Written by Timothy Okooboh
As a healthcare provider, what questions do you ask and what do you look out for in a child with diarrhoea?
According to WHO, diarrhoea is the second leading killer of children under the age of five. Diarrhoea is the passage of loose or watery stools occurring three or more times in a 24 hour period (or more frequent passage than is normal for the individual).
In the past, for most people, severe dehydration and fluid loss were the main causes of deaths from diarrhoea. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths. Therefore, every child presenting with diarrhoea should be properly assessed by the healthcare provider in order to classify the disease into one of three groups: diarrhoea with no dehydration, diarrhoea with some dehydration, and diarrhoea with severe dehydration.
This simple assessment can also help to determine whether it is bloody diarrhoea (dysentery). The essence of this simple assessment is to determine the severity of diarrhoea, appropriate treatment choices, and need for referral.
Steps in assessing a child with diarrhoea
Step 1: Ask the caregiver if the child has diarrhoea.
NB: Ensure the caregiver (e.g. the mother) knows what diarrhoea is: passage of loose or watery stools at least three times within 24 hours.
Step 2: If yes, ask for how long.
This can help to determine if the child has acute or persistent diarrhoea. Diarrhoea less than 14 days is acute; diarrhoea greater than or equal to 14 days is persistent. Persistent diarrhoea in children increases the risk for other infections, malnutrition, and death.
Step 3: Ask if there is blood in the stool.
This can help to determine if it is dysentery (bloody diarrhoea). Bloody diarrhoea would require administration of an appropriate antibiotic, as it indicates infection by invasive pathogens that cause inflammation of the intestinal barrier.
Step 4: Assess for signs of dehydration.
Look at the child’s general condition and determine if the child is irritable/restless or lethargic/unconscious. Also, look at the child’s eyes if they are sunken. If you can’t determine whether the eyes are sunken, ask the caregiver if the eyes appear unusual.
Step 5: Offer the child fluid (water or ORS) and observe the reaction.
Does the child drink eagerly as if thirsty?, does the child drink poorly or is unable to drink?, does the child drink normally?.
Step 6: Carry out the skin pinch test.
Pinch the skin of the abdomen by placing your thumb and first finger halfway between the umbilicus and side of the abdomen. Does the skin return back slowly, very slowly or immediately?
If two or more of the following signs are present, then the child has diarrhoea with some dehydration:
- Sunken eyes
- Restless or irritable
- Drinks eagerly or thirsty
- Skin pinch goes back slowly.
If two or more of the following signs are present, then the child has diarrhoea with severe dehydration:
- Sunken eyes
- Lethargic or unconscious
- Not able to drink or drinks poorly
- Skin pinch goes back very slowly (>2 seconds).
Diarrhoea without any of those signs is diarrhoea with no dehydration.
No matter the classification of diarrhoea, the immediate treatment is to replace lost fluids and electrolytes until the diarrhoea stops.
How significant is this assessment?
It can help to classify diarrhoea as diarrhoea with some dehydration, diarrhoea with severe dehydration, and diarrhoea with no dehydration.
So what? Let’s assume a child who presents with diarrhoea has sunken eyes plus inability to drink or drinks poorly, this assessment can help you to classify the condition as diarrhoea with severe dehydration.
Therefore, immediate treatment of choice will be to replace lost fluids with intravenous fluids and not with oral fluids (since the child can’t drink). This implies an immediate referral to the health centre instead of dispensing ORS to the mother to be administered at home as would have been the case in diarrhoea with some dehydration or diarrhoea with no dehydration (where ORS will be given to prevent dehydration).
It can also help to diagnose dysentery where initiation of antibiotics, apart from fluid replacement, will be needed.
As a healthcare provider, when next you meet a child with diarrhoea, do well to apply this step by step guide and see if the outcome of the assessment will not improve your intervention in children with diarrhoea. I bet it will! Also, apart from the steps above, you can check for fever, as diarrhoea may be a symptom of an underlining disease.
To see the practical demonstration of the assessment of a child with diarrhoea, you can watch this video⇒https://youtu.be/fdWSS6H1q8Y
You can make your comments below. Help share this article.