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[Geneva, Switzerland], WHO, 1994. , 17 p. (WHO/CDD/94.49)The clinical diagnosis of bloody diarrhea refers to any diarrheal episode in which the loose or watery stools contain visible red blood. This does not include episodes in which blood is present in streaks on the surface of formed stool, is detected only by microscopic examination or biochemical tests, or in which stools are black due to the presence of digested blood. The health practitioner may diagnose the presence of bloody diarrhea in a child by either asking the mother whether the child's stool contains red blood or by looking at the stool, but the former approach is usually more efficient than waiting for the child to pass a stool and as equally sensitive and precise. All infants and children with bloody diarrhea should be treated promptly with an antimicrobial effective against Shigella. Such antimicrobials include ampicillin, TMP-SMX (cotrimoxazole), nalidixic acid, pivvmecillinam, newer quinolones, and ceftriaxone. Dehydration when detected in children with bloody diarrhea should be treated at the health facility. Children with bloody diarrhea and signs of dehydration are at increased risk of complications and should be re-evaluated two days after treatment. The caretakers of all children should be encouraged to offer increased amounts of suitable fluids at home. Moreover, the continued provision of nutritious food is important for all children with dysentery, even though they may have to be coaxed to eat. Appetite usually improves after 1-2 days of effective antibiotic therapy. Frequent small meals with familiar foods are usually better tolerated than a few large meals. Furthermore, mothers should be advised to breastfeed as often and as long as their children want, while children convalescing from dysentery should be given an extra meal each day for at least two weeks. Severely malnourished children with bloody diarrhea are at very high risk of complications and should be referred immediately to hospital after starting treatment for shigellosis.