Acute Diarrhoea in Children
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define acute diarrhoea and describe its common causes.
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Identify signs and symptoms of diarrhoeal illness and dehydration.
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Assess hydration and nutritional status accurately.
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Implement fluid management according to WHO/Zambian guidelines (Plans A, B, C).
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Understand the role of zinc supplementation and continued feeding.
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Recognize when antibiotics or other drugs are indicated.
Description
Acute diarrhoea is the passage of three or more loose or watery stools per day, or one voluminous loose/watery stool. Causes may be infectious (bacterial, viral, parasitic, or systemic infections) or non-infectious (food poisoning, drugs, food intolerance or allergy, intestinal disease).
Causes
| Category | Examples |
|---|---|
| Bacterial | Vibrio cholerae, Salmonella spp., Shigella, E. coli, Campylobacter pylori |
| Viral | Rotavirus, Norovirus, Adenovirus, Astrovirus, Norwalk virus |
| Parasitic | Giardia lamblia, Entamoeba histolytica, Cryptosporidium |
| Systemic infections | Influenza, measles, malaria, HIV, pneumonia, UTI, meningitis, sepsis |
| Non-infectious | Food poisoning, drugs (antibiotics, antihypertensives, antacids), lactose intolerance, food allergy (cow’s milk, soya), inflammatory bowel disease, coeliac disease |
Signs and Symptoms
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Watery or loose stools ± blood (dysentery)
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Abdominal cramps, pain, urgency, tenesmus
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Vomiting, poor appetite, fever
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Signs of dehydration (see Table below)
Assessment of Hydration Status (WHO Classification)
| Feature | No Dehydration | Some Dehydration | Severe Dehydration |
|---|---|---|---|
| General condition | Well, alert | Restless, irritable | Lethargic or unconscious |
| Eyes | Normal | Sunken | Very sunken |
| Thirst | Drinks normally, not thirsty | Thirsty, drinks eagerly | Drinks poorly, or not able to drink at all |
| Skin pinch | Goes back quickly | Goes back slowly (<2 sec) | Goes back very slowly (>2 sec) |
Fluid Management Plan
| Plan | Hydration Status | Action |
|---|---|---|
| Plan A | No dehydration | Oral Rehydration Solution (ORS) per loose stool: <2 yrs: 50–100 mL, 2–5 yrs: 100–200 mL, >5 yrs: freely as tolerated |
| Plan B | Some dehydration | ORS: 75 mL × weight (kg) over 4 hours; reassess and adjust accordingly |
| Plan C | Severe dehydration | Rapid IV rehydration: 100 mL/kg Ringer’s Lactate or ½ strength Darrow’s with 5–10% dextrose; reassess every 1–2 hours. Repeat once if no improvement. |
Notes:
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IV fluids are required only for shock, severe acidosis, ileus, altered consciousness, resistant vomiting, or lack of improvement after 4 hours of ORS.
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If IV therapy unavailable, ORS can be given via nasogastric tube (20 mL/kg/hour × 6 hours).
Zinc Supplementation
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Infants <6 months: 10 mg daily for 10–14 days
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Children ≥6 months: 20 mg daily for 10–14 days
Nutritional Support
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Assess malnutrition according to WHO standards.
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Continue feeding during diarrhoea; avoid juices, carbonated drinks, and cereal-based ready-to-drink preparations.
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Children with diarrhoea and malnutrition are at higher risk of fluid overload and serious bacterial infection — individualized rehydration is required.
Drug Therapy
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Antibiotics: Not indicated for most acute watery diarrhoea; indicated for dysentery or suspected cholera.
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Antimotility agents: Not recommended (e.g., loperamide, diphenoxylate-atropine, tincture of opium) — may cause paralytic ileus.
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Antiemetics: Avoid promethazine; ondansetron may be used up to two doses (0.15 mg/kg).
Key Summary
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Acute diarrhoea = ≥3 loose stools/day or 1 voluminous loose stool
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Major risk: dehydration → assess using WHO table
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Plan A: No dehydration, oral rehydration
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Plan B: Some dehydration, ORS 75 mL/kg over 4 hrs
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Plan C: Severe dehydration, rapid IV rehydration
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Zinc supplementation for 10–14 days
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Continue age-appropriate feeding
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Antibiotics only when indicated; avoid antimotility agents