Topic:ARI and Diarrhea of under five and their management.
Question: Define persistent diarrhea in children. How would you manage a case of persistent diarrhea.
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Definition of Persistent Diarrhea in Children (according to WHO): Persistent diarrhea in children is defined as the presence of diarrhea that lasts for 14 days or more, and it is a significant health issue associated with increased morbidity and mortality.
Management of Persistent Diarrhea in Children (as per WHO guidelines):
- Rehydration:
- Begin with the assessment of hydration status. Severe dehydration requires prompt correction using oral rehydration solution (ORS) or, in severe cases, intravenous fluids.
- Nutritional Support:
- Ensure adequate nutritional support. Encourage continued breastfeeding for infants and provide appropriate dietary options for older children to prevent malnutrition.
- Zinc Supplementation:
- Administer zinc supplementation. WHO recommends a 10- to 14-day course of zinc supplementation for all children with persistent diarrhea to reduce the duration and severity of the episode.
- Continue Feeding:
- Encourage continued feeding during the episode. There is a shift from the previous practice of fasting; now, children with diarrhea are encouraged to continue their usual diet.
- Antimicrobial Treatment:
- Consider antimicrobial treatment if there is evidence of a bacterial infection. Antibiotics may be prescribed based on the specific pathogen identified or suspected.
- Monitoring and Follow-up:
- Regularly monitor the child’s hydration status, nutritional intake, and general well-being. Schedule follow-up visits to assess progress, adjust treatment if needed, and address any emerging issues.
- Exclusive Breastfeeding:
- For infants, exclusive breastfeeding is emphasized. Mothers should be encouraged to continue breastfeeding, and complementary feeds can be introduced based on the child’s age and nutritional needs.
- Oral Rehydration Solution (ORS):
- Promote the use of ORS as the primary fluid for rehydration. Homemade solutions, fruit juices, and sugary drinks should be avoided.
- Probiotics:
- Consider the use of probiotics, especially in settings where they are readily available. Probiotics may help restore normal gut flora and reduce the duration of diarrhea.
- Health Education:
- Provide health education to caregivers on proper hygiene practices, safe water and food handling, and the importance of seeking medical attention if symptoms worsen.
- Referral for Severe Cases:
- For severe or complicated cases, referral to a higher level of care may be necessary. This includes cases of persistent diarrhea with signs of severe malnutrition or other complications.
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