(less than 2 seconds) |
Ask for
diarrhea in ALL children:
· ASK:
Does the child have diarrhea?
Use words for diarrhea the mother understands.
If the mother answers NO, ask about the next
main symptom, fever. You do not need to assess the child further for signs
related to diarrhea then assess fever.
If the mother answers YES, or if the mother
said earlier that diarrhea was the reason for coming to the clinic, record her
answer. Then assess the child for signs of dehydration, persistent diarrhea and
dysentery.
·
ASK: For how long?
Diarrhea, which lasts 14 days or more, is
persistent diarrhea.
Give the mother time to answer the question.
She may need time to recall the exact number of days.
·
ASK: Is there blood in the stool?
Ask the mother if she has seen blood in the
stools at any time during this episode of diarrhea.
Check for signs of dehydration.
When a child becomes dehydrated, he is at first
thirsty restless and irritable. If dehydration continues, the child becomes
lethargic or unconscious.
As the child's body loses fluids, the eyes may
look sunken. When pinched, the skin will go back slowly or very slowly.
LOOK & FEEL
for the following signs:
·
LOOK & FEEL for Child's general condition:
Is the child lethargic or unconscious? Or Restless and irritable?
Check to see if
the child was lethargic or unconscious. If the child is lethargic or
unconscious, he has a general danger sign.
Remember to use this general danger sign when
you classify the child's diarrhea.
A child has the sign restless and irritable if
the child is restless and irritable all the time or every time he is touched
and handled. If an infant or child is calm when breastfeeding but again
restless and irritable when he stops breastfeeding, he has the sign
"restless and irritable". Many children are upset just because they
are in the clinic. If these children can be consoled and calmed, they do not
have the sign "restless and irritable".
·
LOOK for Sunken eyes:
The eyes of a
child who is dehydrated may look sunken. Decide if you think the eyes are
sunken.
Then ask the
mother if she thinks her child's eyes look unusual. Her opinion helps you
confirm that the child's eyes are sunken.
Note: In a
severely malnourished child who is visibly wasted (that is, who has marasmus),
the eyes may always look sunken, even if the child is not dehydrated. Even
though sunken eyes are less reliable in a visibly wasted child, still use the
sign to the child's dehydration.
·
OFFER the child fluid. Is the child not able to
drink or drinking poorly? Drinking eagerly, thirsty?
Ask the mother
to offer the child some water in a cup or spoon. Watch the child drink. A child
is not able to drink if he is not able to suck or swallow when offered a drink.
A child may not be able to drink because he is lethargic or unconscious.
A child is
drinking poorly if the child is weak and cannot drink without help. He may be
able to swallow only if fluid is put in his mouth.
A child has the
sign drinking eagerly, thirsty if it is clear that the child wants to drink.
Look to see if the child reaches out for the cup or spoon when you offer him
water. When the water is taken away, see if the child is unhappy because he
wants to drink more.
If the child
takes a drink only with encouragement and does not want to drink more, he does
not have the sign "drinking eagerly, thirsty."
·
PINCH the skin of the abdomen. Does it go back:
slowly (less than 2seconds) or very slowly (longer than 2 seconds)?
Ask the mother
to place the child on the examining table so that the child is flat on his back
with his arms at his sides (not over his head) and his legs straight. Or, ask
the mother to hold the child so he is lying flat in her lap.
Locate the area
on the child’s abdomen halfway between the umbilicus and the side of the
abdomen. To do the skin pinch, use your thumb and first finger. Do not use your
fingertips because this will cause pain.
Place your hand
so that when you pinch the skin, the fold of skin will be in a line up and down
the child's body and not across the child's body. Firmly pick up all of the
layers of skin and the tissue under them. Pinch the skin for one second and
then release it. When you release the skin, look to see if the skin pinch goes
back:
·
Very slowly
(longer than 2 seconds)
·
Slowly (less
than 2 seconds)
·
Immediately
Note:
In a child with
severe acute malnutrition, the skin may go back slowly even if the child is not
dehydrated. In an overweight child, or a child with edema, the skin may go back
immediately even if the child is dehydrated. Even though skin pinch is less
reliable in these children, still use it to classify the child's dehydration.
classify diarrhea
Diarrhea: is the
passage of on usually loose or watery stools, usually at least three times in a
24 hours’ period. There are three classification tables for classifying
diarrhea. All children with diarrhea are classified for:
·
Dehydration.
·
Persistent diarrhea if diarrhea for 14 days or
more.
· Dysentery
If blood in the stool.
4.2.1 Classify Dehydration
There are three
possible classifications of dehydration in a child with diarrhea:
· Severe
dehydration usual fluid loss more than10% of body weight.
· Some
dehydration including moderate dehydration5-10%of body loss and mid dehydration
3-5%of body loss both has the same signs of dehydration vary in severity but
the health worker cannot differentiate.
· No dehydration
there is fluid loss but clinically not detectable less than 3% of body weigh
|
Two of the following signs: · Lethargic
or unconscious · Sunken
eyes · Not
able to drink or drinking poorly · Skin
pinch goes back very slowly. |
SEVERE
DEHYDRATION |
|
Two of the following signs: · Restless,
irritable · Sunken
eyes · Drinks
eagerly, thirsty · Skin
pinch goes back slowly. |
SOME
DEHYDRATION |
|
Not enough signs to classify as some or
severe dehydration |
NO
DEHYDRATION |
To classify the child's dehydration, look at
the table begin with pink row:
o
If two or more of the signs in the pink row are
present, classify the child as having SEVERE DEHYDRATION.
o
If two or more of the signs are not present,
look at the yellow (or middle) row classify the child as having SOME
DEHYDRATION.
o
If two or more of the signs from the yellow row
are NOT present, classify the child as having NO DEHYDRATION. This child
does not have enough signs to be classified as having SEVERE OR SOME
DEHYDRATION. Some of these children may have one sign of dehydration or
have lost fluids without showing signs.
EXAMPLE:
A 4-month-old
child called Mona was brought to the clinic because she had diarrhea for 5
days. She did not have danger signs and she was not coughing. The health worker
assessed the child's diarrhea.
Here is her
recording form
|
ASK:
LOOK &
FEEL For how long? 5 Days Look at the child’s general
condition. Is the child Restless
or irritable? Look for sunken eyes. Offer the child fluid. Is the child:
Drinking eagerly, thirsty? Pinch the skin of the abdomen.
Does it go back:
Slowly?(less than 2second) |
|
· The child does
not have two signs in the pink row. The child does not have SEVERE DEHYDRATION.
|
Two of the
following signs: ·
Lethargic or unconscious ·
Sunken eyes ·
Not able to drink or drinking
poorly ·
Skin pinch goes back very slowly. |
SEVERE DEHYDRATION |
|
·
Restless, irritable ·
·
Drinks eagerly, thirsty ·
|
DEHYDRATION |
|
Not enough
signs to classify as some or severe dehydration. |
NO DEHYDRATION |
· The child had
two signs from the yellow row. The health worker classified the child's
dehydration as SOME DEHYDRATIO
The health
worker recorded Mona’s classification on the Recording Form.
|
DOES THE CHILD HAVE
DIARRHOEA? YES ASK:
LOOK & FEEL For how long? 5 Days Look at the child’s
general condition. Is the child Is there blood in the stools? Lethargic or
unconscious?
Look for sunken eyes.
Offer the child fluid. Is the child: Drinking
eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back
Slowly? (less than 2second) |
SOME
DEHYDRATION |
* * *
Here is a
description of each classification for dehydration:
SEVERE
DEHYDRATION
If the child has two of the following signs --
lethargic or unconscious, sunken eyes, not able to drink or drinking poorly,
skin pinch goes back very slowly. Classify the dehydration as SEVERE
DEHYDRATION.
SOME
DEHYDRATION
If the child has two or more of the following
signs: restless, irritable, sunken eyes, drinks eagerly, thirsty, skin pinch
goes back slowly; classify the child's dehydration as SOME DEHYDRATION.
NO DEHYDRATION
A child who does not have two or more signs in
either the pink or yellow row is classified as having NO DEHYDRATION.
4.2.2
Classify Persistent Diarrhea
After you
classify the child's dehydration, classify the child for persistent diarrhea if
the child has had diarrhea for 14 days or more. There are two classifications
for persistent diarrhea:
· SEVERE PERSISTENT
DIARRHOEA
· PERSISTENT
DIARRHOEA
|
Dehydration
present |
Severe Persistent Diarrhea |
|
No
dehydration |
Persistent Diarrhea |
SEVERE
PERSISTENT DIARRHOEA
If
a child has had diarrhea for 14 days or more, and also had some or severe
dehydration then classify the child as SEVERE PERSISTENT DIARRHOEA.
PERSISTENT
DIARRHOEA
A child who has
had diarrhea for 14 days or more and who has no signs of dehydration is
classified as having PERSISTENT DIARRHOEA.
4.2.3 Classify Dysentery
There is only
one classification for dysentery:
|
Blood in the
stool |
DYSENTERY |
DYSENTERY
Classify a
child with diarrhea and blood in the stool as having DYSENTERY.
Note: A child with diarrhea may have one or
more classifications for diarrhea. Record any diarrhea classifications the
child has in the Classify column on the Recording Form.
For example, this child was classified as
having NO DEHYDRATION and DYSENTERY. Here is how the health worker recorded his
classifications
|
Does
the child have diarrhea? Yes No . ASK: LOOK AND FEEL: -
For
how long? 2days . Look at the
child’s general condition Is the child: -
Blood
in the stool?
- Lethargic or unconscious? - Restless and irritable?
. Look for sunken eyes.
. Offer the child fluid. Is the
child:
- Not able to drink or
drinking poorly?
- Drinking eagerly, thirsty?
. Pinch the skin of the
abdomen. Does it go back -
Very
slowly (longer than 2 seconds)? -
Slowly?
(less than 2 seconds) |
|
NO DEHYDRATION + DYSENTERY |
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