Key Features

• Requires TWO or more of the following signs: Lethargic/unconscious OR Movement only when stimulated/no movement OR Sunken eyes OR Skin pinch goes back very slowly (>2 seconds).
• Indicates severe fluid and electrolyte loss, which is particularly dangerous in young infants.
• Requires immediate fluid resuscitation, preferably IV or NG if trained (Plan C), and urgent referral.

Classification

• Two or more of the following signs: (Movement only when stimulated or no movement at all / Lethargic or unconscious) OR (Sunken eyes) OR (Skin pinch goes back very slowly) -> SEVERE DEHYDRATION

Enfuga

Non-Pharmacological Management

• If providing Plan C in clinic: Ensure immediate access to IV/NG equipment and ORS. Monitor closely.
• If referring: Keep infant warm. Continue ORS sips frequently if possible.

Pharmacological Treatment

• TREAT WITH PLAN C (Young Infant Version - Page 41):
• If IV Therapy Possible Immediately: Start IV fluid. Give 100 ml/kg Ringer's Lactate Solution (or Normal Saline). Give 30ml/kg in 1 hour, THEN 70ml/kg in 5 hours.
• Reassess frequently (every hour initially). If hydration not improving, give IV drip faster.
• Also give ORS (about 5 ml/kg/hour) by mouth/NG tube as soon as infant can take it.
• Reassess dehydration status after 6 hours and choose appropriate plan (A, B, repeat C).
• If IV Therapy Not Available/Possible:
• If trained in NG tube insertion: Start rehydration by NG tube with ORS solution: give 20 ml/kg/hour for 6 hours (total 120 ml/kg). Reassess every 1-2 hours. If vomiting/distension, slow rate. If not improving after 3 hrs, refer urgently for IV.
• If NG tube not possible AND infant can drink: Refer URGENTLY. Give mother ORS and show how to give frequent sips during the trip.
• If infant also has another severe classification (e.g., PSBI): Refer URGENTLY after stabilizing airway/breathing and giving essential pre-referral treatments (e.g., antibiotic). Give frequent sips of ORS on the way if possible.

Monitoring & Follow-Up

• Managed initially under Plan C, then reassessed.
• If discharged on Plan A or B, follow-up as per those plans.

Counselling Points

• Explain the seriousness of dehydration in a young baby and the need for urgent hospital treatment.
• Show how to give ORS sips frequently during transport if applicable.
• Advise on keeping infant warm.
• Advise mother to continue breastfeeding whenever infant wants.

Key Features

• Absence of sufficient signs for Some or Severe Dehydration.
• Management focuses on preventing dehydration at home (Plan A).
• Exclusive breastfeeding is the mainstay; ORS/water used supplementally.

Classification

• Not enough signs to classify as Some or Severe Dehydration -> NO DEHYDRATION

Enfuga

Non-Pharmacological Management

• Treat with Plan A (Young Infant Version - Page 43):
• Advise mother to continue breastfeeding frequently and for longer at each feed, day and night.
• Give extra fluids: Advise giving ORS or clean water in addition to breastmilk.
• Show how much extra fluid to give after each loose stool (approx 50-100 ml for <2 years, though this is from the 2m-5y chart - give small frequent amounts appropriate for infant size).
• Teach how to mix and give ORS (give 2 packets for home use).
• Advise mother when to return immediately.

Pharmacological Treatment

• Zinc is NOT routinely recommended for infants under 2 months in this guideline.

Monitoring & Follow-Up

• Follow up in 3 days IF not improving (Page 48).
• Advise immediate return if signs of dehydration or danger signs develop.

Counselling Points

• Explain the 2 Rules of Home Treatment for young infants: 1. Give Extra Fluid (primarily frequent, longer breastfeeding; supplement with ORS/water). 2. When to Return.
• Emphasize continued frequent and longer breastfeeding.
• Teach how to prepare and give ORS.
• Explain signs requiring immediate return: develops danger signs (stopped feeding, convulsions, lethargy etc.), becomes very thirsty, develops sunken eyes, blood in stool.