CLASSIFICATION OF DEHYDRATION

 SEVERE DEHYDRATION  SOME DEHYDRATION  NO DEHYDRATION

Severe Dehydration
- requires immediate IV infusion, nasogastric or oral

fluid replacement according to WHO treatment guidelines -a fluid deficit of >10% of the body weight leads to severe dehydration
-Signs: Lethargic or unconscious Not able to drink or drinking poorly Sunken eyes Skin pinch that goes back very slowly

y -requires active oral treatment y -children with some dehydration have a fluid deficit 5-

10% of their body weight

y Signs:  Restless/irritable  Sunken eyes  Drinks eagerly, thirsty  Skin pinch goes back slowly

No Dehydration
- Patients

with diarrhea but with no signs of dehydration usually have a fluid deficit of <5% of their body weight

Classification of Persistent Diarrhea

Severe Persistent Diarrhea- who also have any degree of dehydration require special treatment and should be referred to a hospital. Persistent Diarrhea- no signs of dehydration can be safely managed in the outpatient clinic, at least initially. - proper feeding is the most important aspect of treatment for most children with persistent diarrhea

Classification of Dysentery

FEVER- ALL SICK CHILDREN SHOULD BE CHECKED FOR FEVER. IT MAY BE CAUSED BY MINOR INFECTION, BUT MAY ALSO BE THE MOST OBVIOUS SIGN OF A LIFETHREATENING ILLNESS, PARTICULARLY MALARIA OR OTHER SEVERE INFECTION INCLUDING MENINGITIS , TYPHOID FEVER OR MEASLES.

Clinical Assessment- children are considered to have fever if their body temp. is above 37.5 (axillary) or 38 (rectal) degree celcious.

Stiff neck- may be a sign of meningitis, cerebral malaria, or severe febrile disease
Risk of malaria and other endemic infections: High malaria risk setting- ages 2 to 59 months Low malaria risk setting- ages 2 to 59 months No malaria risk setting- does not normally occur in the area

Runny Nose- a child w/ fever and a runny nose does not need an antimalarial drug. Duration of Fever- fever due to viral illnesses are self limiting. Fever for more than 5 days can mean that the child has a more severe disease. eg:; typhoid fever

Measles- children w/ fever should be assessed for signs of current(w/in last 3 months) measles. Signs: Red eyes, runny nose, and cough

CLASSIFICATION OF FEVER VERY SEVERE FEBRILE DISEASE HIGH MALARIA-RISK AREA LOW MALARIA-RISK AREA NO MALARIA-RISK AREA

CLASSIFICATION OF MEASLES
Complicated- severe stomatitis w/ deep extensive mouth ulcers or severe eye complication Measles w/ eye or mouth complications- as pus draining from eye (a sign of conjunctivitis) Ear problem- cough or difficult breathing, diarrhea, and fever Clinical assessment- by the used of otoscopy Tender swelling behind the ear- the most serious complication of an ear Ear pain- early stages of acute otitis Ear discharge or pus- another important sign of ear infection
Severe/

Ear Problems:
Mastoiditis- tenderness or swelling of the mastoid bone Acute Ear Infection- ear discharge for less than 14 days Chronic Ear Infection- ear discharge for > 14 days, the ear should be dried by wicking No Ear Infection- no signs of infection

3. Weight for age- helps to identify children with low weight for age 4. Palmar pallor- sick children w/ severe anemia often caused by malaria infection.

Checking Immunization Status

Children being referred urgently to the hospital should not be immunized. Live vaccines (BCG, measles, polio, yellow fever) should not be given to children w/ immunodeficiency disease DPT2/DPT3 should not given to children who have had convulsions shock w/in 3 days of a previous doses. DPT should not be given to children w/ recurrent convulsions or another active neurological disease of the CNS.