MANAGEMENT OF THE SICK CHILD AGED 2 MONTHS UP TO 5 YEARS

Child’s Name: __________________________________ Age: __________ Sex: _______ Weight (kg): __________ Height/Length (cm): _________________ Temperature (˚C): ______________
ASK: What are the child’s problems? ______________________________________ Initial visit: _____________________ Follow-up visit: ______________ Date: __________________________
ASSESS: (Encircle all signs present)
CLASSIFY
`CHECK FOR GENERAL DANGER SIGNS General danger sign
• NOT ABLE TO DRINK OR BREASTFEED • LETHARGIC OR UNCONSCIUS Present?
• VOMITS EVERYTHING • CONVULSING NOW YES____NO____
• CONVULSIONS
_____________________
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES_________NO________
 For how long? _____days  Count the breaths in one minute: ______ breaths per minute.
Fast breathing?
 Look for chest indrawing.
 Look and listen for stridor.
 Look and listen for wheezing.
DOES THE CHILD HAVE DIARRHEA? YES________NO_________
 For how long? _____days  Look at the child’s general condition. Is the child:
 Is there blood in the stools? Abnormally sleepy or difficult to awaken?
Restless or irritable?
 Look for sunken eyes.
 Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
 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°C or above) YES__________NO_________
Decide malaria risk LOOK and FEEL:
 Does the child live in a malaria area?  Look or feel for stiff neck.
 Has the child visited/travelled or stayed overnight in a  Look for runny nose.
malaria area in the past 3 weeks?
If malaria risk, obtain a blood smear
(+) (Pf) (Pv) (-) (not done)
Look for signs of MEASLES
 For how long has the child have fever? ____days  Generalized rash and
 If more than 7 days, has fever been present every day?  One of these: cough, runny nose or red eyes
 Has the child had measles within the past 3 months?
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 eyes.
 Look for clouding of the cornea.

ASSESS DENGUE HEMORRHAGIC FEVER YES________NO_________

THEN ASK: LOOK AND FEEL:
 Has the child had any bleeding from the nose or gums or in the vomitus  Look for bleeding from the nose or gums.
or stools?  Look for skin petechiae.
 Has the child had black vomitus or black stools?  Feel for cold and clammy extremities.
 Has the child had persistent abdominal pain?  Check capillary refill. _____ seconds
Has the child had persistent vomiting?  Perform tourniquet test if child is 6 months or older AND has no
other signs AND has fever for more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM? YES ________NO___________
 Is there ear pain?  Look for pus draining from the ear.
 Is there ear discharge?  Feel for tender swelling behind the ear.
If yes, for how long? ___days
THEN CHECK FOR ACUTE MALNUTRITION  Look for edema of both feet
AND ANEMIA  Determine WFH/L z-score:
*Less than -3? Between -3 and -2? -2 or more?
 Child 6 months or older measure MUAC _____mm
 Look for palmar pallor.
* Severe palmar pallor? Some palmar pallor?
If child has MUAC less than 115 mm or WFH/L • Is there any medical complication: General danger sign?
Less than -3 z-scores: Any severe classification? Pneumonia with chest indrawing?
• Child 6 months or older: Offer RUTF to eat. Is the child:
* Not able to finish? Able to finish?
• Child less than 6 months: Is there a breastfeeding problem?
CHECK THE CHILD’S IMMUNIZATION STATUS (Encircle immunizations needed today), Vitamin A
status, deworming status, Dental Check-up (Circle if needed today) Return for next
BCG Pentavalent 1 Pentavalent 2 Pentavalent 3 MMR MMR Vitamin A immunization on:
Hep B0 OPV-1 OPV-2 OPV -3 IPV - 2 Mebendazole/Albendazole __________________
RTV-1 RTV-2 IPV - 1 Dental check-up (Date)
PCV-1 PCV-2 PCV-3

ASSESS FEEDING if child is less than 2 years old, has MODERATE ACUTE MALNUTRITION, ANEMIA or is HIV exposed or infected FEEDING PROBLEMS
 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 MODERATE ACUTE MALNUTRITION, 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? __________________________________________________________________________________________
 aa

ASSESS OTHER PROBLEMS ASK ABOUT MOTHER’S OWN HEALTH