Treat the Child
Transcript of Treat the Child
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INTEGRATED MANAGEMENT
OF CHILDHOOD ILLNESS
(IMCI)
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Aged 2 Months Up to 5 Years
TREAT THE CHILD
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Objectives
Determining appropriate oral drugs and dosages
Giving oral drugs and teaching how and when to giveoral drugs at home
Treating local infections and teaching how and when togive treatments at home
Checking the mothers understanding
Giving injectable pre-referral drugs
Preventing low blood sugar
Treating different classifications of dehydration andteaching about extra fluids to give at home
Immunizing children
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give an appropriate antibiotic
The following needs antibiotic General danger signs
Severe pneumonia or very severe disease Pneumonia
Severe dehydration with cholera in the area
Dysentery
Very severe febrile disease/malaria
Severe complicated measles
Mastoiditis
Acute ear infection
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give first-line oral antibiotic if it is available. Second-
line antibiotic is given only if the first-line is
unavailable, or the illness does not respond to the first-
line antibiotic Sometimes, one antibiotic can be given for several
illnesses. Do not double the dose or prolong the
duration of giving the drug
To determine the correct dose, choose the row for theweight or age. Weight is better used in choosing the
right dose
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
For PNEUMONIA, ACUTE EAR INFECTION, VERY
SEVERE DISEASE, MASTOIDITIS
First-line antibiotic: Cotrimoxazole
Second-line antibiotic: Amoxycillin
AGE OR WEIGHT COTRIMOXAZOLE
- Give two times daily for 5 days
AMOXYCILLIN
- Give three times daily for 5 days
ADULT TABLET
80 mg/ 400/mg
SYRUP
40 mg/ 200mg/ 5 mL
TABLET
250 mg
SYRUP
125 mg/ 5 mL
2 months up to 12
months (4-10 kg)
1/2 5 mL 1/2 5 mL
12 months up to 5
years (10-19 kg)
1 10 mL 1 10 mL
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
For DYSENTERY: Give antibiotic recommended for
Shigella in your area for 5 days
First-line antibiotic: Cotrimoxazole
Second-line antibiotic: Nalidixic Acid
COTRIMOXAZOLE
- Give two times daily for 5 days
NALIDIXIC ACID
- Give four times daily for 5 days
AGE OR WEIGHT See above dosage SYRUP 250 mg/ 5 mL
2 months up to 4months (4-6 kg) 1.25 mL (1/4 tsp)
4 months up to 12
months (6-10 kg) 2.5 mL (1/2 tsp)
12 months up to 5
years (10-19 kg)5 mL (1 tsp)
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
For CHOLERA: Give an antibiotic recommended for
Cholera in your area for 3 days
First-line antibiotic: Tetracycline
Second-line antibiotic: Cotrimoxazole
TETRACYCLINE
- Give four times daily for 3
days
COTRIMOXAZOLE
- Give two times daily for 5
days
AGE OR WEIGHT CAPSULE (250 mg) See above dosage
2 months up to 4 months (4-6
kg)
4 months up to 12 months (6-
10 kg)
1/2
12 months up to 5 years (10-
19 kg)
1
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give an Oral Antimalarial Treatment with Chloroquine assumes that the child has not
yet been treated with that drug before. Confirm this withthe mother. Use instructions in the GIVE FOLLOW-UP CARE
MALARIA on the TREAT THE CHILD chart if it is a follow-upvisit
Reduce the dose for the three-day treatment of Chloroquine
Explain the possible itching as a side effect of the drug
If (+) for P. Falciparum, a single dose of
Sulfadoxine/Primaquine is given. Then the first dose ofChloroquine is given after two hours to minimize gastricirritation. A single dose of Primaquine will be given on Day4 at the health center
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
If (+) P. Vivax, a first dose of Primaquine and
Chloroquine is given in the center, the, one dose each
day for another 13 days
For mixed infections, treat as P. Falciparum and startPrimaquine as in P. Vivax
If no blood smear test done, treat as P. Falciparum
DO NOT give Primaquine to children under 12 months
of age
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give an oral antimalarial
First-line: Chloroquine, Primaquine, Sulfadoxine and
Pyrimethamine
Second-line: Artemeter-Lumefrantine
If Chloroquine
Explain to watch child carefully for 30 minutes after
giving a dose of Chloroquine. Repeat ifthe child vomitsafter 30 minutes
Itching is a possible side-effect of the drug
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
If Sulfadoxine + Pyrimethamine
Give single dose in the health center 2 hours before
intake of Chloroquine
If Primaquine
Give single dose on Day 4 for P. Falciparum
If Artemeter-Lumefrantine
Give for three days
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
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
AGE TABLET(150 mg)
TABLET(15 mg)
TABLET(15 mg)
TABLET(500 mg/ 25 mg)
DAY 1 DAY 2 DAY 3
2 months up
to 5 months
(4-7 kg)
1/2 1/2 1/2 1/4
5 months up
to 12 months
(7-10 kg)
1/2 1/2 1/2 1/2
12 months up
to 3 years
(10-14 kg)
1 1 1/2 1/2 1/4 3/4
3 years up to
5 years (14-
19 kg)
1 1/2 1 1/2 1 3/4 1/2 1
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give Paracetamol for High Fever (38.5 or higher)
or Ear Pain
Give one dose Paracetamol in the center then give
enough for one day
PARACETAMOL
AGE OR WEIGHT TABLET (500 mg) SYRUP (120 mg/ 5 mL)
2 months up to 3 years (4-
14 kg)
1/4 5 mL (1 tsp)
3 to 5 years (14-19 kg) 1/2 10 mL (2 tsp)
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give Vitamin A
Vitamin A is given in SEVERE PNEUMONIA or VERY
SEVERE DISEASE, SEVERE PERSISTENT DIARRHEA or
PERSISTENT DIARRHEA, or MEASLES, or SEVEREMALNUTRITION or VERY LOW WEIGHT
For both treatment and supplementation, a single dose
is given in the health center
Should be given only Age six months and older
Children who have not had a dose in the past six months
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
AGE VITAMIN A CAPSULES
100,000 IU 200,000 IU
6 months up to 12 months 1 1/2
12 months up to years - 1
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give Iron
Some palmar pallor
Give syrup to a child under 12 months old. Iron/folate
tablet for children above 12 months
Give mother enough iron for 14 days and tell to give
one dose daily. Teach how to give and what to observe
If receiving antimalarial sulfadozine pyrimethamine
(Fansidar), do not give Iron/Folate tablet yet until a
follow-up visit in two weeks. If the Iron available does
not contain Folate, it may be given
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
AGE OR WEIGHT IRON/FOLATE
TABLET
Ferrous sulfate 200
mg + 250 mcg
folate
(60 mg elemental
iron)
IRON SYRUP
Ferrous sulfate 150
mg/ 5mL
(6 mg elemental
iron per mL)
IRON DROPS
Ferrous sulfate 25
mg
(25 mg elemental
iron/ mL)
3 months up to 4
months (4-6 kg)
2.5 mL (1/2 tsp) 0.6 mL
4 months up to 12months (6-10 kg)
4 mL (3/4 tsp) 1 mL
12 months up to 3
years (10-14 kg)
1/2 5 mL 1.5 mL
3 years up to 5
years (14-19 kg)
1 10 mL (1 tsp) 2 mL
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Select an Appropriate Oral Drug and
Determine the Dose and the Schedule
Give Mebendazole
A one-year old child who is anemic and with
hookworms or whipworms needs to be given this drug
Mebendazole 500 mg or Albendazole 400 mg assingle dose is given at the center if the child has not
been given one in the previous six months
AGE OR WEIGHT ALBENDAZOLE 400 mg
Tablet
MEBENDAZOLE 500 mg
Tablet
12 months up to 23 months 1/2 1
24 months up to 59 months 1 1
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Use Good Communication Skills
Success of home treatment depends on how well thehealth care worker communicated. The motherneeds to know how to give the treatment and
understand the importance of the treament Skills in communication include the following
ASK questions and LISTEN to find out what the mother isalready doing for the child
PRAISE for what she has done well ADVISE how to treat at home
CHECK the understanding
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Use Good Communication Skills
ADVISE THE MOTHER HOW TO TREAT HER CHILD AT
HOME
Three basic steps in teaching
Give information explain how to do the task Show an example show how to do the task
Let her practice ask to do the task while you watch
When teaching
Use words easily understood Use teaching aids that are familiar, such as common containers
Give feedback
Encourage to ask questions
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Use Good Communication Skills
CHECK THE MOTHERS UNDERSTANDING
Use good checking questions to help make sure that the
mother learns and remembers how to treat her child
Good checking questions require that she describeWHY, HOW, or WHEN
GOOD CHECKING QUESTIONS POOR CHECKING QUESTIONS
How will you prepare the ORS?
How often should you breastfeed your child?On what part of the eye do you apply the
ointment?
How much extra fluid should you give after each
loose stool?Why is it important for you to wash your hands?
Do you remember how to mix the ORS?
Should you breastfeed your child?Have you used ointment on your child
before?
Do you know how to give extra fluids?
Will you remember to wash your
hands?
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Teach the Mother to Give Oral Drugs
at Home
Follow these instructions
Determine the appropriate drugs and dosage for ageand weight
Tell the reason for giving the drug including why andwhat problem it is treating
Demonstrate how to measure a dose
If the drug is in syrup form, show how to measure using
common household teaspoon 1.25 mL tsp
2.5 mL tsp
5 mL 1 tsp
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Teach the Mother to Give Oral Drugs
at Home
Show how to give Vitamin A capsule
Watch the mother practice measuring a dose
Ask the mother to give the first dose. If the child
vomits within 30 minutes, give another dose. If thechild is dehydrated and vomiting, wait until the childis rehydrated before giving the dose again
Explain carefully, then label and package the drug
To write information on a drug label Full name of the drug and the total amount to complete the
treatment
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Teach the Mother to Give Oral Drugs
at Home
Write the correct dose and when to give
Write the daily dose and schedule
Write clearly
Put the drug in its own labelled container, keeping it clean
and dry Ask questions to make sure the mother understands
If more than one drug will be given, package each drugseparately
Explain that all oral drugs must be used to finish the course
of treatment even if the child gets better Advise to store drugs properly
Check mothers understanding before she leaves
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Teach the Mother to Treat Local
Infections at Home
Treat eye infection with Tetracycline eye ointment
If the child will be referred, clean eye gently and squirt
a small amount
If the child will not be referred, teach how to applydrug at home
Treat both eyes until redness is gone from the infected
eye
Do not use any other eye ointments, drops, or
alternative treatments
Bring the child to health center after two days
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Teach the Mother to Give Oral Drugs
at Home
Dry the ear by wicking
Use clean, absorbent cotton cloth or soft strong tissue
paper for making a wick
Done three times daily until wick no longer gets wet
Do not place anything in the ear between wicking
treatments. Do not allow water to get in the ear
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Teach the Mother to Give Oral Drugs
at Home
Treat mouth ulcers with gentian violet
Use half-strength gentian violet
Use clean soft cloth dipped in salt water
Use cotton-tipped stick to paint the gentian violet on the
mouth ulcers. Do not allow child to drink the gentian
violet
Treat mouth ulcers two times per day for five days
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Teach the Mother to Give Oral Drugs
at Home
Soothe the throat and relieve cough with safe
remedy
Should not contain atropine (oral and nasal
decongestants), codeine derivatives or alcohol
Safe remedies to recommend
Breastmilk for exclusively breastfed infants
Tamarind, calamansi, or ginger
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Determine Priority of Advice
When the child has several problems, the
instructions to the mother can be quite complex. In
this case, instructions will have to be limited to what
is most important How much likely can this mother understand and
remember?
Is she likely to come back for follow-up treatment? If so,
some advice can wait until then
What advice is most important
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Determine Priority of Advice
Essential treatments include giving antibiotics or
antimalarial drugs, and giving fluids to a child with
diarrhea
If necessary, OMIT or DELAY
Feeding assessment and couselling
Soothing remedy for cough and cold
Paracetamol Iron treatment
Wicking the ear
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Give These Treatments in Health Center
Only
May need to be given in the health center Intramuscular antibiotic if the child cannot take oral
antibiotic
Quinine for severe malaria
Breastmilk or sugar water to prevent low blood sugar Intramuscular Chloramphenicol may need to be givenbefore leaving for the hospital if Not able to drink or breastfeed
Vomits everything Has convulsions
Abnormally sleepy or difficult to awaken
Cannot take oral antibiotic
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Give These Treatments in Health Center
Only
Give an intramuscular antibiotic
First dose is given then refer urgently to hospital
If referral is not possible
Repeat injection every 12 hours for 5 days
Change to appropriate antibiotic to complete 10 days of
treatmentAGE OR WEIGHT CHLORAMPHENICOL
40 mg/ kg
Add 5 mL sterile water to vial containing 1,000 mg
= 5.6 mL at 180 mg/ mL
2 months up to 4 months (4-6 kg) 1 mL = 180 mg
4 months up to 9 months (6-8 kg) 1.5 mL = 270 mg
9 months up to 12 months (8-10 kg) 2 mL = 360 mg
12 months to 3 years (10-14 kg) 2.5 mL = 450 mg
3 to 5 years (14-19 kg) 3.5 mL = 630 mg
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Give These Treatments in Health Center
Only
Quinine injection is given to a child with VERYSEVERE FEBRILE DISEASE/ MALARIA if there is goingto be any delay in the child reaching the referral
hospital. It is given intramuscularly ONLY becauseof these possible side effects
Sudden drop in blood pressure
Dizziness
Ringing of the ears Sterile abscess
Should remain lying down for one hour
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Give These Treatments in Health Center
Only
Give first dose of intramuscular Quinine then refer
urgently to hospital
If referral is not possible
Repeat Quinine injection at 4 to 8 hours later, then 12
hours until child is able to take oral antimalarial. Do not
continue injections for more than 1 week
DO NOT GIVE QUININE TO A CHILD LESS THAN 4
MONTHSOF AGE
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Give These Treatments in Health Center
Only
AGE OR WEIGHT INTRAMUSCULAR QUININE
300 mg/ mL (in ampules)
4 months up to 12 months (6-10 kg) 0.3 mL
12 months up to 2 years (10-12 kg) 0.4 mL
2 years up to 3 years (12-14 kg) 0.5 mL
3 years up to 5 years 914-19 kg) 0.6 mL
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Give These Treatments in Health Center
Only
Treat the child to prevent low blood sugar
Low blood sugar occurs in serious infections such as
severe malaria or meningitis, or when the child is not
able to eat for many hoursGiving some breastmilk, breastmilk substitute, or sugar
water is done before the child is referred
Give 30-50 mL of milk or sugar water before
departure To make sugar water: Dissolve 4 level teaspoons of sugar
(20 grams) in 200-mL cup of clean water
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Give These Treatments in Health Center
Only
If the child is not able to swallow
Give 50 mL of milk or sugar water by nasogastric tube
If the child is difficult to awaken or unconscious, start IV
infusion Give 5 mL/ kg of 10% of dextrose solution (D10) over a
few minutes
Or give 1 ml/ kg of 50% (D50) by slow push
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
Plan A: Treat diarrhea at home
Treatment plan for child with diarrhea with NO
DEHYDRATION
Three rules of home treatment Give extra fluids (as much as the child will take)
Continue feeding
When to return
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
GIVE EXTRA FLUIDS Tell the mother
For exclusively breastfed babies, breastfeed frequently andlonger, and give ORS or clean water. For children over six
months, no food-based fluids For children not exclusively breastfed, give one or more of the
following: ORS, food-based fluids, and/or clean water
Teach how to mix and give ORS. Give two packets of ORSto use at home
Show how much fluid to give in addition to the usual fluidintake Up to 2 years 50 to 100 mL after each loose stool
2 years or older 100 to 200 mL after each loose stool
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
CONTINUE FEEDING
WHEN TO RETURN
The following signs indicate that the child should be returned
immediately Not able to drink of breastfeed
Becomes weaker
Develops fever
If the child has diarrhea, also tell the mother to return if the
child Has blood in the stool
Drinking poorly
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
Plan B: Treat some dehydration with ORS
Initial treatment for four hours in the health center
If the child is for referral, do not try to rehydrate
before leaving. The child will be given frequent sips ofORS on the way
After four hours, reassess and classify
DETERMINE THE AMOUNT OF ORS TO GIVE DURINGTHE FIRST FOUR HOURS The age or weight, degree of dehydration, and number of
stools passed during rehydration will affect the amount ofORS needed
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
To determine the amount needed
Multiply childs weight (in kilograms)by 75
Giving ORS should not interfere with breastfeeding. For
infants under six months who are not breastfed, 100-200 mL
clean water should be given during the first four hours in
addition to the ORS
SHOW MOTHER HOW TO GIVE ORS
Food should not be given within the first four hours of
treatment
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
AFTER FOUR HOURS Reassess using the ASSESS and CLASSIFY chart
Reassess child BEFORE four hours if child is not taking ORS orseems to be getting worse
If childs eyes are puffy, it is a sign of overhydration. Stop ORSand give clean water or breastmilk. ORS is resumed whenpuffiness is gone
IF THE MOTHER MUST LEAVE BEFORE COMPLETINGTREATMENT Show how to prepare ORS
Show how much to give to complete the 4-hour treatment Give enough packets to complete rehydration plus two more
packets as recommended in Plan A
Explain the three Rules of Home Treatment
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Give Extra Fluid for Diarrhea and DHF
and Continue Feeding
Plan C: Treat severe dehydration quickly
Treatment depends on Type of equipment available
Training of the health worker Whether the child can drink
Treat persistent diarrhea
Requires special feeding
Treat dysenteryOral antibiotic recommended for Shigella is given and
mother is told to return in two days for follow-up
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Immunize Every Sick Child as Needed
If the child is well enough to go home, give thenecessary immunization before he/she leaves the center
Immunization is given even if only one child needs theimmunization
Reconstituted vaccines must be discarded after six hours Opened vials of OPV may be kept if Not yet expired
Stored between 0 to 8 degrees Celsius
Not taken out of the health center OPV vials with vaccine vial monitors that changed in
color indicate expiration
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Immunize Every Sick Child as Needed
Record all immunizations on the childs immunizationcard
If the child has diarrhea and needs OPV, give it but donot record the dose. Tell the mother to return in four
weeks for an extra dose Tell the possible side effects of each vaccine BCG: ulceration
OPV: none
DPT: fever, irritability and soreness Measles: fever and mild rash a week after lasting for oneto
three days
Hepatitis B: none