14.

Management of a child by IMNCI protocol

CASE HISTORY: - Pinky is an 18 months old girl. She weighs 11.5 kg. Her temperature is
37.5 C. Her mother was asked, "What are the child's problems?" The mother said "She has
been coughing for 6 days, and she is having trouble breathing." This is the initial visit for this
illness. She was checked for general danger signs. The mother said that Pinky is able to drink.
She has not been vomiting. She has not had convulsions during this illness. Her mother was
asked, "Does Pinky seem unusually sleepy?" The mother said, "Yes." Hands were clapped to
see the response. The mother was asked to shake the child. Pinky opened her eyes, but did not
look around. Pinky was called for and talked to, but she did not look towards the face. She
stared blankly and appeared not to notice what was going on around her. Her mother was asked
to lift Pinky's shirt. The number of breaths the child took in a minute, was counted. The child
was counted to take 41 breaths per minute. There was no chest in drawing noticed. No stridor
was heard. Her mother was asked, "Does the child have diarrhoea?" The mother said, "Yes, for
3 days." There was no blood in the stool. Pinky's eyes looked sunken. Her mother was asked,
"Do you notice anything different about Pinky's eyes?" The mother said, "Yes." Her mother
was given some clean water in a cup and asked her to offer it to Pinky. When offered the cup,
Pinky would not drink. When pinched, the skin of Pinky's abdomen went back very slowly.
Because Pinky's temperature was 37.5 C and she felt hot, Pinky was further assessed for signs
related to fever. The mother said Pinky's fever began 2 days ago. The risk of malaria is low.
Pinky has not had measles within the last 3 months, and there are no signs suggesting measles.
She does not have stiff neck. Pinky was noticed to have a runny nose. The mother was further
asked whether the child had any ear problem to which the mother replied no. also there was no
severe wasting, bipedal oedema, palmar pallor and her weight for age was normal. The
immunization status of the child was normal and up to date.

DIAGNOSIS – The diagnosis of Pinky according to the IMNCI PROTOCOL was Pneumonia
with Severe Persistent Diarrhoea with Severe Dehydration with Fever-Malaria unlikely and
without measles.

MANAGEMENT –
1. The child was referred to the nearest hospital immediately for administration of intravenous
fluids according to Plan C for severe persistent diarrhoea with severe dehydration and the
mother was shown how to prepare ORS solution and and was told to give sips of ORS if
possible on the way to hospital.
2. Pinky’s mother was told to give 10 ml of amoxicillin syrup (125/5) thrice daily for 5 days
and honey to soothe the throat when the child accepts orally.
3. Pinky was given paracetamol syrup (125/5), 6.5 ml one dose immediately and then advised
to be given thrice daily until fever was gone.
4. Pinky’s mother was told to follow-up the child after 5 days of discharge from the hospital
5. Pinky’s mother was advised to inititate and continue breastfeeding as soon as possible as
and when the child wants, to offer food from the family pot, to wash her and Pinky’s hand with
soap and water everytime before feeding and to increase frequency or duration of
breastfeeding.
6. Her mother was told to offer small frequent soft, varied, appetizing foods to encourage the
child to eat much more, to look whether there is a blocked nose and follow up after discharge
if there are any feeding problems.
7. Her mother was also advised to increase fluid intake and give soup, rice water, yoghurt
drinks as much as possible.
8. Her mother was advised to complete the rest of the vaccines on time and give the
supplemental doses of Vitamin A and IFA as appropriate.