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

Name:________________________________________ Age: Sex: Weight (kg): Height/Length (cm): Temperature:_______

ASK: What are the child’s problems? Initial visit?___________ Follow-up visit?________ Date:_________________
ASSESS (Circle all signs present) CLASSIFY
CHECK FOR GENERAL DANGER SIGN General danger sign present?
 NOT ABLE TO DRINK OR BREASTFEED • LETHARGIC OR UNCONSCIOUS Yes___ No____
 VOMITS EVERYTHING • CONVULSING NOW Remember to use Danger sign
 CONVULSIONS when selecting classifications
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 stool? ° Lethargic or unconscious? Restless and 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 malaria area? • Look or feel for stiff neck
 Has the child visited/travelled or • Look for runny nose
stayed overnight in the past 3weeks?
 If malaria risk, obtain a blood smear LOOK for signs of Measles
(+) (Pf) (Pv) (-) (Not done) • Generalized rash and
 For how long has the child had fever?___days • One of these, cough, runny nose, or red eyes
 If more than 7 days, has fever been presents every day? • Look for any other cause of fever
 Has the child had measles within the past 3 months
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If the child has measles now or within the last • Look for mouth ulcers. If yes, are they deep and extensive
3 months • Look for pus draining from the eye.
• Look for clouding of the cornea
ASSESS DENGUE HEMORRHAGIC FEVER YES______ NO_______
THEN ASK
 Has the child had any bleeding from the nose or • Look for bleeding from nose or gums
gums or in the vomitus or stool • Look for skin petechiae
 Has the child had black vomitus or stool? • 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? If Yes, for how long?____ Days • Feel for tender swelling behind the ear
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?
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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 FOR HIV INFECTION
Note mother’s and/or child’s HIV status
 Mother’s HIV test: NEGATIVE POSITIVE NOT DONE/KNOWN
 Child’s virological test: NEGATIVE POSITIVE NOT DONE
 Child’s serological test: NEGATIVE POSITIVE NOT DONE
 If mother is HIV-positive and NO positive virological test in child:
° Is the child breastfeeding now?
° Was the child breastfeeding at the time of test or 6 weeks before it?
° If breastfeeding: Is the mother and child on ARV prophylaxis?
CHECK THE CHILD’S IMMUNIZATION STATUS (Circle immunizations needed today), Vitamin A Return for next
Status, deworming status, Dental Check-up (Circle if needed today)
immunization on:
BCG PENTA1 PENTA2 PENTA3 MCV 1 MCV 2 Vitamin A
HEP B0 OPV-1 OPV-2 OPV-3 Mebendazole/Albendazole
PCV-1 PCV-2 PCV-3 Dental Check up Date
ASSESS FEEDING if the child is less than 2 years old, has MODERATE ACUTE MALNUTRITION, ANEMIA, OR IS HIV
EXPOSED OR INFECTED
 Do you breastfeed your child? Yes____ NO____
o If yes, how many times in 24 hours?____times. Do you breastfeed during the night? Yes____ No____
 Does the child take any other foods or fluids? Yes____ No____
o If yes, what food or fluids?
o How many times per day?____times. What do you use to feed the child?
o If MODORATE ACUTE MALNUTRITION: How large are servings?
o Does the child receive his own serving?____ Who feeds the child and how?
 During this illness, has the child’s feeding changed? Yes____ No____
o If Yes, How?
ASSESS OTHER PROBLEMS? ASK ABOUT MOTHERS OWN HEALTH
 TREAT
Remember to refer any child who has a danger sign and no other severe classification

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Return for follow-up in_____________________________________
Advise mother when to return immediately:_____________________
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Give any immunization needed______________________________
And feeding advice today__________________________________
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