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Transcript of IMCI New
All sick children must be examined for “General Danger Signs”
All sick children must be routinely assessed for Major Symptoms
Assessed for Nutritional Status, Immunization Status, & Vitamin A Status
Only a limited number of carefully selected clinical signs are used.
IMCI management procedures use a limited number of essential drugs & encourage active participation of caretakers.
An essential component of the IMCI guidelines is the counseling of caretakers.
Ask the Mother what the child’s problems are?
IF YES
REFER URGENTLY + 1st DOSE of APPROPRIATE ANTIBIOTICS & Other URGENT TREATMENT
Does the child have Cough or Difficult Breathing?
IF YES:
ASK: How Long?
LOOK & LISTEN: RRChest IndrawingStridor
1. Fast Breathing?
2. No Signs of PNM
3. Danger Signs + Chest Indrawing and Stridor
SIGNS CLASSIFY AS TREATMENT
CUVACSSEVERE PNEUMONIA
OR VERY SEVERE DISEASE
ANTIBIOTIC
VIT. A
TREAT TO PREVENT LOW BLOOD SUGAR
REFER!
Fast Breathing PNEUMONIA
Antibiotic (5 days)
Soothe the throat
When to Return
Follow up in 2 days
No signs of PNM or Very Severe Disease
NO PNEUMONIA:
COUGH OR COLD
Soothe the throat
When to Return
Follow up in 5 days
SIGNS CLASSIFY AS TREATMENT
CUVACSSEVERE PNEUMONIA OR VERY SEVERE DISEASE
1st Dose of Antibiotic
Refer
* Treat Low Blood Sugar at Vit A
Fast Breathing PNEUMONIA
Antibiotic (3 days)
(+) Wheezing = Rapid acting Bronchodilator (5 days)
More than 3 weeks (BAKA TB)
Soothe the throat
When to Return
Follow up in 2 days
No signs of PNM or Very Severe Disease
NO PNEUMONIA:
COUGH OR COLD
(+) Wheezing = Rapid acting Bronchodilator (5 days)
More than 3 weeks (BAKA TB)
Soothe the throat
When to Return
Follow up in 5 days
Does the child have Diarrhea?IF YES:
ASK: How Long?Is there a blood in the stool?
LOOK & LISTEN: General ConditionSunken Eyeball
Not able to drink or eagerly Pinch skin (very slow or slow)
DehydrationIf Diarrhea is for 14 days and moreIf presence of blood in the stool
1. Thirsty
Sunken Eyes
Slow Skin Pinch
2. Abnormally Sleepy
Sunken Eyes
Very Slow Skin Pinch
3. No enough signs and symptoms
Dehydration
2 of the following signs
Sunken eyeball
Skin pinch = very slow
Unable to drink
Abnormally sleepy
SEVERE DEHYDRATION
No other severe classification: Plan C
REFER! (ORS/BF)
2 yrs old + (+) cholera in area = Antibiotic
2 of the following signs
Sunken eyeball
Skin pinch = slow
Drinks eagerly
Restless
SOME DEHYDRATION
Plan B
When to Return
Follow up in 5 days If not improving
Not enough signs to classify as some or severe dehydration NO DEHYDRATION
Plan A
Zinc Supplement
When to Return
Follow up in 5 days
DEHYDRATION
2 of the following signs
Sunken eyeball
Skin pinch = very slow
Unable to drink
Abnormally sleepy
SEVERE DEHYDRATION
No other severe classification: Plan C
REFER! (ORS/BF)
2 yrs old + (+) cholera in area = Antibiotic
2 of the following signs
Sunken eyeball
Skin pinch = slow
Drinks eagerly
Restless
SOME DEHYDRATION
Plan B
Zinc Supplement
When to Return
Follow up in 5 days If not improving
Not enough signs to classify as some or severe dehydration NO DEHYDRATION
Plan A
Zinc Supplement
When to Return
Follow up in 5 days
DEHYDRATION
1. 14 days
Sunken Eyes
Abnormally Sleepy
2. 14 days
Sunken Eyes
Slow Skin Pinch
Restless
3. 14 days
No sunken eyes
Skin pinch goes back fast
Diarrhea of 14 days and more
(+) DehydrationSEVERE
PERSISTENT DIARRHEA
Treat Dehydration
Vit. A
REFER!
(-) DehydrationPERSISTENT
DIARRHEA
Advise on feeding
Vit. A
Follow up in 5 days
When to Return
If Diarrhea is 14 days or more
(+) DehydrationSEVERE
PERSISTENT DIARRHEA
Treat Dehydration
REFER!
* Vitamin A
(-) DehydrationPERSISTENT
DIARRHEA
Advise on feeding
Give multivitamins and minerals + zinc for 14
days
Follow up in 5 days
*When to Return
If Diarrhea is 14 days or more
Blood in the stool DYSENTERY
Antibiotic (5 days)
Follow up in 2 days
When to Return
(+) Blood in the Stool
Blood in the stool DYSENTERY
Ciprofloxacin (3 days)
Follow up in 2 days
*When to Return
(+) Blood in the Stool
Does the child have fever?
ASK: Does the child live in a malaria area?
Has the child visited/travelled in a malaria area in the past 4
weeks?
YES to EITHER: OBTAIN BLOOD SMEAR
IF YES:ASK: How long?
If more than 7 daysFever = everyday?
(+) Measles within the last 3 months
LOOK & LISTEN:
Stiff neck, Runny noseGeneralized Rash, Cough, Runny Nose, Red Eyes
1. Lives in Palawan
(-) Blood Smear
(+) Measles
2. Stayed in Palawan for 1 month
(+) Blood Smear
CUVAS
3. Had a Vacation in Palawan for 2 months
(+) Blood Smear
No danger signs and stiff neck
Malaria Risk
MALARIA RISK
CUVASVERY SEVERE
FEBRILE DISEASE
Quinine
Antibiotic
Low Blood Sugar
Paracetamol
Send the blood smear with client
REFER!
(+) Blood smear
> If BS is not done:
(-) runny nose
(-) measles
(-) other cause of fever
MALARIA
Oral Antimalarial
Paracetamol
When to Return
Follow up in 2 days
(-) Blood smear
(+) runny nose
(+) measles
(+) other cause of fever
FEVER: MALARIA UNLIKELY
Paracetamol
When to Return
Follow up in 2 days
1. Caregiver reported no travelling for the past year
Convulsion
Stiff Neck
2. Caregiver reported of 38 degree celsius temperature of her child with
the use of a rectal thermometer
No Malaria Risk
NO MALARIA RISK
CUVASVERY SEVERE
FEBRILE DISEASE
Antibiotic
Low Blood Sugar
Paracetamol
REFER!
No signs of very severe febrile disease
FEVER:
NO MALARIA
Paracetamol
When to Return
Follow up in 2 days
If the child has measles now or within the last 3 months
ASK: Measles within last 3 months?
LOOK & LISTEN: Signs of measles (cough, runny nose, red eyes)Mouth UlcersPus draining from eyesClouding of cornea
1. Cough
Coryza
Conjunctivitis
NOW
2. Pus draining from the eye
Mouth Ulcer
3. Danger Signs
Clouding of the Cornea
Deep Mouth Ulcer
Measles
Clouding of cornea
Deep or extensive mouth ulcers
CUVA
SEVERE COMPLICATED
MEASLES
Antibiotic
Vit. A
Tetracycline or Gentian Violet
REFER!
Pus draining from the eye
Mouth ulcers
MEASLES WITH EYE/MOUTH
COMPLICATION
Vit. A
Tetracycline or Gentian Violet
Follow up in 2 days
When to Return
Measles now or within the last
3 monthsMEASLES
Vit. A
When to Return
If DENGUE risk
ASK: Has the child had any bleeding from nose or gumsHas the child had black vomitus? Persistent
vomiting? Black stools?Persistent abdominal pain
LOOK & LISTEN:Bleeding in nose and gumsSkin petechiae Cold & clammy extremities
Tourniquet test
1. (-) Persistent Vomiting
(-) Tourniquet test
38.1 degree Celsius
(-) Melena
2. (+) Black Vomitus
(+) Melena
(+) Abdominal Pain
Epistaxis
3. (+) Tourniquet Test
(+) Vomiting
(+) Abdominal Pain
Dengue Hemorrhagic Fever
BLEEDING
Skin petechiae
+ Tourniquet Test
Cold and Clammy ext.
Persistent abd pain
Persistent vomiting
Bleeding in Stool
SEVERE DENGUE HEMORRHAGIC
FEVER
(+)VAST: Plan B
Signs of Bleeding: Plan C
Low Blood Sugar
NO ASPIRIN!
REFER!
No signs of SDHFFEVER: DENGUE HEMORRHAGIC
FEVER UNLIKELY
NO ASPIRIN!
Follow up in 2 days if fever persist or (+) signs
of Bleeding
When to Return
Does the child have an Ear Problem?IF YES:
ASK: Is there Ear Pain?Ear Discharge?How Long?
LOOK & LISTEN:Pus Tender swelling behind ear
1. No Tender Swelling Behind ear
No pus draining
No pain
2. More than 14 days of pus draining from the ear
3. 12 days complain of ear pain and pus draining
4. Tender Swelling Behind Ear
Ear Problem
Tender swelling behind the ear
MASTOIDITIS
Antibiotic
Paracetamol
REFER!
Discharge of Less than 14 days
Ear pain
ACUTE EAR INFECTION
Antibiotic (5 days)
Paracetamol
Dry the ear by wicking
Follow up in 5 days
When to Return
Discharge of 14 days or more
CHRONIC EAR INFECTION
Dry the ear by wicking
Follow up in 5 days
When to Return
No ear pain
No dischargeNO EAR INFECTION No additional treatment
Tender swelling behind the ear
MASTOIDITIS
Antibiotic
Paracetamol
REFER!
Discharge of Less than 14 days
Ear pain
ACUTE EAR INFECTION
Antibiotic (5 days)
Paracetamol
Dry the ear by wicking
Follow up in 5 days
When to Return
Discharge of 14 days or more
CHRONIC EAR INFECTION
Dry the ear by wicking
Treat with Topical Quinolone
Follow up in 5 days
When to Return
No ear pain
No dischargeNO EAR INFECTION No additional treatment
LOOK & LISTEN:Visible severe wastingEdema on both feetPalmar pallor: Severe or some?Weight
Classify nutritional status…
VESSEVERE
MALNUTRITION OR SEVERE ANEMIA
Vit. A
REFER!
Some Palmar pallor
Very low weight for ageANEMIA OR VERY LOW
WEIGHT
Paracetamol
Assess child’s feeding: Follow up in 5 days
(FEEDING PROBLEM)
Iron and Mebendazole (12 months + (-) 6
months)
Follow up in 14 days
Vit. A: Follow up in 30 days (LOW WEIGHT)
Not very low weight for age
NO ANEMIA OR Not VERY LOW WEIGHT
Assess child’s feeding: Follow up in 5 days
VESEVERE
MALNUTRITION
Treat to prevent LOW BLOOD SUGAR
REFER!
Very low weight for age VERY LOW WEIGHTAssess child’s feeding: Follow up in 30 days
Not very low weight for age
NOT VERY LOW WEIGHT
Assess child’s feeding: Follow up in 5 days
Severe Palmar Pallor SEVERE ANEMIA REFER!
Some Palmar Pallor ANEMIA
Give Iron
Mebendazole
Anti Malarial (Malaria Risk)
Follow 14 days
No Palmar Pallor NO ANEMIAAssess child’s feeding:
Follow up in 5 days
IMMUNIZATION SCHEDULE
AGE VACCINE
Birth BCG
6 weeks DPT1, OPV1, Hep-B1
10 weeks DPT2, OPV2, Hep-B2
14 weeks DPT3, OPV3, Hep-B3
9 months Measles
Vitamin A Supplementation ScheduleGive the first dose at 6 months or above.Give subsequent doses every 6 months.
Give an Appropriate Oral AntibioticFor Pneumonia, Acute Ear Infection, or
Very Severe Disease
First-line antibiotic:Second-line antibiotic:
COTRIMOXAZOLE (2 X daily for 5)
AGE/WEIGHT
ADULT TAB80 mg
Trimethoprim +400 mg
sulphamethoxazole
SYRUP40 mg T
+200 mg S
/5ml
2 mos – 12 mos(4-<10kg)
½ 5
12 mos – 5 years(10-19 kg)
1 10
AMOXYCILLIN (3 x daily for 5)AGE/WEIGHT
TABLET250 mg
SYRUP125 mg/5ml
2 mos – 12 mos(4-<10 kg)
½ 5
12 mos – 5 years(10-19 kg)
1 10
Give an Appropriate Oral AntibioticFor Pneumonia, Acute Ear Infection, or
Very Severe Disease
First-line antibiotic: Amoxicillin/Co - TriSecond-line antibiotic:
Give an Appropriate Oral AntibioticFor Dysentery
First-line antibiotic:Second-line antibiotic:
COTRIMOXAZOLE SAME with above doses
NALIDIXIC ACID (4 x a day for 5)AGE/WEIGHT
SYRUP 250 mg/5ml
2 mos – 4 mos (4-<6 kg) 1.25
4 mos – 12 mos (6-<10kg) 2.5
12 mos – 5 years (10-19 kg) 5
Give an Appropriate Oral AntibioticFor Dysentery
First-line antibiotic: CIPROFLOXACIN (BID x 3)
Second-line antibiotic:
Give an Appropriate Oral AntibioticFor Cholera
First-line antibiotic:Second-line antibiotic:
TETRACYCLINE (4 x a day for 5)AGE/WEIGHT CAPSULE (250 mg)
2 mos – 4 mos (4-<6 kg)
4 mos – 12 mos (6-<10 kg)
12 mos – 5 years (10-19 kg)
COTRIMOXAZOLESame with above doses
Give an Appropriate Oral AntibioticFor Cholera
First-line antibiotic: TetracyclineSecond-line antibiotic: ERYTHROMYCIN (4x
for 3)
Determine appropriate drugs and dosage for child’s age and weight
Tell the reason for giving drugsHow to measureWatch mother perform measuring dose herself1st doseExplain carefully how to give drugs, then labelFinish all course of txCheck the mother’s understanding before she leaves
Give an Oral AntimalarialFirst-line Antimalarial:Second-line Antimalarial: Artemeter
CHLOROQUINERemember!
Watch the child carefully for 30 mins.Itching is a possible side effect but is not
dangerous.
SULFADOXINE & PYRIMETHAMINERemember!
If the child with some palmar pallor is receiving the antimalarial Sulfadoxine-Pyrimethamine (Fansidar), do not give Iron/Folate until a follow up in two weeks.
CHLOROQUINE (3 days)AGE TABLET ( 150 mg base )
DAY 1 DAY 2 DAY 3
2 mos – 5 mos(4-<7 kg)
1/2 1/2 ½
5 mos – 12 mos(7-<10 kg)
1/2 1/2 ½
12 mos – 3 yrs(10-<14 kg)
1 1 ½
3 yrs – 5 yrs(14-<19 kg)
1 1/2 1 1/2 1
PRIMAQUINEAGE/WEIGHT P (Single Dose in
HC for P.Falcifarum)
P (Give Daily for 14 days for P. vivax)
Tablet (15 mg base) Tablet (15 mg base)
2 mos – 5 mos(4-<7 kg)
5 mos – 12 mos(7-<10 kg)
12 mos – 3 yrs(10-<14 kg)
1/2 ¼
3 yrs – 5 yrs(14-<19 kg)
3/4 ½
SULFADOXINE + PYRIMETHAMINE (Single dose)AGE/WEIGHT TABLET (500 mg S + 25 mg
P)
2 mos – 5 mos(4-<7 kg)
¼
5 mos – 12 mos(7-<10 kg)
½
12 mos – 3 yrs(10-<14 kg)
¾
3 yrs – 5 yrs(14-<19 kg)
1
Give an Oral AntimalarialFirst-line Antimalarial: Co Artemeter
LumefantrineSecond-line Antimalarial:
Artemeter is 20 mg while Lumefantrine is 120 mg5 months – 3 years (1 tab): 0h, 8h, 24h, 36h, 48h,
60h3 years – 5 years (2 tabs): 0h, 8h, 24h, 36h, 48h, 60h
Give ParacetamolHigh FeverEar pain
Give paracetamol every 6 hours
Give Vitamin A (100,000; 200,000 IU)6 months to 1 year old:
1 year old to 5 years:
Give Iron
Give one dose daily for 14 days.
Give Mebendazole/AlbendazoleGive 500 mg Mebendazole as a single dose in
health center if:12 mos – 23 mos: A (400 mg): ½
M (500 mg): 124 mos – 59 mos: A (400 mg): 1
M (500 mg): 1
EYE INFECTIONTreat Eye Infection 3 times daily
Tetracycline Eye Oinment
EAR INFECTIONDry the Ear by wicking atleast 3 times daily
MOUTH ULCERSTreat Mouth ulcers with Gentian VioletTreat the mouth ulcers twice daily
COUGHSoothe the Throat, Relieve the Cough with
Safe RemedyBF, Tamarind, Calamansi, Ginger
Do not give:
Codeine cough syrupOther cough syrupsOral and nasal decongestantsAntitussives
Give an Intramuscular AntibioticFor children being referred urgently who
cannot take an oral antibiotic:
GIVE 1st DOSE of IM CHLORAMPHENICOL
Ampicillin 50mg/kgGentamicin 7.5 mg/kg
UPDATE
Give Quinine for Severe MalariaFor children being referred with very severe
febrile disease/ malaria:GIVE 1st DOSE OF IM QUININE
If Referral is not possible:Give 1st IM QUININERemain lying down for 1 hourRepeat injection 4-8 hours, then 12 hours until
child is able to take oral anti malarial
TREAT HYPOGLYCEMIAIf the child is able to breastfeed:
If unable to breastfeed, but able to swallow:Give EXPRESSED MILK/BREASTMILK SUBSUGAR WATER
Make sugar water:20gms sugar + 200ml water
If unable to swallow:50 ml of milk or sugar water thru NGT
If unconscious & NGT is not possible:Give D10 IVGive D50 slow push
PLAN A: 3 Rules of Home TreatmentGive extra Fluid
BFORSFLUID INTAKE
Up to 2 years – 50 to 100 ml each stool 2 years & more – 100 -200 ml each stool
Continue Feeding
When to Return
PLAN B: 4 Hours ORS TreatmentGive ORS during the first 4 hours
Age 0-4mos4mos- 1year
1-2 years 2-5 years
Weight < 6 kg 6-<10 kg 10-<12 kg 12-19 kg
In ml 200-400 400-700 700-900 900-1400
Things to Remember!What if the child vomits?
What will you do after 4 hours?Reassess child – classify DHNSelect app. Plan to continue TXBegin feeding the child in health center
If the Mother must leave before completing treatment:Prepare ORS, Give enough ORS packs, Plan A
Rules
PLAN C: I.V. TreatmentStart IV fluid ImmediatelyGive 100 ml/kg Ringer’s Lactate solution
Age1st give
30 ml/kg in:
Then give
70 ml/kg in:
0-1 year 1 hour 5 hours
1-5 years 30 minutes 2 ½ hours
Reassess an infant after 6 hours and a child after 3 hours.
PNEUMONIAAfter 2 days
If (+) chest indrawing or a general danger sign:URGENT REFERRAL
If breathing, fever,& eating are the same:2nd Line Antibiotics
If breathing is slower, less fever or eating better: COMPLETE 5 days Antbiotics
PERSISTENT DIARRHEAAfter 5 days
If the diarrhea has not stopped: REASSESS, TREAT, then REFER
If the diarrhea has stopped: Inform the mother to follow USUAL RECOMMENDATION for child’s age
DYSENTERYAfter 2 days
If the child is dehydrated: 2nd line antibiotics for 5 days, FFUP 2 days
If condition becomes better: Continue giving same antibiotics
MALARIAIf fever persists after 2 days, or returns after 14
days: FULL ASSESSMENT, CLASSIFY
If (+) CUVAS: Treat as VERY SEVERE MALARIA
If (+) other cause of fever other than malaria:Provide Treatment
If Malaria is the only apparent cause of fever:Blood Smear, 2nd line antimalarial
FEVER-MALARIA UNLIKELYIf fever persists after 2 days: ASSESS,
CLASSIFY
If (+) CUVAS: Treat as VERY SEVERE MALARIA
If Malaria is the only apparent cause of fever:Blood smear, 1st line antimalarial
FEVER (NO MALARIA)If fever persists after 2 days: ASSESS,
CLASSIFY
If (+) travel to a malarious area and blood smear(+): Treat accordingly
If (-) travel to a malarious area and blood smear(-):+CUVA - Refer
MEASLES WITH EYE OR MOUTH COMPLICATIONAfter 2 days
Eye InfectionIf (+) pus draining from the eye: Correct
tx=refer, wrong tx=teach mother correct tx
If (-) pus but (+) redness : Continue tx
If (-) pus & (-) redness: Stop Tx
Mouth Ulcers
If ulcers are worse: REFER
If ulcers are the same or better: CONTINUE HALF STRENGTH GENTIAN VIOLET
FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY
If fever persists after 2 days: ASSESS, CLASSIFY
If the child has any apparent cause of fever:Provide Treatment
If (+) fever for 7 days:Refer for assessment
If no apparent cause of fever:Advise mother to return daily until child
has had no fever for at least 48 hours
EAR INFECTIONAfter 5 days: ASSESS, CLASSIFY
If (+) tender swelling behind the ear or high fever: Treat as MASTOIDITIS
Acute ear infection: If ear pain or discharge persists: CONTINUE WICKING
Chronic Ear infection: CONTINUE EAR WICKING
If no ear pain or discharge: FINISH ANTIBIOTIC, PRAISE HER!!!
FEEDING PROBLEMAfter 5 days
Counsel the mother for any new or continuing feeding problem
If the child is very low weight for age: Ask mother to return in 30 DAYS
ANEMIAAfter 14 days
Give Iron
If the child has any palmar pallor after 2 months: REFER
VERY LOW WEIGHTAfter 30 days: WEIGH
If no longer low weight for age: PRAISE THE MOTHER!!!
If still low weight for age: COUNSEL
Feeding Recommendations0-4mos 4-6mos 6-12mos 12mos-2yrs
2 years & above
•Breastfeed
•Do not give other foods or fluids
•Breastfeed
•Give complementary foods
•Breastfeed
•Give complementary foods
•Breastfeed
•Give complementary foods
•Give adequate amount of food at 3 meals each day
Feeding Recommendation for a Child with Persistent Diarrhea
If still breastfeeding: CONTINUE, DAY and NIGHT
If taking other milk: REPLACE this INCREASED BF
DO NOT USE CONDENSED OR EVAPORATED MILK
FOLLOW-UP VISITS
If the child has: Return for follow-up in:
Pneumonia
Dysentery
Malaria, If fever persists
Fever-Malaria Unlikely, If fever persists
Fever (No Malaria), If fever persists
Measles with eye/mouth complications
Dengue Hemorrhagic Fever Unlikely, If fever persists
2 days
Persistent Diarrhea
Acute & Chronic Ear Infection
Feeding Problem
5 days
Anemia 14 days
Very Low weight for age 30 days
WHEN TO RETURN IMMEDIATELY
Any sick child •Unable to drink or breastfeed•Becomes sicker•Develops a Fever
No Pneumonia: Cough or Cold •Fast breathing•Difficult breathing
Child with Diarrhea •Blood in stool•Drinking poorly
Fever: Dengue Hemorrhagic Fever Unlikely
•Any sign of bleeding•Abdominal pain•Vomiting
CLASSIFICATIONS NEEDING VITAMIN A
Severe Pneumonia or Very Severe DiseasePersistent DiarrheaSevere Persistent Diarrhea Severe Complicated MeaslesMeasles with Eye & Mouth ComplicationsMeaslesSevere Malnutrition & Severe AnemiaVery Low Weight by Age
Ask the Mother what the infant’s problems are?
ASK: Has the infant had CONVULSION?
LOOK & LISTEN:RR, Chest Indrawing, Nasal Flaring, Bulging Fontanelles, Pus in ear,
Draining pus at the umbilicus, Temperature, Skin Pustules, abnormally asleep…
Classify all Young Infants…
CUVA
ALL MAJOR SIGNS (+)
POSSIBLE SERIOUS
BACTERIAL INFECTION
IM Antibiotic
Glucose
Warmth
REFER!
•Red Umbilicus or draining pus•Skin pustules
LOCAL BACTERIAL INFECTION
Antibiotic (5 days)
Treat Local Infection
Follow-up in 2 days
CUVA
ALL MAJOR SIGNS (+)
POSSIBLE SERIOUS
BACTERIAL INFECTION
IM Antibiotic
Glucose
Warmth
REFER!
•Red Umbilicus or draining pus•Skin pustules
LOCAL BACTERIAL INFECTION
Antibiotic (5 days)
Treat Local Infection
Follow-up in 2 days
•No Signs of Very Severe Disease or Local Bacterial Infection
SEVERE DISEASE/ LOCAL BACTERIAL
INFECTION
UNLIKELY
Advise Mother to give home care
Does the young infant have Diarrhea?
Classify Diarrhea- dehydration- If diarrhea 14 days or more- If blood in stool
SAMESEVERE
DEHYDRATIONPlan C or
REFER!
SAMESOME
DEHYDRATIONPlan B or
REFER!
Not enough signs to classify as some or severe dehydration.
NO DEHYDRATION Plan A
DEHYDRATION
Diarrhea lasting 14 days or more
SEVERE PERSISTENT DIARRHEA
Treat dehydration if dehydrated
REFER!
If Diarrhea is 14 days or more
Blood in the stool DYSENTERY REFER!
(+) Blood in the Stool
•Not able to feed•No attachment at all•Not sucking at all
NOT ABLE TO FEED-
POSSIBLE SERIOUS
BACTERIAL INFECTION
IM antibiotic
Glucose
Warmth
REFER!
•Not well attached•Not sucking effectively•< 8 breastfeeds in 24 hours•Low weight for age•Thrush
FEEDING PROBLEM OR LOW WEIGHT
•Advise mother on breastfeeding•Treat Thrush
•Follow-up feeding problem or thrush in 2
days•Follow up low weight for
age in 14 days
Not low weight for age and no other signs of inadequate feeding
NO FEEDING PROBLEM
Home care
Praise the mother
UPDATE
No More NOT ABLE TO FEED: POSSIBLE SERIOUS BACTERIAL INFECTION
IMMUNIZATION SCHEDULE
AGE VACCINE
Birth BCG
6 weeks DPT1, OPV1, Hep-B1
Give an Appropriate Oral AntibioticFor Local Bacterial Infection:
First line antibiotic:Second line antibiotic:
COTRIMOXAZOLE (2 x a day for 5)AGE/WEIGHT ADULT TAB SYRUP
Birth – 1 month (<3kg)
1.25 ml
1 – 2 months (3-4 kg) 1/4 2.5
AMOXYCILLIN (3 x a day for 5)AGE/WEIGHT TABLET (250 mg) SYRUP (125 mg/5
ml)
Birth – 1 month (<3kg)
1.25 ml
1 – 2 months (3-4 kg) 1/4 2.5 ml
REMEMBER!!!Avoid cotrimoxazole in infants less than 1
month of age who are premature jaundiced.
Give 1st dose of Intramuscular AntibioticGive 1st dose of both Benzylpenicillin and
Gentamicin IM.
Give 1st dose of Gentamicin and Ampicillin
UPDATE
TREAT LOCAL INFECTION AT HOMETreat Skin Pustules twice daily
GENTIAN VIOLET
TREAT LOCAL INFECTION AT HOMETreat Umbilical Infection twice daily
GENTIAN VIOLET
TREAT LOCAL INFECTION AT HOMETreat Thrush twice daily
WET WITH SALT WATERPAINT with HALF STRENGTH GENTIAN
VIOLET
Correct Positioning & Attachment for Breastfeeding
Infant’s head & body straightFacing her breast, with infant’s nose opposite
her nippleInfant’s body close to her bodySupport infant’s whole bodyTouch infant’s lips with her nipple
Wait until her infant’s mouth is opening wideMove the infant quickly onto the breast
Signs of Good Attachment
Chin touching the breastMouth wide openLower lip turned outwardMore areola visible above than below the
mouth
Give Home CareBreastfeed frequently, as often and as long as
the infant wants, day or night, during sickness and health.
FOLLOW-UP VISITS
If the child has: Return for follow-up in:
Local bacterial Infection
Any Feeding Problem
Thrush
2 days
Low weight for age 14 days
WHEN TO RETURN IMMEDIATELY
Breastfeeding or drinking poorly
Becomes sicker
Develops a fever
Fast breathing
Difficult breathing
Blood in stool
Keep the Infant Warm at all times
In cool weather, cover the infant’s head and feet & dress the infant with extra clothing
LOCAL BACTERIAL INFECTIONAfter 2 days
If Pus or redness remains or is worse: REFER
If pus and redness are improved:CONTINUE ANTIBIOTICS FOR 5 DAYS
FEEDING PROBLEMAfter 2 days
Counsel the mother for any new or continuing feeding problem: BRING CHILD BACK
If the child is low weight for age: RETURN CHILD 14 DAYS
LOW WEIGHTAfter 14 days
If no longer low weight for age: PRAISE
If still low weight for age, but is feeding well:COME AGAIN
If still low weight for age & still has a feeding problem: RETURN IN 14 DAYS
THRUSHAfter 2 days
If Thrush is worse or (+) problems with attachment or suckling: REFER
If Thrush is the same or better and is feeding well: CONTINUE HALF STRENGTH GENTIAN VIOLET