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Diarrhoea and Dehydration Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme.

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Presentation on theme: "Diarrhoea and Dehydration Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme."— Presentation transcript:

1 Diarrhoea and Dehydration Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

2 What is Diarrhoea?  Loose or watery stools  Above 12 months of age, more than 3 loose stools per day (Eddleston & Plerini, 1999)  Often accompanied by fever, nausea, vomiting, abdominal pain  May be explosive or foul smelling  May contain blood  May be green Different categories of diarrhoea (WHO):  Acute, watery diarrhoea for 14 days or less  Persistent diarrhoea for longer than 14 days  Dysentery: diarrhoea with blood, with/without fever

3 Remember!  Every child’s stools and stool pattern differ  Ask the care givers what the child’s ‘normal’ stools are like  A young, breast-fed baby may have many soft, watery stools in a day  This is NOT diarrhoea ©TALC

4 Causes of Diarrhoea All images ©TALC  Unhygienic food preparation  Unsafe storage of food  Inadequate hand washing  Antibiotics and other drugs  Malnutrition  No access to clean water  HIV itself

5 ALL Children are at risk…  Dependent on others for good hygiene  Does not know to wash his hands  Puts hands/objects in his mouth as part of his development  Will play in/with anything!  There immune system is still developing

6 Children with HIV Increased risk of Diarrhoea:  More susceptible to infections causing diarrhoea  HIV damages the gut so food is not absorbed properly  Commonly malnourished, increasing severity and frequency of diarrhoea  Multiple drugs are being taken which cause diarrhoea ©TALC

7 Preventing Diarrhoea  Good personal hygiene  Hand washing  Improve access to clean water  Safe, clean preparation of food  Safe storage of food  Sterilisation of feeding implements  Improve sanitation  Good nutrition  Breastfeeding  Safe disposal of soiled materials ©TALC

8 Breaking the Cycle Flies Faeces Fingers Food Cover Food Wash hands before eating and preparing food Bury faeces, use latrine Wash hands after defecation Adapted from Lankester, 2000

9 Effects of Diarrhoea Diarrhoea may cause great discomfort to a child Diarrhoea may also be accompanied by or cause:  fever  abdominal pain ©TALC

10 Effects of Diarrhoea Diarrhoea increases the risk of skin breakdown A child with HIV is then more likely to get skin infections which may be painful and difficult to treat Skin breakdown and infections must be prevented

11 Effects of Diarrhoea  Children with diarrhoea are at risk of dehydration  Children become dehydrated more quickly than adults  May occur over days or very quickly indeed  Dehydration will lead to death if not managed appropriately and quickly ©TALC

12 Getting it Right! All around the world, children with diarrhoea are dying from dehydration because carers:  Stop fluids and food  Do not know what fluids to give  Do not know the signs of dehydration  Do not know how quickly a child becomes dehydrated  Do not act quickly enough  Have not been taught how to make and use ORS  DO not know what to do when the child vomits or refuses to drink

13 How Do I Assess Dehydration? Does the child have Diarrhoea?  Restless, irritable  Sunken eyes  Drinks eagerly, thirsty  Sunken fontanelle  Skin pinch goes back slowly  Dry tongue, no tears ©TALC

14 Signs of Dehydration  Not able to drink/ drinking poorly  Weak, inactive or unconscious  Watery stools  Vomiting  Has small amount of dark urine  Has stopped passing urine ©TALC


16 Plan A: Treat for Diarrhoea at Home Counsel the mother on the 3 Rules of Home Treatment: Give Extra Fluid Continue Feeding When to Return ©TALC

17 Plan A: Give Extra Fluid  As much as the child will take!  Breastfeed frequently and for longer at each feed  If exclusively breast-fed, give SSS in addition to breast milk  If child is not receiving breast milk or is not exclusively breastfed, give one or more of:  Porridge, Amasi (Maas), SSS, ORS ©TALC

18 Plan A: ORS and SSS To make SSS: 1 litre boiled (or clean) water + 8 teaspoons sugar + Half a teaspoon salt ORS Teach the Mother How to mix and Give SSS or ORS Used to prevent dehydrationUsed to correct dehydration and can be life-saving!

19 Plan A: Giving ORS & SSS Show the mother how much fluid to give in addition to the usual fluid intake: Up to 2 Years: 50 – 100 ml after each loose stool 2 Years or more: 100 – 200 ml after each loose stool Tell the mother to:  Give frequent, small sips from a cup  If the child vomits, wait 10 minutes. Then continue, but more slowly  Continue giving extra fluid until the diarrhoea stops

20 Plan A: Continue Feeding A child with diarrhoea loses the nutrients he needs for: Growth, Energy and a Strong immune system Diarrhoea may therefore lead to:  Malnutrition  A weakened immune system  More infections This is particularly worrying for a child with HIV who:  Is normally malnourished  Has a weakened immune system  More likely to get infections ©TALC

21 Plan A: Continue Feeding  It is therefore extremely important to continue feeding a child with diarrhoea  Even if the diarrhoea continues!  DO not be surprised if the child loses weight having been ill with diarrhoea  BUT, it is important to help the child regain that weight by encouraging an extra meal a day for two weeks  Sometimes, a doctor may advise that the child does not taken certain foods ie milk. If the mother has been told this, encourage her to take that advise

22 Plan B: Treat for Some Dehydration with ORS If a child with diarrhoea has been assessed and considered to have some dehydration, the child needs rehydration with ORS Refer to clinic immediately

23 Infection Control Risk of Infection to Others  Others may be infected by the germs causing diarrhoea eg Salmonella  Others may be infected by HIV is diarrhoea contains blood ©TALC

24 Handling Soiled Linen  Wear Gloves  Cut small holes in a plastic bag and line a container with it  Pour Jik 1:10 in to the plastic bag  Put the dirty wound dressing, newspaper etc in to the plastic bag for half an hour  Remove the bag, allowing the fluid to run into the container  Put the plastic bag into a second plastic bag  Dispose of it into a pit toilet or bury it OR  Wear gloves  Place waste in to double plastic bags  Knot bags and bury them or dispose in pit  Wash hands

25 Summary  Children with HIV will experience episodes of diarrhoea  Diarrhoea may resolve itself without drugs  Prevent dehydration using Plan A  Treat dehydration using Plan B and C  Provide nutritious foods throughout  Refer if: a) diarrhoea persists after three days, refer for diagnosis and treatment of underlying cause b) child becomes sicker, develops danger signs You can easily prevent many children from dying!

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