By ULY CLINIC Staff,
Persistent diarrhoea in Children
Diarrhoea lasting 14 days or longer without remission in between. When there are signs of some or severe dehydration, it is classified as “severe persistent diarrhoea”
Diagnostic Criteria
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Diarrhoea for 14 days or more
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No remission in between
Investigations
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Stool analysis
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Stool culture and sensitivity.
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Stool pH and reducing substances
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Serum electrolytes (Na, K, Cl, Ca),
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Serum Creatinine, BUN
Treatment
Non-Pharmacological Treatment
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Encourage breast feeding (high purging rate, reappearance of dehydration) give diet two
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For infants >6months of age, Give diet one for 7days. If no improvement
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When child improves return to appropriate diet.
Diet one: starch based, reduced milk (low lactose)
It contains at least 70 calories/100g. 10% of calories as protein but lactose should not be more than 3.7g/kg body weight/day.
Full fat diet
Full –fat dried milk---------11g or (whole liquid milk 85ml)
Rice---------------------------15g
Vegetable oil-----------------3.5g
Sugar-------------------------3g
Water to make 200ml
With this diet 130 ml/kg provides 110Kcal/kg
Diet two: A milk free (lactose- free) diet and Cereal (starch)
It contains 70 calories/100mls at least 10% of calories as protein (egg or chicken)
Free lactose diet
Whole egg----------------------64g
Rice-----------------------------30g
Vegetable oil-------------------4g
Glucose-------------------------3g
Water to make 200ml
With this diet, 145ml/Kg provides 110Kcal/Kg. If grinded chicken (12g) is used in place of an egg, the diet provides 70Kcal per 100g.
Pharmacological Treatment
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Treat dehydration/electrolyte imbalance if present as above
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Give folic acid PO 5mg once daily for 14 days
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Give Zinc Sulphate- for Children under 6 months 10 mg orally once a day for 10 days, for children Six months and above 20 mg orally once a day for 10 days
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Give multivitamin 1 tablet once daily for 14 days
Note:
Refer children with severe malnutrition, Persistent diarrhoea not responding to treatment and Infants below six months to next level with adequate expertise and facility
Last updated on 06.09.2020
References
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Tanzanian Standard treatment guideline for children 2017 edition page 72-73