RLE FORM 020

Cebu Normal University
College of Nursing
Cebu City
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date: _____________________________
Child’s name: __________________________________________________ Age: ____________ Sex: ________ Weight: ____________kg.
Temperature: __________ oC
ASK: What are the child’s problems? _____________________________________________________________________________ Initial visit: _______ Follow-up visit: _______
ASSESS (Circle all signs present)
CLASSIFY
CHECK FOR GENERAL DANGER SIGNS

GENERAL DANGER SIGNS
PRESENT?

NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
CONVULSIONS

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
YES_____ NO_____

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
 For how long? _____days

DOES THE CHILD HAVE DIARRHEA?
· For how long? _____ days
· Is there blood in the stool?

YES_____ NO_____
 Count the breaths in one minute.
_____breaths per minute. Fast breathing?
 Look for chest indrawing.
 Look and listen for stridor.
YES_____ NO_____

· Look at the child’s general condition. Is the child:
Abnormally sleepy or difficult to awaken?
Restless or irritable?
· Offer the child fluid.
Is the child unable to drink or breastfeed?
Is the child drinking eagerly, thirsty?
· Look for sunken eyes.
· Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5 o C or above)
Decide malaria risk
· Does the child live in malaria area?
LOOK AND FEEL:
· Has the child visited or
 Look or feel for stiff neck
stayed overnight in a malaria area in the
· Look for runny nose
past 4 weeks?
If malaria risk, obtain a blood smear.
(+)
(Pf)
(Pv)
(-)
(not done)
THEN ASK:
Look for signs of MEASLES
· For how long has the child has fever? _____ days
· Generalized rash and
· If more than 7 days, has the fever been present every day?
· One of these: cough, runny nose, or
· Has the child had measles within the last 3 months?
eyes red

YES_____ NO_____

If the child has measles now or within the last 3 months:
· Look for mouth ulcers.
If yes, are they deep and extensive?
· Look for pus draining from the eye.
· Look for clouding of the cornea.
ASSESS DENGUE HEMORRHAGIC FEVER
ASK:
· Has the child had any bleeding from the nose or
gums or in the vomitus or stool?
· Has the child had black vomitus or black stool?
· Has the child had persistent abdominal pain?
· Has the child had persistent vomiting?

DOES THE CHILD HAVE AN EAR PROBLEM?
· Is there ear pain?
· Is there ear discharge?
If Yes, for how long? _______ days

LOOK AND FEEL:
· Look for bleeding from nose or gums.
· Look for skin petechiae.
· Feel for cold and clammy extremities.
· Check capillary refill. ____ seconds.
· Perform tourniquet test if child is 6 months or older AND has no other
signs AND has fever for more than 3 days.
YES _____ NO _____
· Look for pus draining from the ear.
· Feel for tender swelling behind the ear.

THEN CHECK FOR MALNUTRITION and ANEMIA
· Look for visible severe wasting.
· Look for edema of both feet.
· Look for palmar pallor.
Severe palmar pallor? Some palmar pallor?
· Determine weight for age.
Very low?
CHECK THE CHILD’S IMMUNIZATION STATUS (Tick the immunization already given; circle immunization needed today.)
_____
______
BCG
HEP B1
_____
_____
______
DPT1
OPV1
HEP B2
_____
_____
________
DPT2
OPV2
MEASLES
_____
_____
______
DPT3
OPV3
HEP B3
CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older
Is the child six months of age or older?
Yes ___ No ___
Has the child received Vitamin A in the past 6 months?
Yes ___ No ___

Return for next immunization
on

(Date)

Vitamin A needed today
Yes_____ No _____
Abendazole/Menbendazole
Needed today?
Yes _____ No ______

CHECK FOR DEWORMING STATUS for children 12 months or older
Has the child received Abendazole/Mebendazole for the past 6 months? Yes ____ No ____
ASSESS THE CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old
· Do you breastfeed your child?
Yes ___ No ___
If Yes, how many times in 24 hours? _____ times. Do you breastfeed during the night? Yes ___ No ___
· Does the child take any other food or fluids?
Yes _____ No_____
If yes, what food or fluids?_____________________________________________________________________________________________________
· How many times per day? _____ times. What do you use to feed the child? ______________________________________________________________
If very low weight for age: How large are the servings? ______________________________________________________________________________
Does the child receive his/her own serving? _____ Who feeds the child and how? _________________________________________________________
· During the illness, has the child’s feeding changed? Yes ___ No ___
If yes, how? ________________________________________________________________________________________________________________

Feeding Problems:

ASSESS CARE FOR DEVELOPMENT:
Ask questions about how the mother cares for her child. Compare the mother’s answers to the Recommendations for Care and Development for the child’s
age.
· How do you play with your child?
· How do you communicate with your child?

Care and Development
Problems:

ASSESS OTHER PROBLEMS

__________________________________
Student Nurse
__________________________________
Health Center Staff

__________________________________
Clinical Instructor

TREAT .

___________________________________________ Give any immunizations needed today: ______________________________________________ Give vitamin A if needed today: _____________________________________________________ Feeding advice: __________________________________________________________________ Care for Development Advice __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 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__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Return for follow-up in: ____________________________________________________________ Advise mother when to return immediately.