Diarrhoea & Dehydration
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Transcript Diarrhoea & Dehydration
Diarrhoea and Dehydration
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
What is Diarrhoea?
Loose or watery stools
Above 12 months of age, more than 3 loose stools per day (Eddleston
& Plerini, 1999)
Often accompanied by fever, nausea, vomiting, abdominal pain
May be explosive or foul smelling
May contain blood
May be green
Different categories of diarrhoea (WHO):
Acute, watery diarrhoea for 14 days or less
Persistent diarrhoea for longer than 14 days
Dysentery: diarrhoea with blood, with/without fever
Remember!
Every child’s stools and stool
pattern differ
Ask the care givers what the
child’s ‘normal’ stools are like
A young, breast-fed baby may
have many soft, watery stools
in a day
This is NOT diarrhoea
©TALC
Causes of Diarrhoea
Unhygienic food preparation
Unsafe storage of food
Inadequate hand washing
Antibiotics and other drugs
Malnutrition
No access to clean water
HIV itself
All images ©TALC
ALL Children are at risk…
Dependent on others for
good hygiene
Does not know to wash his
hands
Puts hands/objects in his
mouth as part of his
development
Will play in/with anything!
There immune system is still
developing
Children with HIV
Increased risk of Diarrhoea:
More susceptible to
infections causing diarrhoea
HIV damages the gut so food
is not absorbed properly
Commonly malnourished,
increasing severity and
frequency of diarrhoea
Multiple drugs are being
taken which cause diarrhoea
©TALC
Preventing Diarrhoea
Good personal hygiene
Hand washing
Improve access to clean water
Safe, clean preparation of food
Safe storage of food
Sterilisation of feeding implements
Improve sanitation
Good nutrition
Breastfeeding
Safe disposal of soiled materials
©TALC
Breaking the Cycle
Flies
Cover
Food
Bury faeces, use
latrine
Food
Faeces
Wash hands
before eating
and preparing
food
Wash
hands after
defecation
Fingers
Adapted from Lankester, 2000
Effects of Diarrhoea
Diarrhoea may cause great
discomfort to a child
Diarrhoea may also be
accompanied by or cause:
fever
abdominal pain
©TALC
Effects of Diarrhoea
Diarrhoea increases the risk
of skin breakdown
A child with HIV is then more
likely to get skin infections
which may be painful and
difficult to treat
Skin breakdown and infections
must be prevented
Effects of Diarrhoea
Children with diarrhoea are at
risk of dehydration
Children become dehydrated
more quickly than adults
May occur over days or very
quickly indeed
Dehydration will lead to death if
not managed appropriately and
quickly
©TALC
Getting it Right!
All around the world, children with diarrhoea are dying from
dehydration because carers:
Stop fluids and food
Do not know what fluids to give
Do not know the signs of dehydration
Do not know how quickly a child becomes dehydrated
Do not act quickly enough
Have not been taught how to make and use ORS
DO not know what to do when the child vomits or refuses to
drink
How Do I Assess Dehydration?
Does the child have Diarrhoea?
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Sunken fontanelle
Skin pinch goes back slowly
Dry tongue, no tears
©TALC
Signs of Dehydration
Not able to drink/ drinking
poorly
Weak, inactive or
unconscious
Watery stools
©TALC
Vomiting
Has small amount of dark
urine
Has stopped passing urine
Plan A: Treat for Diarrhoea at
Home
Counsel the mother on the
3 Rules of Home Treatment:
Give Extra Fluid
Continue Feeding
When to Return
©TALC
Plan A: Give Extra Fluid
As much as the child will take!
Breastfeed frequently and for longer at each feed
If exclusively breast-fed, give SSS in addition to
breast milk
If child is not receiving breast milk or is not
exclusively breastfed, give one or more of:
Porridge, Amasi (Maas), SSS, ORS
©TALC
Plan A: ORS and SSS
Teach the Mother How to mix and Give SSS or ORS
To make SSS:
ORS
1 litre boiled (or clean) water
+
8 teaspoons sugar
+
Half a teaspoon salt
Used to prevent dehydration
Used to correct dehydration and
can be life-saving!
Plan A: Giving ORS & SSS
Show the mother how much fluid to give in addition to the usual
fluid intake:
Up to 2 Years: 50 – 100 ml after each loose stool
2 Years or more: 100 – 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
Plan A: Continue Feeding
A child with diarrhoea loses the nutrients he needs for:
Growth, Energy and a Strong immune system
Diarrhoea may therefore lead to:
Malnutrition
A weakened immune system
More infections
©TALC
This is particularly worrying for a child with HIV who:
Is normally malnourished
Has a weakened immune system
More likely to get infections
©TALC
Plan A: Continue Feeding
It is therefore extremely important to continue feeding a child
with diarrhoea
Even if the diarrhoea continues!
DO not be surprised if the child loses weight having been ill
with diarrhoea
BUT, it is important to help the child regain that weight by
encouraging an extra meal a day for two weeks
Sometimes, a doctor may advise that the child does not taken
certain foods ie milk. If the mother has been told this,
encourage her to take that advise
Plan B: Treat for Some Dehydration
with ORS
If a child with diarrhoea has been
assessed and considered to have
some dehydration, the child needs
rehydration with ORS
Refer to clinic immediately
Infection Control
Risk of Infection to Others
Others may be infected by the
germs causing diarrhoea eg
Salmonella
Others may be infected by HIV is
diarrhoea contains blood
©TALC
Handling Soiled Linen
Wear Gloves
Cut small holes in a plastic bag and line a container with it
Pour Jik 1:10 in to the plastic bag
Put the dirty wound dressing, newspaper etc in to the
plastic bag for half an hour
Remove the bag, allowing the fluid to run into the container
Put the plastic bag into a second plastic bag
Dispose of it into a pit toilet or bury it
OR
Wear gloves
Place waste in to double plastic bags
Knot bags and bury them or dispose in pit
Wash hands
Summary
Children with HIV will experience episodes of diarrhoea
Diarrhoea may resolve itself without drugs
Prevent dehydration using Plan A
Treat dehydration using Plan B and C
Provide nutritious foods throughout
Refer if:
a) diarrhoea persists after three days, refer for diagnosis and
treatment of underlying cause
b) child becomes sicker, develops danger signs
You can easily prevent many children from dying!