Diarrhoea (Age 2 months up to 5 years)

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Ask

• For how long?
• Is there blood in the stool?

Look, Listen, Feel

• Look at the young infant’s general condition. Is the child:
  - 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(> 2 seconds)?
  - Slowly?

Classify Diarrhoea

For Dehydration:

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	Start treatment for severe dehydration  Refer URGENTLY Test for low blood sugar, then treat and prevent  Give frequent sips of ORS on the way Advise the caregiver to continue breastfeeding when possible
Some Dehydration
Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly	Give fluids to treat for some dehydration  Advise caregiver to continue breastfeeding and feeding Give zinc for 2 weeks Follow-up in 2 days  Advise the caregiver when to return immediately
No Visible Dehydration
Not enough signs to classify as severe or some dehydration	Give fluid and food for diarrhoea at home  Advise caregiver when to return immediately  Give zinc for 2 weeks  Follow up in 5 days if not improving

Diarrhoea 14 days or more:

Severe Persistent Diarrhoea
Dehydration present OR Losing weight	Start treatment for dehydration Refer URGENTLY Give frequent sips of ORS on the way Give additional dose of Vitamin A
Persistent Diarrhoea
No visible dehydration	Counsel the caregiver about feeding  Give additional dose of Vitamin A  Give zinc for 2 weeks  Follow-up in 5 days Advise the caregiver when to return immediately

If blood in stool:

Severe Dysentery
Dehydration present OR Age less than 12 months	Refer URGENTLY Keep child warm  Test for low blood sugar, then prevent or treat
Dysentery
Age 12 months or more AND No dehydration	Treat for 3 days with ciprofloxacin  Advise when to return immediately  Follow-up in 2 days

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; Diarrhoea

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Last checked for updates: June 2023