Diarrhea is common in children under 5 years old and is a major cause of morbidity and mortality. It is defined as frequent, loose or liquid stool. The main causes are bacteria, viruses and parasites. Risk factors include lack of exclusive breastfeeding, poor hygiene and malnutrition. Clinical manifestations depend on the cause but often include vomiting and fever. Dehydration is a key complication and is assessed based on vital signs, weight and physical signs. Management involves oral rehydration, continued feeding and use of zinc and antibiotics in some cases. Prevention focuses on breastfeeding, clean water, handwashing and nutrition.

1. DIARHEA IN CHILDREN
CREATED: Rifka Nur Anisa (41181396100013)
SUPERVISED BY DR. PULUNG M. SILALAHI, SP.A

2. Definition
 When someone defecates with a soft
or liquid consistency, it can even be
water only and the frequency is more
frequent than usual (3x or more) in
one day.

3. Epidemiology
In infant death (age 29 days-11 months)  diarrhea
(31.4%) and pneumonia (23.8%).
In children under five (aged 12-59 months) 
diarrhea (25.2%) and pneumonia (15.5%).
Diarrhea is one of the causes of high morbidity & mortality rates in
children <5 years old worldwide (1 billion in pain & 3 million deaths per
year).

4. Transmission

5. Risk Factors
Do not do
exclusive
breastfeedi
ng
Water
contamination
Lack of
cleaning
facilities
(MCK)
Immunodeficiency
Poor food
hygiene
preparation and
storage
Poor
environmental
and personal
hygiene
Malnutrition
Decreased
intestinal
motility
Decreased
stomach acid

6. Risk Factors
Ag
e
Most episodes of diarrhea occur in the first 2 years of life.
(6-11 month  complemented food with breastmilk is
given)
Asymptomatic
infection
Most intestinal infections are asymptomatic and the
proportion of these asymptomatic increases after the
age of 2 years due to the formation of active
immunity
Seasonal
factors
Rotavirus : throughout the year with an increase
during the dry season.
Bacteria : the rainy season.

7. Etiology
BACTERIA VIRUS PARASITE
Aeromonas Astrovirus Balantidium coli
Bacillus cereus Calcivirus (Norovirus, Sapovirus) Blastocystis homonis
Canpilobacter jejuni Enteric adenovirus Crytosporidium parvum
Clostridium perfringens Coronavirus Entamoeba histolytica
Clostridium defficile Rotavirus Giardia lamblia
Escherichia coli Norwalk virus Isospora belli
Plesiomonas shigeloides Herpes simpleks virus Strongyloides stercoralis
Salmonella Cytomegalovirus Trichuris trichiura
Shigella
Staphylococcus aureus
Vibrio cholera
Vibrio parahaemolyticus
Yersinia enterocolitica
- Infection
- Non-infection

8. Classification
Duration
- Acute diarrhea : < 14
days
- Persistent diarrhea : > 14 days
- Prolonged diarrhea : 7-14 days

9. Pathophysiology
Osmotic/ absorption
disorders
There is food
or substance
that can not be
absorbed
Osmotic
pressure in the
intestinal cavity
rises
Shifting of water
and electrolytes
(Na) into the
intestinal cavity
Excessive contents
of the intestinal
cavity will stimulate
the intestines to
expel them
Diarrhea

10. Pathophysiology
Secretion disorders
Due to certain
causes (eg toxins)
in the intestinal wall
There will be an
increase in
secretion, water
and electrolytes
into the cavity in
the intestinal wall
Increased
intestinal cavity
contents
Diarrhea

11. Pathophysiology
(Rotavirus)

12. Clinical Manifestation
(Based on etiology)
Viral
Bacteria
l
Protozo
a
• Vomiting followed by diarrhea and fever
• No fecal leukocytes
• Recovery occurs within 7 days
• Fever is found > 40 0C
• Bloody stool, Abdominal pain
• No vomiting before diarrhea
• > 10 times / day
• > 7 days
• Expulsive diarrhea accompanied by
vomiting, abdominal cramps, and
flatulence.

14. Clinical Manifestation
(Dehydration)

15. Clinical Manifestation
(Dehydration)

16. Clinical Manifestation
(Dehydration)

17. Diagnosis
ANAMNESIS
Diarrhea symptoms and risk
factors
PHYSICALEXAMINATION
Vitalsigns, weight, dehydration
signs, perianal rash.
LABORATORIUM
Serumelectrolytes, arterialblood
gas,stool analysis, stool culture

19. Pemeriksaan Fisik

21. Managements

22. Managements (Rehydration)

23. Managements (Rehydration)

24. Managements (Rehydration)

25. Managements (Rehydration)

27. Managements
Correction of acid base and imbalance
electrolyte

28. Managements
Correction of acid base and imbalance
electrolyte

29. Zink
<6 months:
½ tablet (10 mg)
per day for 10 days
>6 months:
1 tablet (20 mg)
per day for 10 days

30. Antibiotics should not be used routinely
Diarrhea with blood (mostly due to shigellosis),
suspected cholera.

31. Complications
Electrolyt
e
Imbalanc
e
Edema/
Over-
hydration
Seizure
Colitis
pseudom
embranos
a
Metabolic
acidosis
Paralytic
Ileus

32. Preventions

33. References
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