<b>Plan A (No dehydration and for prevention)</b><br>ffCounsel the mother on the 4 rules of home treatment: extra fluids (ORS), continue feeding, zinc supplementation, when to return ffGive extra fluids: as much as the child will take –– If child exclusively breastfed, give ORS or safe clean water in addition to breast milk –– If child not exclusively breastfed, give one or more of: ORS, soup, rice-water, yoghurt, clean water –– In addition to the usual fluid intake, give ORS after each loose stool or episode of vomiting Child <2 years: 50-100 ml Child 2-5 years: 100-200 ml –– Give the mother 2 packets to use at home –– Giving ORS is especially important if the child has been treated with Plan B or Plan C during current visit –– Give frequent small sips from a cup -Advice the mother to continue or increase breastfeeding}<b>If child vomits, wait 10 minutes, then give more slowly</b><br> –– In a child with high fever or respiratory distress, give plenty of fluids to counter the increased fluid losses in these conditions –– Continue giving extra fluid as well as ORS until the diarrhoea or other cause of dehydration stops -If diarrhoea, give Zinc supplementation Child <6 months: 10 mg once a day for 10 days Child >6 months: 20 mg once a day for 10 days}<b>Plan B (Some dehydration)</b><br>ff-Give ORS in the following approximate amounts during the first 4 hours}Only use child’s age if weight is not known –– You can also calculate the approximate amount of ORS to give a child in the first 4 hours as weight (kg) x 75 ml ffShow the mother how to give the ORS –– Give frequent small sips from a cup –– If the child wants more than is shown in the table, give more as required –– If the child vomits, wait 10 minutes, then continue more slowly ffFor infants <6 months who are not breastfed, also give 100-200 ml of clean water during the first 4 hours ffReassess patient frequently (every 30-60 minutes) for classification of dehydration and selection of Treatment Plan}<b>After 4 hours</b><br> ffReassess the patient ffReclassify the degree of dehydration ffSelect the appropriate Treatment Plan A, B or C ffBegin feeding the child in the clinic}<b>If mother must leave before completing the child’s treatment</b><br> ffShow her how to prepare ORS at home and how much ORS to give to finish the 4-hour treatment –– Give her enough packets to complete this and 2 more to complete Plan A at home ffCounsel mother on the 4 rules of home treatment: extra fluids, continue feeding, zinc, when to return}<b>Plan C (Severe dehydration)</b><br>If you are unable to give IV fluids and this therapy is not available nearby (within 30 minutes) but a nasogastric tube (NGT) is available or the child can drink ffStart rehydration with ORS by NGT or by mouth: Give 20 ml/kg/hour for 6 hours (total = 120 ml/ kg) ffReassess the child every 1-2 hours –– If there is repeated vomiting or increasing abdominal distension, give more slowly –– If hydration status is not improving within 3 hours, refer the child urgently for IV therapy ffAfter 6 hours, reassess the child ffClassify the degree of dehydration ffSelect appropriate Plan A, B, or C to continue treatment}<b>If you are able to give IV fluids</b><br> ffSet up an IV line immediately –– If child can drink, give ORS while the drip is set up ffGive 100 ml/kg of Ringer’s Lactate –– Or half-strength Darrow’s solution in glucose 2.5% or sodium chloride 0.9% - ffReassess patient frequently (every 30-60 minutes) to re-classify dehydration and treatment plan If the patient is not improving ffGive the IV fluids more rapidly