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Key Features

• Requires TWO or more of the following signs: Lethargic/unconscious, Sunken eyes, Not able to drink/drinking poorly, Skin pinch goes back very slowly (>2 seconds).
• Indicates significant fluid and electrolyte loss.
• Requires immediate fluid resuscitation, preferably with IV fluids (Plan C).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long?
• Ask: Is there blood in the stool?
• Look/Feel: Look at the child's general condition. Is the child Lethargic or unconscious?
• Look/Feel: Look for sunken eyes.
• Look/Feel: Offer the child fluid. Is the child Not able to drink or drinking poorly?
• Look/Feel: Pinch the skin of the abdomen. Does it go back Very slowly (longer than 2 seconds)?

Classification

• Two or more of the following signs: (Lethargic or unconscious) OR (Sunken eyes) OR (Not able to drink or drinking poorly) OR (Skin pinch goes back very slowly) -> SEVERE DEHYDRATION

Management

Non-Pharmacological Management

• If providing Plan C in clinic: Ensure availability of IV fluids, cannulas, giving sets. Monitor hydration status closely.
• If referring: Keep child warm during transport. Continue giving ORS sips frequently if the child can drink.

Pharmacological Treatment

• TREAT WITH PLAN C:
• If IV Therapy Possible Immediately: Start IV fluid immediately. Give 100 ml/kg Ringer's Lactate Solution (or Normal Saline if RL not available), divided as follows: Age < 12 months: Give 30ml/kg in 1 hour, THEN 70ml/kg in 5 hours. Age 12 months - 5 years: Give 30ml/kg in 30 minutes, THEN 70ml/kg in 2 hours.
• Reassess the child every 1-2 hours. If hydration status is not improving, give IV drip more rapidly.
• Also give ORS (about 5 ml/kg/hour) by mouth as soon as the child can drink (usually after 3-4 hrs for infants, 1-2 hrs for children).
• Reassess dehydration status after the initial IV phase (e.g., after 6 hrs for infants, 3 hrs for children) and choose appropriate plan (A, B, or repeat C if needed).
• If IV Therapy Not Available Nearby (<30 mins) or Not Possible:
• If trained in NG tube insertion: Start rehydration by NG tube with ORS solution: give 20 ml/kg/hour for 6 hours (total 120 ml/kg). Reassess every 1-2 hours. If vomiting persists or distension occurs, slow the rate. If hydration not improving after 3 hrs, refer urgently for IV.
• If child can drink: Refer URGENTLY to hospital for IV/NG treatment. Give mother ORS solution and show her how to give frequent sips during the trip.
• If child is 2 years or older AND cholera is in your area: Give appropriate antibiotic for cholera (e.g., Erythromycin).
• If child also has another severe classification (e.g., Severe Pneumonia): Refer URGENTLY after stabilizing airway/breathing and giving essential pre-referral treatments (e.g., antibiotic), give frequent sips of ORS on the way.

Pre-Referral Treatment

• If referring urgently: Ensure airway is clear. Give frequent sips of ORS on the way if child can drink. Keep child warm. Give other essential pre-referral treatments based on other classifications (e.g., antibiotic for severe pneumonia).

Monitoring & Follow-Up

• Managed initially under Plan C, then reassessed and managed according to Plan A or B.
• If discharged on Plan A or B, follow-up as per those plans.

Counselling Points

• If Plan C given in clinic: Explain the procedure and need for close monitoring. Reassure the mother.
• If referring: Explain the seriousness of dehydration and the need for hospital treatment (IV fluids). Show how to give ORS sips frequently during transport. Advise on keeping child warm. Advise mother to continue breastfeeding whenever child wants.

Differential Diagnosis

• Some Dehydration
• Septic shock (may mimic dehydration signs)
• Severe malnutrition with oedema (skin changes may be misleading)
• Other causes of altered consciousness (meningitis, severe malaria)

Potential Complications

• Hypovolemic shock
• Acute kidney injury
• Seizures (due to electrolyte imbalance or hypoglycemia)
• Cerebral edema (if rehydrated too rapidly with hypotonic fluids, rare with ORS/RL/NS)
• Death

Prevention

• Exclusive breastfeeding for 6 months.
• Use of safe water and sanitation.
• Handwashing with soap.
• Appropriate complementary feeding.
• Measles vaccination.
• Rotavirus vaccination (if available).
• Prompt use of ORS and Zinc at the start of diarrhoea.
• Continued feeding during diarrhoea.

Key Features

• Requires TWO or more of the following signs: Restless/irritable, Sunken eyes, Drinks eagerly/thirsty, Skin pinch goes back slowly.
• Absence of signs of severe dehydration.
• Requires supervised administration of ORS over 4 hours (Plan B).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long?
• Ask: Is there blood in the stool?
• Look/Feel: Look at the child's general condition. Is the child Restless, irritable?
• Look/Feel: Look for sunken eyes.
• Look/Feel: Offer the child fluid. Is the child Drinking eagerly, thirsty?
• Look/Feel: Pinch the skin of the abdomen. Does it go back Slowly?

Classification

• Two or more of the following signs: (Restless, irritable) OR (Sunken eyes) OR (Drinks eagerly, thirsty) OR (Skin pinch goes back slowly) -> SOME DEHYDRATION

Management

Non-Pharmacological Management

• Supervise administration of ORS in clinic.
• Continue breastfeeding frequently.
• After 4 hours, reassess hydration status.

Pharmacological Treatment

• TREAT WITH PLAN B:
• Give recommended amount of ORS over 4-hour period in the clinic. Amount based on weight or age: <6kg (<6m): 200-450ml; 6-<10kg (6-<12m): 450-800ml; 10-<12kg (12m-<2y): 800-960ml; 12-<20kg (2y-5y): 960-1600ml. (Approximate amount in ml = weight in kg x 75).
• Show the mother how to give ORS: frequent small sips from a cup.
• If child vomits, wait 10 minutes, then continue ORS but more slowly.
• If the child wants more ORS than calculated, give more.
• If eyelids become puffy, stop ORS and give plain water or breastmilk; resume Plan B when puffiness is gone.
• After 4 hours: Reassess the child and classify dehydration. Select appropriate plan (A, B, or C) to continue treatment.
• Begin feeding the child in clinic after 4 hours.
• Give Zinc Sulphate 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of expressed breastmilk, ORS or clean water.
• If child also has a severe classification: Refer URGENTLY to hospital. Give frequent sips of ORS on the way. Advise mother to continue breastfeeding.

Pre-Referral Treatment

• If referring due to co-existing severe classification: Give frequent sips of ORS on the way. Keep child warm. Give other needed pre-referral treatments.

Monitoring & Follow-Up

• If hydration improves and child is discharged on Plan A: Follow-up in 5 days if not improving.
• If Plan B needs to be repeated or other issues arise: Follow-up as needed.
• Advise mother to return immediately if signs of dehydration worsen or other danger signs appear.

Counselling Points

• Explain that the child needs special fluids (ORS) because of dehydration.
• Show the mother how much ORS to give over 4 hours.
• Show how to give ORS (sips from cup, what to do if vomits).
• Explain the importance of Zinc and show how to give it for 10 days.
• If mother must leave before 4 hours: Show her how to prepare ORS at home. Show how much ORS to give to finish the 4-hour treatment. Explain the 4 Rules of Home Treatment (Give Extra Fluid, Give Zinc, Continue Feeding, When to Return).
• Advise mother when to return immediately (signs listed on page 30 - not drinking, sicker, fever; for diarrhoea also: blood in stool, drinking poorly).

Differential Diagnosis

• Severe Dehydration
• No Dehydration
• Early sepsis (child may be irritable)

Potential Complications

• Progression to severe dehydration
• Electrolyte imbalance (less common if ORS used correctly)
• Persistent vomiting leading to treatment failure

Prevention

• Exclusive breastfeeding for 6 months.
• Use of safe water and sanitation.
• Handwashing with soap.
• Appropriate complementary feeding.
• Measles vaccination.
• Rotavirus vaccination (if available).
• Prompt use of ORS and Zinc at the start of diarrhoea.
• Continued feeding during diarrhoea.

Key Features

• Absence of sufficient signs for Some or Severe Dehydration classification.
• Management focuses on preventing dehydration and providing nutritional support at home (Plan A).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long?
• Ask: Is there blood in the stool?
• Confirm absence of TWO or more signs of Some or Severe Dehydration (Child is not lethargic/unconscious, not restless/irritable; eyes are not sunken; drinks normally, not thirsty; skin pinch goes back immediately).

Classification

• Not enough signs to classify as Some or Severe Dehydration -> NO DEHYDRATION

Management

Non-Pharmacological Management

• Treat with Plan A: Home Care to prevent dehydration and malnutrition.
• Counsel mother on the 4 Rules of Home Treatment:

Pharmacological Treatment

• 1. Give Extra Fluid: As much as the child will take. Tell mother: Breastfeed frequently and longer. If exclusively breastfed, give ORS or clean water in addition. If not exclusively breastfed, give ORS or food-based fluids (soup, rice water, yoghurt drinks). Give after each loose stool: Age < 2 years: 50-100 ml. Age 2 years or more: 100-200 ml. Teach how to mix and give ORS (give 2 packets to use at home).
• 2. Give Zinc Sulphate: Give 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of EBM, ORS or clean water.
• 3. Continue Feeding: Continue usual feeding practices. (Exclusive breastfeeding if <6m).
• 4. When to Return: Advise mother to return immediately if child develops any danger sign (becomes sicker, not able to drink/breastfeed, develops fever) OR signs of dehydration (drinking poorly, becomes very thirsty, sunken eyes) OR has blood in stool.

Monitoring & Follow-Up

• Follow-up in 5 days ONLY IF not improving (e.g., diarrhoea persists, feeding problems).
• Advise immediate return if danger signs or signs of dehydration develop.

Counselling Points

• Explain the 4 Rules of Home Treatment clearly.
• Teach how to prepare and give ORS solution.
• Teach how to give Zinc supplement for the full 10 days.
• Emphasize continuing feeding and giving extra fluids.
• Clearly explain the signs that require immediate return to the clinic.

Differential Diagnosis

• Some Dehydration (mild)
• Toddler's diarrhoea (chronic non-specific diarrhoea, usually no dehydration)

Potential Complications

• Dehydration (if fluid intake is inadequate)
• Malnutrition (if feeding is stopped or inadequate)

Prevention

• Exclusive breastfeeding for 6 months.
• Use of safe water and sanitation.
• Handwashing with soap.
• Appropriate complementary feeding.
• Measles vaccination.
• Rotavirus vaccination (if available).
• Prompt use of ORS and Zinc at the start of diarrhoea.
• Continued feeding during diarrhoea.

Key Features

• Diarrhoea duration of 14 days or more.
• Presence of signs classifying as SOME DEHYDRATION or SEVERE DEHYDRATION.
• High risk for malnutrition and underlying infections (including HIV).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long? (Response is 14 days or more).
• Assess for Dehydration (Look/Feel for signs of Some or Severe Dehydration - see IMCI_2M5Y_005 & 006 assessments).

Classification

• Diarrhoea for 14 days or more AND Dehydration present (Signs of Some or Severe Dehydration) -> SEVERE PERSISTENT DIARRHOEA

Management

Non-Pharmacological Management

• Treat dehydration first (Plan C if severe, Plan B if some) BEFORE referral, unless the child has another severe classification requiring immediate referral.
• If referring, keep child warm.

Pharmacological Treatment

• Treat dehydration as per Plan C or Plan B.
• If child has another severe classification (e.g., Very Severe Febrile Disease), give pre-referral treatments for that condition (e.g., antibiotic, antimalarial).

Pre-Referral Treatment

• Stabilize hydration as much as possible (start Plan C or B).
• Give other essential pre-referral treatments if needed for co-existing severe classifications.
• Keep child warm.
• Advise mother to continue breastfeeding.

Monitoring & Follow-Up

• To be managed at referral hospital, which will investigate cause and provide specialized feeding/treatment.

Counselling Points

• Explain that the long duration of diarrhoea combined with dehydration is serious and requires hospital care.
• Explain any dehydration treatment being given.
• Advise mother to continue breastfeeding frequently.
• Advise on keeping child warm during transport.
• Write a detailed referral note mentioning duration of diarrhoea, dehydration status, and any treatments given.

Differential Diagnosis

• Persistent Diarrhoea (without dehydration)
• Acute Diarrhoea with Dehydration
• Secondary lactose intolerance
• Cow's milk protein allergy
• Other food intolerances/allergies
• Post-enteritis syndrome
• Giardiasis
• Cryptosporidiosis (especially if HIV+)
• Other specific enteropathogens
• Malnutrition-associated gut changes

Potential Complications

• Severe malnutrition
• Micronutrient deficiencies
• Severe dehydration and shock
• Sepsis
• Electrolyte imbalance
• Death

Prevention

• Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
• Good nutrition, Vitamin A.
• Measles vaccination.
• Handwashing, safe water/sanitation.
• Early identification and management of HIV infection.

Key Features

• Diarrhoea duration of 14 days or more.
• Absence of signs of dehydration.
• Management focuses on nutritional rehabilitation and investigating potential underlying causes.

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long? (Response is 14 days or more).
• Assess for Dehydration: Confirm NO DEHYDRATION (Not enough signs for Some or Severe Dehydration).

Classification

• Diarrhoea for 14 days or more AND No Dehydration -> PERSISTENT DIARRHOEA

Management

Non-Pharmacological Management

• Advise the mother on feeding a child with PERSISTENT DIARRHOEA:
• If still breastfeeding: Breastfeed more frequently and longer, day and night.
• If taking other milk: Replace with fermented milk products (e.g., yoghurt) OR Replace half the milk with nutrient-rich semisolid food (e.g., porridge).
• For other foods: Ensure adequate energy intake. Give small, frequent meals (at least 6 times/day). Use foods rich in energy and nutrients. Mix foods well.
• Give foods rich in potassium (e.g., bananas, coconut water).
• Ensure adequate fluid intake using ORS or recommended home fluids after loose stools.
• Check for HIV Infection (refer to HIV assessment algorithm page 8).

Pharmacological Treatment

• Give multivitamins and minerals (including zinc) for 10 days (or longer per local guidelines). Ensure Zinc dose is 10mg (=6m) daily.

Monitoring & Follow-Up

• Follow up in 5 days.
• At follow-up (Day 5):
• Ask: Has diarrhoea stopped? How many stools per day?
• Assess feeding and check for dehydration.
• If diarrhoea has not stopped: Do a full reassessment. Treat dehydration if present. Refer to hospital for assessment (including for ART if HIV+).
• If diarrhoea has stopped: Tell mother to follow usual age-appropriate feeding recommendations. Complete 10 days of zinc.

Counselling Points

• Explain the importance of special feeding during persistent diarrhoea.
• Provide specific, practical advice on recommended foods and feeding frequency based on local availability and child's age.
• Explain how to give multivitamins and zinc.
• Advise on giving extra fluids.
• Advise when to return immediately (danger signs, signs of dehydration).
• Advise on follow-up visit in 5 days.

Differential Diagnosis

• Severe Persistent Diarrhoea (if dehydration develops)
• Secondary lactose intolerance
• Cow's milk protein allergy
• Other food intolerances/allergies
• Giardiasis
• Cryptosporidiosis
• Malnutrition
• HIV infection

Potential Complications

• Malnutrition
• Micronutrient deficiencies
• Dehydration (if fluid/feeding advice not followed)
• Increased susceptibility to other infections

Prevention

• Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
• Good nutrition, Vitamin A.
• Measles vaccination.
• Handwashing, safe water/sanitation.
• Early identification and management of HIV infection.

Key Features

• Presence of blood in the stool is the defining feature.
• Requires treatment with an antibiotic effective against Shigella (first-line typically Ciprofloxacin in this guideline).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: Is there blood in the stool? (Confirm visually if possible, or rely on mother's report).

Classification

• Blood in the stool -> DYSENTERY

Management

Non-Pharmacological Management

• Treat dehydration according to classification (Plan A, B, or C) if present.
• Advise on increased fluid intake (Plan A principles).
• Continue feeding.

Pharmacological Treatment

• Give oral Ciprofloxacin twice daily for 3 days. Dosage (15mg/kg/day divided twice daily): Age <6m: 125mg per dose (1/4 of 500mg tab or 1/2 of 250mg tab). Age 6m-5y: 250mg per dose (1/2 of 500mg tab or 1 of 250mg tab).
• Give Zinc Sulphate 10-20mg once daily for 10 days (as per doses in Plan A/B).

Pre-Referral Treatment

• If severe dehydration or another severe classification is present, provide appropriate pre-referral treatments along with the first dose of Ciprofloxacin if possible before urgent referral.

Monitoring & Follow-Up

• Follow up in 2 days.
• At follow-up (Day 2):
• Assess general condition, check for fever, dehydration, abdominal pain, number of stools, blood in stool, feeding.
• If dehydrated: Treat dehydration (Plan B or C).
• If condition is worse (more stools, more blood, higher fever, worse abdominal pain, poor feeding) OR same: Change to second-line oral antibiotic recommended locally for Shigella (treat for 5 days). Advise return in 2 days OR Refer to hospital (especially if <12m, dehydrated on first visit, or had measles recently).
• If improving (fewer stools, less blood, less fever, less pain, eating better): Continue Ciprofloxacin for the full 3 days. Ensure mother understands oral rehydration and feeding.

Counselling Points

• Explain the diagnosis (dysentery) and the need for antibiotic.
• Teach how to give Ciprofloxacin: correct dose, frequency (twice daily), duration (full 3 days).
• Teach how to give Zinc for 10 days.
• Advise on giving extra fluids (ORS/home fluids) and continuing feeding.
• Advise when to return immediately (danger signs, signs of dehydration, worsening dysentery).
• Advise on follow-up visit in 2 days.

Differential Diagnosis

• Amoebiasis (less common cause of dysentery in young children compared to Shigella)
• Campylobacter infection
• Salmonella infection (non-typhoidal)
• E. coli (invasive strains)
• Intussusception (may present with 'red currant jelly' stool)
• Anal fissure (streaks of fresh blood on stool surface)
• Allergic colitis (e.g., milk protein allergy)

Potential Complications

• Severe dehydration
• Sepsis
• Intestinal perforation (rare)
• Toxic megacolon (rare)
• Hemolytic Uremic Syndrome (HUS - associated with E.coli O157:H7, rare Shigella strains)
• Reactive arthritis
• Persistent diarrhoea
• Malnutrition

Prevention

• Handwashing with soap (especially after toilet use, before handling food).
• Safe disposal of faeces.
• Use of safe drinking water.
• Safe food handling practices.
• Exclusive breastfeeding.
• Measles vaccination.

Key Features

• Requires TWO or more of the following signs: Lethargic/unconscious OR Movement only when stimulated/no movement OR Sunken eyes OR Skin pinch goes back very slowly (>2 seconds).
• Indicates severe fluid and electrolyte loss, which is particularly dangerous in young infants.
• Requires immediate fluid resuscitation, preferably IV or NG if trained (Plan C), and urgent referral.

Assessment

• Ask: Does the young infant have diarrhoea? (Note: Stools are normally frequent/semisolid in breastfed babies. Diarrhoea is a change to many watery stools).
• Look/Feel: Look at the infant's general condition/movements. Is the infant lethargic or unconscious? Moves only when stimulated or no movement at all?
• Look/Feel: Look for sunken eyes.
• Look/Feel: Pinch the skin of the abdomen. Does it go back Very slowly (longer than 2 seconds)?

Classification

• Two or more of the following signs: (Movement only when stimulated or no movement at all / Lethargic or unconscious) OR (Sunken eyes) OR (Skin pinch goes back very slowly) -> SEVERE DEHYDRATION

Management

Non-Pharmacological Management

• If providing Plan C in clinic: Ensure immediate access to IV/NG equipment and ORS. Monitor closely.
• If referring: Keep infant warm. Continue ORS sips frequently if possible.

Pharmacological Treatment

• TREAT WITH PLAN C (Young Infant Version - Page 41):
• If IV Therapy Possible Immediately: Start IV fluid. Give 100 ml/kg Ringer's Lactate Solution (or Normal Saline). Give 30ml/kg in 1 hour, THEN 70ml/kg in 5 hours.
• Reassess frequently (every hour initially). If hydration not improving, give IV drip faster.
• Also give ORS (about 5 ml/kg/hour) by mouth/NG tube as soon as infant can take it.
• Reassess dehydration status after 6 hours and choose appropriate plan (A, B, repeat C).
• If IV Therapy Not Available/Possible:
• If trained in NG tube insertion: Start rehydration by NG tube with ORS solution: give 20 ml/kg/hour for 6 hours (total 120 ml/kg). Reassess every 1-2 hours. If vomiting/distension, slow rate. If not improving after 3 hrs, refer urgently for IV.
• If NG tube not possible AND infant can drink: Refer URGENTLY. Give mother ORS and show how to give frequent sips during the trip.
• If infant also has another severe classification (e.g., PSBI): Refer URGENTLY after stabilizing airway/breathing and giving essential pre-referral treatments (e.g., antibiotic). Give frequent sips of ORS on the way if possible.

Pre-Referral Treatment

• If referring urgently: Ensure airway is clear. Give frequent sips of ORS on the way if infant can drink. Keep infant warm (Page 40). Give other essential pre-referral treatments based on other classifications (e.g., antibiotic for PSBI - Page 40).

Monitoring & Follow-Up

• Managed initially under Plan C, then reassessed.
• If discharged on Plan A or B, follow-up as per those plans.

Counselling Points

• Explain the seriousness of dehydration in a young baby and the need for urgent hospital treatment.
• Show how to give ORS sips frequently during transport if applicable.
• Advise on keeping infant warm.
• Advise mother to continue breastfeeding whenever infant wants.

Differential Diagnosis

• Some Dehydration (Young Infant)
• Septic shock
• Other causes of altered consciousness/lethargy (PSBI, meningitis, hypoglycemia)

Potential Complications

• Hypovolemic shock
• Acute kidney injury
• Severe electrolyte imbalance
• Seizures
• Death

Prevention

• Exclusive breastfeeding.
• Handwashing.
• Safe water/sanitation.
• Rotavirus vaccination (where available, consider age limits).
• Prompt management of diarrhoea with ORS and continued feeding.

Key Features

• Requires TWO or more of the following signs: Restless/irritable, Sunken eyes, Skin pinch goes back slowly.
• Absence of signs of severe dehydration.
• Requires supervised administration of ORS over 4 hours (Plan B).

Assessment

• Ask: Does the young infant have diarrhoea?
• Look/Feel: Look at the infant's general condition. Is the infant Restless, irritable?
• Look/Feel: Look for sunken eyes.
• Look/Feel: Pinch the skin of the abdomen. Does it go back Slowly?

Classification

• Two or more of the following signs: (Restless, irritable) OR (Sunken eyes) OR (Skin pinch goes back slowly) -> SOME DEHYDRATION

Management

Non-Pharmacological Management

• Supervise ORS administration in clinic.
• Continue breastfeeding frequently alongside ORS.
• After 4 hours, reassess hydration.

Pharmacological Treatment

• TREAT WITH PLAN B (Young Infant Version - Page 43):
• Give recommended amount of ORS over 4-hour period in the clinic. Amount for infant < 6kg (Birth up to 4 months): 200-450 ml. (Approximate amount in ml = weight in kg x 75). Use standard ORS (new low osmolarity ORS preferred).
• Show the mother how to give ORS: frequent small sips from a cup (or syringe/dropper).
• If infant vomits, wait 10 minutes, then continue ORS more slowly.
• Continue breastfeeding whenever the infant wants.
• Also give 100-200 ml clean water during this period IF using standard osmolarity ORS (not needed if using low osmolarity ORS).
• After 4 hours: Reassess dehydration. Select appropriate plan (A, B, or C).
• If mother must leave before 4 hours: Show how to prepare ORS. Give enough packets to complete rehydration + 2 more for Plan A. Explain how much to give to finish 4-hour treatment. Explain Plan A rules.
• If infant has any severe classification: Refer URGENTLY. Give frequent sips of ORS on the way. Advise continued breastfeeding.
• Zinc is NOT routinely recommended for infants under 2 months in this guideline (Zinc starts at 2 months in Plan A/B on page 16).

Pre-Referral Treatment

• If referring due to co-existing severe classification: Give frequent sips of ORS on the way. Keep infant warm. Give other needed pre-referral treatments.

Monitoring & Follow-Up

• If hydration improves and discharged on Plan A: Follow up in 3 days if not improving (Page 48).
• Advise immediate return if signs worsen.

Counselling Points

• Explain the infant needs special fluids (ORS) for dehydration.
• Show how much ORS to give over 4 hours.
• Show how to give ORS (sips, what to do if vomits).
• Emphasize continuing frequent breastfeeding.
• Explain home care (Plan A) if infant is discharged.
• Advise when to return immediately (danger signs, signs of worsening dehydration).

Differential Diagnosis

• Severe Dehydration (Young Infant)
• No Dehydration (Young Infant)
• Irritability due to other causes (colic, hunger, infection)

Potential Complications

• Progression to severe dehydration
• Electrolyte imbalance
• Treatment failure due to vomiting or inadequate intake

Prevention

• Exclusive breastfeeding.
• Handwashing.
• Safe water/sanitation.
• Prompt management of diarrhoea.

Key Features

• Absence of sufficient signs for Some or Severe Dehydration.
• Management focuses on preventing dehydration at home (Plan A).
• Exclusive breastfeeding is the mainstay; ORS/water used supplementally.

Assessment

• Ask: Does the young infant have diarrhoea?
• Confirm absence of TWO or more signs of Some or Severe Dehydration (Infant is not lethargic/unconscious, not restless/irritable; eyes are not sunken; skin pinch goes back immediately).

Classification

• Not enough signs to classify as Some or Severe Dehydration -> NO DEHYDRATION

Management

Non-Pharmacological Management

• Treat with Plan A (Young Infant Version - Page 43):
• Advise mother to continue breastfeeding frequently and for longer at each feed, day and night.
• Give extra fluids: Advise giving ORS or clean water in addition to breastmilk.
• Show how much extra fluid to give after each loose stool (approx 50-100 ml for <2 years, though this is from the 2m-5y chart - give small frequent amounts appropriate for infant size).
• Teach how to mix and give ORS (give 2 packets for home use).
• Advise mother when to return immediately.

Pharmacological Treatment

• Zinc is NOT routinely recommended for infants under 2 months in this guideline.

Monitoring & Follow-Up

• Follow up in 3 days IF not improving (Page 48).
• Advise immediate return if signs of dehydration or danger signs develop.

Counselling Points

• Explain the 2 Rules of Home Treatment for young infants: 1. Give Extra Fluid (primarily frequent, longer breastfeeding; supplement with ORS/water). 2. When to Return.
• Emphasize continued frequent and longer breastfeeding.
• Teach how to prepare and give ORS.
• Explain signs requiring immediate return: develops danger signs (stopped feeding, convulsions, lethargy etc.), becomes very thirsty, develops sunken eyes, blood in stool.

Differential Diagnosis

• Some Dehydration (Young Infant)
• Normal stool pattern for breastfed infant

Potential Complications

• Dehydration (if feeding/fluid advice not followed)
• Malnutrition (less common if breastfeeding maintained)

Prevention

• Exclusive breastfeeding.
• Handwashing.
• Safe water/sanitation.