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MANAGEMENT OF SICK CHILDREN < 2 MONTHS OF AGE

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Management of sick children

► Management of sick children below 2 months

of age
- Bacterial infection
- Pneumonia
- Jaundice
- Feeding Problem
* Immunization
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A. Steps of management of illness in
infant of less than 2 months age
Assess
Signs of possible bacterial infection, nutrition, immunization
status and other problems
Classify
According to signs as per Color Coding
Identify
Specific Treatment
Provide Treatment
Pre referral treatment, Medical treatment
Counsel
Feeding problems, home management
Follow-up care
1.Check:- For Very Severe disease/Possible Serious
Bacterial infection/Pneumonia or Bacterial Infection 4
ASK
•Has the infant had convulsions ?
•Does the child have feeding difficulty?
LOOK ,LISTEN ,FEEL:-
•Count the breaths in one minute. Repeat the count if RR>60.
•Look for severe chest indrawing
•Measure axillary temperature
•Look at the umbilicus-is it red or draining pus ?
•Look for skin pustules.
•See if the young infant is lethargic or unconscious
•Look at the young infant’s movements. Are they less than
normal?
 SIGNS
Any one or more of the following
signs
- Not feeding at all or not feeding
well or
- Convulsions or
- Severe chest indrawing or
- Fever (38 c or above) or
- Low body temperature (less than
35.5c) or
-Movement only when stimulated
or no movement at all or
-Fast breathing in infant less than 7
days
CLASSIFY As IDENTIFY TREATMENT
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Give first dose of intramuscular
Possible serious
antibiotics (Ampicillin and
bacterial Gentamycin)
infection Treat to prevent low blood sugar
Or, Warm the young infant by skin to skin
contact while arranging referral
Very severe
Advise mother how to keep the young
disease infant warm on the way to the hospital
Refer URGENTLY to hospital
If Referral not possible, treat in the
clinic until referral.
Signs Classification Management 6
•Fast breathing only in Pneumonia Give oral Amoxycillin
7-59 days (<2 months) for 7 days
Advise the mother to
give home care
Follow up in 3 days
•Umbilicus red or Local bacterial infection Give oral Amoxycillin
draining pus for 5 days
•Skin pustules Teach mother to treat
local infections at home
Follow up in two days

•No signs of local Infection unlikely Advise mother to give

bacterial infection or home care
very severe disease
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Draining
Umbilicus pus
red
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Assess Jaundice

► Ask: when did jaundice appear?

► Look and feel:
- Look for yellow skin
- Look at the infant’s palm and sole
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SIGNS CLASSIFY AS IDENTIFY TREATMENT
•Jaundice in child of SEVERE JAUNDICE Treat to prevent low blood sugar
age <24hrs Warm the young infant while
arranging referral
•Palms or soles yellow
Advise mother how to keep the
at any age young infant warm on the way to the
hospital
Refer URGENTLY to hospital
-Jaundice appearing JAUNDICE Advise mother to give home care for
after 24 hours of age and the young infant
-Palms or soles not Advise mother when to return
yellow immediately if palms/sole become
yellow
If the young infant is older than 3
weeks, refer to a hospital for
assessment
Follow up in 1 day
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IF DIARRHOEA, LOOK AND FEEL:
Look at the young infant's general condition:
Infant's movements
Does the infant move on his/her own?
Does the infant not move even when stimulated but
then stops?
Does the infant not move at all?
Is the infant restless and irritable?

Look for sunken eyes.

Pinch the skin of the abdomen. Does it go back:
- Very slowly (longer than 2 seconds)?
- or slowly?
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Then check for feeding problem and
low weight for age
► Ask the mother:-
Is there any difficulty in feeding?
Is the infant breastfed?
If yes - how many times in 24 hours?
Does the infant usually receive any other food or drinks?
If yes - how often?
What do you use to feed the infant?
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ALSO,

Determine weight for age: Growth

chart or Road to Health chart
Look for ulcers or white patches in the
mouth
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Assess Breast Feeding :-

•Has the infant breastfed in previous hour?
•Is the infant able to attach?

To check attachment, look for:

Chin touching breast
Mouth wide open
Lower lip turned outward
More areola visible above than below .
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In breastfed babies

Signs Classify Identify treatment

Weight <2 kg in infants less than Very low weight for age -Refer to hospital for
7 days Kangaroo mother care
-Treat to prevent low
blood sugar
-Advise the mother to
keep the infant warm on
the way to hospital
Signs
-Not well attached to
breast or
-Not suckling effectively or
-Less than 8 breastfeeds in
24 hours or
-Receives other foods and
drinks or
-Weight <-2 z score or
-Oral thrush
Classify Identify treatment
-If not well attached, teach correct
positioning and attachment 22
Feeding problem -If not able to attach well, teach mother to
and or express breastmilk and feed
Low weight for age -Advise to increase frequency and demand
feeding
-Advise mother to increase breastfeeding
and reduce other feeding and use a cup
-If not breastfeeding at all, refer for
counseling or teach mother about
substitutes
-Advise on feeding and keeping infant
warm at home
-Teach the mother to treat thrush
-F/u in 2 days for thrush
-f/u in 14 days if feeding problem
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Signs Classify Identify treatment

Weight >-2 Z score and no No feeding problem -Advise mother on giving

other sign of inadequate home care to the infant
feeding -Praise mother for feeding
infant well.
 For infants who are not breastfed:
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Ask Look, listen, feel
-What milk are you giving? -Determine the weight for age
-How many times during the day and -Look for white patches or ulcers in the
night? mouth
-How much do you give at each feed?
-How do you prepare the milk?
-How is the milk given? Cup or bottle?
-How do you clean the feeding utensils?
-Do you give any breastmilk at all?
-What other food and fluid do you give
in addition?
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Signs Classify Identify treatment
- Weight <2 kg in infants Very low weight for age -Refer to hospital for
less than 7 days Kangaroo mother care
-Treat to prevent low
blood sugar
-Advise the mother on
keeping the baby warm
on the way to hospital
Signs Classify Identify treatment
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-Giving inadequate Feeding problem -Counsel about feeding
replacement feeds And/or -Explain the guidelines for safe
-Giving insufficient feeds Low weight for age replacement feeding
-Incorrectly or -Identify concerns of mother
unhygienically prepared and family of feeding
milk -Teach cup feeding if bottle is
-Using a feeding bottle used
-An HIV positive mother -Teach the mother how to treat
giving both breastmilk thrush
and feeds before 6 -Follow up feeding problem or
months thrush in 2 days
-Weight for age <-2 z -Follow low weight for age on 7
score days
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Treat to prevent low blood sugar

► If the infant is able to breastfeed, ask the mother to feed the

child
► If the infant can’t breastfeed but swallow then give 20-50 ml
(10ml/kg) expressed breast milk before referral. Or, give 20-50
ml of sugar water
► If unable to swallow, give 20-50 ml of sugar water through
nasogastric tube

* Dissolve 4 teaspoon of sugar (20 gm) in 200 ml of clean water

to make sugar water solution
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► Check for Immunization status

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Teach the mother how to keep the
infant warm

► Provide skin to skin contact or

► Keep the infant clothed or covered as much as possible
all the time. Dress the infant with extra clothing with
cap, gloves, socks, wrap with soft dry cloth and cover
with blanket.
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Assignment

A 9 month aged child is brought to the health facility with

complains of fever and difficulty in breathing. The child was able to
breastfeed and there was no history of diarrhoea or vomiting.
On examination, child was febrile and RR was 55 breaths per
minute. There was chest indrawing but no jaundice, no local
infection etc.
A. Write the classification of the disease of the above case and
management according to IMCI.
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► https://www.who.int/maternal_child_adolescent/documents/managemen
t-sick-young-infant-0-2-months/en/