Professional Documents
Culture Documents
SICK CHILD
AGE 2 MONTHS UP TO 5 YEARS
ASSESS AND CLASSIFY THE SICK CHILD TREAT THE CHILD, continued
WHO/CHD FMOH/SUDAN unicef
Assess, Classify and Identify Treatment Give Extra Fluid for Diarrhoea
and Continue Feeding
Check for General Danger Signs ..................................... 2 SICK YOUNG INFANT
Then Ask About Main Symptoms: Plan A: Treat Diarrhoea at Home............................. 12
Does the child have cough or difficult breathing?................ 2 Plan B: Treat Some Dehydration with ORS ............. 12 AGE 1 WEEK UP TO 2 MONTHS
Does the child have diarrhoea? ....................................... 3 Plan C: Treat Severe Dehydration Quickly .............. 13
Does the child have fever?.............................................. 4 ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT
Classify malaria ...................................................... 4
Classify measles ..................................................... 4 Immunize Every Sick Child, As Needed ..................... 13 Assess, Classify and Identify Treatment
Does the child have an ear problem? ............................... 5
Then Check for Malnutrition and Anaemia....................... 6 Check for Possible Bacterial Infection ............................................. 22
Then Check the Childs Immunization and Vitamin A Give Follow-up Care Then ask: Does the young infant have diarrhoea? .......................... 23
Supplementation Status................................................... 6 Then Check for Feeding Problem or Low Weight............................ 24
Assess Other Problems ................................................... 6 Pneumonia ............................................................... 14 Then Check the Young Infants Immunization Status...................... 25
Persistent Diarrhoea ................................................ 14 Assess Other Problems ................................................................... 25
TREAT THE CHILD Dysentery ................................................................. 14
Malaria (Low or High Malaria Risk) ... ...................... 15 Treat the Young Infant and Counsel the Mother
Teach the Mother to Give Oral Drugs at Home Fever Malaria Unlikely (Low Malaria Risk)............ 15
Measles with Eye or Mouth Complications .............. 15 Oral Antibiotic .................................................................................. 26
Oral Antibiotic ............................................................ 7 Ear Infection ............................................................. 16 Intramuscular Antibiotics.................................................................. 26
Oral Antimalarial ........................................................ 8 Feeding problem ..................................................... 16 To Treat Diarrhoea, See TREAT THE CHILD Chart .................. 12-13
Paracetamol............................................................... 8 Pallor ........................................................................ 16 Immunize Every Sick Young Infant.................................................. 27
Vitamin A ................................................................... 8 Very Low Weight ...................................................... 16 Treat Local Infections at Home........................................................ 27
Iron............................................................................. 8 Correct Positioning and Attachment for Breastfeeding.................... 28
Home Care for Young Infant............................................................ 28
Teach the Mother to Treat COUNSEL THE MOTHER
Local Infections at Home Give Follow-up Care for the Sick Young Infant
Food
Treat Eye Infection with Tetracycline Eye Ointment .. 9 Assess the Childs Feeding...................................... 17 Local Bacterial Infection................................................................... 29
Dry the Ear by Wicking .............................................. 9 Feeding Recommendations ..................................... 18 Feeding problem.............................................................................. 30
Treat Mouth Ulcer with Gentian Violet ....................... 9 Counsel About Feeding Problems ........................... 19 Low Weight ...................................................................................... 30
Soothe the Throat, Relieve the Cough with Thrush.............................................................................................. 30
a Safe Remedy .......................................................... 9 Fluid
Increase Fluid During Illness.................................... 20
Give These Treatments in Clinic Only RECORDING FORMS
SICK YOUNG INFANT .................................................. 31
Intramuscular Antibiotic............................................ 10 When to Return
SICK CHILD ..................................................................... 33
Quinine for Severe Malaria ...................................... 10 Advise the Mother When to Return to
Prevent Low Blood Sugar ........................................ 11 Health worker ........................................................... 20
Treat a convulsing child ........................................... 11
WEIGHT FOR AGE CHART.........................................on back cover
Treat wheezing ........................................................ 11 Counsel the Mother About
Her Own Health............................................................. 21
2
Does the child have cough or difficult breathing? Any general danger sign Give first dose of an appropriate antibiotic.
or SEVERE Refer URGENTLY to hospital.*
Treat wheezing if present.
IF YES, ASK: LOOK, LISTEN, FEEL: Classify Chest indrawing PNEUMONIA
Prevent low blood sugar.
(If also wheezing go to
COUGH or treat wheezing) or
OR VERY
For how long? Count the breaths in one minute SEVERE DISEASE
CHILD MUST DIFFICULT Stridor in calm child.
Look for chest indrawing. BE CALM BREATHING
Fast breathing. Give an appropriate antibiotic for 5 days.
(If also wheezing go Treat wheezing if present.
Look and listen for stridor.
to treat wheezing) Soothe the throat and relieve the cough with
PNEUMONIA
a safe remedy.
Look and listen for wheezing If the child is: Fast breathing
Advise mother when to return immediately.
is:
Follow-up in 2 days.
2 months up 50 breaths per
to 12 months minute or more No signs of pneumonia If coughing more than 30 days, refer for
or very severe disease. assessment.
12 months up 40 breaths per
(If also wheezing go to Treat wheezing if present.
to 5 years minute or more NO PNEUMONIA:
treat wheezing) Soothe the throat and relieve the cough with
COUGH OR COLD a safe remedy.
Advise mother when to return immediately.
Follow-up in 5 days if not improving.
Does the child have diarrhoea?
Two of the following signs: If child has no other severe classification:
- Give fluid for severe dehydration (Plan C).
OR
IF YES, ASK: LOOK AND FEEL: for
Lethargic or unconscious
If child also has another severe classification:
Sunken eyes
DEHYDRATION Not able to drink or drinking SEVERE - Refer URGENTLY to hospital with mother
For how long? Look at the childs general condition. DEHYDRATION giving frequent sips of ORS on the way.
Is the child: poorly Advise the mother to continue breastfeeding.
Is there blood Skin pinch goes back very
in the stool? Lethargic or unconscious? slowly. If child is 2 years or older and there is cholera in
Restless and irritable? your area, give antibiotic for cholera.
Look for sunken eyes. Two of the following signs: Give fluid and food for some dehydration (Plan B).
Offer the child fluid. Is the child: Restless, irritable If child also has a severe classification:
Sunken eyes SOME - Refer URGENTLY to hospital with mother
Not able to drink or drinking poorly? Classify giving frequent sips of ORS on the way.
Drinking eagerly, thirsty? Drinks eagerly, thirsty DEHYDRATION
DIARRHOEA Skin pinch goes back slowly.
Advise the mother to continue breastfeeding.
Pinch the skin of the abdomen. Advise mother when to return immediately.
Does it go back: Follow-up in 5 days if not improving.
and if diarrhoea Dehydration present. SEVERE Treat dehydration before referral unless the child
14 days or more PERSISTENT has another severe classification.
Refer to hospital.
DIARRHOEA
and if blood Blood in the stool. Treat for 5 days with an oral antibiotic
in stool DYSENTERY recommended for Shigella in your area.
Follow-up in 2 days.
*If referral is not possible, manage the child as described in Integrated Management of Childhood Illness, Treat the Child,
Annex: Where Referral Is Not Possible, and WHO guidelines for inpatient care.
Any general danger sign or Give quinine for severe malaria (first dose).
Does the child have fever? High Stiff neck. VERY SEVERE Give first dose of an appropriate antibiotic.
(by history or feels hot or temperature 37.5C** or above) FEBRILE Treat the child to prevent low blood sugar.
Malaria Risk Give one dose of paracetamol in clinic for high fever (38.5C ).
DISEASE
Decide Malaria Risk: high or low Refer URGENTLY to hospital.
IF YES:
Fever (by history or feels Give oral antimalarial.
THEN ASK: LOOK, FEEL AND CHECK: Give one dose of paracetamol in clinic for high fever (38.5C ).
hot or temperature 37.5
C** or above). MALARIA Advise mother when to return immediately.
Look or feel for stiff neck. Follow-up in 2 days if fever persists.
For how long? If fever is present every day for more than 7 days, refer for assessment.
If more than 7 days, has fever Look for runny nose.
been present every day? Check BF result * +ve -
ve Any general danger sign or Give quinine for severe malaria (first dose).
Has the child had measles within Classify available
Stiff neck. VERY SEVERE Give first dose of an appropriate antibiotic.
the last 3 months? Look for signs of MEASLES Fever laboratory. FEBRILE Treat the child to prevent low blood sugar.
Generalized rash and services Give one dose of paracetamol in clinic for high fever (38.5C ).
DISEASE
One of these: cough, Refer URGENTLY to hospital.
runny nose, or red eyes.
...................................... Positive thick blood film Give oral antimalarial.
.................................................. Give one dose of paracetamol in clinic for high fever (38.5C ).
for malaria.
If the child has measles now MALARIA Advise mother when to return immediately.
or within the last 3 months: Look for mouth ulcers. Follow-up in 2 days if fever persists.
Are they deep and extensive? If fever is present every day for more than 7 days, refer for assessment.
Low Malaria
Look for pus draining from the eye. Risk Negative thick blood film FEVER _ MALARIA Give one dose of paracetamol in clinic for high fever (38.5C ).
Look for clouding of the cornea. for malaria. UNLIKELY Treat other causes of fever.
Advise mother when to return immediately.
Follow-up in 2 days if fever persists.
If fever is present every day for more than 7 days, refer for assessment.
Any general danger sign or Give quinine for severe malaria (first dose).
Stiff neck. VERY SEVERE Give first dose of an appropriate antibiotic.
No available FEBRILE DISEASE Treat the child to prevent low blood sugar.
laboratory. Give one dose of paracetamol in clinic for high fever (38.5C ).
Refer URGENTLY to hospital.
services
NO runny nose and Give oral antimalarial.
*A child with general danger sign or NO measles and Give one dose of paracetamol in clinic for high fever (38.5C ).
NO other cause of fever Advise mother when to return immediately.
severe classification should be referred MALARIA
Follow-up in 2 days if fever persists.
urgently, dont do BF for malaria If fever is present every day for more than 7 days, refer for assessment.
Runny nose PRESENT or Give one dose of paracetamol in clinic for high fever (38.5C ).
* Send the child to do BF for malaria Measles PRESENT now or FEVER _ MALARIA Treat other causes of fever.
Other cause of fever Advise mother when to return immediately.
after completion of the full UNLIKELY Follow-up in 2 days if fever persists.
PRESENT.
assessment. If fever is present every day for more than 7 days, refer for assessment.
** These temperatures are based on axillary temperature. Rectal temperature readings are approximately 0.5C higher. *** Other important complications of measles - pneumonia, stridor, diarrhoea, ear infection, and malnutrition - are classified in other tables.
Does the child have an ear problem?
IF YES, ASK: LOOK AND FEEL: Tender swelling behind the Give first dose of an appropriate antibiotic.
Classify ear. MASTOIDITIS Give first dose of paracetamol for pain.
EAR PROBLEM Refer URGENTLY to hospital.
Is there ear pain? Look for pus draining from the ear.
Is there ear discharge? Feel for tender swelling behind the ear. Pus is draining from the ear
If yes, for how long? and discharge is reported ACUTE EAR Give an antibiotic for 5 days.
for less than 14 days, or Give paracetamol for pain.
INFECTION
Dry the ear by wicking.
Ear pain.
Follow-up in 5 days.
.
5
FEVER
MALARIA, MEASLES
EAR PROBLEM
6
Look for palmar pallor. Is it: Some palmar pallor or Assess the child's feeding and counsel the mother on feeding
Severe palmar pallor? Very low weight for age. according to the FOOD box on the COUNSEL THE MOTHER chart.
Some palmar pallor? If feeding problem, follow-up in 5 days.
ANAEMIA
Look for oedema of both feet. OR VERY If pallor:
LOW WEIGHT Give iron*.
Determine weight for age. Give oral antimalarial. (If High Risk Malaria Area)
Follow-up in 14 days.
If very low weight for age, follow-up in 30 days.
Not very low weight for age and If child is less than 2 years old, assess the childs feeding and
* A child with sickle cell anaemia no other signs of malnutrition. NO ANAEMIA counsel the mother on feeding according to the FOOD box on
should not be given iron AND NOT VERY the COUNSEL THE MOTHER chart.
If feeding problem, follow-up in 5 days.
LOW WEIGHT
Advise mother when to return immediately.
Exception: Rehydration of the child according to Plan C may resolve danger signs so that referral is no longer needed.
TREAT THE CHILD
CARRY OUT THE TREATMENT STEPS IDENTIFIED ON
THE ASSESS AND CLASSIFY CHART
COTRIMOXAZOLE AMOXYCILLIN
Follow the instructions below for every oral drug to be given at home. (trimethoprim + sulphamethoxazole) Give three times
Also follow the instructions listed with each drugs dosage table. Give two times daily for 5 days daily for 5 days
ADULT TABLET PEDIATRIC TABLET SYRUP TABLET SYRUP
80 mg 20 mg 40 mg trimethoprim
AGE or WEIGHT trimethoprim trimethoprim +200 mg 250 mg 125 mg
Determine the appropriate drugs and dosage for the childs age or weight. + 400 mg +100 mg sulphamethoxazole per 5 ml
sulphamethoxazole sulphamethoxazole per 5 ml
2 months up to 12 months
Tell the mother the reason for giving the drug to the child. (4 - <10 kg) 1/2 2 5.0 ml 1/2 5 ml
12 months up to 5 years
(10 - 19 kg) 1 3 7.5 ml 1 10 ml
Demonstrate how to measure a dose.
Give antibiotic recommended for Shigella in your area for 5 days.
Watch the mother practise measuring a dose by herself.
FIRST-LINE ANTIBIOTIC FOR SHIGELLA: COTRIMOXAZOLE
Ask the mother to give the first dose to her child. SECOND-LINE ANTIBIOTIC FOR SHIGELLA: NALIDIXIC ACID
FOR CHOLERA:
Explain carefully how to give the drug, then label and package the drug. COTRIMOXAZOLE NALIDIXIC ACID
(trimethoprim + sulphamethoxazole) Give four times daily for 5 days
Give two times daily for 5 days
If more than one drug will be given, collect, count and package each drug AGE or WEIGHT TABLET
separately. 250 mg
2 months up to 4 months
(4 - <6 kg) 1/4
Explain that all the oral drug tablets or syrups must be used to finish the 4 months up to 12 months See doses above
(6 - <10 kg) 1/2
course of treatment, even if the child gets better. 12 months up to 5 years
(10 - 19 kg) 1
Check the mothers understanding before she leaves the clinic. Give antibiotic recommended for Cholera in your area for 3 days.
TETRACYCLINE COTRIMOXAZOLE
Give four times daily for 3 days (trimethoprim + sulphamethoxazole)
Give two times daily for 3 days
AGE or WEIGHT TABLET
250 mg
2 months up to 4 months
(4 - <6 kg) See doses above
4 months up to 24 months
(6 - <12 kg)
2 4months up to 5 years
ANTIBIOTICS (12- 19 kg) 1
MALNUTRITION and ANAEMIA
IMMUNIZATION STATUS
TREAT 7
8
1-< 3 10 14 1 1 1 1 1 1 6
1-< 7 10-< 20 1 1 1 1
3-< 8 15 24 2 2 2 2 2 2 12
7-13 20-40 2 2 2 2
8 10 25 34 3 3 3 3 3 3 18
14+ 40 +
3 4 4 4 11+ 35 + 4 4 4 4 4 4 24
Ask the child to look up. Harmful remedies and practices to discourage:
Squirt a small amount of ointment on the inside of the lower lid. All cough medicines
Removal of the uvula
Wash hands again.
The use of oil as nasal drops
Treat until redness is gone.
Do not use other eye ointments or drops, or put anything else in the eye.
ORAL DRUGS
LOCAL INFECTIONS
10
Determine the dose appropriate for the childs weight (or age).
Use a sterile needle and sterile syringe. Measure the dose accurately.
CHLORAMPHENICOL BENZYL PENICILLIN AGE or WEIGHT INTRAMUSCULAR QUININE 300 mg/ml* (in 2 ml ampoules)
Dose: 40 mg per kg Dose 50 000 units per kg
AGE or WEIGHT Add 5.0 ml sterile water to vial containing Add 3.6 ml sterile water to vial containing
1000 mg = 5.6 ml at 180 mg/ml 600 mg (1 000 000 units)
Amount of undi- Add this amount of Total diluted solution To
2 months up to 4 months 1.0 ml = 180 mg 0.6 ml Normal saline administer (60mg/ml)
(4 - < 6 kg) luted Quinine
4 months up to 9 months 1.5 ml = 270 mg 0.8 ml 2 months up to 4 months 0.2 ml 0.8 ml 1.0 ml
(6 - < 8 kg) (4 - < 6 kg)
INTRAMUSCULAR ANTIBIOTIC,
INTRAMUSCULAR QUININE, 11
WHEEZING, LOW BLOOD SUGAR
AND CONVULSION
12
Plan A: Treat Diarrhoea at Home Plan B: Treat Some Dehydration with ORS
Counsel the mother on the 3 Rules of Home Treatment: Give in clinic recommended amount of ORS over 4-hour period
Give Extra Fluid, Continue Feeding, When to Return
DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS.
It is especially important to give ORS at home when: If the child wants more ORS than shown, give more.
- the child has been treated with Plan B or Plan C during this visit. For infants under 6 months who are not breastfed, also give 100-200 ml clean water
- the child cannot return to a clinic if the diarrhoea gets worse. during this period.
TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2 SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.
PACKETS OF ORS TO USE AT HOME. Give frequent small sips from a cup.
If the child vomits, wait 10 minutes. Then continue, but more slowly.
SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE Continue breastfeeding whenever the child wants.
USUAL FLUID INTAKE:
Up to 2 years 50 to 100 ml after each loose stool AFTER 4 HOURS:
2 years or more 100 to 200 ml after each loose stool Reassess the child and classify the child for dehydration.
Select the appropriate plan to continue treatment.
Tell the mother to: Begin feeding the child in clinic.
- Give frequent small sips from a cup.
- If the child vomits, wait 10 minutes. Then continue, but more slowly. IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:
- Continue giving extra fluid until the diarrhoea stops. Show her how to prepare ORS solution at home.
Show her how much ORS to give to finish 4-hour treatment at home.
Give her enough ORS packets to complete rehydration. Also give her 2 packets as
recommended in Plan A.
Explain the 3 Rules of Home Treatment:
}
See Plan A for recommended fluids
2. CONTINUE FEEDING
See COUNSEL THE MOTHER chart 2. CONTINUE FEEDING and
3. WHEN TO RETURN See COUNSEL THE MOTHER chart
3. WHEN TO RETURN
GIVE EXTRA FLUID FOR DIARRHOEA AND CONTINUE FEEDING
(See FOOD advice on COUNSEL THE MOTHER chart)
START HERE Start IV fluid immediately. If the child can drink, give ORS by mouth while the drip is
set up. Give 100 ml/kg Ringers Lactate Solution (or, if not available, normal saline),
Can you give divided as follows:
intravenous (IV) fluid YES
immediately? AGE First give Then give
30 ml/kg in: 70 ml/ kg in:
Infants
(under 12 months) 1 hour * 5 hours
Children
(12 months up to 5 years) 30 minutes* 2 1/2 hours
NO
NOTE:
IMMUNIZE EVERY SICK CHILD, AS NEEDED
If possible, observe the child at least 6 hours after rehydration to be sure the mother
can maintain hydration giving the child ORS solution by mouth.
Refer URGENTLY to
hospital for IV or NG
treatment
13
PLAN A, PLAN B
PLAN C
14
DYSENTERY
PNEUMONIA After 2 days:
After 2 days:
Assess the child for diarrhoea. > See ASSESS & CLASSIFY chart.
See ASSESS & CLASSIFY chart.
Check the child for general danger signs.
Assess the child for cough or difficult breathing. Ask:
Are there fewer stools?
Ask: Is there less blood in the stool?
Is the child breathing slower? Is there less fever?
Is there less fever? Is there less abdominal pain?
Is the child eating better? Is the child eating better?
Treatment: Treatment:
If chest indrawing or a general danger sign, give a dose of second-line antibiotic or If the child is dehydrated, treat dehydration.
intramuscular chloramphenicol. Then refer URGENTLY to hospital. If number of stools, amount of blood in stools, fever, abdominal pain, or eating is
If breathing rate, fever and eating are the same, change to the second-line antibiotic and the same or worse:
advise the mother to return in 2 days or refer. (If this child had measles within the last 3 Change to second-line oral antibiotic recommended for Shigella in your area.
months, refer.) Give it for 5 days. Advise the mother to return in 2 days.
After 5 days: If fewer stools, less blood in the stools, less fever, less abdominal pain, and eating
better, continue giving the same antibiotic until finished.
Ask:
Has the diarrhoea stopped?
How many loose stools is the child having per day?
Treatment:
If the diarrhoea has not stopped (child is still having 3 or more loose stools per day),
do a full reassessment of the child. Give any treatment needed. Then refer to hospital.
If the diarrhoea has stopped (child having less than 3 loose stools per day), tell the
mother to follow the usual feeding recommendations for the childs age.
GIVE FOLLOW-UP CARE
FEVER- MALARIA UNLIKELY (Low Malaria Risk)
Care for the child who returns for follow-up using all the boxes that If fever persists after 2 days:
match
Do a full reassessment of the child. > See ASSESS & CLASSIFY chart.
the childs previous classifications. Assess for other causes of fever.
If the child has any new problem, assess, classify and treat the new
Treatment:
problem
If the child has any general danger sign or stiff neck, treat as VERY SEVERE
MALARIA (Low or High Malaria Risk) FEBRILE DISEASE.
If fever persists after 2 days, or returns within 14 days: If the child has any cause of fever other than malaria, provide treatment.
If malaria is the only apparent cause of fever:
Do a full reassessment of the child. > See ASSESS & CLASSIFY chart.
Assess for other causes of fever. Treat with first-line oral antimalarial. Advise the mother to return again in 2
days
Treatment: if the fever persists.
If the child has any general danger sign or stiff neck, treat as VERY SEVERE If fever has been present for 7 days, refer for assessment.
FEBRILE DISEASE.
If the child has any cause of fever other than malaria, provide treatment.
If malaria is the only apparent cause of fever:
Treat with the second-line oral antimalarial. (If no second-line antimalarial
MEASLES WITH EYE OR MOUTH
is available refer to hospital.) Advise the mother to return again in 2 days
if the fever persists.
COMPLICATIONS
After 2 days:
If fever has been present for 7 days, refer for assessment.
Look for red eyes and pus draining from the eyes.
Look at mouth ulcers.
Smell the mouth.
as on the Assess AND CLASSIFY chart. If pus 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 mouth ulcers are worse, or there is a very foul smell from the mouth, refer to
hospital.
If mouth ulcers are the same or better, continue using half-strength gentian violet for
a total of 5 days.
15
PNEUMONIA, PERSISTENT DIARRHOEA, DYSENTERY
MALARIA, FEVER, MEASLES
FOLLOW-UP
16
Reassess for ear problem. > See ASSESS & CLASSIFY chart. Weigh the child and determine if the child is still very low weight for age.
Measure the childs temperature. Reassess feeding. > See questions at the top of the COUNSEL chart.
Treatment: Treatment:
If there is tender swelling behind the ear or high fever (38.5C or above), refer If the child is no longer very low weight for age, praise the mother and
URGENTLY to hospital. encourage her to continue.
Acute ear infection: if ear pain or discharge persists, treat with 5 more days of the If the child is still very low weight for age, counsel the mother about any feeding
same antibiotic. Continue wicking to dry the ear. Follow-up in 5 days. problem found. Ask the mother to return again in one month. Continue to see the
child monthly until the child is feeding well and gaining weight regularly or is no
Chronic ear infection: Check that the mother is wicking the ear correctly. Encourage longer very low weight for age.
her to continue.
Exception:
If no ear pain or discharge, praise the mother for her careful treatment. If she has not If you do not think that feeding will improve, or if the child has lost weight, refer
yet finished the 5 days of antibiotic, tell her to use all of it before stopping. the child.
FOOD
Assess the Childs Feeding
Ask questions about the childs usual feeding and feeding during this illness.
Compare the mothers answers to the Feeding Recommendations
for the childs age in the box below.
During this illness, has the childs feeding changed? If yes, how?
EAR INFECTION 17
FEEDING PROBLEM ASSESS FEEDING
PALLOR, VERY LOW WEIGHT
COUNSEL
Feeding Recommendations During Sickness and Health
Up to 4 Months of Age 4 Months up to 6 Months 6 Months up to
6 Months up12tomonths
12 Mont 12 Months up to 2 Years 2 Years and Older
* A good daily diet should be adequate in quantity and include an energy-rich food (for example, thick cereal with added oil); meat, fish, eggs, or pulses; and fruits and vegetables.
Give complementary foods at the end of the 4 month only if the child: Feeding Recommendations For a Child Who Has PERSISTENT DIARRHOEA
- Show interest in semi solid food OR
- Appears hungry after breast feeding. OR If still breastfeeding, give more frequent, longer breastfeeds, day and night.
- Is not gaining weight adequately
If taking other milk:
replace with increased breastfeeding OR
replace with fermented milk products, such as yoghurt OR
replace half the milk with nutrient-rich semisolid food.
For other foods, follow feeding recommendations for the childs age.
Counsel the Mother About Feeding 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. (See YOUNG INFANT chart.)
As needed, show the mother correct positioning and attachment for breastfeeding.
If the child is less than 6 months old and there are no signs to start complementary feedings and is tak-
ing other milk or foods:
Build mothers confidence that she can produce all the breastmilk that the child needs.
Suggest giving more frequent, longer breastfeeds day or night, and gradually reducing other milk or foods.
19
FEEDING RECOMMENDATIONS
FEEDING PROBLEMS
20
FLUID
Advise the Mother to Increase Fluid During Illness
FOR ANY SICK CHILD:
Giving extra fluid can be lifesaving. Give fluid according to Plan A or Plan B on TREAT THE CHILD chart.
WHEN TO RETURN
Advise the Mother When to Return to Health Worker
FOLLOW-UP VISIT
Advise the mother to come for follow-up at the earliest time listed for
the childs problems.
If the child has: Return for
follow-up in:
PNEUMONIA
DYSENTERY
MALARIA, if fever persists 2 days
FEVER- MALARIA UNLIKELY, if fever persists
MEASLES WITH EYE OR MOUTH COMPLICATIONS
PERSISTENT DIARRHOEA
ACUTE EAR INFECTION WHEN TO RETURN IMMEDIATELY
CHRONIC EAR INFECTION 5 days
FEEDING PROBLEM
ANY OTHER ILLNESS, if not improving Advise mother to return immediately if the child has any of these signs:
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 up her own strength and health.
Check the mothers immunization status and give her tetanus toxoid if needed.
Family planning
21
FLUID
WHEN TO RETURN
MOTHERS HEALTH
22
Not enough signs to Give fluids to treat diarrhoea at home (Plan A).
classify as some or NO DEHYDRATION
severe dehydration.
* These thresholds are based on axillary temperature. The thresholds for rectal temperature readings are approximately 0.5C higher.
** If referral is not possible, see Integrated Management of Childhood Illness, Treat the Child, Annex: Where Referral Is Not Possible.
23
BACTERIAL INFECTION
DIARRHOEA
ASSESS AND CLASSIFY
24
IF AN INFANT: Has any difficulty feeding, Not suckling effectively or If not well attached or not suckling
effectively, teach correct positioning and
Is breastfeeding less than 8 times in 24 hours, attachment.
Is taking any other foods or drinks, or Less than 8 breastfeeds in
24 hours or If breastfeeding less than 8 times in 24
Is low weight for age, hours, advise to increase frequency of
AND Receives other foods or feeding.
Has no indications to refer urgently to hospital: drinks or FEEDING
PROBLEM If receiving other foods or drinks, counsel
ASSESS BREASTFEEDING: Low weight for age or OR mother about breastfeeding more, reducing
LOW WEIGHT other foods or drinks, and using a cup.
Thrush (ulcers or white
Has the infant If the infant has not fed in the previous hour, ask the mother patches in mouth)
If not breastfeeding at all:
br e ast fe d i n the to put her infant to the breast. Observe the breastfeed for Refer for breastfeeding counselling
previous hour? 4 minutes. and possible relactation.
Advise about correctly preparing
breastmilk substitutes and using a
(If the infant was fed during the last hour, ask the mother if she cup.
can wait and tell you when the infant is willing to feed again.)
If thrush, teach the mother to treat thrush at
TO CHECK ATTACHMENT, LOOK FOR: home.
- Chin touching breast Advise mother to give home care for the
- Mouth wide open young
- Lower lip turned outward infant.
- More areola visible above than below the mouth
Follow-up any feeding problem or thrush in
(All of these signs should be present if the attachment is good.)
Not low weight for age and Advise mother to give home care for the
Is the infant able to attach? no other signs of young
NO FEEDING
inadequate feeding. PROBLEM infant.
no attachment at all not well attached good attachment
Praise the mother for feeding the infant well.
Is the infant suckling effectively (that is, slow deep sucks,
sometimes pausing)?
AGE VACCINE
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FEEDING PROBLEM
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COTRIMOXAZOLE AMOXYCILLIN
(trimethoprim + sulphamethoxazole) Give three times daily for 5 days
Give two times daily for 5 days
Adult Tablet Pediatric Tablet Syrup Tablet Syrup
AGE or WEIGHT single strength (20 mg trimethoprim (40 mg trimethoprim
(80 mg trimethoprim + 400 mg +100 mg +200 mg 250 mg 125 mg in 5 ml
sulphamethoxazole) sulphamethoxazole) sulphamethoxazole)
Birth up to 1 month (< 3 kg) 1/2* 1.25 ml* 1.25 ml
* Avoid cotrimoxazole in infants less than 1 month of age who are premature or jaundiced.
For blood in stool:
Refer urgently to hospital, give ORS on the way
If referral is not possible give Cotrimoxazole for 5 days.
Referral is the best option for a young infant classified with POSSIBLE SERIOUS BACTERIAL INFECTION. If referral is not
possible, give benzylpenicillin and gentamicin for at least 5 days. Give benzylpenicillin every 6 hours plus gentamicin every
8 hours. For infants in the first week of life, give gentamicin every 12 hours.
TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER
To Treat Skin Pustules or Umbilical Infection To Treat Thrush (ulcers or white patches in mouth)
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ANTIBIOTICS
LOCAL INFECTIONS
Look for signs of good attachment and effective suckling. If the attachment or suckling is not good, try again.
}
FOOD
Breastfeed frequently, as often and for as long as the
infant wants, day or night, during sickness and health.
FLUIDS
WHEN TO RETURN
If the infant has: Return for follow-up in: Advise the mother to return immediately if the
young infant has any of these signs:
In cool weather, cover the infants head and feet and dress the infant with extra clothing.
GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT
Treatment:
If 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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LOCAL INFECTIONS
BREASTFEEDING
HOME CARE
FOLLOW-UP
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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 young infant back again.
If the young infant is low weight for age, ask the mother to return 14 days after the initial visit to measure the young infants weight gain.
Exception:
If you do not think that feeding will improve, or if the young infant has lost weight, refer the child.
LOW WEIGHT
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 above.
If the infant is no longer low weight for age, praise the mother and encourage her to continue.
If the infant is still low weight for age, but is feeding well, praise the mother. Ask her to have her infant weighed again within a month or
when she returns for immunization.
If the 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 when she returns for immunization, if this is within 2 weeks). Continue to see the young infant every few weeks
until the infant is feeding well and gaining weight regularly or is no longer low weight for age.
Exception:
If you do not think that feeding will improve, or if the young infant has lost weight, refer to hospital.
THRUSH
After 2 days:
Look for ulcers or white patches in the mouth (thrush).
Reassess feeding. > See Then Check for Feeding Problem or Low Weight above.
If thrush is worse, or the infant has problems with attachment or suckling, refer to hospital.
If thrush is the same or better, and if the infant is feeding well, continue half-strength gentian violet for a total of 5 days.