MANAGEMENT OF THE SICK CHILD AGED 2 MONTHS UP TO 5 YEARS Nave: ap Weight gy Heighten em Temperature (C) ‘ASK What are the eb probiems? ‘ntalVer? Followup Vist? ASSESS [Cea allsgns presen) cussrY [CHECK FOR GENERAL DANGER SIGN (General dangar sit NOT ABLE TO DRINK OR BREASTFEED LETHARGIC OR UNCONSCIOUS resent? VOUS EVERYTHING © CONVULSNGNOW Yer__ Ne. © CONVULSION. DOES THE GHILD HAVE GOUGH OR DIFFICULT BREATHING? Deck msn rk: High tow No Look otf frat rock * Forhowleng?_ Days Look errany nse 4 rere han 7 deta feverboanprsertevay day? * Look br sons of MEASLES: + Has ont measles wit te last 3eorthe? 2 Soe rate oat ae Do asa test, NO genera danger signin al casesin 5, O08 Bese cough. runny nose, ore eyes ng arta ik of NO aus caus of fover now Look or any eer cate ot alana isk [Test POSITIVE? P felipanen P. viva NEGATIVE? ifthe child has measies now or within the» Look iormmoth cers. : * Look erpuscraning fombeye last 3 months: ¢ faok or rscranng tomes Yes No «© Forhewlong?_Daya © Caunt ti breasin ane mite: _bmathe per minute. Fast breathing? 1 Laok crenest drawing Look and ata foe str + Look ond iat for waoeeing DOES THE CHILD HAVE DIARRHOEA? Yes_ Ne « Forbow long? _ Days + Look at tna cis gonaralcondtion. * lather Blood ia stl? © Letharge or unconscious? Reslless and irate? Look foreankon ayes, (Offer the ee fui. isthe ch: ‘8 Notatle to dink or drinking potly? Drinking eagety, thirsty? «+ Prichite sk of te abxdmen. Does go back ‘e Very wly (ong ther 2 seconds)? Slowly? DOES THE CHILD HAVE FEVER? (by history/fools hovtomporature 37.5°C or above) Yeo Fo. DOES THE CHILD HAVE AN EAR PROBLEM? ‘+ Doyoubroasfeed yourchld? Yor _No__ © yes, how many tes in 24 hou? “es. Do you breastced dung the right? Yo Docs the chi take any other foods or face? Ves No Yes, whal fod or Rae? © Haw many ties per day? __ umes, What do yous to feed the chia? (© FWODERATE AGUTE HALNUTRITION. How rye are servings? {© Does the chi ecaive is gan serng? Wha foecs tno ld and how? + Dang tras, hase eh ong eBrGa? Yes No Ye No * tsbere corpon? + Look fo pus raring rom fi cor 1 bg tre ear scharg? ies forhow long? _Davs Feel frre evan btn fn oar TTHEN CHECK FOR AGUTE MALNUTRITION — + Look trcndnra fect ot Dele FHI sor JAND ANAEMIA © Lesethan.3? Belvoon-3and.2? -2ormere? ‘+ CaldS monhs er oldermoasuro MUAC__ rn. * Look fr pair paler. pnts pnsinniein Severe palma pale? Sere painar ple? we cee it child has MUAC toss than 148 mm or» ts tiee any mecca consiicaler: General danger son? FHV. less than -3 Z scores: ‘aysovare clasticator? _ Preumoria win chet indraving? + hid Brant er cle: Cller RUTF te eats he chil: © Note nish? | Ablf nish? CHECK FOR HIV INFECTION ‘+ Nole meshers andor cies HY status ‘© Mote’s HIVtssl. NEGATIVE POSTIVE —NOTDONEKNOWN © Chie’ vloglaltast_ NEGATVE POSTIVE NOT DONE © Ghids seriegcaltest NEGATE POSTIVE _ NOT DONE + iether is HIV-positve and NO postive vrologial test n hi: © laine chic breasteding row? ‘© Was the chic breasted al th ine of oso 6 wooks before 7 © Heasoeding' Is the mater and chil on ARV propyl? [CHECK THE CHILD'S IMMUNIZATION STATUS (Circle Immunizations needed today) Roun frre Bos OPTHHE-1—DPT#HIB2 ——«OPTHES easiest Meesies2 earn smurcznbon on: onva ova ove ops Neterdacae = Hep 60 Hep Bt Heo Hep Bs RIA RIv2 Rvs Pov Pove Pov [ASSESS FEEDING if the child is less than 2 years old, has MODERATE ACUTE MALNUTRITION, FEEDING. JANAENIA, or Is HIV exposed or Infected PROELENS [ASSESS OTHER PROBLEMS: ‘ask about emer Dane‘Treat FRetura for follow-up in. days. Advina mother when to retum imme aly. Give any Immuntzatlon and feeding advice needed today.ART INITIATION RECORDING FORM FOLLOW THESE STEPS TO INITIATE ART IF CHILD DOES NOT NEED URGENT REFERRAL Neme: Ae Weight (ka Temperature ("C} Date: ASSESS (Circe al findings) TREAT STEP 1: CONFIRM HIV INFECTION Yes __No '¢ Chid under 18 mantns: Virological est pesitve + ‘Send tests that are required |— Check mat chia nas not breastfed for at least § weeks * Send confirmation test © Chid 18 monthe and over: Serological text postive {HIV infection confirmed, and chiid Ie in stable condition, GO TO STEP 2 Second serological test positive (Check that chit has not breastfed fora least 8 weeks STEP 2: CAREGIVER ABLE TO GIVE ART Yes __No| ‘ Caregiver available and wilng lo give medication it yea: GOTO STEP 3. | eae imag bed lo mother edit crisPart it na: COUNSEL AND SUPPORT THE CAREGIVER. STEP 3: DECIDE IF ART CAN BE INITIATED AT FIRST LEVEL YEs_NO ‘© Weight under 3 kg Many present: REFER |\— + Ghana tinone prtent: GO TO STEP [STEP 4: RECORD BASELINE INFORMATION Weight: __kg. ‘+ Send tests that are required and GO TO STEPS Heighitengih __em 1+ Feeding probiem # WHO dinical stage today: * CD4 count:__calistmm’d CDA: * Vi dtavaladel: 2 Hogi ISTEP 5: START ART AND COTRIMOXAZOLE PROPHYLAXIS © Less tian 3 years: inate ABC +3TC+LPV, of RECORD ARVS & DOSAGES HERE: clher recommended frstine regimen 1 ‘+ B.years and older: iniiale ABCS3TC+ EFV, oretner 3 recommended firstiine 3 PROVIDE FOLLOW-UP CARE + Folow-up according i national gudelnes NEXT FOLLOW-UP DATE:RECORD ACTIONS AND TREATMENTS HERE: ALWAYS REMEMBER TO COUNSEL THE MOTHER AND PROVIDE ROUTINE CAREFOLLOW-UP CARE FOR CONFIRMED HIV INFECTION ON ART: SIX STEPS Nome A Went tor Holghtlegh (on Temperature "Cy: Date: Cree all inaings ISTEP 1: ASSESS AND CLASSIFY RECORD JASK: does the cits have any protlems? tyes, record here: ACTIONS | ASK: has the child received care at ancther health ‘YES, NO | PARC facility since the last visit? '* Check for general danger signs: © NOT ABLE TO ORINK OR BREASTFED © VOMTSEVERYTHNG, {general danger signs or ART severe sie etfecs, provide preseteral reatment © CONVLLSIONS ad REFER URGENTLY © LETHARGIC OR UNCONSCIOUS © CONVULSING NOW Check tor ART sovero side etfecte: © Severe sin rasn 2 Yelow eyes ‘Assess, classify, teat, and followup main symptoms according lo IMCI guidelines. © Diffcutly breathing and severe abdominal pain Refer f necessary. © Fever, vomiting, ash (only fen Abaca} * Check for main symptoms: © Cough er aifcuty treating © Diarthooa 2 Fever 2° Ear problem 2 Other problems ISTEP 2: MONITOR ARV TREATMENT RECORD Assees acherenc: 1. REFER NON-URGENTLY IF ANY OF THE FOLLOWING ARE PRESENT: [ACTIONS le Takes alldoses - Frequently misses doses - ‘© Not gaining weight for 3 months |TAKEN: lOccasionaly misses a dose - Loss of milestones Not king mesieation oot adherence despito adherence couns loeatiects Sige se ae eke peepee rraragement * Higher circa! siege than Ss seanging. mm, or painfulhands, feet or CO count significantly lower then before “ “Abnormal dietmbuton ot * UDLhigherthan 38 mrelt nezness - Abnormal esibutonl 4 Tagyeares (TS) hgnerthan 56 mmelL ae iar zaice mo sorters Progrossed to higher stage 2 SEND TES Sage wren ART inated: 1-2-9 = 4 Untrown 1 CLM sais + Monitor blood results: Tess sould be sertater > [pt cneibsorctand tighcerdes Emons on AfVs, ther yeary.Mecordlest Qrucewae Go To Sige celeinma alec ton Pfc LDL Ghalesterot Tos: [STEP 3: PROVIDE ART AND OTHER MEDICATION lasceaTesLevie RECORD ART DOSAGES: lancestcorry 1 Icovmaoxazcle 2 | Vitamin A x lotr Mecseaton + COTRIMOXAZOLE DOSAGE: + VITAMIN A DOSAGE: ‘OTHER MEDICATION DOSAGE: + 2 Es STEP 4; COUNSEL DATE OF Use every vist edvcate he caregher and provde RECORD ISSUES DISCUSSED: NEXT ViStT: suppor. Kay issues ince? How is hid progressing - Adherence - Supper to Jcarogvor =. Dicsosure (lo ofhor & child) - Sido- effects and errect managementRECORD ACTIONS TAKEN:MANAGEMENT OF THE SICK YOUNG INFANT AGED UP TO 2 MONTHS Name: Poe: ‘Welght (ka Temperature ("Ck ‘Ask Whal ae the infants probiems?: i ASSESS [ce sagt prse) maven aasane CHECK FOR SEVERE DISEASE AND LOCAL BACTERIAL INFECTION * the infant having ec in feeding? ‘+ Countthe breaths in one minute, __ bresths per minule «Has the fart had comnisions? Repeatif elevated: Fast beating? * Look for severe chestindrawing, + Look and fsen for grunting. + Lookat te umbiculus. [sit red or draining pus? Fever (lemperature 38°C or above els hot) or tow body lemperatre (below 35.6°C or foais coo!) * Look for skin pustules. Are there mary or severe pustules? Movement cry when stimuiated er no movement even when stimulated? THEN CHECK FOR JAUNDICE ‘* Whon oid tne Jauncie appear frst?” + Look for jaundice (yellow eyes or skin) Look. te young intants palms and sales. Are they yellow? DOES THE YOUNG INFANT HAVE * Look at he young infants general condition. Does the infant Yes__ No ‘© move only when stimulated? PIARRHOEA? © nal move even when simulated? Is the infant resiess and iriaba? * Look for sunken eyes. ‘= Pinch the kin ofthe sbdomen. Does it go back: © Very slowy? _ © Slowly? THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT fh Infant has ra indication to refer urgentyto hospital * Determine weight for ago. Low _ Not ow _ ‘sere any cmcutyfoocing? Yes _ No__ + Look for ers ar white patches in tho mouth (hrs. + [the infant breastfed? Yes _ NO. ityes, how many tines in 24 ours? —_ times + Does the infant usualy receive any ciher foods oF inks? Yes No tyes, ow oon? ‘+ What do you use to fed the eit? [CHECK FOR HIV INFECTION + Note mothers andlor chile HIV ete: ‘© Mothers HiVtest: NEGATIVE POSITIVE NOTDONEKNOWN © Chikgs vrological test: NEGATIVE POSITIVE NOTDONE Chis serosal tect: NEGATIVE POSITIVE NOT DONE « mother is HIV postive and and NO gosiive iological testin young infant © Ie the infor breastioecing row? © Was the fant breasticeding tthe time of tastor 6 wooks botore R? 0 ITbreestieeding ts the mother and inlanton ARV prophyiaxis? [ASSESS BREASTFEEDING «Has the infant breasted in the previous hour? ithe lnfant has not fd in tho previous hour, ask ne mother to puter infant othe breast. Observe the breasted for 4 minutes. + Is the infant able lo attach? To check attachment, lock ter ‘© Chin touching breast: Yes __ Ne © Mouth wide oper: Yes _ © Lower ip tured outward: Yes & More wea abov hen awe me Yeo _ ‘ot wellatizched good attachment «Is the infant sucking ettecthely (that, siow deep sucks, sometimes pausing)? nat sucking sucking elfectvely effecively ICHECK THE CHILD'S IMMUNIZATION STATUS (Circle Immunizations needed today) Return tornoxt 8G DPTHIB- — OPT+HIB2 HepB Hep 82 700,000 10 immunization ox ovo oPv-t oPv2 vitamin Ato mother Darel JASSESS OTHER PROBLEMS: Tak about rothore ewn healtTreat ‘danger sign anc no otner severe y7t. Adve mother when to retum immediately. Give any immunization and teeing advice neetad today.