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)
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Often accompanied by fever, nausea, vomiting, abdominal pain
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May be explosive or foul smelling

May contain blood
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May be green
Different categories of diarrhoea (WHO):
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Acute, watery diarrhoea for 14 days or less
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Persistent diarrhoea for longer than 14 days
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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
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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
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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
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Wear gloves
Place waste in to double plastic bags
Knot bags and bury them or dispose in pit
Wash hands
Summary
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Children with HIV will experience episodes of diarrhoea
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Diarrhoea may resolve itself without drugs
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Prevent dehydration using Plan A
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Treat dehydration using Plan B and C
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Provide nutritious foods throughout
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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!