Professional Documents
Culture Documents
IMCI Eng
IMCI Eng
Does the chiId have diarrhoea?
Classify
DIARRHOEA
for
DEHYDRATION
and if blood
in stool
LOOK AND FEEL:
x Look at the child's general condition.
s the child:
- Lethargic or unconscious?
- Restless and irritable?
x Look for sunken eyes.
x Offer the child fluid. s the child:
- Not able to drink or
drinking poorly?
- Drinking eagerly, thirsty?
x Pinch the skin of the abdomen.
Does it go back:
- Very slowly (longer than
2 seconds)?
- Slowly?
and if diarrhoea for
14 days or more
IF YES,
ASK:
x For how long?
x s there blood
in the stool?
Two of the following signs:
x Lethargic or unconscious
x Sunken eyes
x Not able to drink or drinking poorly
x Skin pinch goes back very slowly.
SEVERE
DEHYDRATION
Two of the following signs:
x Restless, irritable
x Sunken eyes
x Drinks eagerly, thirsty
x Skin pinch goes back slowly
SOME
DEHYDRATION
f child has no other severe classification:
- Give fluid for severe dehydration (Plan C)
OR
If child also has another severe classification:
- Refer URGENTLY to hospital with mother
giving frequent sips of ORS on the way
- Advise the mother to continue breastfeeding
If child is 2 years or older and there is cholera in your area,
give antibiotic for cholera
Give fluid, zinc supplements and food for some dehydration
(Plan B)
If child also has a severe classification:
- Refer URGENTLY to hospital with mother
giving frequent sips of ORS on the way
Advise the mother to continue breastfeeding
Advise mother when to return immediately
Follow-up in 5 days if not improving.
Not enough signs to classify as some
or severe dehydration
Give fluid, zinc supplements and food to treat diarrhoea at home
(Plan A)
Advise mother when to return immediately
Follow-up in 5 days if not improving.
NO
DEHYDRATION
x Dehydration present
SEVERE
PERSISTENT
DIARRHOEA
Treat dehydration before referral unless the child has another
severe classification
Refer to hospital
x No dehydration
PERSISTENT
DIARRHOEA
Advise the mother on feeding a child who has PERSSTENT
DARRHOEA
Give multivitamins and minerals (including zinc) for 14 days
Follow up in 5 days
DYSENTERY
x Blood in the stool
Give ciprofloxacin for 3 days
Follow-up in 2 days
4
IF YES:
Decide Malaria Risk: high or low
THEN ASK:
x For how long?
x f more than 7 days, has fever
been present every day?
x Has the child had measles
within the last 3 months?
LOOK AND FEEL:
x Look or feel for stiff neck.
x Look for runny nose.
Look for signs of MEASLES
x Generalized rash and
x One of these: cough, runny nose,
or red eyes.
Give quinine for severe malaria (first dose)
Give first dose of an appropriate antibiotic
Treat the child to prevent low blood sugar
Give one dose of paracetamol in clinic for high fever
(38.5C or above)
Refer URGENTLY to hospital
x Any general danger sign or
x Stiff neck.
VERY SEVERE
FEBRILE
DISEASE
x Fever (by history or feels hot or
temperature 37.5C** or above)
MALARIA
Give oral co-artemether or other recommended antimalarial
Give one dose of paracetamol in clinic for high fever
(38.5C or above)
Advise mother when to return immediately
Follow-up in 2 days if fever persists
f fever is present every day for more than 7 days, refer for
assessment
Classify
FEVER
HIGH MALARIA RISK
if MEASLES
now or within
last 3 months,
Classify
Does the chiId have fever?
(by history or feels hot or temperature 37.5C** or above)
LOW MALARIA RISK
High
Malaria Risk
Low
Malaria Risk
If the child has measles now
or within the last 3 months:
Does the chiId have an ear probIem?
IF YES, ASK:
NOT VERY
LOW WEIGHT
VITAMIN A SUPPLEMENTATION
Give every child a dose of Vitamin A every six
months from the age of 6 months. Record the dose
on the child's card.
ROUTINE WORM TREATMENT
Give every child mebendazole every 6 months from
the age of one year. Record the dose on the child's
card.
IMMUNIZATION SCHEDULE:
AGE
Birth
6 weeks
10 weeks
14 weeks
9 months
Follow national guidelines
VACCINE
BCG OPV-0
DPT+HB-1 OPV-1 Hepatitis B1
DPT+HB-2 OPV-2 Hepatitis B2
DPT+HB-3 OPV-3 Hepatitis B3
Measles*
* Second dose of measles vaccine may be given at any
opportunistic moment during periodic supplementary immunisation
activities as early as one month following the first dose
8
FOR CHOLERA:
TEACH THE MOTHER TO GIVE ORAL DRUGS AT HOME
GIVE INHALED SALBUTAMOL for WHEEZING
USE OF A SPACER*
A spacer is a way of delivering the bronchodilator drugs effectively into the lungs. No
child under 5 years should be given an inhaler without a spacer. A spacer works as
well as a nebuliser if correctly used.
From salbutamol metered dose inhaler (100 Pg/puff) give 2 puffs.
Repeat up to 3 times every 15 minutes before classifying pneumonia.
Spacers can be made in the foIIowing way:
Use a 500ml drink bottle or similar.
Cut a hole in the bottle base in the same shape as the mouthpiece of the inhaler.
This can be done using a sharp knife.
Cut the bottle between the upper quarter and the lower 3/4 and disregard the up-
per quarter of the bottle.
Cut a small V in the border of the large open part of the bottle to fit to the child's
nose and be used as a mask.
Flame the edge of the cut bottle with a candle or a lighter to soften it.
n a small baby, a mask can be made by making a similar hole in a plastic (not
polystyrene) cup.
Alternatively commercial spacers can be used if available.
To use an inhaIer with a spacer:
Remove the inhaler cap. Shake the inhaler well.
nsert mouthpiece of the inhaler through the hole in the bottle or plastic cup.
The child should put the opening of the bottle into his mouth and breath in and out
through the mouth.
A carer then presses down the inhaler and sprays into the bottle while the child
continues to breath normally.
Wait for three to four breaths and repeat for total of five sprays.
For younger children place the cup over the child's mouth and use as a spacer in
the same way.
* If a spacer is being used for the first time, it should be primed by 4-5 extra puffs
from the inhaler.
Give Iron
Give one dose daily for 14 days
Give OraI Co-artemether
Give the first dose of co-artemether in the clinic and observe for one hour f child vomits
within an hour repeat the dose. 2nd dose at home after 8 hours
Then twice daily for further two days as shown below
Co-artemether should be taken with food
Co-artemether tabIets
(20mg artemether and 120mg lumefantrine)
WEIGHT (age) 0hr 8h 24h 36h 48h 60h
5 - <15 kg (5 months up to 3 years) 1 1 1 1 1 1
15 - <20 kg (3 years up to 5 years) 2 2 2 2 2 2
AGE or WEIGHT
IRON/FOLATE TABLET
Ferrous sulfate 200 mg +
250 Pg Folate
(60 mg elemental iron)
IRON SYRUP
Ferrous fumarate
100 mg per 5 ml
(20 mg elemental iron per ml)
2 months up to 4 months (4 - <6 kg) 1.0 ml (< 1/4 tsp)
4 months up to 12 months (6 - <10kg) 1.25 ml (1/4 tsp)
12 months up to 3 years (10 - <14 kg) 1/2 tablet 2.0 ml (<1/2 tsp)
3 years up to 5 years (14 - 19 kg)
1/2 tablet 2.5 ml (1/2 tsp)
10
TEACH THE MOTHER TO TREAT LOCAL INFECTIONS AT HOME
CIear the Ear by Dry Wicking and Give Eardrops*
Do the foIIowing 3 times daiIy
x Roll clean absorbent cloth or soft, strong tissue paper into a wick
x Place the wick in the child's ear
x Remove the wick when wet
x Replace the wick with a clean one and repeat these steps until the ear is dry
x nstil quinolone eardrops* for two weeks
Treat Mouth UIcers with Gentian VioIet (GV)
Treat the mouth uIcers twice daiIy
x Wash hands
x Wash the child's mouth with a clean soft cloth wrapped around the finger
and wet with salt water
x Paint the mouth with 1/2 strength gentian violet (0.25% dilution)
x Wash hands again
x Continue using GV for 48 hours after the ulcers have been cured
x Give paracetamol for pain relief
Soothe the Throat, ReIieve the Cough with a Safe Remedy
Safe remedies to recommend:
- Breast milk for a breastfed infant
_______________________________________________________
_______________________________________________________
GIVE VITAMIN A AND MEBENDAZOLE IN CLINIC
ExpIain to the mother why the drug is given
Determine the dose appropriate for the chiId's weight (or age)
Measure the dose accurateIy
Give Vitamin A
VITAMIN A SUPPLEMENTATION:
Give first dose any time after 6 months of age to ALL CHLDREN
Thereafter give vitamin A every six months to ALL CHLDREN
VITAMIN A TREATMENT:
Give an extra dose of Vitamin A (same dose as for supplementation) as part of
treatment if the child has measles or PERSSTENT DARRHOEA.
f the child has had a dose of Vitamin A within the past month, DO NOT GVE
VTAMN A
Always record the dose of Vitamin A given on the child's chart
12
GIVE THESE TREATMENTS IN THE CLINIC ONLY
ExpIain to the mother why the drug is given
Determine the dose appropriate for the chiId's weight (or age)
Use a steriIe needIe and steriIe syringe when giving an injection
Measure the dose accurateIy
Give the drug as an intramuscuIar injection
If the chiId cannot be referred, foIIow the instructions provided
Give An IntramuscuIar Antibiotic
GIVE TO CHILDREN BEING REFERRED URGENTLY
Give ampicillin (50 mg/kg) and gentamicin (7.5mg/kg)
AMPICILLLIN
Dilute 500mg vial with 2.1ml of sterile water (500mg/2.5ml)
Where there is a strong suspicion of meningitis the dose of ampiciIIin
can be increased 4 times
GENTAMICIN
Use undiluted 2 ml vial (40mg/ml)
Of the dose range provided below, use lower dose for children with weight at lower
end of the category, and higher dose for children at the higher end of the category
F REFERRAL S NOT POSSBLE OR DELAYED, repeat the ampicillin injection
every 6 hours, and the gentamicin injection once daily
Give Quinine for Severe MaIaria
FOR CHILDREN BEING REFERRED WITH VERY SEVERE FEBRILE DISEASE:
Check which quinine formulation is available in your clinic
Give first dose of intramuscular quinine and refer child urgently to hospital
Give Diazepam to Stop ConvuIsions
Turn the child to his/her side and clear the airway. Avoid putting things in the mouth
Give 0.5mg/kg diazepam injection solution per rectum using a small syringe
(like a tuberculin syringe) without a needle, or using a catheter
Check for low blood sugar, then treat or prevent
Give oxygen and REFER
f convulsions have not stopped after 10 minutes repeat diazepam dose
WEIGHT AGE DOSE OF DIAZEPAM
(10 mg / 2 ml)
< 5 kg <6 months 0.5 ml
5 - < 10 kg 6 months up to 12 months 1.0 ml
10 - < 14 kg 12 months up to 3 years 1.5 ml
14 - 19 kg 3 years up to 5 years 2.0 ml
AGE or WEIGHT
150 mg /ml* (in 2 ml) 300 mg /ml* (in 2 ml )
2 months up to 4 months (4 - < 6 kg) 0.4 ml 0.2 ml
4 months up to 12 months (6 - < 10 kg) 0.6 ml 0.3 ml
12 months up to 2 years (10 - < 12 kg) 0.8 ml 0.4 ml
2 years up to 3 years (12 - < 14 kg) 1.0 ml 0.5 ml
3 years up to 5 years (14 - 19 kg) 1.2 ml 0.6 ml
INTRAMUSCULAR QUININE
AGE WEIGHT AMPICILLIN
500 mg viaI
GENTAMICIN 2mI viaI
(at 40 mg/mI)
2 months up to 4 months 4 <6 kg 1 ml 0.5 - 1.0 ml
4 up to 12 months 6 <10 kg 2 ml 1.1 - 1.8 ml
12 months up to 3 years 10 <14 kg 3 ml 1.9 - 2.7 ml
3 up to 5 years 14 19 kg 5 ml 2.8 - 3.5 ml
*quinine salt
13
Treat the ChiId to Prevent Low BIood Sugar
If the chiId is abIe to breastfeed:
Ask the mother to breastfeed the child
If the chiId is not abIe to breastfeed but is abIe to swaIIow:
x Give expressed breast milk or breast-milk substitute
x f neither of these is available give sugar water
x Give 30-50 ml of milk or sugar water before departure
To make sugar water: Dissolve 4 level teaspoons
of sugar (20 grams) in a 200-ml cup of clean water
If the chiId is not abIe to swaIIow:
x Give 50ml of milk or sugar water by naso-gastric tube
14
TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2
PACKETS OF ORS TO USE AT HOME.
GIVE FOLLOW-UP CARE
Care for the chiId who returns for foIIow-up using aII the boxes that
match the chiId's previous cIassification
If the chiId has any new probIems, assess, cIassify and treat the new
probIem as on the ASSESS AND CLASSIFY chart
MALARIA (Low or High MaIaria Risk)
If fever persists after 2 days, or returns within 14 days:
Do a full reassessment of the child > See ASSESS & CLASSIFY chart.
Assess for other causes of fever.
Treatment:
f the child has any general danger sign or stiff neck, treat as VERY SEVERE
FEBRLE DSEASE.
f the child has any cause of fever other than malaria, provide treatment.
f malaria is the only apparent cause of fever:
- Treat with the second-line oral antimalarial (if no second-line antimalarial is
available, refer to hospital.) Advise the mother to return again in 2 days if the fever
persists.
- f fever has been present for 7 days, refer for assessment.
GIVE FOLLOW-UP CARE
Care for the chiId who returns for foIIow-up using aII the boxes that match the chiId's previous cIassification
If the chiId has any new probIems, assess, cIassify and treat the new probIem as on the ASSESS AND CLASSIFY chart
EAR INFECTION
After 5 days:
Reassess for ear problem. > See ASSESS & CLASSIFY chart.
Measure the child's temperature.
Treatment:
f there is tender swelling behind the ear or high fever (38.5C or above), refer URGENTLY to
hospital.
Acute ear infection: if ear pain or discharge persists, treat with 5 more days of the same 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 to continue.
f no ear pain or discharge, praise the mother for her careful treatment. f she has not yet finished the
5 days of antibiotic, tell her to use all of it before stopping.
FEEDING PROBLEM
After 5 days:
Reassess feeding > See questions at the top of the COUNSEL chart.
Ask about any feeding problems found on the initial visit.
Counsel the mother about any new or continuing feeding problems. f you counsel the mother to make
significant changes in feeding, ask her to bring the child back again.
f the child is very low weight for age, ask the mother to return 30 days after the initial visit to measure
the child's weight gain.
ANAEMIA
After 14 days:
Give iron. Advise mother to return in 14 days for more iron.
Continue giving iron every 14 days for 2 months.
f the child has palmar pallor after 2 months, refer for assessment.
FEEDING RECOMMENDATIONS DURING SICKNESS AND HEALTH
* A good quality 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.
Feeding Recommendations for a chiId who has PERSISTENT DIARRHOEA
x f still breastfeeding, give more frequent, longer breastfeeds, day and night.
x f 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
x Breastfeed as often as the child
wants, day and night, at least
8 times in 24 hours.
x Do not give other foods or fluids.
Up to 6 Months
of Age
x Breastfeed as often as the child wants.
x Give adequate servings of:
___________________________
___________________________
___________________________
___________________________ *
- 3 times per day if breastfed plus
snacks
- 5 times per day if not breastfed.
6 Months up
to 12 Months
x Breastfeed as often as the child
wants.
x Give adequate servings of:
__________________________
__________________________
__________________________
__________________________*
or family foods 3 or 4 times per day
plus snacks.
12 Months
up to 2 Years
x Give family foods at 3 meals
each day. Also, twice daily, give
nutritious food between meals,
such as:
__________________________
__________________________
__________________________
__________________________
__________________________
2 Years
and OIder
21
COUNSEL THE MOTHER ABOUT FEEDING PROBLEMS
If the chiId is not being fed as described in the above recommendations, counseI the mother accordingIy. In addition:
If the mother reports difficuIty with breastfeeding, assess breastfeeding (see YOUNG INFANT chart).
As needed, show the mother correct positioning and attachment for breastfeeding.
If the chiId is Iess than 6 months oId and is taking other miIk or foods:
- Build mother's confidence that she can produce all the breast milk that the child needs.
- Suggest giving more frequent, longer breastfeeds day or night, and gradually reducing other milk or foods.
If other miIk needs to be continued, counseI the mother to:
- Breastfeed as much as possible, including at night.
- Make sure that other milk is a locally appropriate breast milk substitute.
- Make sure other milk is correctly and hygienically prepared and given in adequate amounts.
- Finish prepared milk within an hour.
If the mother is using a bottIe to feed the chiId:
- Recommend substituting a cup for bottle.
- Show the mother how to feed the child with a cup.
If the chiId is not feeding weII during iIIness, counseI the mother to:
- Breastfeed more frequently and for longer if possible.
- Use soft, varied, appetizing, favourite foods to encourage the child to eat as much as possible, and offer
frequent small feeds.
- Clear a blocked nose if it interferes with feeding.
- Expect that appetite will improve as child gets better.
If the chiId has a poor appetite:
- Plan small, frequent meals.
- Give milk rather than other fluids except where there is diarrhoea with some dehydration.
- Give snacks between meals.
- Give high energy foods.
- Check regularly.
f the mother is sick, provide care for her, or refer her for help.
f 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 mother's immunization status and give her tetanus toxoid if needed.
Make sure she has access to:
x Family planning
x Counselling on STD and ADS prevention.
23
FLUID
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 child's problems.
NEXT WELL CHILD VISIT
Advise mother when to return for next immunization according to
immunization schedule.
If the chiId has: Return for first foIIow-up in:
x PNEUMONA
x DYSENTERY
x MALARA, if fever persists
x FEVER-MALARA UNLKELY, if fever persists
x MEASLES WTH EYE OR MOUTH COMPLCATONS
2 days
x PERSSTENT DARRHOEA
x ACUTE EAR NFECTON
x CHRONC EAR NFECTON
x FEEDNG PROBLEM
x COUGH OR COLD, if not improving
5 days
x ANAEMA
14 days
x VERY LOW WEGHT FOR AGE
30 days
Any sick child x Not able to drink or breastfeed
x Becomes sicker
x Develops a fever
f child has COUGH OR COLD, also
return if:
x Fast breathing
x Difficult breathing
f child has Diarrhoea, also return if: x Blood in stool
x Drinking poorly
Advise mother to return immediateIy if the chiId has any of these signs:
Advise the Mother to Increase FIuid During IIIness
FOR ANY SICK CHILD:
f child is breastfed, breastfeed more frequently and for longer at each feed. f child is taking breast-milk substitutes, increase
the amount of milk given
ncrease other fluids. For example, give soup, rice water, yoghurt drinks or clean water.
FOR CHILD WITH DIARRHOEA:
Giving extra fluid can be lifesaving. Give fluid according to Plan A or Plan B on the TREAT THE CHILD chart
WHEN TO RETURN IMMEDIATELY
24
CHECK FOR VERY SEVERE DISEASE AND
LOCAL BACTERIAL INFECTION
THEN CHECK FOR JAUNDICE
If jaundice present,
ASK:
xWhen did jaundice first
appear?
LOOK, LISTEN, FEEL:
xLook for jaundice (yellow eyes or
skin).
xLook at the young infant's palms and
soles. Are they yellow?
Classify
Jaundice
SIGNS
CLASSIFY AS
TREATMENT
(Urgent pre-referraI treatments are in boId print)
26
THEN CHECK THE YOUNG INFANT'S IMMUNIZATION AND VITAMIN A STATUS:
Give aII missed doses on this visit.
mmunize sick infants unless being referred.
Advise the caretaker when to return for the next dose.
IMMUNIZATION
SCHEDULE:
AGE
Birth
6 weeks
10 weeks
VACCINE VITAMIN A
BCG OPV-0 200 000 U to the mother within 6 weeks of delivery
DPT+HB-1 OPV-1 Hepatitis B 1
DPT+HB-2 OPV-2 Hepatitis B 2
ASSESS OTHER PROBLEMS
29
*Avoid using undiluted 40 mg/ml gentamicin.
Referral is the best option for a young infant classified as VERY SEVERE DSEASE. f referral is not possible, continue to
give ampicillin and gentamicin for at least 5 days. Give ampicillin two times daily to infants less than one week of age and 3
times daily to infants one week or older. Give gentamicin once daily.
AMPICILLIN
Dose: 50 mg per kg
GENTAMICIN
To a vial of 250 mg Undiluted 2 ml vial containing 20 mg = 2 ml at 10 mg/ml
OR
WEIGHT Add 1.3 ml sterile water =
250 mg/1.5 ml
AGE <7 days
Dose: 5 mg per kg
AGE>7 days
Dose: 7.5 mg per kg
1-<1.5 kg 0.4 ml 0.6 ml 0.9 ml
1.5-<2 kg 0.5 ml 0.9 ml 1.3 ml
2-<2.5 kg 0.7 ml 1.1 ml 1.7 ml
2.5-<3 kg 0.8 ml 1.4 ml 2.0 ml
3-<3.5 kg 1.0 ml 1.6 ml 2.4 ml
3.5-<4 kg 1.1 ml 1.9 ml 2.8 ml
4-<4.5 kg 1.3 ml 2.1 ml 3.2 ml
Add 6 ml sterile water to 2 ml vial containing 80 mg* = 8 ml at 10 mg/ml
Treat the Young Infant to Prevent Low Blood Sugar
If the young infant is able to breastfeed:
Ask the mother to breastfeed the young infant.
If the young infant is not able to breastfeed but is able to swallow:
Give 20-50 ml (10 ml/kg) expressed breast milk before departure. f not possible to give expressed breast milk, give 20-50 ml (10
ml/kg) sugar water (To make sugar water: Dissolve 4 level teaspoons of sugar (20 grams) in a 200-ml cup of clean water).
If the young infant is not able to swallow:
Give 20-50 ml (10 ml/kg) of expressed breast milk or sugar water by naso-gastric tube.
30
TREAT THE YOUNG INFANT
Teach the Mother How to Keep the Young Infant Warm on the Way to the Hospital
Provide skin to skin contact, OR
Keep the young infant clothed or covered as much as possible all the time. Dress the young infant with extra clothing
including hat, gloves, socks and wrap the infant in a soft dry cloth and cover with a blanket.
Give an Appropriate Oral Antibiotic for local infection
For local bacterial infection:
First-line antibiotic : ___________________________________________________________________________________________
Second-line antibiotic: ___________________________________________________________________________________________
* Avoid cotrimoxazole in infants less than 1 month of age who are premature or jaundiced.
COTRIMOXAZOLE
(trimethoprim + sulphamethoxazole)
Give two times daily for 5 days
AGE or WEIGHT
Adult Tablet
single strength
(80 mg trimethoprim + 400
mg sulphamethoxazole)
Paediatric Tablet
(20 mg trimethoprim
+100 mg
sulphamethoxazole)
Syrup
(40 mg trimethoprim
+200 mg
sulphamethoxazole)
Tablet
250 mg
Syrup
125 mg in 5 ml
Birth up to 1 month (<4 kg) 1/2* 1.25 ml* 1/4 2.5 ml
1 month up to 2 months (4-<6 kg) 1/4 1 2.5 ml 1/2 5 ml
AMOXICILLIN
Give two times daily for 5 days
31
Wash hands
Gently wash off pus and crusts with soap and water
Wash hands
Treatment:
f umbilical pus or redness remains same or is worse, refer to hospital. f pus and redness are improved, tell the mother to continue giving the 5
days of antibiotic and continue treating the local infection at home.
f skin pustules are same or worse, refer to hospital. f improved, tell the mother to continue giving the 5 days of antibiotic and continue treating the local
infection at home.
DIARRHOEA
After 2 days:
Ask: -Has the diarrhoea stopped ?
Treatment:
f the diarrhoea has not stopped, assess and treat the young infant for diarrhoea. >SEE Does the Young nfant Have Diarrhoea ?
f the diarrhoea has stopped, tell the mother to continue exclusive breastfeeding.
ASSESS EVERY YOUNG INFANT FOR 'VERY SEVERE DISEASE" DURING FOLLOW UP VISIT.
JAUNDICE
After 1 day:
Look for jaundice. Are palms and soles yellow?
f palms and soles are yellow, refer to hospital.
f palms and soles are not yellow, but jaundice has not decreased, advise the mother home care and ask her to return for
follow up in 1 day.
f jaundice has started decreasing, reassure the mother and ask her to continue home care. Ask her to return for follow up at three
weeks of age. f jaundice continues beyond three weeks of age , refer the young infant to a hospital for further assessment.
36
GIVE FOLLOW-UP CARE FOR THE YOUNG INFANT
FEEDING PROBLEM
After 2 days:
Reassess feeding. > See Then Check for Feeding Problem or Low Weight above.
Ask about any feeding problems found on the initial visit.
Counsel the mother about any new or continuing feeding problems. f you counsel the mother to make significant changes in feeding,
ask her to bring the young infant back again.
f the young infant is low weight for age, ask the mother to return 14 days after the initial visit to measure the young infant's
weight gain.
Exception:
f you do not think that feeding will improve, or if the young infant has lost weight, refer to hospital.
37
GIVE FOLLOW-UP CARE FOR THE YOUNG INFANT
LOW WEIGHT FOR AGE
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.
f the infant is no longer low weight for age, praise the mother and encourage her to continue.
f 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.
f 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 14 days). 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:
f 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.
f thrush is worse, or the infant has problems with attachment or suckling, refer to hospital.
f thrush is the same or better, and if the infant is feeding well, continue half-strength gentian violet for a total of 7 days.
38
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