COMMUNITY HEALTH NURSING - MIDTERM
By : Krystal Aira A. Puno
INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS (I.M.C.I)
➢ Integrated approach to child health;
focuses on the well-being of the
whole child
➢ Birth up to 5 years old
- Sick children birth – 2 mos.
(sick young infants); very
severe disease & local
bacterial infection (bacteria
from the umbilical cord)
- Sick children 2 mos. – 5 yrs
old (sick infants); general
danger signs
RATIONALE FOR AN INTEGRATED
APPROACH IN THE MANAGEMENT
OF SICK CHILDREN
Majority of these deaths are caused by
preventable and treatable diseases namely :
➢ Pneumonia
➢ Diarrhea
➢ Malaria
➢ Measles
➢ Malnutrition
Three (3) out of four (4) episodes of
childhood illnesses are caused by these five
(5) conditions.
WHO ARE THE CHILDREN COVERED
BY I.M.C.I PROTOCOL
➢ Sick children birth up to 2 months
(sick young infants)
➢ Sick Children 2 months up to 5 years
old (sick infant child)
STRATEGIES / PRINCIPLES IN I.M.C.I
➢ All sick children aged 2 months up to
5 years are examined for GENERAL
DANGER SIGNS and all sick young
infant birth to 2 months are examine
for VERY SEVERE DISEASE AND
LOCAL BACTERIAL INFECTION
➢ The children and infants are then
assessed for main symptoms for the
sick children. The main symptoms
include cough or difficulty in
breathing, diarrhea, fever and ear
infection. For sick young infants,
local bacterial infection, diarrhea
ALL SICK CHILDREN ARE ROUT
ASSESSED FOR NUTRITIONAL
➢ Only a limited number of clinical
signs are used.
➢ A combination of individual signs
leads to a child classification within
one or more symptom groups rather
than a diagnosis.
➢ I.M.C.I management procedures are
limited numbers of essential drugs
and encourage active participation of
caretakers in the treatment of
children
➢ Counseling of caretakers on home
care, Correct feeding and giving
fluids and when to return to
clinic/health center is an essential
components of I.M.C.I
10 LEADING CAUSE OF CHILD
MORTALITY
1. Pneumonia
2. Diarrheas and Gastroenteritis
3. Congenital Anomalies
4. Septicemia
5. Other Diseases of the Nervous
System
6. Accidental Drowning
7. Dengue Fever
8. Chronic Lower Respiratory System
9. Meningitis
10. Leukemia

10 LEADING CASES OF INFANT
MORTALITY
1. Congenital Pneumonia
2. Intrauterine Hypoxia and Birth
Asphyxia
3. Other Congenital Malformation
4. Diarrheas and Gastroenteritis
presumed infection origin
5. Neonatal Aspiration Syndrome
6. Congenital Malformation of the Heart
7. Disorders Related to Short
Gestation, Low Birth Weight
8. Respiratory Disorders of Newborn
9. Bacterial Sepsis of Newborn
10. Pneumonia
WHY I.M.C.I (C.R.E.A.M)
C - Conditions Overlap (Other Problems)
R - Relies on History (Hx) and Signs and
Symptoms (S/S)
E - Equipment & Drugs are Scarce
A - Ability of Health workers to practice
complicated clinical procedures are few
M - Minimal or Non-Existent Diagnostic
Tools
WHY I.M.C.I (U. S. I)
U - Upgrading the case management and
counseling skills of healthcare providers
S - Strengthening the healthcare system for
effective management of childhood illnesses
I - Improving the family and community
health practices related to childhood and
nutrition
ELEMENTS OF I.M.C.I
1. ASSESS THE CHILD
By checking first the danger signs (or
possible bacterial infection in a young
infant)
➢ Asking questions about common
conditions
➢ Examining the child
➢ Checking the nutrition and
immunization status
➢ Includes checking the child for other
problems
2. CLASSIFY A CHILD'S ILLNESS
USING COLOR-CODED TRIANGLE
SYSTEM
➢ PINK - URGENT PRE-REFERRAL
TREATMENT AND REFERRAL
➢ YELLOW - SPECIFIC MEDICAL
TREATMENT AND ADVICE / HOME
TREATMENT
➢ GREEN - SIMPLE ADVICE ON
HOME MANAGEMENT
3. IDENTIFY SPECIFIC
TREATMENTS FOR THE CHILD
➢ PINK - If urgent referral, give
essential treatment before the
patient is transferred.
➢ GREEN - If the child requires
treatment at home, develop and
integrated plan for the child and give
the 1st dose of drugs in the clinic.
➢ YELLOW - If a child should be
immunized, give immunization.
4. PROVIDE PRACTICAL
TREATMENT INSTRUCTIONS
➢ Teaching the caretaker on oral drug
administration
➢ How to feed and give oral fluids
during illness
➢ How to treat local infections at home
➢ Aske the caretaker to return for
follow up on a specific date
 ➢ Teach the caretaker on how to
recognize signs that indicate that the
child should be return immediately to
health facility
5. COUNSEL
➢ Assess feeding, including
breastfeeding practices.
COUNSEL to solve any
feeding problem found. Then
counsel the mother about her
own health.
6. FOLLOW UP CARE
➢ When a child is brought back
to the clinic as requested,
GIVE FOLLOW UP CARE
and if necessary, reassess
the child for new problems
CHECK FOR GENERAL DANGER
SIGNS (need URGENT REFERRAL)
➢ Inability to drink or breastfeed
➢ Convulsions
➢ Lethargy or unconsciousness
➢ Abnormally Sleepy or difficult to
awaken
➢ Vomiting everything taken.
A CHILD WITH ANY OF THE DANGER
SIGNS HAS A SERIOUS PROBLEMS AND
NEEDS URGENT REFERRAL TO THE
HOSPITAL
ASK : Is the child able to drink or
breastfeed?
➢ A child has this sign if he/she is to
weak to drink and is not able to suck
or swallow when offered a drink
➢ If you are not sure about the
mother’s answer, ask her to offer the
child a drink. Look to see the child’s
response
➢ Breastfeeding children may have
difficulty sucking when their nose is
blocked, clear it first.
ASK: Does the child vomit everything?
➢ A child who is not able to hold on
anything down at all has the sign
“vomits everything”
ASK: Has the child had convulsion?
➢ Use the term for convulsions like
“fits”, “spasm” or “jerky movements”
which the mother understands
LOOK: See if the child is abnormally sleepy
of difficult to awaken
➢ An abnormally sleepy child is drowsy
and does not show interest in what
is happening around him/her
➢ He does not look at his mother or
watch your face when you talk
➢ He may stare blankly and does not
notice what is going on around him
➢ He does not respond when she is
touched, shaken or spoken to.
I. COUGH OR DIFFICULTY IN
BREATHING
CLINICAL ASSESSMENT
Three key clinical signs are used to assess
a sick child with cough or difficult breathing:
➢ RESPIRATORY RATE -
Distinguishes children who have
pneumonia from those who do not
➢ LOWER CHEST WALL INDRAWING
– indicates severe pneumonia;
inward movement of the bony
structure of the chest wall w/
inspiration; considered present if
consistently present in a calm child;
agitation/blocked nose/breastfeeding
can cause temporary chest
indrawing
It is more specific than "intercostal
indrawing"; soft tissue between the
 ribs w/o involvement of the bony
structure of the chest wall IF THE CHILD IS FAST BREATHING
➢ STRIDOR – harsh noise when the IS
child inhales (breathes in); have a
substantial risk of obstruction & 2 week to 2 Months 60 or more per
minute
should be referred in children who
have stridor when calm 2 to 12 months 50 or more per
➢ WHEEZING – heard when a child minute
exhales (breathes out); associated
with asthma; test with rapid acting 12 months to 5 40 or more per
years old minute
bronchodilator can be made on
presence/absence of fast breathing

COUGH OR DIFFICULTY IN BREATHING

SIGN CLASSIFY TREATMENT

- ANY GENERAL DANGER
SIGNS
- CHEST INDRAWING
- STRIDOR IN A CALM
CHILD
SEVERE PNEUMONIA OR - Give the 1st dose of an appropriate
VERY SEVERE DISEASE antibiotic.
- Treat wheezing if present.
- Treat the child to prevent low blood
sugar.
- Refer URGENTLY to the hospital.

FAST BREATHING PNEUMONIA - Give an appropriate antibiotic for 5

days.
- Treat wheezing if present.
- If coughing for more than 30 days,
refer for assessment.
- Soothe the throat and relieve the
cough with a safe remedy.
- Advise mother when to return
immediately.
- Follow up in 2 days.

NO SIGN OF PNEUMONIA NO PNEUMONIA COUGH OR - Treat wheezing if

OR VERY SEVERE COLD present.
DISEASE - Coughing > 30 days, refer to a
hospital for assessment.
- Soothe the throat & relieve the
cough with a safe remedy.
- Advise mother when to return
immediately.
 - Follow up in 2 days if wheezing.
- Follow-up in 5 days if not improving

d. Show how much fluid to give

her child in addition to the
DIARRHEA
child;s usual fluid intake
DEHYDRATION *BELOW 2 years old : 50 - 100 mL after
1. All the children with diarrhea are each loose stool evacuation
assessed for dehydration *2 years old or above : 100-200 mL after
2. If the child had diarrhea for less 14 each loose stool evacuation
days classify the child’s diarrhea as e. If the child vomits, wait for
PERSISTENT DIARRHEA, or 10 minute
diarrhea of more than 14 days and
dehydration is 2. Continue feeding the Child
3. Return to the Health Center
4. Give Zinc Supplementation

PLAN B : TREAT SOME DEHYDRATION

WITH ORS
1. Determine the amount of ORS to
present classify the child’s diarrhea give during the 1st 4 hours
as SEVERE PERSISTENT 2. Show the mother how to give
DIARRHEA ➢ ORS Solution
3. If there is blood in the child’s stool, ➢ Reassess and Classify the
classify the child as having Child for dehydration
dysentery
AGE WEIGHT AMOUNT (mL)

Below 4 < 6 kg 200 - 400

Months
PLAN A : TREATING DIARRHEA AT HOME
1. Give Extra Fluid (as much as the 4 to 12 6 to < 10 400-700
months kg
child will take )
a. Breastfeed frequently and for 12 months to 10 to <12 700-900
longer time 2 years old kg
b. If the child is exclusively
breastfeed, give ORS or 2 to 5 years 12 to < 900-1400
old 19 kg
clean water in addition
c. If the child is not exclusively * NOTE: weight x 75 – how much ORS to
breastfed, give ORS give to a child (used when you do not know
Solution, food-based fluid, his/her weight)
clean water
 PLAN C : TREAT SEVERE DEHYDRATION
QUICKLY
1. CAN YOU GIVE IV FLUID IMMEDIATELY
2. Is IV treatment available nearby (within
30 minutes)?
- If yes, Give the child IV Fluid in your health
center
3. Are you trained to use NGT for
rehydration
- Refer the child URGENTLy to a hospital
4. Can the child drink?
5 Refer urgently to a hospital for IV/ NGT
treatment
Give ORS by NGT or by mouth

PERSISTENT DIARRHEA

SIGN CLASSIFY TREATMENT

- DEHYDRATION PRESENT SEVERE PERSISTENT - Treat dehydration a referral unless

DIARRHEA the child has another severe
classification
- Refer to hospital

- NO DEHYDRATION PERSISTENT DIARRHEA - Advise the mother on feeding a child.

- Give multivitamin, mineral
supplement.
- Advise mother when to return ASAP
- Follow-up in 5 days

- BLOOD IN THE STOOL DYSENTERY - Treat for 5 days with an oral antibiotic
recommended for Shigella.
- Advise mother when to return ASAP
- Follow up in 2 days

FEVER (Malaria, Measles,

Dengue Hemorrhagic Fever)
DECIDING OF THERE IS MALARIA RISK
CATEGORY PROVINCES
A. Provinces with no significant
improvement in malaria situation in
the last ten years or the situation
worsened in the last five years, the
average cases is more than 1,00 in
the last ten years. (Agusan del sur,
Cagara, Davao, Palawan, Quezon,
Tawi-tawi. etc.)
B. Provinces where the situation has
improved in the last five years
average number of cases is
100-1,000 cases. (Abra, Bataan,
Ilocos Norte, Pangasinan, Romblon
etc.)
C. Provinces with a significant
reduction in cases in the last five
years (Albay, Batanes, Batangas,
Marinduque etc.)
 D. Provinces that are malaria-free malarious due to vectors (Aklan,
although some are potentially Bohol, Capiz, Cebu etc.

MALARIA RISK

SIGN CLASSIFY TREATMENT

- ANY GENERAL VERY SEVERE FEBRILE - Give 1st dose of quinine (under
DANGER SIGNS DISEASE/ MALARIA medical supervisor/hospital not
- STIFF NECK accessible w/n 4 hrs.
- Give 1st dose of right antibiotic
- Treat to prevent lowering of blood.
sugar level
- 1 dose of paracetamol for high fever
(38.5 or >)
- Send a blood smear
- Refer urgently to hospital

- BLOOD SMEAR (+) MALARIA - Treat w/ oral antimalarial

- 1 dose of paracetamol for high fever
- Advise the mother when to return
ASAP
- Follow up in 2 day if fever persist
- Fever present everyday for > 7
days, refer to hospital

- BLOOD SMEAR (-) FEVER: - 1 dose of paracetamol

MALARIA - Advise the mother when to return
UNLIKELY ASAP
- Follow up in 2 days
- Fever present everyday for > 7
days, refer to hospital

NO MALARIA RISK

SIGN CLASSIFY TREATMENT

- ANY GENERAL DANGER VERY SEVERE FEBRILE - Give 1st dose of right antibiotic
SIGN DISEASE - Treat to prevent lowering of blood.
STIFF NECK sugar level
- 1 dose of paracetamol for high
fever (38.5 or >)
- Send a blood smear
- Refer urgently to hospital

NO SIGN OF A VERY FEVER NO MALARIA - 1 dose of paracetamol

SEVERE FEBRILE - Advise the mother when to return
DISEASE ASAP
- Follow up in 2 days
- Fever present everyday for > 7
days, refer to hospital

ORAL ANTIMALARIAL
First Line : CHLOROQUINE & Second Line : SULFADOXINE &
PRIMAQUINE PYRIMETHAMINE
If CHLOROQUINE & PRIMAQUINE If SULFADOXINE & PYRIMETHAMINE
➢ Watch carefully the child for 30 ➢ Give a single dose in the health
mins.; if child vomits within 30 min., center
repeat dose & return to health center
for additional tablets; itching is a
possible side effect

MEASLES
➢ MMR Vaccine (Measles, Mumps, & Rubella) – prevention
➢ Pneumonia – secondary complication
➢ Give Vit. A
SIGN CLASSIFY TREATMENT

- CLOUDING OF THE SEVERE COMPLICATED - Vit. A

CORNEA MEASLES -1st dose of right antibiotic
- DEEP, EXTENSIVE MOUTH - Apply tetracycline eye ointment if
ULCERS there is clouding of cornea/pus
- ANY GENERAL DANGER draining
SIGNS

- PUS DRAINING FROM THE MEASLES W/ EYE OR - Vit. A

EYES MOUTH COMPLICATIONS - Pus draining; apply tetracycline
- MOUTH ULCERS - Mouth ulcers; teach mother how
to treat w/ Gentian Violet
- Follow up 2 days
- Advise mother when to return
ASAP

MEASLES NOW OR WITHIN MEASLES - Vit A

THE LAST 3 MOS. - Advise mother when to return
ASAP
 DENGUE HEMORRHAGIC FEVER
➢ 4S (Control of Dengue); Search & Destroy; Seek early consultation; Self-protection; Say
yes to fogging
➢ DO NOT give aspirin, only paracetamol
SIGN CLASSIFY TREATMENT

- BLEEDING OF NOSE/ SEVERE DENGUE - Skin petechiae, persistent abdominal

GUMS HEMORRHAGIC FEVER pain & vomiting, (+); give ORS
- BLOOD IN - Any other sign/bleeding is (+); give
STOOLS/VOMITS fluids rapidly
- BLACK STOOLS/VOMITS - Treat to prevent lowering of blood
- SKIN PETECHIAE Sugar level
-COLD & CLAMMY - DO NOT GIVE ASPIRIN
EXTREMITIES
- SLOW CAPILLARY
REFILL < 3 SECS.
- PERSISTENT
ABDOMINAL PAIN
- TOURNIQUET TEST (+)

NO SIGN OF SEVERE FEVER ; DENGUE - Advise when to return ASAP

DENGUE HEMORRHAGIC HEMORRHAGIC FEVER - Follow up in 2 days if fever is
FEVER UNLIKELY persistent, sign of bleeding
- DO NOT GIVE ASPIRIN

EAR PROBLEM

SIGN CLASSIFY TREATMENT

- TENDER SWELLING MASTOIDITIS - 1st dose of right antibiotic

BEHIND THE EAR - 1st dose of paracetamol for pain

- PUS DRAINING & ACUTE EAR INFECTION - Antibiotic for 5 days

DISCHARGE ≤ 14 DAYS - Paracetamol
- EAR PAIN - Dry ear by wicking
- Follow up 5 days
- Advise mother when to return ASAP

- PUS DRAINING & CHRONIC EAR INFECTION - Dry ear by wicking

DISCHARGE ≥ DAYS OR - Instill quinolone otic drops for 2 wks.
MORE - Follow up 5 days
- Advise mother when to return ASAP

NO EAR PAIN & PUS NO EAR INFECTION - No additional Tx

DRAINING FROM THE EAR - Advise Mother when to return ASAP.
 CHILD NUTRITIONAL STATUS AND ANEMIA
Assess Malnutrition:
1. Determine weight for age
2. Look for edema of both feet
3. Look for visible severe wasting
4. For children aged 6 mos. and >, determine if
MUAC is less than < 115mm

SIGN CLASSIFY TREATMENT

- AGE UP TO 6 MOS.; SEVERE MALNUTRITION - Treat child to prevent low blood

VISIBLE SEVERE sugar
WASTING, EDEMA OF - Vit. A
BOTH FEET
- AGE 6 MOS.& >; MUAC <
115mm, VISIBLE SEVERE
WASTING, EDEMA OF
BOTH FEET

VERY LOW WEIGHT FOR VERY LOW WEIGHT - Assess child's feeding & counsel the
AGE mother on feeding according to
feeding recommendations & care for
development
- Vit. A
- Advise when to return ASAP
- Follow up in 30 days

NOT VERY LOW WEIGHT
FOR AGE & NO OTHER
SIGNS OF MALNUTRITION
NOT VERY LOW WEIGHT
- Child < 2 years old, assess child's
feeding & counsel the mother on
feeding
- If feeding is a problem, follow up in 5
days
- Advise when to return ASAP

ANEMIA
Assess Anemia:
➢ Look for palmar pallor; assess if it is severe palmar pallor or some palmar pallor
SIGN CLASSIFY TREATMENT

SEVERE PALMAR PALLOR SEVERE ANEMIA - Refer child urgent to a hospital

SOME PALMAR PALLOR ANEMIA - Assess child's feeding & counsel

mother on feeding
- Give IRON
 - Give ALBENDAZOLE/
MEBENDAZOLE if the child is 1 yr
or > & has not had a dose in the
previous 6 mos.
- Advise when to return ASAP
- Follow up in 14 days

NO PALMAR PALLOR NO ANEMIA - If child is < 2 yrs old, assess child's

feeding & counsel the mother
- If feeding is a problem, follow up in
5 days
- Advise when to return ASAP
NOTE :
GIVE IRON Give 1 Dose for 14 days daily
ALBENDAZOLE - Treats hookworm and whipworm infection. These Infections contribute to
anemia because of iron loss through internal bleeding

AGE/ IRON/FOLATE IRON SYRUP Ferrous IRON DROPS

WEIGHT TABLET Sulfate 150 mg per 5 Ferrous Sulfate 25
Ferrous Sulfate ml mg(25 mg elemental
200 mg + 250 mcg (6 mg elemental iron iron per ml)
Folate (60 mg per ml)
elemental iron)

3 up to 4 mos. (4 - < 2.5 ml (½ tsp) 0.6 ml

6 kg)

4 - 12 mos. (6 - <10 4 ml (¾ tsp) 1.0 ml

kg)

12 mos. - 3 yrs. (10 ½ tablet 5 ml (1 tsp) 1.5 ml

-
<14 kg)

3 - 5 yrs.(14 - <19 1 tablet 10 ml (2 tsp) 2.0 ml

kg)

APPROPRIATE ANTIBIOTICS

FOR 1ST LINE 2ND LINE

Pneumonia Cotrimoxazole Amoxycillin

Acute Ear Infection Cotrimoxazol Amoxycillin

Very Severe Disease Cotrimoxazole Amoxycillin

 Dysentery Cifrofloxacin Nalidixic Acid

Cholera Tetracycline Cotrimoxazole

BACTERIAL INFECTION

SIGN CLASSIFY TREATMENT

ANY OF THE FF. SIGNS VERY SEVERE DISEASE - Give the young infant 1st dose
- NOT FEELING WELL of IM antibiotic
- CONVULSIONS - Treat to prevent lowering of
- FAST BREATHING (60 OR > blood sugar level
BREATHS/MIN) INDRAWING - Advice mother to keep infant
- FEVER (37.5C/FEELS HOT) warm on the way to hospital
LOW BODY TEMP ( - Refer urgently to a hospital
<35.5C/FEELS COLD)
- MOVEMENT ONLY WHEN
STIMULATED MOVEMENT AT
ALL

- RED UMBILICUS/DRAINING LOCAL BACTERIAL - Give young infant an

PUS INFECTION appropriate antibiotic
- SKIN PUSTULES - Treat local infection in the
health center & teach mother to
treat it at home
- Advice mother to give home
care
- Assess & counsel mother on
care for development
- Follow up in 2 days

NONE OF THE SIGNS OF VERY SEVERE DISEASE OR LOCAL - Advice mother to give home
SEVERE DISEASE OR LOCAL INFECTION UNLIKELY care for the young infant
BACTERIAL INFECTION - Assess & counsel mother on
care for the development

THE INFANT’S FEEDING

SIGN CLASSIFY TREATMENT

- NOT ABLE TO BREASTFEED POSSIBLE SERIOUS - 1st dose of IM antibiotics

- NO ATTACHMENT AT ALL BACTERIAL INFECTION - Treat to prevent lowering of
- NO SUCKING AT ALL blood sugar level
- Advice to keep young infant
warm on the way to hospital
 - Refer urgently to the hospital

- NOT WELL ATTACHED TO THE FEEDING PROBLEM OR - Advice mother to breastfeed

BREAST LOW BIRTH WEIGHT often, as long as the young
-NOT SUCKING EFFECTIVELY infant wants to be breastfeed;
- < 8 BREASTFEEDING IN 24 day or night
HRS. - If receiving other foods and
- RECEIVES OTHER FOOD OR drinks, counsel the mother
DRINKS about breastfeeding the infant
- LOW WEIGHT FOR AGE more
THRUSH (ULCERS/WHITE & reducing intake of other
PATCHES IN THE MOUTH) foods/drinks & about using a
cup for feeding
- Thrush; teach the mother to
treat it at home
- Advise mother how to give
home care
- Follow up any feeding
problem/thrush in 2 days
- Follow up low weight for age

NOT LOW WEIGHT FOR AGE & NO FEEDING PROBLEM - Advise mother how to give
NO EITHER SIGNS OF home care
INADEQUATE FEEDING - Praise mother for feeding the
infant well

JAUNDICE

SIGN CLASSIFY TREATMENT

- ANY JAUNDICE IF AGE IS < 24 SEVERE JAUNDICE - Treat infants to prevent

HRS. lowering of blood sugar level
- YELLOW PALMS & SOLES AT - Advise mother about how to
ANY AGE keep the young infant warm on
the way to hospital
- Refer urgently

- JAUNDICE APPEARING AFTER JAUNDICE - Advice mother to give home

24 HRS. OF AGE care for the infant
- PALMS & SOLES ARE NOT - Advice mother to return ASAP
YELLOW if palms & soles are yellow
- If the young infant is older
than 14 days, refer to a hospital
for assessment
- Assess & counsel mother on
care for development
- Follow up in 1 day
NO JAUNDICE NO JAUNDICE - Assess & counsel the mother
on care for development
- Advice mother to give home
care

DEHYDRATION

SIGN CLASSIFY TREATMENT

TWO OF THE FF. SIGNS SEVERE DEHYDRATION If infant does not have VERY
- MOVEMENT ONLY WHEN SEVERE DISEASE/ SEVERE
STIMULATED OR NO JAUNDICE nor DYSENTERY
MOVEMENT AT ALL - Give fluid for severe
- SUNKEN EYES dehydration
-SKIN PINCH GOES BACK (Plan C) or if infant has it,
VERY SLOW refer URGENTLY to hospital
w/ mother
giving frequent sips of ORS on
the way
- Advice mother to continue
breastfeeding
- Advice mother to keep infant
warm on the way

TWO OF THE FF. SIGNS SOME DEHYDRATION - Give fluid (Plan B) If an

- RESTLESS, IRRITABLE infant has very severe
- SUNKEN EYES disease, severe jaundice or
- SKIN PINCH GOES BACK dysentery, refer urgently w/
SLOWLY mother giving freq. sips of
ORS on the way to hospital
- Advice mother to continue
breastfeeding
- Assess & counsel the mother
on care for development

NOT ENOUGH SIGNS TO NO DEHYDRATION - Give fluid to

CLASSIFY AS SOME OR Treat diarrhea at home (Plan
SEVERE DEHYDRATION A)
- Assess & counsel mother on
care for development

NOTE : • Dysentery – bld. in the stool

Severe Persistent Diarrhea – lasting
for 14 days or >
CARE FOR DEVELOPMENT V. Counsel the mother about her own
I. What is care for development? health
➢ Children are different at birth SOME COMMON FEEDING
and the differences affect PROBLEMS
how they learn. ➢ Difficulty in breastfeeding
➢ Much of what children learn, ➢ Child less than 4 months
they learn when they are taking other milk/food
young. ➢ Use breastmilk substitute
➢ Children need a safe e.g., cow’s milk, evaporated
environment as they learn. milk
➢ Children need consistent ➢ Use of feeding bottles
loving attention from at least ➢ Lack of active feeding
one person ➢ Not feeding well during
➢ Mothers can help by illness
responding to their ➢ Complementary food not
words/actions/interests. enough in quantity / quality /
➢ Children learn by playing & variety
trying things out & by ➢ Child 6 months or older, but
observing & copying what not yet given Complementary
others do. foods
➢ Infant not exclusively
II. Assess the child care for breastfed
development ➢ Improper handling and use of
➢ Children are different at birth breastmilk substitute
and the differences affect
how they learn. WHEN TO RETURN FOLLOW-UP VISIT
➢ Much of what children learn,
they learn when they are
young. IF THE CHILD HAS : RETURN
➢ Children need a safe FOR
environment as they learn. FOLLOW-UP

- PNEUMONIA 2 DAYS
III. Identify problems in care for - WHEEZE
development - DYSENTERY
➢ The child is not responding - MALARIA, If fever
for development persists
➢ The child is being raised by - FEVER : MALARIA
UNLIKELY, If fever
someone other that the
persist
mother - FEVER: NO
IV. Counsel the mother care about care MALARIA, If fever
for development persist
➢ Give relevant advice - MEASLES WITH
➢ Give good communication EYER OR MOUTH
skills (ALPAC) COMPLICATIONS
 - DENGUE also return if : VOMITING; SKIN
HEMORRHAGIC PETECHIAE; SKIN
FEVER UNLIKELY, If RASH
fever persists

- PERSISTENT 5 DAYS
DIARRHEA
- ACUTE EAR
INFECTION
- CHRONIC EAR
INFECTION
- FEEDING
PROBLEMS
- ANY OTHER
ILLNESS, If not
improving

ANEMIA 14 DAYS

VERY LOW WEIGHT FOR 30 DAYS

AGE

WHEN TO RETURN IMMEDIATELY

ADVISE THE IMMEDIATELY IF THE

MOTHER TO CHILD HAS ANY OF
RETURN THESE SIGNS

ANY SICK CHILD NOT ABLE TO DRINK

OR BREASTFEED
BECOMES SICKER
DEVELOPS A FEVER

IF THE CHILD HAS FAST BREATHING

NO PNEUMONIA: DIFFICULT
COLD OR BREATHING
COUGH, also
return if :

IF THE CHILD HAS BLOOD IN THE

DIARRHEA, also STOOL
return if : DRINKING POORLY

IF THE CHILD HAS ANY SIGN OF

FEVER : DENGUE BLEEDING;
HEMORRHAGIC PERSISTENT
FEVER UNLIKELY, ABDOMINAL PAIN ;
COMMUNITY HEALTH NURSING TOPIC
#1 - FAMILY