Diarrhea or “Runny Stomach” as said in Malawian English

Diarrhea is a common concern among all children in Africa. It’s a good idea to keep a couple of packets of ORS in your medicine cabinet so you can help your family or friends stay hydrated when having diarrhea.

Signs and symptoms: Diarrhea is characterized by loose and frequent poos, belly cramps, and sometimes a fever. 

What is happening in the body? In normal digestion most of the liquids, nutrients, and electrolytes (sodium, potassium, etc…) we eat are absorbed into the body through the intestines as the food travels down the length of the intestinal tube.  When something happens to disrupt this process, diarrhea occurs.  Some toxins (cholera for example) multiply to cover and irritate the inner lining of that intestinal tube. This irritation causes the intestines to do the opposite of what they are supposed to do and instead of absorbing water and electrolytes they actually pour water and electrolytes back into the intestines causing the poo to get very watery.  In other cases, the offending agent actually pushes past the inner lining and invades the actual tissue (mucosa) of the intestines causing inflammation, pain, bleeding, pus, decreased absorption, and sometimes fever.  The biggest danger to the child is that they are losing water and electrolytes that their body needs to survive.  The first goal of treatment is to replace the fluid and electrolytes faster than the child is losing them.  

ORS (oral rehydration salts) can be found in pharmacies all over the world. It’s important to have the right amount of ORS to water ratio.  Mix 1 packet of ORS with 1 liter of clean water. Keep the ORS mixture in a pitcher and pour the specific amount needed into your child’s cup. If possible refrigerate as it tastes better cold. If not used in 24hours, discard and mix up a new packet with 1 liter of water.

There are different brands, but it helps to see a WHO approved symbol.

The importance of early rehydration cannot be stressed enough.  

Most moms don’t give enough ORS, so the volumes listed below give you a good starting point. Volumes can be increased or decreased depending on your child’s needs.  The more he takes, the sooner he will feel better, so do all you can to encourage him to drink.  

The WHO recommends starting ORS treatment even before seeing signs of dehydration:

If no signs of dehydration yet give the following amounts after each diarrhea stool:

< 2yr give 50-100 ml per diarrhea episode up to 500 ml/day

2yr-9yr give 100-200 ml per diarrhea episode up to 1000 ml/day

10 yr and up give as much as 100 ml every 5 minutes up to 2000 ml/day

If your child begins to show signs of dehydration

Signs and symptoms of moderate dehydration include: dry mouth and tongue, sunken eyes, decreased urine, skin goes back down slowly when pinched, irritability, and decreased tears.

With moderate dehydration then you need to push the ORS and check on your child every hour. Go to the clinic if the symptoms don’t turn around or you can’t get your child to drink. Signs and symptoms that your child is improving include tears, full wet diapers, increased energy level, and moist mouth.

You can calculate the amount your child needs in the first four hours as follows:

Weight of child in _______ kg  X 75ml = _________ ml of ORS in 4 hours. You can divide this number by four to know about how much to give per hour. This may be repeated so long as your child is still dehydrated. Go to the clinic if not better in 4 hours.

If your child is vomiting as well, give the ORS in small, frequent sips.  Go to the clinic if you can’t keep up on rehydrating from home. If no vomiting, your child can eat a regular diet as they like. 

When to go to the clinic: 

  1. If your child shows signs of moderate to severe dehydration: very dry mouth or lips, decreased or no urine output, sunken eyes, decreased or no tears, lethargy, skin goes down slowly or stays up when pinched, and/or sunken fontanelle (soft spot on the top of the head). Your child is more likely to show signs of dehydration if both diarrhea and vomiting.  Medicines can be given at the clinic to decrease the nausea and allow him to drink ORS better.  Go ahead and push the ORS as you head to the clinic.

2. If your child has a fever, intense abdominal pain, or blood or mucus in the diarrhea.

3. If diarrhea persists for 5 days or more.

4. If you have any concerns. We are always happy to examine your child.

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