The 4 rules are explained to the care giver:
• If the child has no dehydration at presentation
• After adequate rehydration is achieved at the clinic using intravenous (for severe dehydration) or ORS (for moderate dehydration): the rules are explained at the time of discharge
The four rules of home treatment are very important to remember:
1. Give extra fluid – as much as the child will take
2. Give zinc
3. Continue feeding
4. When to return (for a follow-up visit, or immediately if danger signs develop)
RULE 1: GIVE EXTRA FLUID
Tell the caregiver to give as much fluid as the child will take. The purpose of giving extra fluid is to replace the fluid lost in diarrhoea and thus to prevent dehydration. The critical action is to give more fluid than usual, as soon as the diarrhoea starts
HOW SHOULD THE CAREGIVER GIVE EXTRA FLUID?
Tell the mother that breastfeeding should continue, with the addition of ORS and clean water.
If the child is exclusively breastfed, it is important for this child to be breastfed more frequently than usual. Breastfed children under 4 months should first be offered a breastfeed then given ORS.
If the child is not being breastfed, the child should receive ORS solution, food based fluids (soup, rice water, yoghurt drinks), and clean water. In your country, the national programme for diarrhoeal disease control may have specified several food-based fluids to use at home.
RULE 2: GIVE ZINC SUPPLEMENTS
Zinc treatment can considerably reduce the duration and severity of a child’s diarrhoeal episode.
It is also shown to decrease stool output and decrease the need to hospitalize a child with diarrhoea.
Zinc is only given to children 2 months up to 5 years. This box describes how much zinc to give a child with diarrhoea.
(One tablet is 20 mg zinc)
Remind the caregiver to give zinc supplements for the full 14 days Tell the caregiver how much zinc to give
• Up to 6 months: ½ tablet per day, for 14 days
• 6 months or older: 1 tablet per day, for 14 days
Show the caregiver how to give zinc supplements
• Infants: dissolve the tablet in a small amount of breast milk, ORS, or clean water in a small cup or spoon
• Older children: tablets can be chewed or dissolved in small amount of clean water in a cup or spoon
RULE 3: CONTINUE FEEDING
If still breastfeeding, give more frequent, longer breastfeeds, day and night.
If taking other milk:
— Replace with increased breastfeeding, OR
— Replace with fermented milk products, such as yogurt, OR
— Replace 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.
It may be difficult for these children to digest milk other than breast milk. Caregivers need to temporarily reduce the amount of other milk in the child’s diet. To make up for this reduction, the child must take more breast milk or other foods. Continue other foods appropriate for the child’s age
RULE 4: WHEN TO RETURN
Explain the signs when a caregiver should return immediately to a health worker.
Tell the mother of any sick child that the signs to return are:
• Not able to drink or breastfeed
• Becomes sicker
• Develops a fever If the child has
• If the child has Blood in stool
• Drinking poorly – also includes not able to drink or breastfeed
WHO, 2014: Diarrhoea; IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS: Module 4, Distance Learning Course; available at http://apps.who.int/iris/bitstream/10665/104772/6/9789241506823_Module-4... accessed on 23rd July 2016
Clinical features suggestive of dehydration: http://www.ihatepsm.com/blog/clinical-features-suggestive-dehydration
ORAL REHYDRATION SALT (ORS): http://www.ihatepsm.com/blog/oral-rehydration-salt-ors
Management of Acute Diarrhoea in Children: http://www.ihatepsm.com/blog/management-acute-diarrhoea-children
4 Rules of Home Treatment for Diarrhea in Children: http://www.ihatepsm.com/blog/4-rules-home-treatment-diarrhea-children
Sugar Salt Solution for Rehydration: http://www.ihatepsm.com/blog/sugar-salt-solution-rehydration
6 Steps of ‘Skin Pinch’ Test for Assessing Dehydration: http://www.ihatepsm.com/blog/6-steps-%E2%80%98skin-pinch%E2%80%99-test-a...
Some Clinical features of diarrhea due to common causative organisms: http://www.ihatepsm.com/blog/some-clinical-features-diarrhea-due-common-...
Principles of management of diarrhea: http://www.ihatepsm.com/blog/principles-management-diarrhea
Control of diarrheal diseases: http://www.ihatepsm.com/blog/control-diarrheal-diseases
Indicators of Diarrhea Control: http://www.ihatepsm.com/blog/indicators-diarrhea-control
Vaccines for prevention of diarrhea: http://www.ihatepsm.com/blog/vaccines-prevention-diarrhea
Lecture on acute diarrheal disaeses-1 (epidemiology): https://www.youtube.com/watch?v=8VMSn7mJgm8&t=215s
Lecture on acute diarrheal disaeses-2 (control): https://www.youtube.com/watch?v=85iOg3GNevU&t=41s
Lecture (HINDI) on acute diarrheal disaeses-1 (epidemiology): https://www.youtube.com/watch?v=c-bOaC55u-g&t=5s
Lecture (HINDI) on acute diarrheal disaeses-2 (control): https://www.youtube.com/watch?v=acc-nqkjar4&t=1s