# Community Health Worker Manual/Diarrhea

Diarhhea is a common disease that can in severe cases lead to death. Be very careful when treating a child with diarrhea, and make sure you know how to classify the severity of each case, and how to treat it. Also learn the causes of diarrhea and teach parents how it is spread so they can take preventative measures.

## Classification

Diarrhea causes dehydration, which can be identified through various signs. Refer a child to a health center if he has either of the following two danger signs.
* Sunken eyes
* Turgid skin
There are also some minor signs—if the child has any two of the following minor signs, refer him to a health center:
* Restlessness and irritability
* Thirsty or eager to drink water
* Listless or fatigued
* Inability to drink water

### Testing Skin Turgidity

Pinch the skin on the child's stomach and time how long it takes to return to its normal position.
* If it comes back immediately, it indicates no dehydration.
* If it takes less than 2 seconds, it indicates some dehydration.
* If it takes longer than 2 seconds, this indicates severe dehydration.

## Treatment Overview

There are three principles of treatment for diarrhea:
* Keep giving liquids
* Keep giving nutrition
* Take the child to a health center when necessary

### First Principle -- Keep Giving Liquids

Keep the following in mind:
* The mother should feed the child breastmilk for a longer period of time
* If the child is younger than 6 months and is exclusively breastfed, feed him ORS or even clean water periodically
* If the child is not exclusively breastfed, in addition to ORS, also give him other foods such as soup, rice water, yogurt, etc.
Please note! If the child has excessive diarrhea, it is important to keep feeding him ORS.

#### ORS

ORS or Oral Rehydration Solution, is essential in the treatment of diarrhea. You need to know how to prepare it, how much to give to a child, and how to feed it to the child.

##### ORS Preparation

* Put 4 glasses of clean, boiled water in a jug.
* Wait till the water cools to room temperature
* Put in one packet of ORS solution and stir
* ORS can be used up to 12 hours after preparation at room temperature, or 24 hours if kept in a fridge.
Note: If ORS solution is not available, take a glass of water and put one teaspoon of sugar and one fourth teaspoon SALT and stir

##### How much ORS to give

After every stool:
* If the child is younger than 2 years, feed him a quarter to half a cup of ORS.
* If the child is older than two years, feed him half a cup to a whole cup of ORS.

##### How to feed ORS to a child

Feed the child ORS with small sips from a cup, or by using a teaspoon. If the child vomits, wait ten minutes and then try again, but slower than before. Keep feeding the child ORS or additional liquids until the diarrhea has completely stopped.

### Second Principle -- Keep Giving Nutrition

During diarrhea, feed the child soft food appropriate for his age, such as khichri, sujhi ki kheer, mashed potatoes, mashed bananas, vegetables, seasonal fruit, etc.
* Previous principle
* Next principle

### Third Principle -- Taking to Health Center

Refer the child to a health center immediately if you see even one of the following danger signs:
* Listlessness or fainting
* Inability to drink liquids
* Blood in the stool
* Fever
* Referral
* Previous Principle
* Treatment Overview

## Causes

Diarrhea is caused by the following:
* Eating food without washing dirty hands
* Drinking unboiled water