| What does the presence of blood in stools indicate? | Dysentery – blood in stools | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. • Use thumb and first finger to pinch and not finger tips. • The fold of the skin should be in a line up and down the child’s body. • Firmly pick up all layers of the skin and tissue under them. • Pinch the skin for one second and then release it. | 104 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. | 1 | page=1,block=3 | 0.700 | valid |
| What dietary changes are recommended for children with persistent diarrhea who are breastfeeding? | give more frequent, longer breastfeeds, day and night | 2 of following: a) Lethargy / unconscious b) Sunken eyes c) Not able to drink/ drinking poorly d) Skin pinch - goes back slowly 2 of following: a) Restless , irritable b) Sunken eyes c) Drinks eagerly, thirsty d) Skin pinch - goes back very slowly Not enough signs to classify some or severe dehydration PERSISTENT DIARRHEA • Appropriate fluids to prevent or treat dehydration • Nutrition: • If breastfeeding, give more frequent, longer breastfeeds, day and night. • Other milk: replace with increased breastfeeding, or with fermented milk products, such as yogurt, or half the milk with nutrient-rich semi-solid food. • For other foods, follow feeding recommendations for the child’s age: give small, frequent meals (at least 6 times a day), and avoid very sweet foods or drinks. • Zinc for 14 days • Supplement vitamins / minerals • Antimicrobial to treat diagnosed infection A) Intestinal infection: • If blood in stool: Treat like dysentery • If stool routine suggestive of Amoebiasis: Treat for it • If stool suggestive of cyst/ Trophozoite of Giardia: Give Metronidazole 5mg/kg/dose x 8hrly x 5 -7 days B) Treat Non intestinal such as UTI / Otitis Media • Follow up in 5 days • Refer to hospital (See box) | 410 | summary | 0.970 |
| What should be done if hydration status is not improving during rehydration therapy? | give IV drip more rapidly | For young children Erythromycin 12.5mg/kg 4 times a day x 3 days • Associated vomitings – Ondanstetron 0.15 mg/kg/dose IV/oral in addition to rehydration therapy • Reassess every 15-30 minutes till a strong radial pulse is present and then every hour If hydration status is not improving, give IV drip more rapidly • After 6 hours (infants) and 3 hours (older patients) - evaluate for dehydration and choose the appropriate plan (A, B, or C) to continue treatment • Give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after 3-4 hours (infants) or 1-2 hours (children) • Observe for 6 hours after the child has been fully rehydrated. | 289 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | For young children Erythromycin 12.5mg/kg 4 times a day x 3 days • Associated vomitings – Ondanstetron 0.15 mg/kg/dose IV/oral in addition to rehydration therapy • Reassess every 15-30 minutes till a strong radial pulse is present and then every hour If hydration status is not improving, give IV drip more rapidly • After 6 hours (infants) and 3 hours (older patients) - evaluate for dehydration and choose the appropriate plan (A, B, or C) to continue treatment • Give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after 3-4 hours (infants) or 1-2 hours (children) • Observe for |
| What does dysentery refer to? | blood in stools | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. • Use thumb and first finger to pinch and not finger tips. • The fold of the skin should be in a line up and down the child’s body. • Firmly pick up all layers of the skin and tissue under them. • Pinch the skin for one second and then release it. | 116 | definition | 0.900 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. | 1 | page=1,block=3 | 0.700 | valid |
| What should be done to manage a child showing early signs of shock? | Refer for hospitalization | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. | 402 | summary | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. |
| What are the recommended fluids for starting IV therapy in children? | Ringer lactate solution / Normal saline (DNS in malnourished) | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. | 185 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. |
| What are the signs used to classify severe dehydration in children? | a) Lethargy / unconscious b) Sunken eyes c) Not able to drink/ drinking poorly d) Skin pinch - goes back slowly | 2 of following: a) Lethargy / unconscious b) Sunken eyes c) Not able to drink/ drinking poorly d) Skin pinch - goes back slowly 2 of following: a) Restless , irritable b) Sunken eyes c) Drinks eagerly, thirsty d) Skin pinch - goes back very slowly Not enough signs to classify some or severe dehydration PERSISTENT DIARRHEA • Appropriate fluids to prevent or treat dehydration • Nutrition: • If breastfeeding, give more frequent, longer breastfeeds, day and night. • Other milk: replace with increased breastfeeding, or with fermented milk products, such as yogurt, or half the milk with nutrient-rich semi-solid food. • For other foods, follow feeding recommendations for the child’s age: give small, frequent meals (at least 6 times a day), and avoid very sweet foods or drinks. • Zinc for 14 days • Supplement vitamins / minerals • Antimicrobial to treat diagnosed infection A) Intestinal infection: • If blood in stool: Treat like dysentery • If stool routine suggestive of Amoebiasis: Treat for it • If stool suggestive of cyst/ Trophozoite of Giardia: Give Metronidazole 5mg/kg/dose x 8hrly x 5 -7 days B) Treat Non intestinal such as UTI / Otitis Media • Follow up in 5 days • Refer to hospital (See box) | 16 | list |
| What parameters should be assessed to recognize early shock in a child? | heart rate/ respiratory rate/ BP/ CFT/ consciousness | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. | 321 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | IN mL <5kg 5 – 7.9 kg 8 - 10.9 kg 11 – 15.9 kg 16 – 29.9 kg 30 kg or more 200 - 400 400 - 600 600 - 800 800 - 1200 1200 - 2200 2200 - 4000 • Start IV fluid immediately • Ideal fluid is Ringer lactate solution / Normal saline (DNS in malnourished) • If child can drink, give ORS by mouth while the drip is set up • Assess heart rate/ respiratory rate/ BP/ CFT/ consciousness and recognize early shock • Refer for hospitalization • If prevalance of cholera – Doxycycline single dose 300mg or Tetracycline 12.5mg/kg 4 times a day x 3 days. |
| What type of milk is recommended for children with persistent diarrhea if breastfeeding is not an option? | fermented milk products, such as yogurt, or half the milk with nutrient-rich semi-solid food | 2 of following: a) Lethargy / unconscious b) Sunken eyes c) Not able to drink/ drinking poorly d) Skin pinch - goes back slowly 2 of following: a) Restless , irritable b) Sunken eyes c) Drinks eagerly, thirsty d) Skin pinch - goes back very slowly Not enough signs to classify some or severe dehydration PERSISTENT DIARRHEA • Appropriate fluids to prevent or treat dehydration • Nutrition: • If breastfeeding, give more frequent, longer breastfeeds, day and night. • Other milk: replace with increased breastfeeding, or with fermented milk products, such as yogurt, or half the milk with nutrient-rich semi-solid food. • For other foods, follow feeding recommendations for the child’s age: give small, frequent meals (at least 6 times a day), and avoid very sweet foods or drinks. • Zinc for 14 days • Supplement vitamins / minerals • Antimicrobial to treat diagnosed infection A) Intestinal infection: • If blood in stool: Treat like dysentery • If stool routine suggestive of Amoebiasis: Treat for it • If stool suggestive of cyst/ Trophozoite of Giardia: Give Metronidazole 5mg/kg/dose x 8hrly x 5 -7 days B) Treat Non intestinal such as UTI / Otitis Media • Follow up in 5 days • Refer to hospital (See box) | 525 | list |
| What is the definition of acute diarrhea? | <14 days | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. • Use thumb and first finger to pinch and not finger tips. • The fold of the skin should be in a line up and down the child’s body. • Firmly pick up all layers of the skin and tissue under them. • Pinch the skin for one second and then release it. | 62 | definition | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf | DIARRHEA IS • >3 loose or watery stools/ day • Acute Diarrhea <14 days • Persistent diarrhea >14 days • Dysentery – blood in stools SKIN PINCH TEST • Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. | 1 | page=1,block=3 | 0.700 | valid |