Nurses Revision

Nurses Revision
EN SW LG
Check general danger signs first
Young infant 0-2 months Child 2 months-5 years
Common: Malaria Pneumonia Diarrhoea Fever HIV

Results for "Diarrhoea" (Age: 2 months - 5 years)

Severe Persistent Diarrhoea 2 months - 5 years

Refer URGENTLY (after treating dehydration if severe) High match
What to tell caregiver
  • Explain that the long duration of diarrhoea combined with dehydration is serious and requires hospital care.
  • Explain any dehydration treatment being given.
  • Advise mother to continue breastfeeding frequently.
  • Advise on keeping child warm during transport.
  • Write a detailed referral note mentioning duration of diarrhoea, dehydration status, and any treatments given.

Classification for a child whose diarrhoea has lasted 14 days or more AND who has signs of dehydration present. Requires urgent referral for specialized management.

Key Features
  • Diarrhoea duration of 14 days or more.
  • Presence of signs classifying as SOME DEHYDRATION or SEVERE DEHYDRATION.
  • High risk for malnutrition and underlying infections (including HIV).
Red Flags (Warning Signs)
  • Signs of Severe Dehydration.
  • Signs of severe malnutrition.
  • Signs of associated sepsis or other severe infection.
Assessment
Ask
  • Does the child have diarrhoea?
  • For how long? (Response is 14 days or more).
  • Assess for Dehydration (Look/Feel for signs of Some or Severe Dehydration - see IMCI_2M5Y_005 & 006 assessments).
Classification
  • Diarrhoea for 14 days or more AND Dehydration present (Signs of Some or Severe Dehydration) -> SEVERE PERSISTENT DIARRHOEA
Urgency / Refer urgently

Refer URGENTLY (after treating dehydration if severe)

Pre-referral treatment
  • Stabilize hydration as much as possible (start Plan C or B).
  • Give other essential pre-referral treatments if needed for co-existing severe classifications.
  • Keep child warm.
  • Advise mother to continue breastfeeding.
Management
Non-Pharmacological Management
  • Treat dehydration first (Plan C if severe, Plan B if some) BEFORE referral, unless the child has another severe classification requiring immediate referral.
  • If referring, keep child warm.
Pharmacological Treatment
  • Treat dehydration as per Plan C or Plan B.
  • If child has another severe classification (e.g., Very Severe Febrile Disease), give pre-referral treatments for that condition (e.g., antibiotic, antimalarial).
Monitoring & Follow-Up
  • To be managed at referral hospital, which will investigate cause and provide specialized feeding/treatment.
Counselling Points
  • Explain that the long duration of diarrhoea combined with dehydration is serious and requires hospital care.
  • Explain any dehydration treatment being given.
  • Advise mother to continue breastfeeding frequently.
  • Advise on keeping child warm during transport.
  • Write a detailed referral note mentioning duration of diarrhoea, dehydration status, and any treatments given.
Differential Diagnosis
  • Persistent Diarrhoea (without dehydration)
  • Acute Diarrhoea with Dehydration
  • Secondary lactose intolerance
  • Cow's milk protein allergy
  • Other food intolerances/allergies
  • Post-enteritis syndrome
  • Giardiasis
  • Cryptosporidiosis (especially if HIV+)
  • Other specific enteropathogens
  • Malnutrition-associated gut changes
Potential Complications
  • Severe malnutrition
  • Micronutrient deficiencies
  • Severe dehydration and shock
  • Sepsis
  • Electrolyte imbalance
  • Death
Prevention
  • Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
  • Good nutrition, Vitamin A.
  • Measles vaccination.
  • Handwashing, safe water/sanitation.
  • Early identification and management of HIV infection.

Reference: IMCI Chart Booklet - Page 3, Pages 13, 16

Persistent Diarrhoea 2 months - 5 years

Routine Management / Dietary Counselling High match
What to tell caregiver
  • Explain the importance of special feeding during persistent diarrhoea.
  • Provide specific, practical advice on recommended foods and feeding frequency based on local availability and child's age.
  • Explain how to give multivitamins and zinc.
  • Advise on giving extra fluids.
  • Advise when to return immediately (danger signs, signs of dehydration).
  • Advise on follow-up visit in 5 days.

Classification for a child whose diarrhoea has lasted 14 days or more but who currently has NO signs of dehydration. Requires specific dietary advice and follow-up.

Key Features
  • Diarrhoea duration of 14 days or more.
  • Absence of signs of dehydration.
  • Management focuses on nutritional rehabilitation and investigating potential underlying causes.
Red Flags (Warning Signs)
  • Development of dehydration.
  • Significant weight loss or failure to gain weight.
  • Signs of specific nutrient deficiencies.
  • Refusal to eat.
Assessment
Ask
  • Does the child have diarrhoea?
  • For how long? (Response is 14 days or more).
  • Assess for Dehydration: Confirm NO DEHYDRATION (Not enough signs for Some or Severe Dehydration).
Classification
  • Diarrhoea for 14 days or more AND No Dehydration -> PERSISTENT DIARRHOEA
Urgency / Refer urgently

Routine Management / Dietary Counselling

Management
Non-Pharmacological Management
  • Advise the mother on feeding a child with PERSISTENT DIARRHOEA:
  • If still breastfeeding: Breastfeed more frequently and longer, day and night.
  • If taking other milk: Replace with fermented milk products (e.g., yoghurt) OR Replace half the milk with nutrient-rich semisolid food (e.g., porridge).
  • For other foods: Ensure adequate energy intake. Give small, frequent meals (at least 6 times/day). Use foods rich in energy and nutrients. Mix foods well.
  • Give foods rich in potassium (e.g., bananas, coconut water).
  • Ensure adequate fluid intake using ORS or recommended home fluids after loose stools.
  • Check for HIV Infection (refer to HIV assessment algorithm page 8).
Pharmacological Treatment
  • Give multivitamins and minerals (including zinc) for 10 days (or longer per local guidelines). Ensure Zinc dose is 10mg (=6m) daily.
Monitoring & Follow-Up
  • Follow up in 5 days.
  • At follow-up (Day 5):
  • Ask: Has diarrhoea stopped? How many stools per day?
  • Assess feeding and check for dehydration.
  • If diarrhoea has not stopped: Do a full reassessment. Treat dehydration if present. Refer to hospital for assessment (including for ART if HIV+).
  • If diarrhoea has stopped: Tell mother to follow usual age-appropriate feeding recommendations. Complete 10 days of zinc.
Counselling Points
  • Explain the importance of special feeding during persistent diarrhoea.
  • Provide specific, practical advice on recommended foods and feeding frequency based on local availability and child's age.
  • Explain how to give multivitamins and zinc.
  • Advise on giving extra fluids.
  • Advise when to return immediately (danger signs, signs of dehydration).
  • Advise on follow-up visit in 5 days.
Differential Diagnosis
  • Severe Persistent Diarrhoea (if dehydration develops)
  • Secondary lactose intolerance
  • Cow's milk protein allergy
  • Other food intolerances/allergies
  • Giardiasis
  • Cryptosporidiosis
  • Malnutrition
  • HIV infection
Potential Complications
  • Malnutrition
  • Micronutrient deficiencies
  • Dehydration (if fluid/feeding advice not followed)
  • Increased susceptibility to other infections
Prevention
  • Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
  • Good nutrition, Vitamin A.
  • Measles vaccination.
  • Handwashing, safe water/sanitation.
  • Early identification and management of HIV infection.

Reference: IMCI Chart Booklet - Page 3, Page 22, Page 26 (Feeding Recs), Page 8 (HIV)

Severe Dehydration 2 months - 5 years

Immediate Treatment (Plan C) / Refer URGENTLY if IV not possible High match
What to tell caregiver
  • If Plan C given in clinic: Explain the procedure and need for close monitoring. Reassure the mother.
  • If referring: Explain the seriousness of dehydration and the need for hospital treatment (IV fluids). Show how to give ORS sips frequently during transport. Advise on keeping child warm. Advise mother to continue breastfeeding whenever child wants.

Classification for a child with diarrhoea who exhibits two or more signs of severe dehydration, indicating a life-threatening fluid deficit requiring immediate IV fluid resuscitation (Plan C) or urgent referral.

Key Features
  • Requires TWO or more of the following signs: Lethargic/unconscious, Sunken eyes, Not able to drink/drinking poorly, Skin pinch goes back very slowly (>2 seconds).
  • Indicates significant fluid and electrolyte loss.
  • Requires immediate fluid resuscitation, preferably with IV fluids (Plan C).
Red Flags (Warning Signs)
  • Lethargic or unconscious state
  • Not able to drink or drinking poorly
  • Skin pinch goes back very slowly (> 2 seconds)
  • Signs of shock (cold extremities, weak/fast pulse, capillary refill > 3 sec)
Assessment
Ask
  • Does the child have diarrhoea?
  • For how long?
  • Is there blood in the stool?
Look, listen, feel
  • Look at the child's general condition. Is the child Lethargic or unconscious?
  • Look for sunken eyes.
  • Offer the child fluid. Is the child Not able to drink or drinking poorly?
  • Pinch the skin of the abdomen. Does it go back Very slowly (longer than 2 seconds)?
Classification
  • Two or more of the following signs: (Lethargic or unconscious) OR (Sunken eyes) OR (Not able to drink or drinking poorly) OR (Skin pinch goes back very slowly) -> SEVERE DEHYDRATION
Urgency / Refer urgently

Immediate Treatment (Plan C) / Refer URGENTLY if IV not possible

Pre-referral treatment
  • If referring urgently: Ensure airway is clear. Give frequent sips of ORS on the way if child can drink. Keep child warm. Give other essential pre-referral treatments based on other classifications (e.g., antibiotic for severe pneumonia).
Management
Non-Pharmacological Management
  • If providing Plan C in clinic: Ensure availability of IV fluids, cannulas, giving sets. Monitor hydration status closely.
  • If referring: Keep child warm during transport. Continue giving ORS sips frequently if the child can drink.
Pharmacological Treatment
  • TREAT WITH PLAN C:
  • If IV Therapy Possible Immediately: Start IV fluid immediately. Give 100 ml/kg Ringer's Lactate Solution (or Normal Saline if RL not available), divided as follows: Age < 12 months: Give 30ml/kg in 1 hour, THEN 70ml/kg in 5 hours. Age 12 months - 5 years: Give 30ml/kg in 30 minutes, THEN 70ml/kg in 2 ½ hours.
  • Reassess the child every 1-2 hours. If hydration status is not improving, give IV drip more rapidly.
  • Also give ORS (about 5 ml/kg/hour) by mouth as soon as the child can drink (usually after 3-4 hrs for infants, 1-2 hrs for children).
  • Reassess dehydration status after the initial IV phase (e.g., after 6 hrs for infants, 3 hrs for children) and choose appropriate plan (A, B, or repeat C if needed).
  • If IV Therapy Not Available Nearby (<30 mins) or Not 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 persists or distension occurs, slow the rate. If hydration not improving after 3 hrs, refer urgently for IV.
  • If child can drink: Refer URGENTLY to hospital for IV/NG treatment. Give mother ORS solution and show her how to give frequent sips during the trip.
  • If child is 2 years or older AND cholera is in your area: Give appropriate antibiotic for cholera (e.g., Erythromycin).
  • If child also has another severe classification (e.g., Severe Pneumonia): Refer URGENTLY after stabilizing airway/breathing and giving essential pre-referral treatments (e.g., antibiotic), give frequent sips of ORS on the way.
Monitoring & Follow-Up
  • Managed initially under Plan C, then reassessed and managed according to Plan A or B.
  • If discharged on Plan A or B, follow-up as per those plans.
Counselling Points
  • If Plan C given in clinic: Explain the procedure and need for close monitoring. Reassure the mother.
  • If referring: Explain the seriousness of dehydration and the need for hospital treatment (IV fluids). Show how to give ORS sips frequently during transport. Advise on keeping child warm. Advise mother to continue breastfeeding whenever child wants.
Differential Diagnosis
  • Some Dehydration
  • Septic shock (may mimic dehydration signs)
  • Severe malnutrition with oedema (skin changes may be misleading)
  • Other causes of altered consciousness (meningitis, severe malaria)
Potential Complications
  • Hypovolemic shock
  • Acute kidney injury
  • Seizures (due to electrolyte imbalance or hypoglycemia)
  • Cerebral edema (if rehydrated too rapidly with hypotonic fluids, rare with ORS/RL/NS)
  • Death
Prevention
  • Exclusive breastfeeding for 6 months.
  • Use of safe water and sanitation.
  • Handwashing with soap.
  • Appropriate complementary feeding.
  • Measles vaccination.
  • Rotavirus vaccination (if available).
  • Prompt use of ORS and Zinc at the start of diarrhoea.
  • Continued feeding during diarrhoea.

Reference: IMCI Chart Booklet - Page 3, Page 13 (Plan C), Page 16

Some Dehydration 2 months - 5 years

Treat at Clinic (Plan B) High match
What to tell caregiver
  • Explain that the child needs special fluids (ORS) because of dehydration.
  • Show the mother how much ORS to give over 4 hours.
  • Show how to give ORS (sips from cup, what to do if vomits).
  • Explain the importance of Zinc and show how to give it for 10 days.
  • If mother must leave before 4 hours: Show her how to prepare ORS at home. Show how much ORS to give to finish the 4-hour treatment. Explain the 4 Rules of Home Treatment (Give Extra Fluid, Give Zinc, Continue Feeding, When to Return).
  • Advise mother when to return immediately (signs listed on page 30 - not drinking, sicker, fever; for diarrhoea also: blood in stool, drinking poorly).

Classification for a child with diarrhoea who exhibits two or more signs indicating moderate fluid deficit, requiring treatment with Oral Rehydration Salts (ORS) in the clinic (Plan B).

Key Features
  • Requires TWO or more of the following signs: Restless/irritable, Sunken eyes, Drinks eagerly/thirsty, Skin pinch goes back slowly.
  • Absence of signs of severe dehydration.
  • Requires supervised administration of ORS over 4 hours (Plan B).
Red Flags (Warning Signs)
  • Development of signs of severe dehydration during treatment.
  • Inability to drink ORS adequately.
  • Persistent vomiting.
  • Presence of another severe classification requiring referral.
Assessment
Ask
  • Does the child have diarrhoea?
  • For how long?
  • Is there blood in the stool?
Look, listen, feel
  • Look at the child's general condition. Is the child Restless, irritable?
  • Look for sunken eyes.
  • Offer the child fluid. Is the child Drinking eagerly, thirsty?
  • Pinch the skin of the abdomen. Does it go back Slowly?
Classification
  • Two or more of the following signs: (Restless, irritable) OR (Sunken eyes) OR (Drinks eagerly, thirsty) OR (Skin pinch goes back slowly) -> SOME DEHYDRATION
Urgency / Refer urgently

Treat at Clinic (Plan B)

Pre-referral treatment
  • If referring due to co-existing severe classification: Give frequent sips of ORS on the way. Keep child warm. Give other needed pre-referral treatments.
Management
Non-Pharmacological Management
  • Supervise administration of ORS in clinic.
  • Continue breastfeeding frequently.
  • After 4 hours, reassess hydration status.
Pharmacological Treatment
  • TREAT WITH PLAN B:
  • Give recommended amount of ORS over 4-hour period in the clinic. Amount based on weight or age: <6kg (<6m): 200-450ml; 6-<10kg (6-<12m): 450-800ml; 10-<12kg (12m-<2y): 800-960ml; 12-<20kg (2y-5y): 960-1600ml. (Approximate amount in ml = weight in kg x 75).
  • Show the mother how to give ORS: frequent small sips from a cup.
  • If child vomits, wait 10 minutes, then continue ORS but more slowly.
  • If the child wants more ORS than calculated, give more.
  • If eyelids become puffy, stop ORS and give plain water or breastmilk; resume Plan B when puffiness is gone.
  • After 4 hours: Reassess the child and classify dehydration. Select appropriate plan (A, B, or C) to continue treatment.
  • Begin feeding the child in clinic after 4 hours.
  • Give Zinc Sulphate 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of expressed breastmilk, ORS or clean water.
  • If child also has a severe classification: Refer URGENTLY to hospital. Give frequent sips of ORS on the way. Advise mother to continue breastfeeding.
Monitoring & Follow-Up
  • If hydration improves and child is discharged on Plan A: Follow-up in 5 days if not improving.
  • If Plan B needs to be repeated or other issues arise: Follow-up as needed.
  • Advise mother to return immediately if signs of dehydration worsen or other danger signs appear.
Counselling Points
  • Explain that the child needs special fluids (ORS) because of dehydration.
  • Show the mother how much ORS to give over 4 hours.
  • Show how to give ORS (sips from cup, what to do if vomits).
  • Explain the importance of Zinc and show how to give it for 10 days.
  • If mother must leave before 4 hours: Show her how to prepare ORS at home. Show how much ORS to give to finish the 4-hour treatment. Explain the 4 Rules of Home Treatment (Give Extra Fluid, Give Zinc, Continue Feeding, When to Return).
  • Advise mother when to return immediately (signs listed on page 30 - not drinking, sicker, fever; for diarrhoea also: blood in stool, drinking poorly).
Differential Diagnosis
  • Severe Dehydration
  • No Dehydration
  • Early sepsis (child may be irritable)
Potential Complications
  • Progression to severe dehydration
  • Electrolyte imbalance (less common if ORS used correctly)
  • Persistent vomiting leading to treatment failure
Prevention
  • Exclusive breastfeeding for 6 months.
  • Use of safe water and sanitation.
  • Handwashing with soap.
  • Appropriate complementary feeding.
  • Measles vaccination.
  • Rotavirus vaccination (if available).
  • Prompt use of ORS and Zinc at the start of diarrhoea.
  • Continued feeding during diarrhoea.

Reference: IMCI Chart Booklet - Page 3, Page 16 (Plan B, Zinc), Page 30

No Dehydration 2 months - 5 years

Home Management (Plan A) High match
What to tell caregiver
  • Explain the 4 Rules of Home Treatment clearly.
  • Teach how to prepare and give ORS solution.
  • Teach how to give Zinc supplement for the full 10 days.
  • Emphasize continuing feeding and giving extra fluids.
  • Clearly explain the signs that require immediate return to the clinic.

Classification for a child with diarrhoea who does not have sufficient signs to classify as Some or Severe Dehydration. Requires home management with increased fluids, zinc, continued feeding, and advice on when to return (Plan A).

Key Features
  • Absence of sufficient signs for Some or Severe Dehydration classification.
  • Management focuses on preventing dehydration and providing nutritional support at home (Plan A).
Red Flags (Warning Signs)
  • Development of signs of dehydration (thirst, restlessness, sunken eyes, slow skin pinch).
  • Increased stool frequency/volume.
  • Inability to keep up with fluid intake.
  • Development of any danger sign.
Assessment
Ask
  • Does the child have diarrhoea?
  • For how long?
  • Is there blood in the stool?
  • Confirm absence of TWO or more signs of Some or Severe Dehydration (Child is not lethargic/unconscious, not restless/irritable; eyes are not sunken; drinks normally, not thirsty; skin pinch goes back immediately).
Classification
  • Not enough signs to classify as Some or Severe Dehydration -> NO DEHYDRATION
Urgency / Refer urgently

Home Management (Plan A)

Management
Non-Pharmacological Management
  • Treat with Plan A: Home Care to prevent dehydration and malnutrition.
  • Counsel mother on the 4 Rules of Home Treatment:
Pharmacological Treatment
  • 1. Give Extra Fluid: As much as the child will take. Tell mother: Breastfeed frequently and longer. If exclusively breastfed, give ORS or clean water in addition. If not exclusively breastfed, give ORS or food-based fluids (soup, rice water, yoghurt drinks). Give after each loose stool: Age < 2 years: 50-100 ml. Age 2 years or more: 100-200 ml. Teach how to mix and give ORS (give 2 packets to use at home).
  • 2. Give Zinc Sulphate: Give 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of EBM, ORS or clean water.
  • 3. Continue Feeding: Continue usual feeding practices. (Exclusive breastfeeding if <6m).
  • 4. When to Return: Advise mother to return immediately if child develops any danger sign (becomes sicker, not able to drink/breastfeed, develops fever) OR signs of dehydration (drinking poorly, becomes very thirsty, sunken eyes) OR has blood in stool.
Monitoring & Follow-Up
  • Follow-up in 5 days ONLY IF not improving (e.g., diarrhoea persists, feeding problems).
  • Advise immediate return if danger signs or signs of dehydration develop.
Counselling Points
  • Explain the 4 Rules of Home Treatment clearly.
  • Teach how to prepare and give ORS solution.
  • Teach how to give Zinc supplement for the full 10 days.
  • Emphasize continuing feeding and giving extra fluids.
  • Clearly explain the signs that require immediate return to the clinic.
Differential Diagnosis
  • Some Dehydration (mild)
  • Toddler's diarrhoea (chronic non-specific diarrhoea, usually no dehydration)
Potential Complications
  • Dehydration (if fluid intake is inadequate)
  • Malnutrition (if feeding is stopped or inadequate)
Prevention
  • Exclusive breastfeeding for 6 months.
  • Use of safe water and sanitation.
  • Handwashing with soap.
  • Appropriate complementary feeding.
  • Measles vaccination.
  • Rotavirus vaccination (if available).
  • Prompt use of ORS and Zinc at the start of diarrhoea.
  • Continued feeding during diarrhoea.

Reference: IMCI Chart Booklet - Page 3, Page 16 (Plan A, Zinc), Page 30

Dysentery 2 months - 5 years

Routine Management / Treat with Antibiotic High match
What to tell caregiver
  • Explain the diagnosis (dysentery) and the need for antibiotic.
  • Teach how to give Ciprofloxacin: correct dose, frequency (twice daily), duration (full 3 days).
  • Teach how to give Zinc for 10 days.
  • Advise on giving extra fluids (ORS/home fluids) and continuing feeding.
  • Advise when to return immediately (danger signs, signs of dehydration, worsening dysentery).
  • Advise on follow-up visit in 2 days.

Classification for a child with diarrhoea who has blood visible in the stool. Requires treatment with an appropriate antibiotic effective against Shigella.

Key Features
  • Presence of blood in the stool is the defining feature.
  • Requires treatment with an antibiotic effective against Shigella (first-line typically Ciprofloxacin in this guideline).
Red Flags (Warning Signs)
  • Signs of severe dehydration.
  • High fever.
  • Convulsions.
  • Abdominal distension or severe pain.
  • Failure to respond to first-line antibiotic.
Assessment
Ask
  • Does the child have diarrhoea?
  • Is there blood in the stool? (Confirm visually if possible, or rely on mother's report).
Classification
  • Blood in the stool -> DYSENTERY
Urgency / Refer urgently

Routine Management / Treat with Antibiotic

Pre-referral treatment
  • If severe dehydration or another severe classification is present, provide appropriate pre-referral treatments along with the first dose of Ciprofloxacin if possible before urgent referral.
Management
Non-Pharmacological Management
  • Treat dehydration according to classification (Plan A, B, or C) if present.
  • Advise on increased fluid intake (Plan A principles).
  • Continue feeding.
Pharmacological Treatment
  • Give oral Ciprofloxacin twice daily for 3 days. Dosage (15mg/kg/day divided twice daily): Age <6m: 125mg per dose (1/4 of 500mg tab or 1/2 of 250mg tab). Age 6m-5y: 250mg per dose (1/2 of 500mg tab or 1 of 250mg tab).
  • Give Zinc Sulphate 10-20mg once daily for 10 days (as per doses in Plan A/B).
Monitoring & Follow-Up
  • Follow up in 2 days.
  • At follow-up (Day 2):
  • Assess general condition, check for fever, dehydration, abdominal pain, number of stools, blood in stool, feeding.
  • If dehydrated: Treat dehydration (Plan B or C).
  • If condition is worse (more stools, more blood, higher fever, worse abdominal pain, poor feeding) OR same: Change to second-line oral antibiotic recommended locally for Shigella (treat for 5 days). Advise return in 2 days OR Refer to hospital (especially if <12m, dehydrated on first visit, or had measles recently).
  • If improving (fewer stools, less blood, less fever, less pain, eating better): Continue Ciprofloxacin for the full 3 days. Ensure mother understands oral rehydration and feeding.
Counselling Points
  • Explain the diagnosis (dysentery) and the need for antibiotic.
  • Teach how to give Ciprofloxacin: correct dose, frequency (twice daily), duration (full 3 days).
  • Teach how to give Zinc for 10 days.
  • Advise on giving extra fluids (ORS/home fluids) and continuing feeding.
  • Advise when to return immediately (danger signs, signs of dehydration, worsening dysentery).
  • Advise on follow-up visit in 2 days.
Differential Diagnosis
  • Amoebiasis (less common cause of dysentery in young children compared to Shigella)
  • Campylobacter infection
  • Salmonella infection (non-typhoidal)
  • E. coli (invasive strains)
  • Intussusception (may present with 'red currant jelly' stool)
  • Anal fissure (streaks of fresh blood on stool surface)
  • Allergic colitis (e.g., milk protein allergy)
Potential Complications
  • Severe dehydration
  • Sepsis
  • Intestinal perforation (rare)
  • Toxic megacolon (rare)
  • Hemolytic Uremic Syndrome (HUS - associated with E.coli O157:H7, rare Shigella strains)
  • Reactive arthritis
  • Persistent diarrhoea
  • Malnutrition
Prevention
  • Handwashing with soap (especially after toilet use, before handling food).
  • Safe disposal of faeces.
  • Use of safe drinking water.
  • Safe food handling practices.
  • Exclusive breastfeeding.
  • Measles vaccination.

Reference: IMCI Chart Booklet - Page 3, Page 14 (Ciprofloxacin), Page 16 (Zinc), Page 22 (Follow-up)

Features

IMCI Guidelines

Quickly access assessment, classification, and treatment guidance from the IMCI handbook.

Symptom Search

Search by condition name, keyword, or common symptoms such as fever, cough, or diarrhoea.

Age Groups

Separate guidance for young infants 0-2 months and children 2 months-5 years.

Red Flags

Identify urgent warning signs early and know when referral is needed.

Common Conditions Quick Access

Respiratory

Cough / Pneumonia

Guidance for assessing cough, difficult breathing, and classifying pneumonia severity.

Search Now
Gastrointestinal

Diarrhoea / Dehydration

Protocols for diarrhoea assessment, dehydration levels, and fluid management.

Search Now
Systemic

Fever / Malaria

Steps for managing fever, malaria testing, and treating febrile illness.

Search Now
Severe Illness

Danger Signs

Identify general danger signs that need urgent referral and immediate action.

Search Now

Important Disclaimer

This search tool is for informational and educational use by trained health workers using IMCI guidance. It is not a substitute for professional medical diagnosis, treatment, or emergency care. Parents and caregivers should seek qualified medical help immediately when a child is unwell.

Ready to find information?

Go to the Search Tool

Want notes in PDF? Join our classes!!

Send us a message on WhatsApp
0726113908

Scroll to Top
Enable Notifications OK No thanks