a) What is diarrhoea? b) Describe the types of diarrhoea. c) What information you will collect about the child who is suffering from diarrhoea from the family members and How? d) Write down the effects of diarrhoea on child's health.(2+3+7+3 =15)
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diarrhoea definition types acute persistent chronic dysentery child nursing assessment effects health
I now have solid content from both the medical library (Park's textbook, IMCI guidelines) and authoritative web sources. Let me compile the comprehensive answer.
Diarrhoea in Children - Comprehensive Notes (15 Marks)
a) What is Diarrhoea? (2 marks)
Definition: Diarrhoea is defined as the passage of 3 or more loose or watery stools per day, or an increase in the number of stools with looser consistency than is normal for that individual. It results from an imbalance in the normal physiology of the small and large intestine, leading to augmented water content in stools (above the normal value of approximately 10 mL/kg/day in infants and young children).
According to the WHO/IMCI framework, a young infant has diarrhoea if "the stools have changed from the usual pattern and are many and watery (more water than faecal matter)." The normally frequent or semi-solid stools of a breastfed baby are not considered diarrhoea.
Source: Park's Textbook of Preventive and Social Medicine; WHO IMCI Guidelines
b) Types of Diarrhoea (3 marks)
Diarrhoea is classified by duration, mechanism, and clinical features:
1. Based on Duration
| Type | Duration | Key Features |
|---|---|---|
| Acute Diarrhoea | Less than 14 days | Sudden onset; usually infectious (viral, bacterial, parasitic); self-limiting |
| Persistent Diarrhoea | 14 days or more | Begins as an acute infectious episode but continues; more serious; risk of malnutrition |
| Chronic Diarrhoea | More than 4 weeks | Usually non-infectious; associated with malabsorption, inflammatory bowel disease, enzyme deficiencies |
2. Based on Clinical Features (WHO classification)
| Type | Features | Cause |
|---|---|---|
| Acute Watery Diarrhoea | Profuse, watery stools; rapid dehydration | Rotavirus, ETEC, Vibrio cholerae |
| Dysentery (Bloody Diarrhoea) | Blood and mucus in stools; fever, tenesmus | Shigella, Entamoeba histolytica, Campylobacter |
| Persistent Diarrhoea (with/without dehydration) | Lasts ≥ 14 days; weight loss | Mixed infections; malnutrition-diarrhoea cycle |
3. Based on Pathophysiological Mechanism
- Secretory diarrhoea: Toxins stimulate intestinal cells to secrete excessive fluid (e.g., cholera). Continues even with fasting.
- Osmotic diarrhoea: Unabsorbed solutes draw water into the gut (e.g., lactose intolerance, certain medications). Stops with fasting.
- Inflammatory/exudative diarrhoea: Mucosal damage causes blood and pus in stools (e.g., Shigella, Salmonella).
- Motility-related diarrhoea: Abnormally rapid intestinal transit reduces absorption time.
Source: Park's Textbook of Preventive and Social Medicine; WHO IMCI Classification; StatPearls/NCBI
c) History Collection from Family Members of a Child with Diarrhoea (7 marks)
When assessing a child with diarrhoea, a structured nursing/clinical history is collected from the family (usually the mother or primary caregiver) using a "Ask-Look-Feel" approach (as per IMCI guidelines).
Method of History Collection
Use open-ended questions first, then focused/closed questions. Be calm, culturally sensitive, and use simple language the family understands.
I. Present History of Diarrhoea
Ask:
- Duration - "For how long has the child had diarrhoea?" (to classify acute vs. persistent)
- Frequency - "How many times does the child pass stools in a day?" (to assess severity)
- Character of stools - "Are the stools watery? Is there blood or mucus in the stools?" (to distinguish dysentery)
- Onset - Was it sudden or gradual?
- Associated vomiting - "Is the child vomiting? How many times?" (worsens dehydration)
- Fever - "Does the child have fever?" (suggests infectious cause)
- Abdominal pain/cramps - "Does the child cry as if in pain?"
II. Feeding and Dietary History
Ask:
8. "Is the child breastfed? How many times in 24 hours?"
9. "What does the child eat and drink? Has there been any change in diet recently?"
10. "Did the child eat anything unusual before diarrhoea started?" (food poisoning)
11. "Are the child's foods prepared and stored hygienically?"
III. Signs of Dehydration (Look and Feel)
Ask the mother:
12. "Is the child drinking fluids? Is the child able to drink?"
13. "Does the child appear thirsty/restless/irritable, or drowsy/unconscious?"
Look for:
- Sunken eyes, dry mouth and tongue, absence of tears
- Reduced urine output/dry nappies
- Restlessness or lethargy
Feel:
- Skin pinch test (skin turgor): pinch abdominal skin - goes back very slowly (>2 seconds) = severe dehydration; slowly = some dehydration; immediately = no dehydration
- Assess general condition and consciousness level
IV. Past History
Ask:
14. "Has the child had episodes of diarrhoea before? How many in the past year?"
15. "Was the child treated? What treatment was given at home or by a doctor?"
16. "Any known medical conditions (e.g., malnutrition, HIV, measles)?"
V. Immunization History
Ask:
17. "Has the child received all vaccinations?" (especially Rotavirus vaccine, Measles vaccine - measles can predispose to diarrhoea)
VI. Social and Environmental History
Ask:
18. "What is your source of drinking water?" (piped, well, river?)
19. "Do you have a toilet, or does the family use open defecation?"
20. "How do you dispose of children's stool?"
21. "Does the child attend a daycare or play with other children?" (transmission risk)
22. "Who cares for the child? Is the mother working?" (caregiver practices)
VII. Nutritional Status
Observe and Ask:
23. "What is the child's normal weight? Has there been recent weight loss?"
24. Look for signs of malnutrition: wasting, oedema, pale conjunctivae
The IMCI framework instructs: "ASK - For how long? Is there blood in the stool?" followed by "LOOK AND FEEL - at the child's general condition, for sunken eyes, offer the child fluid and check if the child drinks poorly or not at all, pinch the skin of the abdomen."
- Park's Textbook of Preventive and Social Medicine (IMCI Chapter)
d) Effects of Diarrhoea on a Child's Health (3 marks)
1. Dehydration
This is the most immediate and life-threatening effect. Loss of fluid and electrolytes causes mild, moderate, or severe dehydration. Severe dehydration leads to circulatory collapse (hypovolemic shock) and can result in death if untreated. Signs include sunken eyes, dry mouth, poor skin turgor, and reduced urine output.
2. Electrolyte Imbalance
Loss of sodium (hyponatraemia), potassium (hypokalaemia), and bicarbonate leads to metabolic acidosis, muscle weakness, cardiac arrhythmias, and convulsions, particularly dangerous in young infants.
3. Malnutrition and Growth Failure
Persistent and repeated diarrhoea leads to poor nutrient absorption (malabsorption), reduced appetite, and increased metabolic demands. This results in weight loss, wasting, stunting, and aggravated protein-energy malnutrition. The "diarrhoea-malnutrition cycle" is well-recognized: malnutrition worsens diarrhoea, and diarrhoea worsens malnutrition.
4. Impaired Immunity
Malnutrition from repeated diarrhoea reduces immune defences, making the child susceptible to other infections like pneumonia, measles, and sepsis.
5. Death
Diarrhoea is the second leading cause of death in children under 5 years globally, responsible for approximately 525,000 deaths per year (mainly in developing countries), primarily due to severe dehydration and malnutrition.
6. Developmental Impact
Chronic diarrhoea and malnutrition affect brain development and cognitive function, leading to poor school performance and developmental delays.
7. Perianal Complications
Frequent loose stools cause perianal excoriation (skin breakdown around the anus), which is painful and can become secondarily infected.
Source: Park's Textbook of Preventive and Social Medicine; WHO IMCI Guidelines; ACG (American College of Gastroenterology)
Summary Table
| Part | Topic | Marks |
|---|---|---|
| a | Definition of diarrhoea | 2 |
| b | Types (by duration, by clinical features, by mechanism) | 3 |
| c | History collection - method and content (7 areas) | 7 |
| d | Effects on child's health (dehydration, electrolyte imbalance, malnutrition, immunity, death, development, perianal) | 3 |
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