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IMCI Integrated Management of Childhood Illness PDF
IMCI Integrated Management of Childhood Illness PDF
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SICK CHILD AGED 2 MONTHS TO 5 YEARS SICK YOUNG INFANT
AGED 1 WEEK TO 2 MONTHS
ASSESS AND CLASSIFY THE SICK CHILD TREAT THE CHILD, continued ASSESS, CLASSIFY, AND TREAT THE SICK YOUNG INFANT
Assess, Classify, and Identify the Treatment Give Extra Fluid for Diarrhea and Continue Feeding
2 Plan A: Treat Diarrhea at Home 12 Assess, Classify, and Identify the Treatment
Check for General Danger Signs .................. Check for Possible Bacterial Infection 23
Then Ask About the Main Symptoms: Plan B: Treat Some Dehydration with ORS 12
Plan C 13 Then Ask: Does the Young Infant have Diarrhea? 24
Does the child have cough or difficult breathing? 2 Then Check for Feeding Problems or Low Weight 25
Doesthe child havediarrhea? 3 .
Does the child have fever? 4 Check the Young Infant's Immunization Status 26
Immunize Every Sick Child, as Needed 13 Assess Other Problems 26
Classify malaria 4 Give Every Sick Child Vitamin A, as Needed 13
Classify measles 4
Treat the Young Infant and Counsel the Mother
Classify dengue 4 Give Follow-up Care Oral Antibiotics 27
Does the child have an ear problem? 5 Pneumonia 14
Intramuscular Antibiotics 27
Then Check for Malnutrition and Anemia 6 Persistent Diarrhea , 14
To Treat Diarrhea, See TREAT THE CHILD Chart 28
Then Check the Child's Immunization Status 6 Dysentery 14
Malaria 15 Immunize Every Sick Young Infant, as Needed 28
Then Check the Child's Vitamin A Status 6 Treat Umbilical Infections in the Health Center 28
Assess Other Problems 6 Fever: Malaria Unlikely 15 Treat Local Infections at Home 28
Fever: No Malaria 15
TREA T THE CHILD Correct Positioning and Attachment for Breastfeeding 29
Measles with Eye or Mouth Complications 16 Home Care for the Young Infant 29
Fever: Dengue Hemorrhagic Fever Unlikely 16
Teach the Mother How to Give Oral Drugs at Home Ear Infection 16
Give Follow-up Care for the Sick Young Infant
Oral Antibiotics. 7 Feeding Problem 17 Local Bacterial Infection 30
Oral Antimalarial 8 Anemia 17 31
Feeding Problem
Paracetamol 8 Very Low Weight 17 31
Vitamin A 8 Low Weight
Thrush 31
Iron ......... 8 COUNSEL THE MOTHER
Mebendazole 8 RECORDING FORMS
Food SICK YOUNG INFANT 33
Teach the Mother How to Treat Assess the Child's Feeding 18
.
SICK CHILD 53
Local Infections at Home 19
-
Feeding Recommendations
Treat Eye Infection with Tetracycline Eye Ointment 9 Counsel about Feeding Problems 20 WEIGHT-FOR-AGE CHART on the back cover
Dry the Ear by Wicking 9
Treat Mouth Ulcers with Gentian Violet 9 Fluid 8
UnICef
~ tlfi~
~
21 '-
Soothe the Throat and Relieve Cough with
a Safe Remedy 9
Increase Fluid during Illness
~ .1. ~ WORLD HEALTH
"
"4"'~'"
Advisethe MotherWhento Return ~ '"",,',:' i ..
Give These Treatments in the Health Center Only Association of Deans t"""
Intramuscular Antibiotic 10 to the HealthWorker 21 of Philippine Colleges . "
ASK: LOOK:
. Is the child not able to drink or . See if the child is abnormally
breastfeed? sleepy or difficult to awaken.
.. Does the child vomit everything?
Has the child had convulsions? (during the present illness)
Chestlndrawing ~(
. Stridor';i'nc~lm
~ Give VitarhjJt A.
~ Treatthe;~hildtopre.;erillo
cbll:Q
".. ~ Refer URG~TL Y to hQ$pita
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Does Jhe child have diarrhea?
. Is there blood in
the stool?
Is the child:
- Abnormally sleepy or difficult to
awaken?
- Restlessand irritable?
. Dehydration
present
II
~ Treatdehydrationbeforereferralunlessthe child has
anothersevereclassification.
~ Give Vitamin A.
~ ijf!fer to hospital.
and if blood
in stool
. Blood in the stool DYSENTERY
~ Treat for 5 days with an oral antibiotic
recommended for Shigella in your area.
~ Follow up in 2 days.
~ Advise mother when to return immediately.
*If referral is not possible, manage the child as described in Management of Childhood Illness, Treat the Child,
Annex: Where Referral is Not Possible, and WHO guidelines for inpatient care.
3
DANGER SIGNS, COUGH,
DIARRHEA
_LY, FEVER: NO MALARIA .,~\;I"E:~VIVIIVIE:I'\IU/"\IIVI';:> ,OIVII~;:>
ASSESS AND CLASSIFY 3SESS AND CLASSIFY
AT s FOLLOW-UP UNSEL THE MOTHER FOllOW-UP
4
MalariaRisk
Decide Malaria Risk (including travel or
overnightstay in
. Bloodsmear(+)
If bloodsmearnotdone:
~
~
Treatthe child with an oral antimalarial. ,
Give onedoseof paracetamolin healthcenter for high fever (38.5°Cor above).
Ask:
. Does the child live in a malaria area?
malariaarea) . NOrunnynose,
NOmeasles,and
and
MALARIA
~
~
Advisemotherwhento returnimmediately.
Followup in 2 daysif fever persists.
. Has the child visited/travelled or stayed overnight in a malaria area NOothercausesof fever ~ If fever is presenteverydayfor morethan7 days,referfor assessment.
in the past 4 weeks?
.. Bloodsmear(-)or FEVER:
~
~
Give onedoseof paracetamolin health centerfor high fever (38.5°cor above).
Advisemotherwhento returnimmediately.
If Yes to either, obtain a blood smear. .. Othercauses
Runnynoseor
Measlesor
offever
MALARIA
lINLIKELY
~
~
Followup in 2 daysif fever persists.
If feveris presenteveryday for morethan 7 days,referfor assessment.
THEN ASK: LOOK AND FEEL: ~ Treatothercausesof fever.
.
.
Forhowlong hasthe child had'
fever?
If more than 7 days, has the
. Lookor feel for stiff neck.
Lookfor runny nose.
. fever beenpresenteveryday?
Has the child had measles
within the last 3 months?
. Lookfor signs of MEASLES:
- Generalrashesand
VERYSEVERE ~ Giveone dose of an appropriateantibiotic.
FEBRILE ~ Treatthe child to prevent low blood sl1gar.
a
~ Giveone doseof par.acetamolin healthcenterfor high fever (38.5°cor above).
No MalariaRisk DISEASE
- One of these: cough, runny ~ Refer URGENTLY to hospital.
nose, or red eyes
. disease
Nosignsof a veryseverefebrile
~
~
Give onedoseof paracetamolin health centerfor high fever (38.5°cor above).
Advisemotherwhento returnimmediately.
. FEVER:
NO MALARIA ~
~
Followup in 2 daysif the feverpersists.
If feveris presenteverydayfor morethan7 days,referfor assessment.
If the child has measles now or . Lookfor mouthulcers. ~ Treatother causesof fever. ~
within the last three months:
.
Are they deep and extensive?
Lookfor pusdrainingfromthe eyes. . Cloudingof the corneaor
a
SEVERE,
~ Give VitaminA.
. Lookfor cloudingof the cornea. . ulcers
Deepor extensi~emouth COMPLICATED ~ Give first dose of an appropriate antibiotic.
MEASLES*** ~ If clouding of the cornea or pus draining from the eye, apply tetracycline
.. ....... . Any dangersign eye ointment.
~ Refer URGENTLYto hospital.
. No signsof severedengue
ilemorrhaglcfever
FEVER:DENGUE ~ Advise motherwhen to return immediately.
HEMORRHAGIC ~ Follow up in 2 days if fever persistsor child shows signs of bleeding.
FEVERUNLIKELY ~ DO NOTGIVEASPIRIN.
* If referral is not possible, see manage the child as described in Management of Childhood Illness, Treat the Child, Annex: When Referral is Not Possible, and WHO guidelines for inpatient care.
** These temperatures are based on axillary temperature. Rectal temperature readings are approximately a.5°C higher.
*** Other important complications of measles-pneumonia, stridor, diarrhea, ear infection, and malnutrition-are classified in other tables.
5
FEVER, MALARIA,
MEASLES, EAR PROBLEM
_I, r-I:.VI:.K: I'IV MALAKI'" ,~'" I"\I:.I."UIVIIVII:.I'IIU1"\IIVh;:>
MALNUTRITIONand ANEMIA,
7
IMMUNIZATIONAND VITAMINA STATUS
ANTIBIOTICS
[
_LY, FEVER: NO MALARIA
,
.~ 1"\E:I."UIVIIVIE:I'IIU/,\IIVI"v .CIVllv,:)
TREAT
" FOLLOW-UP JNSEl THE MOTHER
)SESS AND CLASSIFY
FOLLOW-UP
J
. Explain to the mother that she should watch her child carefully for 30 minutes after giving a dose of chloroquine.
child vomits within 30 minutes, she should repeat the dose and return to the health center for additional tablets.
If the
- child has not received a dose of Vitamin A in the
past six months.
. Explain that itching is a possible side effect of the drug, but is not dangerous. AGE VITAMIN A CAPSULES
~ IF SULFADOXINE + PYRIMETHAMINE: Give a single dose in the health center 2 hours before intake of Choroquine. 100,0001U 200,000 IU
~ IF PRIMAQUINE: Give single dose on Day 4 for P. falciparum 6 months up to 12 months 1 1/2 capsule
~ Give Mebendazole/Albendazole
~ Give Paracetamol for High Fever (38.5°C or above) or Ear Pain ~ Give 500 mg Mebendazole/400 mg Albendazole as a single dose in the health center if the
PARACETAMOL chileJis 12 months up to 59 months and has not had a dose in the previous 6 months, with
the following dose.
AGE OR WEIGHT TABLET (500 mg) SYRUP (120 mg/5 ml)
AGE OR WEIGHT Albendazole 400 mg tablet Mebendazole500 mg tablet
2 months up to 3 years (4 - <14 kg) y" 5 ml (1 tsp) 12 months up to 23 months }2 1
~ . wick.
Place the wick in the child's ear.
. Remove the wick when wet.
. Replace the wick with a clean one and repeat these steps
until ear is dry.
~ Treat Eye Infection with Tetracycline Eye Ointment . Wash hands again.
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ORAL DRUGS iSESS AND CLASSIFY
LOCALINFECTIONS FOLLOW-UP UNSEL THE MOTHER L FOLLOW-UP
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10
~ Give the first dose of intramuscular chloramphenicol and refer child urgently to ~ Give first dose of intramuscular QUININE and refer urgently to hospital.
hospital.
IF REFERRAL IS NOT POSSIBLE:
IF REFERRAL IS NOT POSSIBLE: ~ Give first of intramuscular QUININE.
~ Repeat the chloramphenicol injection every 12 hours for 5 days. ~ The child should remain lying down for one hour.
~ Then change to an appropriate oral antibiotic to complete 10 days of treatment. ~ Repeat the QUININE injection at 4 and 8 hours later, and then every 12 hours until the child is
able to take an oral antimalarial. Do not continue QUININE injections for more than 1 week.
CHLORAMPHENICOL ~ DO NOT GIVE QUININE TO A CHILD LESS THAN 4 MONTHS OF AGE.
AGE OR WEIGHT Dose: 40 mg per kg
Add 5.0 ml sterilewaterto vial containing INTRAMUSCULAR QUININE
1,000mg = 5.6 ml at 180mg/ml AGE OR WEIGHT
300 mg/ml* (in ml ampoules)
2 months up to 4 months (4 - <6 kg) 1.0 ml = 180 mg
4 months up to 12 months (6 - <10 kg) 0.3 ml
4 months up to 9 months (6 - <8 kg) 1.5 ml = 270 mg
12 months up to 2 years (10- <12 kg) 0.4 ml
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 2 years up to 3 years (12 - <14 kg) 0.5 ml
3 to 5 years (14 -19 kg) 3.5 ml = 630 mg 3 years up to 5 years (14 -19 kg) 0.6 ml
*quinine salt
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11
INTRAMUSCULARANTIBIOTIC
~ Y, rtVER: NO MALARIJ.\ .,>jl;j KtL;UMMt:NUAIIU~::) ~IVllvv
,
INTRAMUSCULARQUININE
iSESS AND CLASSIFY
LOW BLOOD SUGAR LEVEL FOllOW-UP UNSEl THE MOTHER FOLLOW-UP
f f
12
- ---~
E EXTRA FLUID FOR DIARRHEA AND CONTINUE FEEDING
:See FOOD advice on COUNSEL THE MOTHE,
~ Plan A: Treat Diarrheaat Home ~ Plan B: Treat Some Dehydration with ORS
Counsel the Mother on the 4 Rules of Home Treatment: Give in health center recommended amount of ORS over 4-hour period
Give Extra Fluid, Give Zinc Supplements, Continue Feeding, When to Return
DETERMINE AMOUNT OF ORS TO GIVE DURING THE FIRST 4 HOURS.
1. GIVE EXTRA FLUID (as much as the child will take) AGE Up to 4 months 4 months up to 12 months up to 2 years up to'
12 months 2 years 5 years
~ TELL THE MOTHER:
Breastfeed frequently and longer at each feeding. WEIGHT 12 to 19 kg
<6 kg 6 to -< 10 kg 10 to -< 12 kg
If the child is exclusively breastfed, give ORS or clean water in addition to
breastmilk. 900-1400
AMOUNT (ml) 200-400 400-700 700-900
If the child is not exclusively breastfed, give one or more of the following:
ORS solution, food-based fluids (such as soup, rice water, or "buko juice"),
* Use the child's age only when you do not know the weight. The approximate amount of ORS required
or clean water. (in ml) can also be calculated by multiplying the child's weight (in kg) times 75.
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 the visit, or
For infants under 6 months of age who are not breastfed, also give 100-200 ml clean
the child cannot return to a health center if the diarrhea gets worse.
water 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 breastfeecHng whenever the child wants.
USUAL FLUID INTAKE: '
AFTER 4 HOURS.
Up to 2 years 50 to 100 ml after each loose stool Reassess the child and classify the child for dehydration.
2 years or more 100 to 200 ml after each loose stool Select the appropriate plan to continue treatment.
Begin feeding the child in health center.
Tell the mother:
IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:
- Give frequent small sips from a cup.
- If the child vomits, wait 10 minutes. Then continue, but more slowly. Show her how to prepare ORS solution at home.
- Continue qivinq extra fluid until the diarrhea stoDS. Show her how much ORS to give her child to finish 4-hour treatment at home.
Give her enough ORS packets to complete rehydration. Also give her 2 packets,
2. GIVE ZINC SUPPLEMENTS as recommended in Plan A.
.. 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 See COUNSEL
Explain the 4 rules of home treatment:
. Reassess the child every 1-2 hours. If hydration status is not improving, give the IV
drip more rapidly.
. Also give ORS (about 5 mllkg/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, S, or C) to continue treatment.
Is IV treatment available
nearby (within 30 minutes)? YES.
. Refer URGENTLY to hospital for IV treatment.
NO
. If the child can drink, provide the mother with ORS solution and show her how to
give frequent sips during the trip.
13
\
UNLIKELY, FEVER: NO MALARIA ,,'OJ\,:!~~vVMM~I'OjUI-\IIVI~;) .OIV I Iv;;)
,SESS AND CLASSIFY
PLANA, PLANS, PLAN C FOllOW-UP JUNSEl THE MOTHER FOLLOW-UP
J If
14
,~FO~LI-OW-UP
CARE
~ PNEUMONIA ~ DYSENTERY
After 2 days:
After 2 days:
Check the child for general danger signs.
Assess the child for cough or difficult breathing. } See the ASSESS AND CLASSIFY chart. Assess the child for diarrhea. > See Assess & Classify chart
Ask: Ask:
- Are there fewer stools?
- Is the child's breathing slower?
- Is there less fever? - Is there less blood in the stool?
- Is there less fever?
- Is the child eating better?
- Is there less abdominal pain?
Treatment: - Is the child eating better?
. Ifchest indrawing or a general danger sign, give a dose of second-line antibioticor intramuscular Treatment:
chloramphenicol. Then refer URGENTLY to hospital.
. If the child is dehydrated, treat dehydration.
. If breathing rate, fever, and eating are the same, change to the second-line antibiotic and If number of stools, amount of blood in stools, fever, abdominal pain, or
advise the mother to return in 2 days or refer. (If this child had measles within the last 3 months, eating is the same or worse:
refer.) Change to second-line oral antibiotic recommended for Shigella in your area.
Give it for 5 days. Advise the mother to return in 2 days.
. If breathing slower, less fever, or eating better, complete the 5 days of antibiotic.
Exceptions -if the child:
. If cough is more than 30 days, refer for assessment.
- is less than 12 months old, or
- was dehydrated on the first visit, or
- had measles within the last 3 months } Refer to hospital
~ PERSISTENT DIARRHEA . If fewer stools, less blood in the stools, less fever, less abdominal pain,
and eating better, continue giving the same antibiotic until finished.
After 5 days:
Ask:
- Has the diarrhea stopped?
- How many loose stools is the child having per day?
Treatment:
. If the diarrhea has not stopped (child is still having less than 3 or more loose stools per
day), do a full reassessment of 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 child's age.
FOllOW-UP CARE
~ FEVER-MALARIA UNLIKELY
If fever persists after 2 days:
Do a full assessment of the child. > See ASSESS & CLASSIFY chart.
Assess for other causes of fever.
Treatment:
~ If the child has any general danger sign or stiff neck, treat as VERY SEVERE FEBRILE
DISEASE/MALARIA.
Do a full assessment of the child. > See ASSESS & CLASSIFY chart. ~ FEVER (NO MALARIA)
Treatment: If fever persists after 2 days:
~ If the child has any general danger sign or stiff neck, treat as VERY
SEVERE FEBRILE DISEASE/MALARIA. Do a full assessment of the child. > See ASSESS & CLASSIFY chart.
Make sure that there has been no travel to malarious area and overnight stay in malaria area.
~ If the child has any cause of fever other than malaria, provide If there has been travel and overnight stay take blood smear, if possible.
treatment.
Treatment:
~ If malaria is the only apparent cause of fever. ~ If there has been travel and overnight stay to a malarious area and the blood smear is posi-
tive or there is no blood smear - classify according to Fever with Malaria Risk and treat
- Take a blood smear accordingly.
- Give second-line oral antimalarial without waiting for result of blood ~ If there has been no travel to mfllarious area or blood smear is negative:
smear. - If the child has any general danger sign or stiff neck, treat as VERY SEVERE
- Advise mother to return if fever persists. FEBRILE DISEASE.
- If fever persists after 2 days treatment with second-line oral - If the child has any apparent cause of1ever, provide treatment.
antimalarial, refer with blood smear for reassessment. - If no apparent cause of fever, advise the mother to return again in 2 days if fever
- If fever has been present for 7 days, refer for assessment. persists.
- If fever has been present for 7 days, refer for assessment.
PNEUMONIA, PERSISTENT
15
DIARRHEA, DYSENTERY,
MALARIA, FEVER: MALARIA
UNLIKELY, FEVER: NO MALARIA ,~l:; Kt:t;UMMt:NUAIIUI'i':) .:IIUllv;:'
Do a full assessment of the child. > See ASSESS & CLASSIFY chart.
Do a tourniquet test.
Assess for the other causes of fever.
Treatment:
~ Ifthe child has any signs of bleeding, including skin petechiae or a positive tourniquet
test, or signs of shock, or persistent abdominal pain or persistent vomiting.
~ MEASLES WITH EYE OR MOUTH ~ If the child has any other apparent cause of fever, provide treatment.
COMPLICATIONS ~ 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 had no
After 2 days: fever for least 48 hours.
~ Advise mother to make sure child is given more fluids and is eating.
Look for red eyes and pus draining from the eyes.
Look at mouth ulcers.
Smell the mouth.
Treatment:
~ If pus is gone but redness remains, continue the treatment.
~ If there is tender swelling behind the ear or high fever (38.5°C or above), treat as
MASTOIDITIS.
~ If no pus or redness, stop the treatment.
~ Acute earinfection:if earpain or discharge persists,treatwith5 moredaysof thesame
Treatment for Mouth Ulcers: 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
~ If mouth ulcers are worse, or there is a very foul smell from to continue.
the mouth, refer to hospital.
~ If no ear pain or discharge, praise the mother for her careful treatment. If she has not yet
~ If mouth ulcers are the same or better, continue using half-
strength gentian violet for a total of 5 days.
finished the 5 days of antibiotic, tell her to use all of it before stopping.
r;..
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VE FOLLOW-UP CARE
. ~ ANEMIA
After 14 days:
IF ANY MORE FOllOW-UP VISITS ARE NEEDED BASED ON THE
~ Give iron. Atlvise mother to return in 14 days for more iron. INITIAL VISIT OR THIS VISIT, ADVISE THE MOTHER OF THE
NEXT FOllOW-UP VISIT.
~ Continue giving iron every day for 2 months with follow-up every 14 days.
0
~ If the child has any palmar pallor after 2 months, refer for assessment.
ALSO, ADVISE THE MOTHER WHEN TO RETURN IMMEDIATELY.
(See the COUNSEL THE MOTHER chart.)
17
MEASLES,FEVER:DENGUE
HEMORRHAGICFEVERUNLIKELY,
EARINFECTION, ING RECOMMENDATIONS
\ FEEDINGPROBLEM,ANEMIA,
VERYLOWWEIGHT, UNSEL THE MOTHER
SESS AND CLASSIFY
l FOllOW-UP
f Jj J
18
~ Assess the Child's Feeding ~ Assess the Child's Care for Development
Ask questions about the child's usual feeding and feeding during Ask questions about how mother cares for her child. Compare the
this illness. Compare the mother's answers to the Feeding mother's answers to the Recommendations for Care for
Recommendations for the child's age in the box below. Development.
ASK: ~ Do you breastfeed your child? ASK: - How do you play with your child?
- How many times during the day? - How do you communicate with your child?
- Do you also breastfeed during the night?
rf1 111 r~ r~ ft1 ill r~ rp III {ll ill ~ f1l rTl III f1l fl1 f11 fI1 f11 fl1
l111J1l1l1J111l1l111I111J1l111l1l1lJ;J1l1l1-
/
. Give adequate amount of family foods at 3
. Breastfeed as often as the child wants. . Breastfeed as often as the child wants.
.
meals every day.
. Add any of the following: . Give adequate amount of family foods, such
Give twice daily nutritious
meals such as: Boiled
foods, between
. Exclusively breastfeed as often as the child . Lugawwith added oil, mashedvegetablesor as: rice, camote, potato, fish, chicken, meat,
monggo, steamed tokwa, pulverized roasted
yellow camote,
wants, day and night, at least 8 times in 24 beans, steamed tokwa, flaked fish,
boiled yellow corn,
hours. pulverized roasted dilis, finely ground meat, dilis, milk and eggs, dark-green, leafy and
. Do not give other foods or fluids. egg yolk, bite-size fruits yellow vegetables (malunggay,
squash), fruits (papaya,
peanuts, boiled
saba, banana, taho,
. 3 times per day if fruits, and fruit
Play:
. breastfed
5 times per day if not
breastfed
.
.
banana)
Add oil or margarine.
5 times per day
juices.
. Provide an area where the child could move, play, . Feed the baby nutritious
snacks like fruits.
and develop his senses of sight, touch, and
Play:
hearing.
" Have large, colorful things for your child to reach
Play:
. Help your child count,
for and new things to see.
. Give your child clean, safe household
Play:
name, and compare
things.
Communicate:
things to handle, bang, and drop. . Give your child things to stack up, and to put . Make simple toys for
. Look into your child's eyes and
smile at him or her.
into containers, and take out. your child.
b
Communicate: Communicate:
When you are
breastfeeding, it is . Ask your child simple '. ' . ''' . Encourageyourchild
to talk, and answer
a good time to talk questions. Respond
'
19
ASSESS FEEDING,
FEEDINGRECOMMENDATIONS
iSESS AND CLASSIFY
I ~ COUNSEL THE MOTHER L FOLLOW-UP
r f J1 f J
20
~ Ifthe mother reports difficulty with breastfeeding, assess breastfeeding. (See YOUNG INFANT chart.) As needed, show
the mother correct positioning and attachment for breastfeeding.
~ Ifthe child is less than 6 months old and is taking other milk or foods:
-Build mother's confidence that she can produce all the breastmilk that the child needs.
- Suggest giving more frequent, longer breastfeeding, day and night, and gradually reducing other milk or foods.
~ Ifthe child is not being fed actively, counsel the mother to:
- Sit witbthechild 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.
~ Ifthe 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.
- Clear a blocked nose if it interferes with feeding.
- Expect that appetite will improve as child gets better.
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PERSISTENTDIARRHEA 5 days
. Becomes sicker
Develops a fever
ACUTE EAR INFECTION
CHRONICEAR INFECTION Ifthe childhas NO PNEUMONIA: .. Fast breathing
FEEDINGPROBLEMS COUGHORCOLD,also returnif: Difficultbreathing
MANY OTHER ILLNESSES,if not improving
ANEMIA 14 days
If the child has Diarrhea, also return if: .. Bloodin stool
Drinkingpoorly
VERY LOWWEIGHT FORAGE 30 days If the childhasFEVER:DENGUE .. Any sign of bleeding
HEMORRHAGIC
also return if:
FEVERUNLIKELY,
.. Persistentvomiting
Persistent abdominal pain
. Skin petechiae
Skin rash
21
FEEDING AND CARE FOR
DEVELOPMENT,
FEEDING PROBLEMS, .,)IVllvv I nn.vvl I
SSESS AND CLASSIFY
, FLUID, WHEN TO RETURN
FOLLOW-UP
r If f f
22
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 mother's immunization status and give her Tetanus Toxoid if needed.
Make sure she has access to:
. Family Planning
. Counseling on STD and AIDS prevention.
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ASSESS, CLASSIFY, AND TREAT THE SICK INFANT
AGE 1 WEEK TO 2 MONTHS
I
ASSESS CLASSIFY IDENTIFY
TREATMENT
ASK THE MOTHER WHAT THE YOUNG INFANT'S PROBLEMS ARE USE All BOXES THAT MATCH THE
Determine if this is an initial or follow-up visit for this problem. INFANT'S SYMPTOMS AND PROBLEMS
If follow-up visit, use the follow-up instructions in the follow-up section. TO CLASSifY THE IllNESS.
If initial visit, assess the young infant as follows:
had convulsions? Repeat the count if elevated. Severe ch indrawing or Treat the chirtJto prevent low blood
CHILD INFANTS Nasal flaring or SERIOUS sugar.
Look for chest indrawing. MUST Grunting or BACTERIAL
BECALM. INFECTION . Advise m,pther how to keep the
Look for nasal flaring.
. Look and feel for bulging fontanelle. Fever (37.5°C*or above, or feels hot) or low
bodytemperature (less than 35.5°8*,or . Refer URGENTLY to the hospital.
. Look for pus draining from the ear.
feels cold)or
**
I!I
. Look at the umbilicus.
Does the redness
Is it red or draining
extend to the skin?
pus? Many or severe skin pustules or
Abnormly; sleepy or diffcUlt to awaken or
Less Ulan normal movement.
.
. Measure temperature (or feel for fever or low body temperature).
. Look for skin pustules. Are there many or severe pustules? Red umbilicus or draining pus or LOCAL . Give an appropriate oral antibiotic.
BACTERIAL . Treat the local infection in the health
. See if the young infant is abnormally sleepy or
Skin pustules
INFECTION center, and teach the mother to treat
difficult to awaken. local infections at home.
. Look at the young infant's movements. . Advise mother how to give home care
for young infant.
Are they less than normal? . Follow up in 2 days.
. These thresholds are based on axillary temperature. The thresholds for rectal temperature readings are approximately a.sac higher.
.. If referral is not possible, manage the child as described in Management of Childhood Illness.
Treat the Child, Annex: Where Referral is Not Possible.
l.-
23
MOTHER'SHEALTH
BACTERIALINFECTION
. Refer to hospital.
and if blood
. Blood inthe stool
DYSENTERY
. Refer URGENTLY to hospital, withamother
giving frequent sips of ORS on the way.
in stool
. Advise mother to continue breastfeeding.
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---------------------------------------
What do you use to feed the infant?
. . FEEDING
. If not well attached or not sucking effectively,
teach correct positioning and attachment.
.
~ Advise the mother to give home care for the
no attachment at all not well attached good attachment young infant.
~ Follow up any feeding problem or thrush in 2
TO CHECK ATTACHMENT, LOOK FOR: days.
Chin touching the breast 8< ~ Follow up low weight for age in 14 days.
Mouth wide open
Lower lip turned outward
More areola visible above than below the mouth
(All these signs shouldbe present if the attachment is good.)
.
Is the infant sucking effectively (that is, slow, deep sucks,
sometimes pausing)? . Not low weight for age,
and no other signs of
NO FEEDING ~ Advise mother to give home care for the young
not sucking at all not sucking effectively good effectively PROBLEM infant.
inadequate feeding.
Clear a blocked nose if it interferes with breastfeeding. ~ Praise the mother for feeding the infant well.
25
...IVII\.,,':' IHKU~H
DIARRHEA
\ FEEDING PROBLEMS FOLLOW-UP
/ ]J f r J
26
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COTRIMOXAZOLE AMOXYCILLIN
(trimethoprim + sulphamethoxazole)
~ Give two times daily for 5 days ~ Give three times daily for 5 days
* Avoid cotrimoxazole in infants less than 1 month of age who are premature or jaundiced.
GENTAMICIN BENZYLPENICILLIN
Dose: 5 mg per kg Dose: 50,000 units per kg
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 one dose daily.
27
To Treat Skin Pustules To Treat Umbilical Infection To Treat Oral Thrush (ulcers or white patches in mouth)
The mother should: The mother should: The mother should:
~ Wash hands. ~ Wash hands. ~ Wash hands.
~ Gently wash off pus and ~ Clean with 70% ethyl alcohol ~ Wash mouth with clean soft cloth wrapped around the finger
and wet with salt water.
crusts with soap and water. ~ Paint with gentian violet.
~ Dry the area. ~ Wash hands. ~ Paint the mouth with half-strength gentian violet.
~ Wash hands.
~ Paint with gentian violet.
~ Wash hands.
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29
LOCAL INFECTIONS
BREASTFEEDING THRUSH
\ HOME CARE
FOLLOW-UP
,
p
J j J ] J ] f
30
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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Exception:
If you do not think that feeding will improve, or if young infant has loss 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 young infant is still low weight for age, but is feeding well, praise mother. Ask her to come again within 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 when she returns for immunization, if this is within 2 weeks).
Continue to see the young infant every few weeks until 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 young infant has lost weight, refer to hospital.
~ ORAL 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 if the infant has problems with attachment or sucking, 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.
31
FEEDING PROBLEM,
LOW WEIGHT FOR AGE,
THRUSH
\ FOLLOW~UP
~
I ~
0
r-,! MANAGEMENTOFTHE SICKYOUNGINFANTAGE 1 WEEK UPTO 2 MONTHS LL
6
C)
z
Date: 2i
~
°C 0
6
Child'sName: Age:- Sex:- Weight: kg . Temperature: U
W
ASK:Whataretheinfant'sproblems? Initialvisit: Follow-upvisit: ~
r ASSESS(Circleallsignspresent) CLASSIFY
.
CHECK FOR POSSIBLE BACTERIAL INFECTION
Has the infant had convulsions? . Count the breaths in one minute. breaths
per minute. Repeat if elevated-
.. Fast Breathing?
Look for severe chest indrawing.
Look for nasal flaring.
.
F .. 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?
. Fever (temperature 37.5°C or above or feels hot)
or low body temperature (below 35.5°C or feels cool)
. Look for skin pustules. Are there many or severe pustules?
.
F .
See if the young infant is abnormally sleepy or
difficult to awaken.
Look at the young infant's movements. Less than normal?
F
DOES THE YOUNG INFANT HAVE DIARRHEA? YES_NO-
.. For how long?
Is there blood in the stool?
days . Look at the young infant's general condition. Is the infant:
Abnormally sleepy or difficult to awaken
.-~ ..
Restless or irritable?
6
Look for sunken eyes.
Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
6 .
('f)
Does the infant usually receive any other foods or drinks? Yes - No-
If Yes, how often?
r
. What do you use to feed the child? -----
-----------------------------------
If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or
drinks, or is low weight for age AND has no indications to refer urgently to hospital:
-...~1
CHECK THE YOUNG INFANT'S IMMUNIZATION STATUS Circle immunization needed today.
Return for next
immunization on:
- - -
BCG DPT1 OPV1 HEPB1 "
(Date)
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-.. ASSESS OTHER PROBLEMS
~
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Returnfor follow-upin: ~
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Giveany immunizationsneededtoday: I='
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GROWTH CHART
Record the information along the month-of-weighing line using the symbols below:
weight
F fever
B breastfeeding
C cough/cold
CF - complementary foods introduced
D diarrhea
4 5-6 years
01 other illnesses +2S0 Boys
+250 Girls
A Vitamin A given
H hospitalized 4-5years
1 sign of injuries such as
abrasions/hematoma
20
19
.2S0 Boy.
-280 Girts
14
13
12
11
10
9
8
7 A child who is...
6 not gaining weight has a plotted growth
curve that flattens off or looks like a flat
5
line between the "reference" curves;
4
3 The child's weight should be between
the ~reference~ curves.
2
The plotted growth curve should go in
1 an upward direction
III
0
0 1 2 3 4 5 6 7 8 9 10 11 12
I 1 I 1 1 I I 1 1 I I 1 I A child who is...
. losing weight has a plott edgrDWt h curve
that goes in a downward/declining
. .
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