Annex 7
DRAFT - PREVENTION of dehydration and malnutrition
in infants and young children with diarrhoea - including cholera.
Diarrhoea is the passing of an increased amounts of loose / watery stools
Diarrhoea can lead to illness and death because of:
 Dehydration (not enough liquid in the body) – large amounts of water from the body are lost due to the
diarrhoea
 Malnutrition (the body does not have every thing it needs to be healthy) – diarrhoea causes a reduced food
intake into the body because food goes through the body quickly and also because of a loss of appetite.
Treating diarrhoea at home:
 Give extra fluid and continue feeding
 Give zinc - zinc helps to stop the diarrhoea and make children better
 Take a child to the clinic if:
- They are not to be getting better after 2-3 days
- Has a fever
- They are breathing fast
- Does not eat or drink normally (e.g. great thirst)
- If the child seems sick
- When the skin is pinched it goes back slowly.
- Sunken eyes
- If the child is unhappy, weak and sleepy
- Stools are very watery and/or there is blood in the stools
If your child is under 6 months old
 Exclusively breastfed baby: Breastfeed much more frequently and for as long as the infant wants at each feed.
Breastmilk is usually enough but if diarrhoea is severe give ORS in addition to breastmilk.
 Infant having breastmilk and other foods/fluids: Breastfeed much more frequently and for as long as the infant
wants at each feed – this increases the milk supply so that a baby can be exclusively breastfed after a short while.
In addition to breastmilk give ORS
 Non-breastfed infants: Give them their usual milk or formula at least every 3 hours in a clean cup and also give
ORS or clean water. It is important that the formula is made safely and correctly and is given as long as needed
to try to prevent malnutrition.
ALSO give zinc: ½ tablet (10mg) once a day for 10/14 days. Dissolve the tablet in a small amount (5 ml) of
expressed breastmilk, ORS, or clean water on a small spoon.
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Over 6 months old:
FLUIDS TO GIVE:
 Breastfeed more frequently and for as long as the infant wants at each feed.
 If necessary give expressed breastmilk from a clean cup
 If not breastfeeding give others milks or infant formula that the child normally takes
 To stop dehydration ALSO give ORS:
Children under 2-years-old should get 50-100ml (¼ large cup) of ORS after each loose stool
Children 2 years or more should get ½ to 1 large cup of ORS after each loose stool
Older children should drink as much as they want.
 Other suitable fluids to give are:
- plain safe water (from the safe sources i.e. boreholes, protected wells, chlorinated or boiled water)
- food based liquids e.g. Soup, rice water, yoghurt drinks, fermented drinks like Mahewu
When to stop: ORS or other suitable fluids should be given until the diarrhoea stops. This may last several days.
Fluids NOT to give:
- Drinks sweetened with sugar
- Carbonated soft drinks such as Coca-cola and Fanta
- Commercial fruit juices such as Mazoe
- Sweetened tea, Frizits, Jolly Juices or Ice Lolo
- Coffee
FOODS TO GIVE:
- Mixes of a cereal (such as sorghum, millet) together with locally available beans (such as groundnuts, cowpeas,
sugar beans) or meat or fish.
- Eggs
- Fermented foods e.g. sour porridge, lacto/amasi
- Sweet potato and pumpkin mash
- Mashed potatoes, fresh fruit juices and bananas
 Food Safety: Make sure that the food is prepared hygienically and stored safely.
 How much food?
- Give small amounts at least 6 times a day
- Encourage the child to eat as much as he/she wants but do not force.
ALSO give zinc: 1 tablet (20mg) per day for 10/14 days. Tablets can be chewed or dissolved in a small amount of clean
boiled water
The importance of breastfeeding in the current situation – cholera, flooding and lack of food
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Breastmilk helps to prevent BOTH dehydration and malnutrition.
Breastmilk will protect her baby from getting cholera and other infections
If a mother has cholera or diarrhoea she must practice thorough hygiene and continue to give her baby breastmilk
Each breastfeed treats diarrhoea. It makes the child better more quickly and helps to make sure that the child
doesn’t get diarrhoea again.
 Exclusive breastfeeding from birth provides ALL the food and water that a baby needs until 6 months of age.
 After 6 months continue breastfeeding as before and add other nutrient dense foods (complementary feeds) up to 2
years of age.
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