This document provides guidance on diagnosing and treating diarrhoea in infants and young children. It defines diarrhoea and outlines signs of dehydration. Dehydration is classified as none, some or severe based on symptoms like restlessness, sunken eyes and skin pinch test. Treatment plans involving oral rehydration solution and continued feeding are provided according to dehydration level. Persistent and bloody diarrhoea require additional treatment and follow up. The guidelines aim to safely treat diarrhoea at home or refer urgently when needed.

1. IMNCI: Diarrhoea
Dr. Ramya S

2. DIARRHOEA
• A young infant is considered to have diarrhoea if
the stools have changed from usual pattern and
are many and watery (more water than faecal
matter).

3. Determine the level of dehydration
Depending on the degree of dehydration,
an infant with diarrhoea may be lethargic
or unconscious or look restless/irritable.
Only infants who cannot be consoled and
calmed should be considered restless or
irritable
Infant’s general condition.

4. Determine the level of dehydration.
Sunken eyes.

5. Determine the level of dehydration.
Check elasticity of skin using the skin
pinch test. When released, the skin pinch
goes back either very slowly (longer than
2 seconds), or slowly (skin stays up even
for a brief instant), or immediately.
Elasticity of skin

6. Locate the area on the child's abdomen halfway between the umbilicus and the
side of the abdomen; then pinch the skin using the thumb and first finger.
Place your hand in such a way that when the skin is pinched, the fold of skin will
be in a line up and down the child's body and not across the child's body.

8. Sick young infant upto 2 months
Two of the
following signs:
Classify Treatment
• Movement only
when stimulated
or no movement
at all
• Sunken eyes
• Skin pinch goes
back very slowly
SEVERE
DEHYDRATION
If no other severe
classification give
fluid as per PLAN C
or
If infant has another
severe classification,
Refer URGENTLY
with mother giving
frequent sips of ORS
on the way
Advise mother to
continue
breastfeeding

9. Two of the
following
signs:
Classify Treatment
• Restless
and
irritable
• Sunken
eyes
• Skin pinch
goes back
slowly
SOME
DEHYDRATION
• Give fluid and breastmilk as per
PLAN B
• If infant has any severe
classification, Refer URGENTLY
with mother giving frequent
sips of ORS on the way
• Advise mother to continue
breastfeeding
• Advise mother when to return
• Follow-up in 2 days if not
improving

10. Signs Classification Treatment
• Not enough
signs to
classify as
some or
severe
dehydration
NO
DEHYDRATION
• Give fluids to treat
diarrhea at home and
continue breastfeeding as
per PLAN A.
• Advise mother when to
return immediately
• Follow up in 2 days if not
improving

11. Two of the
following signs:
Classify Treatment
• Lethargic or
unconscious
• Not able to drink
or drinking
poorly
• Sunken eyes
• Skin pinch goes
back very slowly
SEVERE
DEHYDRATION
If no other severe
classification give fluid
as per PLAN C or
If child has another
severe classification,
Refer URGENTLY with
mother giving
frequent sips of ORS
on the way
Advise mother to
continue breastfeeding
Sick child 2 months upto 5 years

12. Two of the
following
signs:
Classify Treatment
• Restless,
irritable
• Drinks
eagerly,
thirsty
• Sunken
eyes
• Skin pinch
goes back
slowly
SOME
DEHYDRATION
• Give fluid, zinc supplements
and food as per PLAN B
• If child has any severe
classification, Refer URGENTLY
with mother giving frequent
sips of ORS on the way
• Advise mother to continue
breastfeeding
• Advise mother when to return
• Follow-up in 5 days if not
improving

13. Signs Classification Treatment
• Not enough
signs to
classify as
some or
severe
dehydration
NO
DEHYDRATION
• Give fluid, zinc
supplements and food to
treat diarrhea at home as
per PLAN A.
• Advise mother when to
return immediately
• Follow up in 5 days if not
improving

14. Signs Classify Treatment
• Dehydration
present
SEVERE
PERSISTENT
DIARRHOEA
Treat dehydration
before referral
unless the child has
another severe
classification
Refer to hospital
If diarrhea present for 14 days or more

15. Signs Classify Treatment
No de-
hydration
PERSISTENT
DIARRHOEA
• Advise the mother on
feeding a child who
has PERSISTENT
DIARRHOEA
• Give multi-vitamins
and minerals including
Zinc for 14 days
• Follow-up in 5 days

16. Sign Classify Treatment
• Blood in
stool
DYSENTERY
• Give Ciprofloxacin for
3 days
• Follow-up in 3 days

17. • Give extra fluid
• Give Zinc (2 months
up to 5 yrs)
• Continue feeding
• When to return
4 Rules of
Home
treatment
17
NO DEHYDRATION: PLAN A-
TREAT DIARRHOEA AT HOME

18. Extra fluid
Age Extra fluid to be given
Up to 2 yrs 50 to 100 ml after each
loose stool
2 yrs or more 100 to 200 ml after each
loose stool

19. Zinc supplementation (2 months to 5 yrs)
Age Dose (Zinc 20 mg tab)
2 to 6 months ½ tablet daily for 14 days
6 months or more 1 tablet daily for 14 days

20. SOME DEHYDRATION: PLAN B-
TREAT WITH ORS
Amount of ORS to be given during first 4 hrs:
Weight < 6 kg 6- < 10 kg 10 - < 12
kg
12 – 19 kg
Age Up to 4
months
4 to 12
months
12 months
up to 2 yrs
2 to 5 yrs
In ml 200-450 450-800 800-960 960-1600

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The approximate amount of ORS
required (in ml) can also be
calculated by multiplying the child’s
weight (in kg) times 75.

22. SEVERE DEHYDRATION: PLAN C-
Intravenous fluid
Give 100 ml/kg Ringer Lactate divided as follows:
Age First give
30 ml/kg in
Then give
70 ml/kg in
Infants (under 12
months)
1 hr 5 hrs
Children (12
months up to 5
yrs)
30 min 2 ½ hrs

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24. Thank you