Chapter 5. Diarrhoea

This chapter gives treatment guidelines on the management of acute diarrhoea (with severe, some, or no dehydration), persistent diarrhoea and dysentery in children aged 1 week to 5 years. Assessment of severely malnourished children is described in sections 7.2 and 7.4.3). The three essential elements in the management of all children with diarrhoea are rehydration therapy, zinc supplementation and counselling for continued feeding and prevention.

In diarrhoea, there is excess loss of water, electrolytes (sodium, potassium, and bicarbonate) and zinc in liquid stools. Dehydration occurs when these losses are not adequately replaced and there are deficits of water and electrolytes. The degree of dehydration is graded according to symptoms and signs that reflect the amount of fluid lost; see chapter 2.3  and 5.2. The rehydration regimen is selected according to the degree of dehydration. All children with diarrhoea should receive zinc supplements.

During diarrhoea, decreased food intake and nutrient absorption and increased nutrient requirements often combine to cause weight loss and failure to grow. Malnutrition can make diarrhoea more severe, more prolonged and more frequent than in well-nourished children. This vicious circle can be broken by giving nutrient-rich foods during and continuing after the diarrhoea episode, when the child is well.

Antibiotics should not be used except for children with bloody diarrhoea (probable shigellosis), suspected cholera with severe dehydration, and other serious non-intestinal infections such as pneumonia and urinary tract infection. Antiprotozoal drugs are rarely indicated. ‘Anti-diarrhoeal’ drugs and anti-emetics should not be given to young children with acute or persistent diarrhoea or dysentery: they do not prevent dehydration or improve nutritional status, and some have dangerous, sometimes fatal, side-effects.