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((((Integrated

Management of

Childhood Illness

((((Integrated

Management of

Childhood Illness

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Assess and Classify the Sick Child

Aged 2 Months up to 5 Years

I.Ask the Mother what the childs problems are

Determine if this is an initialor follow-up visit for this problem

1.if follow up visit, use the follow-up instructions on TREAT THE

CHILD CHART.

2. if initial visit ,assess the child as follows:

II.Classify

III.Identity Treatment

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1. Is the child not able to drink orbreastfeed?

2. Does the child vomit everything?

3. Has the child had convulsions?

(During present illness)

1. Is the child not able to drink orbreastfeed?

2. Does the child vomit everything?

3. Has the child had convulsions?

(During present illness)

See if the child is abnormally sleepy or difficult to awaken?See if the child is abnormally sleepy or difficult to awaken?

A child with any general danger signs needs URGENT attention,

complete the assessment and pre-referral treatment so referral is not

delayed.

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Presence of general danger

signs

Make sure the child with any general danger

sign is referred after the first dose of an

appropriate antibiotic and other urgent

treatments.

Exception : Rehydration of the child according toplan cmay resolve the danger signs so that referral is nolonger

needed.

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If yes, Ask : For how long?If yes, Ask : For how long?

Does the child have cough or

difficult breathing?

Look ,Listen:

1.Count the breaths in one minute.

2. Look for chest indrawing.

3. Look and listen for stridor.

IN ALL 3 CHILD MUST BE CALM

Look ,Listen:

1.Count the breaths in one minute.

2. Look for chest indrawing.

3. Look and listen for stridor.

IN ALL 3 CHILD MUST BE CALM

2-12 mos. 50 breaths/min or more

12 mos. and up 40 breaths/min or more

Considered

fast breathing

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Signs Classify As Treatment(Urgent pre-referral are on bold print)

1. Any general danger

sign or2.Chest indrawing or

3. Stridor in calm child

SEVERE

PNEUMONIAOR SEVERE

DISEASE

1. GIVE FIRST DOSE OF AN APPROPRIATE

ANTIBIOTIC

2. GIVE VIT. A

3. TREAT THE CHILD TOPREVENT LOW

BLOOD SUGAR

4. REFER URGENTLY TOHOSPITAL

Fast breathing PNEUMONIA 1. GIVE AN APPROPRIATE ANTIBIOTIC FOR 5DAYS

2. Soothe the throat and relieve the cough with

a safe remedy.

3. Advise mother when to return immediately.

4. Follow up in 2 days

No signs of

pneumonia or verysevere disease

NO

PNEUMONIACOUGHOR

COLD

1.If coughing for more than 30 days,

refer for assessment.

2. Soothe the throat and relieve the

cough with safe remedy.

3.Advise mother when to return

immediately.

4.Follow up in 5 days if not improving.

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1. For how long?

2. Is there blood in the stool?

A. Look a the childs general condition.Is the child:

1. Abnormally sleepy or difficult to awaken?

2. Restless and irritable?

B. Look for sunken eyes.

C. Offer the child fluid.Is the child:

1. Not able to drink or drinking poorly?

2. Drinking eagerly, thirsty?

D. Pinch the skin or the abdomen. Does it goback:

1. Very slowly (longer than 2 secs.)?

2. Slowly?

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Twoof the ff. signs:

1. Abnormally sleepy or diff. to awaken

2. Sunken eyes

3.Not able to drink or drinking poorly

4.Skin goes back slowly

Severe

Dehydration

If the child has no other severe classification:

Give fluid for severe dehydration.

If the child has another severe classification:

1.Refer urgently to Hospital ,with mother

giving frequent sips of ORS on the way.

2. Advise mother to continue breastfeeding.

If the child is 2 years or older and there is

cholera in your area, give antibiotic for cholera.

Twoof the ff. signs:

1. Restless, Irritable

2. Sunken Eyes

3.Drinks eagerly, thirsty4.Skin goes back slowly

Some

Dehydration

Give fluid and food for some dehydration.

If the child has another severe classification:

1.Refer urgently to Hospital ,with mother

giving frequent sips of ORS on the way.

2. Advise mother to continue breastfeeding

Advise mother when to return immediately.

Follow up in 5 days if not improving.

Not enough signs to

classify as some or severe

dehydration.

No

Dehydration

Give fluid and food to treat diarrhea at home.

Give zinc supplements

Advise mother when to return immediately.

Follow up in 5 days if not improving.

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Dehydration

present

Severe

PersistentDiarrhea

Treat dehydration before referral

unless the child has another

severe classification.

Give Vit. A

Refer to hospital.

NoDehydration

PersistentDiarrhea

Advise the motheron feeding a

child who has persistent diarrhea

Give Vit. A

Follow up in 5 days.

Advise mother when to return

immediately.

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Blood in stool Dysentery 1.Treat for 5 days with anoral antibiotic

recommended for shigella

in your area.

2. Follow up in two days,

3. Advise mother when to

return immediately.

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1. Decide Malaria risk.

2. If the child has measles now or within the last 3 mos.

3. Assess dengue Hemorrhagic Fever.

I. DECIDE MALARIA RISK

ASK:

1. Does the child live in a malaria area.

2.Has the child visited travelled or stayed overnight in

a malaria area in the past 4 weeks.

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Look and feel

If Yes to either, obtain a blood smear.

Then ask

1. For how long has the child had fever?

2.If more than 7 days, has the feverbeen present everyday?

3.Has the child had measles for the last 3 mos. ?

1. Look or feel for stiff neck.

2. Look for runny nose.

Look for signs of measles

1. general rashes and

2. cough, runny nose and red eyes.

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1. Any Generaldanger sign

2. Stiff neck

Verysevere

febrile

disease/

malaria

1.Give first dose of quinine(under medical supervision orif a hospital is not accessible w/in 4 hours.

2.Give first dose of an appropriate antibiotic

3. Treat the child to prevent low blood sugar.

4.Give one dose of paracetamol in health center for high

fever.

5.Send a blood smear with the patient.

6.Refer Urgently to hospital.

1.Blood smear(+)

Ifblood smear not

done:

a. No runny nose

B .No measles

c. Noother cause offever

MALARIA 1.TREAT THE CHILD WITH AN ORAL ANTIMALARIAL.2. GIVE ONE DOSE OF PARACETAMOL IN HEALTH

CENTER FOR HIGH FEVER.

3. Advise mother to return immediately.

4. Follow up in 2 days if fever persists.

5.If fever is present everyday for more than 7 days, referfor assessment.

1.Blood smear(-)

a. runny nose

b. measles

c.other causes of

fever

Fever:

Malaria

unlikely

1. GIVE ONE DOSE OF PARACETAMOL IN HEALTH

CENTER FOR HIGH FEVER.



4.If fever is present everyday for more than 7 days, refer

for assessment.5. Treat other causes of fever.

Malaria risk

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NoMalaria risk

Any general

danger sign.Stiff neck

VERY

SEVEREFEBRILE

DISEASE

1.Give first dose of an appropriate

antibiotic

2. Treat the child to prevent low bloodsugar.

3.Give one dose of paracetamol in health

center for high fever.

4.Refer Urgently to hospital

No signs of a

very severefebrile

disease.

FEVER :

NO

MALARIA

1. GIVE ONE DOSE OF PARACETAMOL IN

HEALTHCENTER FOR HIGH FEVER.



4.If fever is present everyday for more

than 7 days, refer for assessment.

5. Treat other causes of fever.

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Look for mouth ulcers: Are theydeep and extensive?

Look forPUS draining from the

eyes.Look for clouding of the cornea.

Look for mouth ulcers: Are theydeep and extensive?

Look forPUS draining from the

eyes.Look for clouding of the cornea.

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1.Clouding of thecornea.

2.Deep or extensive

mouth ulcers.

3.Any danger sign.

SEVERECOMPLICATED

MEASLES

1. Give Vit. A

2. Give first dose of an appropriate

antibiotic.

3. If clouding of the cornea or PUS

draining from the eye, apply

tetraclyne eye ointment.

4. Refer urgently to hospital.

1.Pus draining from

the eye.

2.Mouth ulcers

MEASLES WITH

EYE OR MOUTH

COMPLICATIONS

1. Give Vit. A

2. If PUS draining from the eye,

apply tetraclyne eye ointment.

3.If mouth ulcers ,teach the mother

to treat with gentian violet.

4.Advise mother when to return

immediately.

Measles now or

within the last 3

mos.

MEASLES 1. Give Vit. A2.Advise mother when to return

immediately.

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1.Has the child had any

bleeding from the nose or

gums, or in the vomitus or

stools?

2.Has the child had black

vomitus?

3.Has the child had

persistent abdominal pain?

4.Has the child had

persistent vomiting?

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1. Look forbleeding from the nose

or gums.

2. Look for skin petechiae.3.Feel for cold and clammy

extremities.

4.Check for slow cpillary refill.If

none of the above ASK,LOOK,andFEEL signs are present and the

child is 6 months orolder & fever

present for more than 3 days.

5.Perform the tourniquet test.

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1. Bleeding from nose or

gums

2.Bleeding in stools or

vomitus

3. Black stools or vomitus

4.Skin petechiae

5.Cold and clammy

extremities

6.Capillary refill for more than

3 seconds

7.Persistent abdominal pain

8.Persistent vomiting

9.Tourniquet test positive

SEVERE

DENGUE

HEMORRHAGIC

FEVER

1.If persistent vomiting or

persistent abdominal pain or

skin petechiae or positive

tourniquet tests are the only

positive, Give ORS

2.If any other signs of

bleeding is positive , givefluids rapidly

3.Treat the children to prevent

low blood sugar.

4.Refer all children urgently to

the hospital.

5. DO NOT GIVE ASPIRIN

No signs of severe

dengue hemorrhagic

fever.

FEVER:

DENGUE

HEMORRHAGIC

FEVER

UNLIKELY.

1. Advise mother when to

return immediately.

2. Follow up in two days if

fever persists or child shows

sighs ofbleeding.

3. DO NOT GIVE ASPIRIN.

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1. Pneumonia

2. Dysentery

3. Severe complicated measles

4. Measles with eye or mouth complications

5. Measles

6. Severe Dengue Hemmorhagic Fever

7. Mastoiditis

8. Acute ear infection

9. Abscess, cellulitis, osteomyelites

10.Severe pneumonia or severe disease

1. Pneumonia

2. Dysentery

3. Severe complicated measles

4. Measles with eye or mouth complications

5. Measles

6. Severe Dengue Hemmorhagic Fever

7. Mastoiditis

8. Acute ear infection

9. Abscess, cellulitis, osteomyelites

10.Severe pneumonia or severe disease

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Then ask

Does the child have an ear problem?

Is there an ear pain?

Is there ear discharge?

If yes, for how long?

Is there an ear pain?

Is there ear discharge?

If yes, for how long?

Look for the Pus draining from the ear.

Feel for tender swelling behind the ear.

Look for the Pus draining from the ear.

Feel for tender swelling behind the ear.

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Tending swellingbehind the ear MASTOIDITISGive first dose of an appropriate

antibiotic.

Give first dose of paracetamol for pain.

Refer urgently toHospital

1. Ear pain

2.Pus is seen

draining from theear, and discharge

is reported forless

than 14 days

ACUTE EAR

INFECTION

Give an antibiotic for 5 days.

Give paracetamol for pain.

Dry the earby wicking.Follow up in 5 days.


immediately.

Pus is seen

draining from the

ear, and dischargeis reported forless

than 14 days.

CHRONIC

EARINFECTION

Dry the earby wicking.


Advise mother when to returnimmediately.

1.No ear pain

2.No pus is seen

draining from the

ear.

NO EAR

INFECTION

No additional treatment


immediately.

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Then Check forMalnutrition and Anemia

Look, Listen

Look for visible severe wasting

Look for edema ofboth feet

Look for palmar pallor, Is it:

- severe palmar pallor?

- some palmar pallor?

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1.Visible severe wasting

2.Edema ofboth feet

SEVERE

MALNUTRITIONOR SEVERAL

ANEMIA

1. Give Vit. A

2. Refer Urgently to hospital.

1. Some palmar pallor

2. Very low weight for

age

ANEMIA OR

VERY LOW

WEIGHT

1. Assess the childs feeding.

- If feeding problem, follow up in 5 days

2.If some pallor:

-Give iron-Give mebendazole/albendazole if the

child is 12 months orolder, and has not

had a dose in the previous 6 mos.

3.If very low weight for age:

-Give Vit. A

- Follow up in 30 days

4. Advise mother when to returnimmediately.

Not very low weight for

age, and noother signs

of malnutrition.

NO ANEMIA AND

NOT VERY LOW

WEIGHT

1.If the child is less than 2 y.o., assess

the child's feeding and counsel the

motheron feeding.

- If feeding problem, follow up in 5 days

2. Advise mother when to return

immediately.

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Birth

6 weeks

10 weeks

14 weeks

9 months

Birth

6 weeks

10 weeks

14 weeks

9 months

BCG

DPT 1 OPV 1 Hep B 1

DPT 2 OPV 2 Hep B 2

DPT 3 OPV 3 Hep B 3

MEASLES

BCG

DPT 1 OPV 1 Hep B 1

DPT 2 OPV 2 Hep B 2

DPT 3 OPV 3 Hep B 3

MEASLES

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Vit. A Schedule

First dose at 6 mos.or above.

Subsequent doses every 6mos.

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Teach the mother to giveoral drugs at home.

1.Determine the appropriate drugs and dosage for the childs age or

weight.

2. Tell the mother the reason for giving the drugs to the child.

3.Demonstrate how to measure a dose.

4. Ask the mother to give the first dose to her child.

5. Explain carefully how to give the drug, then label and package thedrug.

6. If more than one drug will be given, collect , count, and package each

drug separately.

7. Explain that all oral drug tablets or syrup must be used to finish thecourse of treatment even if the child ets better.

1.Determine the appropriate drugs and dosage for the childs age or

weight.

2. Tell the mother the reason for giving the drugs to the child.

3.Demonstrate how to measure a dose.

4. Ask the mother to give the first dose to her child.

5. Explain carefully how to give the drug, then label and package thedrug.

6. If more than one drug will be given, collect , count, and package each

drug separately.

7. Explain that all oral drug tablets or syrup must be used to finish thecourse of treatment even if the child ets better.

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Age or

weight

COTRIMOXAZOLE(trimethopim+sulphamethoxazole)

Give twice a day for 5 days

AMOXYCILIN

Give 3 times daily

for 5 days.

ADULT TABLET80 mg trimethopim + 400

mg sulphamethoxazole

SYRUP

40 mg trimethopim + 200

mg sulphamethoxazole

per 5 ML

TABLET250 mg

Syrup125 mg /

5 ml

2 mos. Up

to 12 mos.

( 4-

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ForDysentery

First line: COTRIMAZOLE Second line: NALIDIXIC ACID

COTRIMAZOLE(trimethopim+sulphamethoxazole)

Give twice a day for 5

days

NALIDIXIC

ACID Give 4times a day for 5

days

Age or weight

See Doses Above

Syrup 250 mg/ 5 ml

2 mos. to 4 mos.

(4 < 6 kg)

1.25 ml (1/4 tsp)

4 mos. to 12 mos.(6 < 10 kg)

2.5 ml (1/2 tsp)

12 mos. to 5 years

(4 < 6 kg)5 ml (1 tsp)

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ForCholera

First line: TETRACYCLINE Second line: COTRIMAZOLE

TETRACYCLINE

Give 4 times a

day for 5 days

COTRIMOXAZOLE(trimethopim+sulphamethoxazole)

Give twice a day for 5 days

Age or weight Syrup 250 mg/ 5 ml

SEE DOSES ABOVE

2 mos. to 4 mos.

(4 < 6 kg)

1.25 ml (1/4 tsp)

4 mos. to 12 mos.

(6 < 10 kg)

2.5 ml (1/2 tsp)

12 mos. to 5 years

(4 < 6 kg)5 ml (1 tsp)

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Teach the mother to give oral Drugs at

home

>Give an Oral Antimalarial

First-line Antimalarial: CHLOROQUINE,PRIMAQUINE,SULFADOXINE

AND PYRIMETHAMINE

Second-line Antimalarial: ARTEMETER-LUMEFRANTINE>IF CHLOROQUINE:

-Explain to the mother that she watch her child carefully for 30 mins after giving a

dose of chloroquine. If the child vomits within 30 mins, she should repeat the dose

and return to the health center for additional tablets.

-Explain that itching is possible side effect of the drug, but is not dangerous

>IF SULFADOXINE +PYRIMETHAMINE: Give a single dose in the health center 2 hrsbefore intake ofChoroquine.

>IF PRIMAQUINE: Give single dose on Day 4 for P.falcifarum

>IF ARTEMETER-LUMEFRANTINE combination: Give for 3 days

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CHLOROQUINE>Give for 3 days

PRIMAQUINE

>Give single dose

in health center for

P.falciparum

PRIMAQUINE

>Give daily for 14

days for P.vivax

SULFADOXINE

+

PYRIMETHAMINE

>Give single dose in

health center

TABLET

(150 mg base)

AGE day 1 day 2 day 3

TABLET

(15 mg base)

TABLET

(15 mg base)

TABLET

(500 mg sulfadoxine)

25 mg pyrimethamine

2 mos. Up

To 5 mos.(4-

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>Give Paracetamol forHigh Fever(38.5 C

or above) or EarPain

PARACETAMOL

AGE OR WEIGHT TABLET (500

mg)

SYRUP(120

mg/5 ml)

2 months up to 3 yrs

(4-

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>Give Vitamin ATREATMENT SUPPLEMENTATION>Give one dose in the health center > Give one dose in health center if :

-child is six mos. Of age or older

-child has not received a dose of

vitamin A in the past six mos.

AGE VITAMIN A CAPSULES

100,000 IU 200,000 IU

6 mos. Up to 12

mos.

1 capsule

12 mos. Up to 5

yrs.

- 1 capsule

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>Give Iron>Give one dose daily for 14 days

AGE OR

WEIGHT

IRON/FOLATE

TABLET

Ferrous sulfate 200

mg + 250 mcg

Folate

(60 mg elementaliron)

IRON SYRUP

Ferrous sulfate 150

mg per 5 ml

(6 mg elemental iron

per ml)

IRON DROPS

Ferrous sulfate

25 mg

(25 mg elemental

iron per ml)

3 mos. Up to 4 mos.

(4 -

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>Give Mebendazole/ Albendazole>Give 500 mg Mebendazole/400 mg Albendazole as a single dose in the health

center if the child is 12 mos. Up to 59 mos. And has not had a dose in theprevious 6 mos. With the following dose.

Age orWeight Albendazole

400 mg tablet

Mebendazole

500 mg tablet

12 mos. Up to

23 mos.

1

24 mos. Up to59 mos.

1 1

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Teach the mother to treat

local infections at home.

1.Explain to the mother what the treatment is and

why it should be given.

2. Describe the treatment steps listed in the

appropriate box.

3. Watch the mother as she does the first treatment

in the health center (except the remedy for cough or

sore throat.

4. Tell how often the treatment should be done at

home.

5. If needed for treatment at home, give mother the

tube of tetracycline ointment or a small bottle of

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Clean both eyes 3 times daily

1. Wash hands

2. Ask child to close eyes

3. Use clean cloth and water to

gently wipe away pus.

Treat Eye Infection with

Tetracycline Eye Ointment.

Treat Eye Infection with

Tetracycline Eye Ointment.Then apply tetracycline in both eyes

3 times daily.

1. Ask the child to look up

2. Squirt small amt. of ointment onthe inside of the lower lid.

3. Wash hands again

Treat until redness is gone

Do not use other eye ointments or drops, or put anything else in the eye

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Dry the ear at least 3 times daily.

1. Roll the clean cloth or soft, strong tissue

paper into a wick.

2.Place the wick in the childs ear.

3.Remove the wick when wet.4.Replace the wick with a clean one and

repeat these steps until ear is dry.

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Treat the mouth ulcers twice daily.

1.Wash hands.

2.Wash childs mouth clean using soft

cloth wrapped around the finger wet with

salt water.

3. Paint the mouth with half strength

gentian violet, using cotton bud.

4. Wash hands again.

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1.Explain to the mother why the drug is

given.

2.Determine the dose appropriate for thechilds weight or age.

3.Use a sterile needle and sterile syringe.

Measure the dose accurately.4.Give the drug as an intramuscular

injection.

5.If children cant be referred follow the

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For children being referred whocannot take oral antibiotic:

Give the first dose of

intramuscularchoramphenicol and refer

child urgently to hospital.If referral is not possible:

1.Repeat the choramphenicol injection every 12

hours for 5 days.

2.Then change to an appropriate oral antibiotic

to complete 10 days of treatment.

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Age or Weight

ChloramphenicolDose:40 mg/kg

Add 5.0 ml sterile water to vial

containing 1000mg.=5.6 ml at 180

mg/ml

2 mos. up to 4 mos.(4 -< 6kg) 1.0 ml = 180 mg

4 mos. up to 9 mos.(6 -< 8kg) 1.5 ml = 270 mg

9 mos. up to 12 mos.(8 -

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or children being referred with a very severe febrile disease/malaria:

Give first dose of intramuscular

QUININE and refer child urgently to

hospital.If referral is not possible:

1.Give first of intramuscularQuinine.

2.The child should remain lying down forone hour.

3.Repeat the Quinine injection 4 and 8 hours later, and then

every 12 hours until the child is able to take an oral anti

malarial. Do not continue Quinine injections for more than 1

week.

4.Do not continue Quinine to a child less than 4 mos.of age.

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Age or Weight

IntramuscularQuinine

300 mg / ml(in ml ampoules)

4 mos. up to 12 mos.(6 -

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Teach the mother to give oral drugs at

home.

Ask the mother tobreastfeed the child.

If the child is not able tobreastfeed but is also to swallow:

1.Give expressed breast milk or a breast milk substitute.

2.If neither is available , give sugar water.

3.Give 30 to 50 mlof milk sugar waterbefore departure.

To make sugar water: Dissolve 4 level teaspoons of sugar

(20 grams) in a 200 ml cup of clean water.

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If the child is not able to swallow:

Give 50 mlof milk sugar waterby nasogastric tube.

If the child is difficult to awaken or

unconscious, start IV

transfusion:

1.Give5 ml/kg of 10 % of dextrose solution(D10) over a few minutes.

2.Or give 1 ml/kg of 50 % (D50) slow push

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Counsel the motheron the 4 Rules of home treatment :Give extra fluid, Give Zinc Supplements, Continue feeding

1. Give Extra Fluid

Tell The mother

Breastfeed frequently and longer each feeding.

If the child is exclusively breastfed, give ORS or clean water in addition to

breast milk.

If the child is not exclusively breastfed, give one or more of the ff: ORS

solution, food based fluids( such as soup, rice water, orbuko juice) or clean

water.

It is specially important to give ORS at home when:

The child has been treated with plan bor plan c during the visit

The child cannot return to a health center if the diarrhea gets worse.

Treat diarrhea at home.

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Teach the mother how to mix and give ORS. Give the

mother 2 packets ofORS to use at home.

Show the mother how much fluid to give in addition

to the usual fluid intake:

Up to 2 years

2 years or more

50 to 100 ml after each loose stool

100 to 200 ml after each loose stool

Tell the mother

Give frequent mall sips from a cup.

If the child vomits,wait 10 mins. Then

continue, but more slowly.

Counting giving extra fluid until the diarrhea

stops.

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2. Give Zinc Supplements

10 mg per day in infants - < 6 mos. For 10 - 14 days.

20 mg per day in children 6 mos. 5 years old for 10

14 days.

3.Continue Feeding

4.When to Return

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Give in Health Center recommended amount ofORS

Age Up to 4

mos.

4 to 12

mos.

12 mos. to

2 years

2 to 5 years

Weight < 6 kg

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Use the childs age only when you do not know

the weight . The approximate amount ofORS

required (in ml) can alsobe calculated by

multiplying the childs weight (in kg) times 75

If the child wants more ORS than shown,give more

For infants under six months of age who

are not breastfed, also give 100 - 200 mlclean water during this period

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Reassess the child and classify the child for dehydration.

Select the appropriate plan to continue treatment.

Begin feeding the child in health center.

Show her how to prepare ORS solution at home.

Show her how much ORS to give to her child to finish 4 hour treatment at home.

Give her enough ORS packets to complete rehydration. Also give her 2 packets.

Explain the 4 rules of home treatment1. Give extra fluid

2. Give zinc supplement

3.Continue feeding

4.Know when to return

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Give extra fluid for diarrhea and

continue feeding


continue feeding

1.Can you give IV fluids immediately? if yes,1.Can you give IV fluids immediately? if yes,

Start IV fluid immediately.If the child can drink, give ORS by mouth

while the drip is set up. Give 100 ml per kg Ringers lactate solution.

(or if not available, normal saline), divided as follows.

Age 1st give 30

ml/kg in:

Then give

70 ml/kg in:

Infants under 12

mos.

1 hour 5 hours

Children 12 mos.

Up to 5 years

30 mins. 2 1/2 hours

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continue feeding


continue feeding

1.Can you give IV fluids immediately? if yes,1.Can you give IV fluids immediately? if yes,

Reassess the child every 1- 2hours.If

hydration status is not improving, give IV drip

more rapidly.

Also give ORS (about 5 ml/kg per hour) as

soon as the child can drink: after 3 4 hours

(infants) 1 -2 hours (Children)

Reassess a infant after6 hours and the childafter 3 hours

If no:If no:

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continue feeding


continue feeding

2.Is IV treatment available nearby(within 30 mins) ? if yes,2.Is IV treatment available nearby(within 30 mins) ? if yes,

Refer urgently to hospital for iv

treatment.

The child can drink, provide

mother with ORS solution and

show her how to give frequentsips within the trip.

If no:If no:

Gi fl id f di h dGi fl id f di h d

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continue feeding


continue feeding

3. Are you trained to use a nasogastricfor rehydration ?

4.Can the child drink? If yes:

3. Are you trained to use a nasogastricfor rehydration ?

4.Can the child drink? If yes: Start rehydrating by tube (or mouth )by

ORS solution: Give 20 ml/kg/hr for6 hours(totalof 120 ml/kg)

Reassess the child every 1-2 hours:

1.If there is repeated vomiting orincrease in abdominal distention

If no:If no:

>Pl A T t Di h t h

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>Plan A: Treat Diarrhea at homeCounsel the mother on the 4 rules of the treatment:

Give extra fluid, give zinc supplements, continue feeding,

when to return

1. GIVEEXTRA FLUID (as much as the child will take)

>TELL THE MOTHER:

-B

reastfeeding frequently and longer at each feeding-If the child is exclusively breastfed, give ORS or clean

water in addition to breastmilk.

-If the child is not exclusively breastfed, give one or more

the following:

ORS solution, food-based fluid(such as soup,rice water or

buko juice), or clean waterIt is especially important to give ORS at home when:

-the child has been treated w/ Plan B or Plan C during the

visit, or

-the child cannot return to a health center if the diarrhea gets worse.

>TEACH THE MOTHER HOW TO MIX AND GIVE ORS GIVE THE

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>TEACH THE MOTHER HOW TOMIX AND GIVE ORS. GIVE THE

MOTHER 2 PACKETS OF ORS TO USE AT HOME.

>SHOW THE MOTHER HOWMUCH FLUID TO GIVE ADDITION TO

THE USUAL FLUID INTAKE:

Up to 2 yrs. 50 to 100 ml after each loose stool

2 yrs or more 100 to 200 ml after each loose stool

Tell the Mother:

-Give frequent small sips from a cup.

-If the vomits,wait 10 mins. Then continue, but more slowly

-Continue giving extra fluid until diarrhea stops.

2. GIVE ZINC SUPPLEMENTS 10 mg per day in infants - < 6 mos. For 10 to 14 days

20 mg per day in children 6 mos. 5 yrs old for 10 14 days

3. CONTINUE FEEDING

4. WHEN TO RETURN

>Plan B: Treat Some Dehydration

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>Plan B: Treat Some Dehydration

with ORSGive in health center recommended amount ORS over 4 hr period

>DETERMINE AMOUNT OF ORS TO GIVE DURING THE 1ST 4 HRS.

AGE Up to 4

mos.

4 mos.

Up to 12

mos.

12 mos.

Up to 2

yrs.

2 yrs up

to 5 yrs

WEIGHT

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, g

For infants under 6 months of age who are breastfed, also give 100 200 ml cleanwater during this period.

>SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.

Give frequent small sips from a cup.

If the child vomits,wait 10 mins. Then continue, but more slowly

Continue breastfeeding whenever the childs wants.

>AFTER 4 HOURS.

Reassess the child and classify the child for dehydration.

Select the appropriate plan to continue treatment.

Begin feeding the child in health center.

>IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:

Show her how to prepare ORS solution at home.

Show her how much ORS to give her child to finish 4-hr treatment at home.

Give her enough ORS packet to complete rehydration. Also give her 2 packets, asa recommended in Plan A.

Explain the 4 rules of home treatment.1. GIVE EXTRA FLUID

2. GIVE ZINC SUPPLEMENTS

3. CONTINUE FEEDING

4. KNOWWHEN TO RETURN

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Plan C: Treat Severe Dehydration QuicklyFOLLOW THE ARROWS.IF ANSWERS IS YES, GO ACROSS.IF NO, GO DOWN

Start here answers by NO

Can u give intravenous (IV) fluid immediately?

Is IV treatment available nearby (within 30 minutes?

Are you trained to use a nasogastric (NG) tube for rehydration?

Can the child drink?

Refer urgently to a hospital forIV or NG treatment.

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Start IV fluid immediately. If the child can drink, give ORS by mouth

while the drip is set up. Give 100/kg Ringers Lactate Solution(or,if not

available,normal saline),divided as follows: NOTE: ANSWERABLE BY

YES

*Repeat once if radial pulse is still very weak or not detectable

Reassess the child every 1-2 hours. If hydration status is not improving, give the IV

drip more rapidly.

Also give ORS (about 5 ml/kg/hr) as soon as the child can drink: usually after 3-4

hours (infants) or 1-2 hours (children).

Reassess an infant after 6 hours and a child after 3 hours. Classify the dehydration.

Then choose the appropriate plan (A, B, orC) to continue treatment.

AGE First give 30

ml/kg in:

Then give 70

ml/kg in:

Infants (under 12

months)

1 hour 5 hours

Children (12 months upto 5 yrs)

30 minutes 2 hours

R f URGENTLY t h it l f IV t t t

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Refer URGENTLY to hospital forIV treatment

If the child can drink, provide the mother with ORS solution and

show her how to give frequent sips during the trip.

Start rehydration by tube (or mouth) with ORS solution: give 20

ml/gk/hr for 6 hours (total of 120 ml/kg).

Reassess the child every 1-2 hours:

-If there is repeated vomiting or increasing abdominal ditension, givemore fluid slowly.

-If hydration status is not improving after 3 hours, send the child for

IV therapy.

After 6 hours, reassess the child. Classify dehydration. Then choose

the appropriate plan (A,B

, orC

) to continue treatment.

NOTE:

If possible, observe the child at least 6 hours after rehydration to be

sure that the mother can maintain hydration, giving the child ORS

solution by mouth.

GIVE FO OW UP CARE

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GIVE FOLLOW-UPCARE

>Care for the child who returns for follow-up using all the boxes that

match the childs previous classifications.>If the child has any new problem, assess, classify, and treat the new

problem as on the ASSESS AND CLASSIFY chart.

>PNEUMONIAAfter 2 days:

-Check the child for general dangerous signs.

-Assess the child for cough or difficult breathing.

Ask:

-Is the childs breathing slower?

-Is there less fever?

-Is the child eating better?

Treatment:

>Ifchest indrawing or a general danger sign, give a dose of second-line antibiotic

or intramuscular chloramphenicol. Then refer URGENTLY to hospital.

>Ifbreathing rate, fever, and eating are the same, change to the second-line

antiobiotic and advise the mother to return in 2 days or refer. (If the child had

measles within the 3 months, refer.)

>Ifbreathing slower, less fever, or eating better, complete the 5 days of antibiotic.

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>Ifcough is more than 30 days, refer for assessment

>PERSISTENT DIARRHEA

After 5 days:

Ask:

-Has the diarrhea stopped?

-How many loose stools is the child having per day?

Treatment:

>Ifthe diarrhea has not stopped (child is still having less than 3 or more loose

stools per day), do a full reassessment of the the child. Give any treatment needed.

Then refer to hospital

Ifthe diarrhea has stopped (child having less than 3 loose stools per day), tell

the mother to follow the usual recommendations for the childs age.

DYSENTERY

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After 2 days:

Assess the child for diarrhea

Ask:

-Ask there fewer stools?

-Is there less blood in the stool?

-Is there less fever?

-Is there less abdominal pain?

-Is the child eating better?

Treatment:

If the child is dehydrated, treat dehydration.If numberof stools, amount ofblood in stools, fever, abdominal pain, or eatingis the same or worse:

Change to second-line oral antibiotic recommended for Shigella in your area.

Give it for 5 days. Advice the mother to return in 2 days.

Exception if the child:

-is less than 12 months old, or-was dehydrated on the first visit, or

-had measles within the last 3 months

Iffewer stools, less blood in the stool, less fever, less abdominal pain, andeating better, continue giving the same antibiotic until finished.

MALARIA

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MALARIA

If fever persists after 2 days, or returns within 14 days:

Do a full assessment of the child.Treatment:

If the child has any general danger sign or stiff neck, treat as VERY SEVERE

FEBRILEDISEASE/MALARIA

If the child has any cause of feverother than malaria, provide treatment

Ifmalaria is the only apparent cause of fever.

-Take a blood smear

-Give second-line oral antimalarial w/o waiting for result of blood smear.

-Advise mother to return if fever persists.

-If fever persists after 2 days treatment w/ second-line oral antimalarial, refer

with blood smear for reassessment.

-If fever has been present for 7 days, refer for assessment

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FEVER-MALARIA UNLIKELY

If fever persists after 2 days:

Do a full assessment of the child.

Assess for other causes of fever.

Treatment:

If the child has any general danger sign or stiff neck, treat VERY SEVERE

FEBRILEDISEASE/MALARIA.

Ifmalaria is the only apparent cause of fever.

-Take a blood smear.

-Treat with the first-line oral antimalarial. Advise the mother to return again in 2

days if the fever persists.

-If fever has been present for 7 days, refer for assessment

FEVER (NO MALARIA)

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FEVER (NOMALARIA)



Make sure that there has been no travel to malarious area and overnight stay inmalaria area.

If there has been travel and overnight stay take blood smear, if possible.

Treatment:

If there has been travel and overnight stay to a malarious area and the blood smear

is positive or there is no blood smear classify according to Fever w/ Malaria Riskand treat accordingly.

If there has been no travel to malarious area orblood smear is negative:

-If the child has any general danger sign or stiff neck, treat as VERY SEVERE

FEBRILEDISEASE.

-If the child has any apparent cause of fever, provide treatment.

-If no apparent cause of fever, advise the mother to return again in 2 days if fever

persists.

-If fever has been present for 7 days, refer for assessment.

MEASLES WITH EYE OR MOUTH

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COMPLICATIONAfter 2 days:

Look for red eyes and pus draining from the eyes.Look at mouth ulcers.

Smell the mouth

Treatment for Eye Infection:

Ifpus is draining from the eye, ask the mother to describe how she has treated the

eye infection. If treatment has been correct, refer to hospital. If treatment has not

been correct, teach mother correct treatment.

If pus is gone but redness remains, continue the treatment.

Ifno pus or redness, stop the treatment.

Treatment forMouth Ulcers:

Ifmouth ulcers are worse, or there is a very foul smell from the mouth, refer to

hospital.

Ifmouth ulcers are the same orbetter, continue using half-strength gentian violet

for a total of 5 days.

FEVER: DENGUE HEMORRHAGIC FEVER

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UNLIKELY



Do a tourniquet test.

Assess for the other causes of fever.

Treatment:

If the child has any signs ofbleeding, including skin petechiae or a positivetourniquet test, or signs of shock, or persistent abdominal pain or persistent

vomiting.

If the child has any other apparent cause of fever, provide treatment.

If fever has been present for 7 days, refer for assessment.

If no apparent cause of fever, advise the mother to return daily until the child has hadno fever for least 48 hours.

Advise mother to make sure child is given more fluids and is eating.

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EAR INFECTION

After 5 days:

Reassess for ear problem.Measure the childs temperature.

Treatment:

If there is tender swelling behind the earor high fever(38.5 Cor above), treat as

MASTOIDITIS. Acute ear infection: if ear pain or discharge persists, treat w/ 5 more days of the

same antibiotic. Continue wicking to dry the ear. Follow up in 5 days.

Chronic ear infection: Check that the mother is wicking the ear correctly.

Encourage her to continue.

If no ear pain or discharge, praise the mother for her careful treatment. If she has

not yet finished the 5 days of antibiotic, tell her to use all of it before stopping.

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FEEDING PROBLEM

After 5 days:

Reassess feeding.

Ask about any feeding problems found on the initial visit.

Counsel the mother about any new or continuing feeding problems. If you counsel

the mother to make significant changes in feeding, ask her to bring the child back

again.

If the child has very low weight for age, ask the mother to return 30 days after the

initial visit to measure the childs weight gain.

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ANEMIA

After 14 days:

Give iron. Advise mother to return in 14 days for more iron.

Continue giving iron every day for 2 months with follow up every14 days.

If the child has any palmar pallor after 2 months, refer for

assessment.

VERY LOW WEIGHT

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VERY LOWWEIGHT

After 30 days:

Weight the child and determine if the child still has very low weight for age.Reassess feeding.

Treatment:

If the child is nolonger very low weight for age, praise the mother and encourage

her to continue.

If the child is very low weight for age, counsel the mother about any feedingproblem found. Continue to see the child monthly until the child is feeding well and

gaining weight regularly or is no longer very low weight for age.

Exception:

If you do not think that feeding will improve, or if the child has lost weight, refer the

child.

Note:

If any more follow up visits are needed based on the initial visit or this visit, advise

the mother of the next follow up visit.

Also, advise the motherwhen to return immediately.

Assess the Childs Feeding

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Ask questions about the childs usual feeding and during this illness. Compare the

mothers answers to the Feeding Recommendations for the childs age in the box

below.

ASK:

Do you breastfeed your child?

-How many times during the day?-Do you alsobreastfeed during the night?

Does the child take any other food or fluids?

-What food or fluids?

-How many times per day?

-What do you use to feed the child?-If very low weight for age: How large are serving?

Does the child receive his own serving?

Who feed the child and how?

During this illness, has the childs feeding changed?

If yes, how?

Assess the Childs Care for Development

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Assess the Child s Care for Development

Ask questions about how mother cares for her child. Compare the

mothers answer to the Recommendations forCare for

Development.

ASK:

-How do you play with your child?

-How do you communicate with your child?

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Sample Feeding Problem

1. Difficulty in breastfeeding

2. Child less than 4 months taking other milk/food

3. Use of breastmilk substitute/cows milk/evap milk

4. Use of feeding bottles

5. Lack of active feeding6. Not feeding well during illness

7. Complementary food not enough in quantity/quality/variety

8. Child 6 months above not yet given complementary foods

9. Infant not exclusively breastfed

10. Improper handling and use of breastmilk substitute

Recommendations for Feeding and Care for

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Recommendations for Feeding and Care for

DevelopmentBirth up to6Months

Exclusively breastfeed as often as the child wants, day and night, at least 8 times in

24 hours.

Do not give other foods or fluids.

Play:

Provide an area where the child could move, play and develop his senses of sight,

touch, and hearing.

Have large, colorful things for your child to reach for and new things to see.

Communicate:

Look into your childs eyes and smile at him or her.

When you are breastfeeding. It is a good time to talk to your child and get a

conversation going with sounds or gestures.

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6 months to 12 months

Breastfeed as often as the child wants.

Add any of the following:

-Lugaw w/ added oil, mashed vegetables or beans, steamed tokwa, flaked fish,

pulverized roasted dilis, finely ground meat, egg yolk, bite-size fruits

3 times per day if breastfed

5 times per day if not breastfed

Play:

Give your child clean, safe household things to handle, bang, and drop.

Communicate:

Respond to your childs sounds and interests. Tell your child the names of things andpeople.

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12 Months to 2 years

Breastfeed as often as the child wants.

Give adequate amount of family foods, such as:

rice,camote,potato, fish, chicken, meat, monggo, steamed tokwa, pulverized

roasted dilis, milk and eggs, dark-green, leafy and yellow vegetables(malunggay,

squash), fruits (papaya, banana)

Add oil or margarine.

5 times per day

Feed the baby nutritious snacks like fruits

Play:

Give your child things to stack up, and to put into containers, and take out.

Communicate:

Ask your child simple questions. Respond to your childs attempts to talk. Play

games like bye

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2 years and older

Give adequate amount of family foods at 3 meals every day. Give twice daily nutritious foods, between meals such as :

-Boiled yellow camote, boiled yellow corn, peanuts, boiled saba, banana, taho,

fruits, and fruit juices.

Play:

Help your child count, name, and compare things.

Make simple toys for your child.

Communicate:

Encourage your child to talk, and answer your childs questions. Teach your

child stories, songs, and games.

Feeding Recommendations for a child who

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Feeding Recommendations for a child who

has PERSISTENT DIARRHEA

If still breastfeeding, give more frequent, longer breastfeeds, day and night

If taking other milk such as milk supplements:

Replace these with increased breastfeeding, or

Replace half the milk with nutrient-rich, semi-solid foods.

Do not use condensed or evaporated filled milk.

For other foods, follow the feeding recommendations for the childs age

Counsel the Mother About Feeding

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Problems

If the child is not being fed as described in the above recommendations, counsel

the mother accordingly.In addition: If the mother reports difficulty with breastfeeding, assess breastfeeding. As needed,

show the mother correct positioning and attachment for breastfeeding.

If the child is less than 6 months old and is taking other milk or foods:

-Build mothers confidence that she can produce all the breastmilk that the child

needs.-Suggest giving more frequent, longer breastfeeding, day & night, and gradually

reducing other milk or foods.

If other milk needs to be continued, counsel the mother to:

-Breastfeed as much as possible, including at night.

-Make sure that other milk is a locally appropriate breastmilk substitute, give

only when necesarry.

-Prepare only an amount of milk which the child can consume within an hour. If

there is some left-over, discard.

If th th i i b ttl t f d th hild

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If the mother is using a bottle to feed the child:

-Recommend substituting a cup for bottle

-Show the mother how to feed the child with a cup.

If the child is not being fed actively, counsel the mother to:

-Sit with the child and encourage eating.

-Give the child an adequate serving in a separate plate or bowl.

-Observe what the child likes and consider this in the preparation of his/her

food.

If the child is not feeding well during illness, counsel the mother to:

-Breastfeed more frequently and longer if possible.

-Use soft, varied, appetizing, favorite foods to encourage the child to eat as

much as possible, and offer frequent small feeding.

-Expect that appetite will improve as child gets better.

> Follow up any feeding problem in 5 days.

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FLUID

Advise the Mother toIncrease Fluid During

Illness

FOR ANY SICK CHILD: Breastfeed more frequently and longer at each feed.

Increase fluid. For example, give soup, rice water, buko juice or clean water.

FOR CHILD WITH DIARRHEA:

> Giving an extra fluid can be lifesaving. Give fluid according to Plan A or PlanB on TREAT THECHILD chart.

WHEN TO RETURN

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Advise the MotherWhen to Return toHealth Center

Follow-up Visit

Advise the mother to come for follow-up at the earliest time listed for the childs problemIf the child has: Return f or follow-up in:

PNEUMONIA

DYSENTERY

MALARIA, if the fever persists

MEASLES WITH EYE OR MOUTHCOMPLICATIONS

DENGUE HEMORRAHAGIC FEVER UNLIKELY, if

the fever persists

2 days

PERSISTENT DIARRHEA

ACUTEEAR INFECTIONCHRONICEAR INFECTION

FEEDING PROBLEMS

MANY OTHER ILLNESS, if not improving

5 days

ANEMIA 14 days

VERY LOW WEIGHT FOR AGE 30 days

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WHEN TO RETURN IMMEDIATELY

Advise the mother to return immediately if the child has any of these signs:Ask sick child Not able to drink or breastfeed

Becomes sicker

Develops a fever

If the child has NO PNEUMONIA:

COUGH OR COLD, also return if:

Fast breathing

Difficult breathing

If the child has Diarrhea, also return if: Blood in stool

Drinking poorly

If the child has FEVER, DENGUEHEMORRHAGIC FEVER, UNLIKELY,

also return if:

Any sign of bleeding

Persistent abdominal pain

Persistent vomiting

Skin petechiae

Skin rash

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COUNSEL THE MOTHER ABOUT HER OWN HEALTH If the mother is sick, provide care for her, or refer her for help.

If she has a breast problem (such as engorgement, sore nipples, breast

infection), provide care for her or refer her for help.

Advise her to eat well to keep her own strength and health.

Check the mothers immunization status and give her Tetanus Toxoid ifneeded.

Make sure she has access to:

Family planning

Counseling on STD and AIDS prevention

ASSESS, CLASSIFY AND TREAT THE SICKINFANT

AGE 1 WEEK TO 2 MONTHS

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ASSESS

ASK THE MOTHER WHAT THE YOUNG INFANTS PROBLEMS AREDetermine if this is an initial or follow-up visit for this problem

-If follow-up visit, use the follow-up instructions in the follow-up section-If initial visi t, assess the young infant as follows:

CHECK FOR POSSIBLEBACTERIALINFECTION

ASK:

Has the infant had

convulsions?

LOOK, LISTEN:

Count the breaths in one minute. Repeat the count

if elevated.

Look for chest indrawing.

Look for nasal flaring.

Look and listen for grunting.Look and feel for bulging fontanelle.

Look for pus draining from the ear.

Look at the umbilicus. Is it red or draining pus?

Does the redness extend to the skin?

Measure temperature (or feel for fever or low body

temperature).

Look for skin pustules. Are the many or severe

pustules?

See if the young infant is abnormally sleepy or

difficult to awaken.

Look at the young infants movements. Are they

less than normal?

Classify

ALL

YOUNGINFANTS

USE ALL BOXES THAT MATCH

THE INFANTS SYMPTOMS ANDPROBLEMS TOCLASSIFY THEILLNESS.

CLASSIFYIDENTIFY

TREATMENT

Convulsions or

Fast breathing (60 breaths per

minute or more) or

Severe chest indrawing or

Nasal flaring or

Grunting orBulging fontanelle or

Pus draining from the ear or

Umbilical redness extending to

the skin or

Fever (37.5C or above, or feels

hot) or low body temperature

(less than 35.5C, or feels cold) or

Many or severe skin pustules or

Abnormally sleepy or difficult to

awaken or

Less than normal movement

Red umbilicus or draining pus or

Skin pustules

Give first dose of

intramuscular antibiotics

Treat the child to prevent

low blood sugar

Advise mother how to keep

the infant warm on the way to

the hospital

Refer URGENTLY to the

hospital

Give an appropriate oral

antibiotic

Treat the local infection in

the health center, and teach

the mother to treat local

infections at home.

Advise mother how to give

home care for young infant.


POSSIBLE

SE

RIOUSBACTERIAL

INFECTION

LOCAL

BACTERIAL

INFECTION

SIGNS CLASSIFY AS TREATMENT

THEN ASK:

Does the young infant have diarrhea?

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Does the young infant have diarrhea?

IF YES, ASK:

For how long?

Is there blood in

the stool?

LOOK AND FEEL:

Look at the young

infants general

condition. Is the

young infant:Abnormally

sleepy or difficult

to awaken?

Restless or

irritable?

Look for sunken

eyes

Pinch the skin of

the abdomen.

Does it go back:

Very slowly

(longer than 2

seconds)?

Slowly?

for

DEHYDRATION

Classify

DIARRHEA

and if diarrhea for

14 days or more

and if blood in

stool

Two of the following signs:

Abnormally sleepy or difficult

to awaken

Sunken eyes

Skin pinch goes back veryslowly

Two of the following signs:

Restless, irritable

Sunken eyes

Skin pinch goes back very

slowly

Not enough signs to classify

as some or severe dehydration

If infant does not have POSSIBLE SERIOUS

BACTERIAL INFECTION orDYSENTERY:

Give fluid for severe dehydration (Plan C)

OR

If infant also has a POSSIBLE SERIOUSBACTERIALINFECTION orDYSENTERY:

Refer URGENTLY to hospital, with mother giving

frequent sips of ORS on the way.

Advise mother to continue breastfeeding.

Advise mother how to keep the young infant warm

on the way to the hospital.

Give fluid for some dehydration (Plan B).

If infant also has POSSIBLE SERIOUS

BACTERIAL INFECTION orDYSENTERY:




Give fluid to treat diarrhea at home (Plan A)

Diarrhea lasting for 14 days or

more

Blood in the stool

If the young infant has dehydration, treat

dehydration before referral unless the infant also has

POSSIBLE SERIOUS BACTERIAL INFECTION.

Refer to hospital.




SEVERE

DEHYDRATION

SOME

DEHYDRATION

NO

DEHYDRATION

SEVERE,

PERSISTENT

DIARRHEA

DYSENTERY

THEN CHECK FOR FEEDING PROBLEMS OR LOWWEIGHT:

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IF YES, ASK: LOOK AND FEEL:

Is there any difficulty breathing?

Is the infant breastfed? If yes, how

many times in 24 hours?

Does the infant usually receive any

other food or drink? If yes, how often?

What do you u se to feed the infant?

Determine weight for age.

IF AN INFANT: Has any difficulty feeding,

Is breastfeeding less than 8 times in 24 hours,

Is taking any other foods or drinks, or

Is low weight for age,

AND

Has no indications t o refer urgently t o hospital

ASSESS THEINFANTS BREASTFEEDING:

Has the infant breastfedin the previous hour?

If the infant has not fed in the previous hours, ask the motherto put her infant to the breast. Observe the breastfeed for 4

minutes.

(If the infant was fed during the last hour, ask the mother if

she can wait, and to tell you when the infant is willing to feed

again.)

Is the infant able to attach?

no attachment at all not well attached good attachment

TO CHECK ATTACHMENT, LOOK FOR:

Chin touching the breast

Mouth wide openLower lip turned outward

More areola visible above than below the mouth

(All these signs should be present if the attachment is good)

Is the infant sucking effectively (that is, slow deep sucks,

sometimes pausing?)

not sucking at all not sucking effectively good effectively

Clear a blocked nose if it interferes with breastfeeding.

Look for ulcers or white patches in the mouth (thrush).

Classify

FEEDING

Not able to feed or

No attachment at all or

Not sucking at all

Not well attached to

breast or

Not sucking

effectively or

Less than 8

breastfeeds in 24

hours or

Receives other

foods or drinks or

Low weight for age

orThrush (ulcers or

white patches in the

mouth)

Not low weight for

age, and no other

signs of inadequate

feeding.

Give the first dose of intramuscular

antibiotics.

Treat to prevent low blood sugar

level.

Advise the mother how to keep the

young infant warm on the way to the

hospital.Refer URGENTLY to hospital.

Advise the mother to breastfeed as

often and for as long as the infant

wants, day and night.

If not well attached or not sucking

effectively, teach correct positioning

and attachment.

If breastfeeding less than 8 times in

24 hours, advise to increase

frequency of breastfeeding.

If receiving other foods or drinks,

counsel mother about breastfeedingmore, reducing other foods and drinks,

and using a cup.

If not breastfeeding at all:

Refer to breastfeeding

counseling and possible

relactation.

Advise about the correct

preparing of breastmilk substitutes,

and using a cup.

If thrush, teach the mother to treat

thrush at home.

Advise the mother to give home care

for the young infant.

Follow up any feeding problems orthrush in 2 days.

Follow up low weight for age in 14

days.

Advise mother to give home care for

the young infant.

Praise the mother for feeding the

infant well.

NOT ABLE

TO FEED

POSSIBLE

SERIOUS

BACTERIAL

INFECTION

FEEDING

PROBLEM

OR LOW

WEIGHT

NO FEEDING

PROBLEM

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THEN CHECK THE YOUNG INFANTS IMMUNIZATION STATUS:

Age Vaccine

Immunization schedule: Birth BCG

6 weeks DPT-1 OPV-1

Hep B-1

ASSESS OTHER PROBLEMS

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TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER

Give an appropriate oral antibiotic

ForLocal bacterial infection:First-line antibiotic: COTRIMOXAZOLE

Second-line antibiotic: AMOXICILLIN

Cotrimoxazole

(trimethoprim + sulphamothoxazole)

Give two times daily for 5 days

Amoxicillin

Give 3 times daily

for 5 days

Age or weight Adult tablet

Single strength (80mg trimethoprim

+400mg sulphamethoxazole)

Syrup

40mg trimethoprim

+200mg

sulphamethoxazole

Per 5 mL

Tablet

250mg

Syrup

125mg per 5

mL

Birth up to 1

month

(

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GIVE FIRST DOSE OF INTRAMUSCULAR ANTIBIOTICS

Give the first dose of both benzylpenicillin and gentamicin

intramuscular

WeightGentamicin

Dose: 5mg per kg

Benzylpenicillin

Dose: 50,000 units per kg

Undiluted 2mL Add 6mL sterilewaterOr vial containing OR to 2mL vialcontaining20mg = 2mL at 10mg/mL 80mg = 8mL at10mg/ml

To a vial of 600mg (1,000,000 units):Add 2.1mL sterile water= OR Add 3.6 sterile water=2.5mL at 400,000 units/mL 4.0mL at 250,000units/mL

1kg 0.5mL 0.1mL 0.2mL

2kg 1.0mL 0.2mL 0.4mL

3kg 1.5mL 0.4mL 0.6mL

4kg 2.0mL 0.5mL 0.8mL

5kg 2.5mL 0.6mL 1.0mL

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~ To treat Diarrhea, see TREAT THECHILD chart

~

Immunize every sick young infant as needed

~ Teach the mother how to treat local infections at home

Explain how the treatment is given

Watch her as she does the final treatment in the health center.

Tell her to do the treatment twice daily. She should return to the health center if infection

worsens.

To treat skin pustules To treat umbilical infection To treat

Oral Thrush

Wash hands ~Wash hands. >Wash hands

Gently wash off pus and crusts. ~Clean with 70% ethyl alcohol >Wash mouth

with

Dry the area ~Paint with gentian violet clean soft cloth

Paint with gentian violet ~Wash hands wrapped around the

Wash hands finger and wet with

salt water.

>Paint the mouth with

half-strength gentian

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Teach correct positioning and attachment for breastfeeding.Show the mother how to hold her infant.

With the infants head and body straight.

Facing her breast, with infants nose opposite her nipples.

With infants body close to her body.

Supporting infants whole body, not just neck and shoulders.

Show her how to help the infant attach. She should:

Touch her infants lips with her nipple.

Wait until her infants mouth is opening wide.

Move her infant quickly onto breast, aiming the infants lower lip well below the nipple.

Look for signs of good attachment and effective sucking. If the

attachment or sucking is good, try again.

ADVISE MOTHER TO GIVE HOME CARE FOR THE YOUNG

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ADVISE MOTHER TO GIVE HOME CARE FOR THE YOUNG

INFANT

Food Breastfeed frequently, as often and for as long as the

infant

Fluid wants, day and night, during sickness and health.

When to return

Follow-up visit When to return immediately:

Make sure the young infant stays warm at all times

In cold weather, cover the infants head and feet, and dress the infant with extra

clothing.

If the infant has: Return f or

follow-up

in:

LOCALBACTERIAL

INF.

ANY FEEDING

PROBLEM

THRUSH

2 days

LOW WEIGHT FOR

AGE

14 days

Advise the mother to return

immediately if the young infant

has any of these signs.

Breastfeeding or drinking poorly

Becomes sicker

Develops a fever

Fast breathing

Difficult breathing

Blood in stool

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GIVE FOLLOW-UPCARE FOR THE SICK YOUNG INFANT

Local bacterial infection

After 2 days:

Look at the umbilicus. Is red or draining pus? Does redness

extend to the skin?Look at the skin postules. Are there many or severe postules?

Treatment

If the pus or redness remains or is worse, refer to hospital.If the pus and redness are improved, tell the mother to continue

giving the 5 days of antibiotic and continue treating the local

infection at home.

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FEEDING PROBLEM

After 2 days:

Reassess feeding.> See Then check for feeding problem or low weightabove.

Ask about feeding problems found on the initial visit.

Counsel the mother about any new or continuing feeding problems.

Ifyou counsel the mother to make significant changes in feeding, ask her to

bring the young infant back again.

If the young infant is low weight for age, ask mother to return in 14 daysafter the initial visit to measure the young infants weight gain.

Exception:

If you do not think that feeding will improve, or if the young infanthas loss weight, refer the child.

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After 14 days:Weigh the young infant and determine if the infant is still

low weight for age.

Reassess feeding.> See Then check for feeding problem

or low weight aboveIf the infant is no longer low weight for age, praise the

mother and encourage her to continue.

If the young infant is still low weight for age, but is feeding

well, praise the mother. Ask the mother to come againwithin a month or when she returns for immunization.

If the young infant is still low weight for age and still has a

feeding problem, counsel the mother about the feeding

problem. Ask the mother to return again in 14 days (or

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After 2 days:

Look for ulcers or white patches in the mouth

(thrush).

Reassess feeding.> See Then check for feedingproblem or low weight above

If thrush is worse, or if the infant has problems with

attachment or sucking, refer to hospital.

If thrush is the same or better, and if the infant isfeeding well, continue half-strength gentian violet for a

total of 5 days

imci part 2[1]

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