IMCI chart

download IMCI chart

of 58

  • date post

    31-Oct-2014
  • Category

    Documents

  • view

    24
  • download

    1

Embed Size (px)

description

IMCI chart

Transcript of IMCI chart

Department of Child and Adolescent Health and Development (CAH)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS FOR HIGH HIV SETTINGSTREAT THE CHILD, continuedGive Extra Fluid for Diarrhoea and Continue Feeding Plan A: Treat for Diarrhoea at Home........................16 Plan B: Treat for Some Dehydration with ORS ........16 Plan C: Treat for Severe Dehydration Quickly .........17 Give Follow-up Care Pneumonia ...............................................................18 Dysentery .................................................................18 Persistent Diarrhoea.................................................18 Malaria......................................................................19 Fever malaria unlikely ............................................19 Ear Infection ............................................................ 19 Anaemia .................................................................. 20 Very Low Weight ......................................................20 Feeding problem ..................................................... 20 Follow up care for HIV .22 HIV Testing .......... 22

CHILD AGE 2 MONTHS UP TO 5 YEARS ASSESS AND CLASSIFY THE SICK CHILDAssess, Classify and Identify Treatment Check for General Danger Signs.................................. 2 Then Ask About Main Symptoms: Does the child have cough or difficult breathing? ............ 2 Does the child have diarrhoea? .................................... 3 Does the child have fever? .......................................... 4 Does the child have an ear problem? ............................ 5 Then check for Malnutrition and Anaemia .................... 6 Then Check for HIV Infection........................................ 7 Then Check the Childs Immunization Status ............... 8 Assess Other Problems ................................................ 8 WHO Paediatric clinical staging for HIV 9

SICK YOUNG INFANT AGE UP TO 2 MONTHSASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANTAssess, Classify and Identify Treatment Check for Very Severe Disease and Local Infection ....................... 30 Does the young infant have diarrhoea?........................................... 31 Check for HIV Infection.................................................................... 32 Then Check for Feeding Problem or Low Weight............................ 33 Then check feeding in non breastfed young infants ........................ 35 Then Check the Young Infants Immunization Status...................... 35 Assess Other Problems................................................................... 35 Assess the mothers health .............................................................. 35 Treat the Young Infant and Counsel the Mother Oral Antibiotic .................................................................................. 36 Intramuscular Antibiotics ................................................................. 36 Immunize Every Sick Young Infant.................................................. 37 Treat Local Infections at Home........................................................ 37 Keep the Low Weight Infant Warm.................................................. 38 Correct Positioning and Attachment for Breastfeeding.................... 39 Safe preparation of formula milk...................................................... 40 Teach a Mother how to Feed by cup ............................................... 40 Home Care for Young Infant............................................................ 41 Give Follow-up Care for the Sick Young Infant Local Bacterial Infection .................................................................. 42 Thrush.......................................................................................... 42 Feeding Problem ............................................................................. 42 Confirmed HIV infection or HIV exposed......................................... 42 Low Weight...................................................................................... 43

TREAT THE CHILDTeach the mother to give oral drugs at home: Oral Antibiotic. ...................................................... 10 Ciproflaxacin......................................................... 10 Cotrimoxazole ...................................................... 10 Pain Relief ........................................................... 11 Iron ...................................................................... 11 Co-artemether ..................................................... 11 Bronchodilator ...................................................... 11 Teach the Mother to Treat Local Infections at Home Clear the ear by dry wicking and give eardrops ... 12 Treat for Mouth Ulcers and Thrush....................... 12 Soothe throat, relieve cough with safe remedy ... 12 Give Preventive Treatments in Clinic Mebendazole ....13 Vitamin A 13 Give Emergency Treatment in Clinic only Quinine for severe malaria ................................... 14 Intramuscular Antibiotic ....................................... 14 Diazepam for convulsions ..... 14 Treat low blood sugar .......................................... 15

COUNSEL THE MOTHERAssess the Childs Feeding ......................................23 Feeding Recommendations .....................................24 Feeding Recommendations for HIV infected mother.....25 Counsel About Feeding Problems............................26 Counsel the mother about feeding and HIV: Stopping Breastfeeding for HIV exposed ..............27 Feeding advice for the HIV confirmed ...................27 AFASS criteria for stopping breastfeeding ............27 Counsel the mother about her own health ...............28 Advise mother when to return ..................................29 Advise mother when to return immediately ..............29

ANNEX A: Skin conditions .......................................................... 44 Mouth conditions ...................................................... 47 ANNEX B: Antiretroviral therapy: Dosages .... .50 ANNEX C: Antiretroviral therapy: Side effects ......53 ANNEX D: Drug dosages for opportunistic infections ..54Recording Forms Sick Child ........................................................................ 55 Sick young infant .......................................................... 56

ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSASSESSASK THE MOTHER WHAT THE CHILDS PROBLEMS ARE Determine if this is an initial or follow-up visit for this problem. - if follow-up visit, use the follow-up instructions on TREAT THE CHILD chart. - if initial visit, assess the child as follows:

CLASSIFY

IDENTIFY TREATMENT

CHECK FOR GENERAL DANGER SIGNSASK: Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions?

LOOK: See if the child is lethargic or unconscious. Is the child convulsing now?

USE ALL BOXES THAT MATCH THE CHILDS SYMPTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS.

A child with any general danger sign needs URGENT attention; complete the assessment and any pre-referral treatment immediately so referral is not delayed.

THEN ASK ABOUT MAIN SYMPTOMS:Does the child have cough or difficult breathing?IF YES, ASK: LOOK, LISTEN, FEEL:

SIGNSAny general danger sign OR Chest indrawing OR Stridor in calm child Fast breathing.

CLASSIFY ASSEVERE PNEUMONIA OR VERY SEVERE DISEASE

TREATMENT(Urgent pre-referral treatments are in bold print.)

Give first dose of an appropriate antibiotic IM. If wheezing give a trial of rapid acting bronchodilator for up to three times before classifying severe pneumonia* Refer URGENTLY to hospital. Give oral antibiotic for 5 days If wheezing give a trial of rapid acting bronchodilator for up to three times before classifying pneumonia. If wheezing give an inhaled bronchodilator for five days* If recurrent wheezing refer for an assessment Soothe the throat and relieve the cough with a safe remedy Check for HIV infection If coughing for more than 30 days refer for possible TB or asthma Advise the mother when to return immediately Follow-up in 2 days If wheezing give an inhaled bronchodilator for 5 days* If recurrent wheezing refer for an assessment Soothe the throat and relieve cough If coughing for more than 30 days refer for possible TB or asthma Advise mother when to return immediately Follow up in 5 days if not improving

For how

Count the breathsin one minute. Look for chest indrawing. Look and listen for stridor or wheezing.

long?

}

CHILD MUST BE CALM

Classify COUGH or DIFFICULT BREATHING

PNEUMONIA

If the child is: 2 months up to 12 months 12 months up to 5 years

Fast breathing is: 50 breaths per minute or more 40 breaths per minute or more

No signs of pneumonia or very severe disease.

COUGH OR COLD

* In settings where inhaler is not available, oral salbutamol may be the second choice

2

Does the child have diarrhoea?Two of the following signs:

for DEHYDRATION

Lethargic or unconscious Sunken eyes Not able to drink or drinking poorly Skin pinch goes back very slowly.

SEVERE DEHYDRATION

IF YES, ASK: For how long? Is there blood in the stool?

LOOK AND FEEL: Look at the childs general condition. Is the child: - Lethargic or unconscious? - Restless and irritable? Look for sunken eyes. Offer the child fluid. Is the child: - Not able to drink or drinking poorly? - Drinking eagerly, thirsty? Pinch the skin of the abdomen. Does it go back: - Very slowly (longer than 2 seconds)? - Slowly? Not enough signs to classify as some or severe dehydration.

If child has no other severe classification: - Give fluid for severe dehydration (Plan C). OR If child also has a