Management of Acute Diarrhoea in Children. Welcome to the module on Management of Acute Diarrhoea (AD) in Children! Diarrhoea l disease remains a leadin g cause of morbidity and mortality amongst children in l ow and middle income countries.
Welcome to the module on Management of Acute Diarrhoea (AD) in Children!
Diarrhoeal disease remains a leading cause of morbidity and mortalityamongst children in lowand middle income countries.
Most deathsresult from the associated shock, dehydrationand electrolyte imbalance.
In malnutrition, the risk of AD, its complications and mortality are increased.
A child presenting with AD
For more information about the
authors of this module, click here
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By the end of this module, you should be
competent in the management of acute
diarrhoea / dehydration.
In particular you should be able to:
*Takes the shape of the container
Diaper stained with watery stool
* UNICEF/WHO, Diarrhoea: Why children are still
dying and what can be done, 2009
Causes of death among children under age of five years
UNICEF: Progress for children, 2007
rushed into the emergency
room. She had AD and had
become very unwell.Scenario AAssessment and management of shock
Q2. How would youproceed?
Write down your answer before moving to the next slide!
with AD. She did not have features
of shock or SAM but was assessed to have severe dehydration.Scenario BClinical assessment of dehydration
Q4. List the 4 clinical signs recommended for classifying a child as severely dehydrated
Write down your answers and then go to the next slide
A mother brought her 2 year old male child to the hospital because of AD. On examination, he was irritable and his skin pinch goes back slowly (1 second)
Q8: Write down your assessment of this child’s hydration status
Q9: List 2 other key clinical signs consistent with this degree of dehydration
Write down your answer and then go to the next slide
A child was brought to the emergency room because of bloody diarrhoea of 3 days duration with associated vomiting and fever.
When examined, there were no signs of dehydration or SAM.
Q11: What it is the most likely diagnosis in this child?
Q12: How will you treat?
Write down your answers and then move to the next slide
All children with severe dysentery require antibiotic treatment for 5 days
Also manage any dehydration
Ensure breastfeeding is continued for childen still breastfeeding and normal diet for older childen
Follow-up the child
Go to Case Scenario E
This 2 year old male child was brought to the
Children’s emergency room with diarrhoea for 6 days. He had angular stomatitis, peri-anal ulceration, weighed 7.0 kg and the MUAC was 10.2 cm.
His hands were cold, pulse weak and fast and skin pinch went back very slowly. However, he appeared to be fully conscious and was not lethargic.
The resident doctor gave 140ml of normal saline by rapid IV infusion but his condition deteriorated.
Q13: What important condition needs to be recognised in this child?
Q14: Was the doctor’s management correct?
Q15: List 2 pathophysiological mechanisms in this condition that affect fluid management.
Q13: The child has severe acute malnutrition: SAM
Q14: No.Dehydration is difficult to diagnose in SAM and it is often over diagnosed. The doctor’s choice of IV normal saline, amount of fluid and rapidity of given IV fluid were all incorrect and may have caused the child’s deterioration
Q15: The pathophysiological mechanisms that affect fluid management are:
This explains why treatment with IV fluids can result in death from sodium overload and heart failure.
IV fluids should be used only to treat shock in children with SAM who are also lethargic or have lost consciousness!
The next few slides are on how to assess nutritional status, indications for laboratory investigations, rational use of antibiotics and usage of zinc
A West African child with kwashiokor
Nutritional assessment can be done by:
Muscle wasting and loss of subcutaneous fat in a West African child with marasmus
AD is usually self-limiting and investigations to identify the infectious agent are
Antibiotics are contraindicated in:
This involves intervention at two levels:
Authors and acknowledgements
Dr. Idowu Senbanjo, Lecturer/Consultant
Paediatrician, Department of Paediatrics and
Child Health, Lagos State University College of
Medicine, Ikeja, Lagos, Nigeria.
Dr. Chinlye Ch‘ng, Consultant
Bro Morgannwg University Health Board,
Singleton Hospital, Swansea, UK.
Prof. Steve Allen, Professor of Paediatrics and
International Health, RCPCH International
Officer and David Baum Fellow, The
College of Medicine, Swansea University, UK.
We would like to acknowledge the British
Society of Gastroenterology for awarding
an educational grant which supported Dr. Senbanjo in developing this module.
Please note that consent was obtained
from parents/carers to use the images in this module for teaching purposes only. The images should not be used for any other purpose.
We are very interested to receive feedback regarding any aspect of this module, especially if it helps us to improve it as a learning resource. Please e-mail any comments to Dr. Senbanjo at [email protected]