INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

Department of Health CENTER FOR HEALTH DEVELOPMENT Western Visayas

ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
ASSESS
ASK THE MOTHER WHAT THE CHILD¶S PROBLEM ARE ‡ Determine if this is an initial or follow-up visit for this problem
± If follow-up visit, use the followup instruction on TREAT THE CHILD chart ± If initial visit, assess the child as follows:

CLASSIFY
USE ALL BOXES THAT MATCH THE CHILD¶S SYMTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS

IDENTIFY TREATMENT

CHECK FOR GENERAL DANGER SIGNS
ASK: ‡ Is the child not able to drink or breastfeed? ‡ Does the child vomits everything? ‡ Has the child had convulsions? LOOK: ‡ See if the child is abnormally sleepy or difficult to awaken

A child with any general danger signs need URGENT attention; complete the assessment and any pre-referral treatment immediately so referral is not delayed.

IF YES:
MAKE SURE CHILD WITH ANY GENERAL DANGER SIGN IS REFERRED after first dose of an appropriate antibiotic and other urgent treatments. Exception: Rehydration of the child according to Plan C may resolve danger signs so that referral is no longer needed.

THEN ASK ABOUT MAIN SYMPTOMS:
Does the child have cough or difficult breathing?

IF YES, ASK: ‡ For how long?

LOOK, LISTEN: ‡ Count the breaths in one minute ‡ Look for chest indrawing ‡ Look and listen for stidor

CHILD MUST BE CALM

If the child is: ‡ 2 months up to 12 months ‡ 12 months up

Fast breathing is: ‡ 50 breaths per minute or more ‡ 40 breaths per minute or more

Classify COUGH or DIFFICULT BREATHING SIGNS ‡ Any general danger sign or ‡ Chest indrawing or ‡ Stridor in calm child CLASSIFY AS SEVERE PNEUMONIA OR VERY SEVERE DISEASE     TREATMENT (Urgent pre-referral treatments are in bold print) Give first dose of an appropriate antibiotic Give Vitamin A Treat the child to prevent low blood sugar Refer URGENTLY to hospital ‡ Fast breathing PNEUMONIA  Give an appropriate antibiotic for 5 days  Soothe the throat and relieve the cough with a safe remedy  Advise mother when to return immediately  Follow-up in 2 days  If coughing 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 5 days if not improving ‡ No signs of pneumonia or very severe disease NO PNEUMONIA: COUGH OR COLD .

ASK: ‡ For how long? ‡ Is there blood in the stool? LOOK AND FEEL: ‡ Look at the child¶s general condition Is the child: Abnormally sleepy or difficult to awaken? Restless and irritable? ‡ Look for sunken eyes ‡ Offer the child fluid.THEN ASK: Does the child have diarrhea? IF YES. thirsty? ‡ Pinch the skin of the abdomen Does it go back: Very slowly (longer than 2 seconds)? Slowly? . Is the Child: Not able to drink or drinking poorly? Drinking eagerly.

give antibiotic for cholera  Give fluid and food for some dehydration (Plan B)  If child also has a severe classification: ‡ Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. Advise mother to continue breastfeeding. Advise the mother to continue breastfeeding.Two of the following signs: ‡ Abnormally sleepy or difficult to awaken ‡ Sunken eyes ‡ Not able to drink or drinking poorly ‡ Skin pinch goes back very slowly Two of the following signs: ‡ Restless. thirsty ‡ Skin pinch goes back slowly SEVERE DEHYDRATION  If child has no other severe classification: ‡ Give fluid for severe dehydration (Plan C) OR If child also has another severe classification: ‡ Refer URGENTLY to hospital with mother giving frequent slips of ORS on the way.  If child is 2 years or older and there is cholera in your area. irritable ‡ Sunken eyes ‡ Drinks eagerly.  Advise mother when to return immediately  Follow-up in 5 days if not improving SOME DEHYDRATION ‡ Not enough signs to classify as some or severe dehydration NO DEHYDRATION  Give fluid and food to treat diarrhea at home (Plan A)  Advise mother when to return immediately  Follow-up in 5 days if not improving .

Classify DIARRHEA and if diarrhea 14 days or more  Treat dehydration before referral unless the child has another severe classification  Give Vitamin A  Refer to hospital  Advise the mother on feeding a child who has PERSISTENT DIARRHEA  Give Vitamin A  Follow-up in 5 days Dehydration present SEVERE PERSISTENT DIARRHEA No dehydration PERSISTENT DIARRHEA .

Classify DIARRHEA and if blood in stool Blood in the stool DYSENTERY  Treat for 5 days with an oral antibiotic recommended for Shigella in your area  Follow-up in 2 days .

THEN ASK: Does the child have fever? Decide Malaria Risk Ask: ‡ Does the child live in a malaria area? ‡ Has the child visited a malaria area in past 4 weeks? If Yes to either. obtain a blood smear THEN ASK: ‡ For how long has the child had fever? ‡ If more than 7 days. runny nose. has fever been present every day? ‡ Has the child had measles within the last 3 months? LOOK AND FEEL: ‡ Look or feel for stiff neck ‡ Look for runny nose Look for signs of MEASLES: ‡ Generalized rash and ‡ One of these: cough. or red eyes .

ACUTE EAR INFECTION. VERY SEVERE DISEASE.0 ml 1/2 5 ml 1 10 ml 1 10 ml . Give an Appropriate Oral Antibiotic  FOR PNEUMONIA. MASTOIDITIS FIRST-LINE ANTIBIOTIC: SECOND-LINE ANTIBIOTIC: COTRIMOXAZOLE AMOXYCILLIN COTRIMOXAZOLE (trimethoprim + sulphamethoxazole) ‡ Give two times daily for 5 days AGE or WEIGHT ADULT TABLET 80 mg trimethoprim + 400 mg sulphamethoxazole SYRUP 40 mg trimethoprim + 200 mg sulphamethoxazole per 5 ml AMOXYCILLIN  Give three times daily for 5 days TABLET 250 mg SYRUP 125 mg per 5 ml 2 months up to 12 months (4 -<10 kg) 12 months up to 5 years (10-19 kg) 1/2 5.

5°C or above)  Refer URGENTLY to hospital  Give one dose of paracetamol in health center for high fever (38. refer for assessment ‡ No sign of very severe febrile disease FEVER: NO MALARIA .5°C or above)  Advise mother when to return immediately  Follow-up in 2 days if fever persists  If fever is present every day for more than 7 days.Classify FEVER: No Malaria Risk ‡ Any general danger sign or ‡ Stiff neck VERY SEVERE FEBRILE DISEASE  Give first dose of and appropriate antibiotic  Treat the child to prevent low blood sugar  Give one dose of paracetamol in health center for high fever (38.

5°C or above)  Advise mother when to return immediately  Follow-up in 2 days if fever persists  If fever is present every day for more than 7 days.5°C or above)  Advise mother when to return immediately  Follow-up in 2 days if fever persists  If fever is present every day for more than 7 days.) or Runny nose. and NO other causes of fever MALARIA ‡ ‡ ‡ ‡ Blood smear ( . refer for assessment  Give one dose of paracetamol in health center for high fever (38. or Other causes of fever FEVER: MALARIA UNLIKELY . and NO measles. or Measles. refer for assessment ‡ Blood smear (+) If blood smear not done: ‡ NO runny nose.5°C or above)  Send a blood smear with the patient  Refer URGENTLY to hospital  Treat the child with an oral antimalarial  Give one dose of paracetamol in health center for high fever (38.Classify FEVER: Malaria Risk (including travel to malaria area) ‡ Any general danger sign or ‡ Stiff neck VERY SEVERE FEBRILE DISEASE/ MALARIA  Give first dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours)  Give first dose of an appropriate antibiotic  Treat the child to prevent low blood sugar  Give one dose of paracetamol in health center for high fever (38.

ASK: ‡ Is there ear pain? ‡ Is there ear discharge? If yes.THEN ASK: Does the child have an ear problem? IF YES. for how long? LOOK AND FEEL: ‡ Look for pus draining from the ear ‡ Feel for tender swelling behind the ear .

For Measles: If the child has measles now or within the last three months ‡ Look for mouth ulcers Are they deep and extensive? ‡ Look for pus draining from the eye ‡ Look for clouding of the cornea .

apply tetracycline eye ointment  Refer URGENTLY to hospital  Give Vitamin A  If pus draining from the eye.If MEASLES now or within last 3 months. Classify  Give Vitamin A  Give first dose of an appropriate antibiotic  If clouding of the cornea or pus draining from the eye. teach the mother to treat with gentian violet  Follow-up in 2 days  Give Vitamin A ‡ Clouding of cornea or ‡ Deep or extensive mouth ulcers SEVERE COMPLICATED MEASLES ‡ Pus draining from the eye or ‡ Mouth ulcers MEASLES WITH EYE OR MOUTH COMPLICATIONS ‡ Measles now or within the last 3 months MEASLES . apply tetracycline eye ointment  If mouth ulcers.

For Dengue: Decide Dengue Risk: Yes or No If Dengue risk: THEN ASK: ‡ Has the child had any bleeding from the nose or gums or in the vomitus or stools? ‡ Has the child had black vomitus? ‡ Has the child had black stools? ‡ Has the child had persistent abdominal pain? ‡ Has the child persistent/been vomiting? LOOK AND FEEL: ‡ Look for bleeding from nose or gums ‡ Look for skin petechiae ‡ Feel for cold and clammy extremities ‡ Check for slow capillary refill If none of above ASK or LOOK and FEEL signs are present and the child is 6 months or older and fever present for more than three days do« ‡ Perform the tourniquet test .

give fluids rapidly as in Plan C  Treat the child to prevent low blood sugar  Refer all children URGENTLY to hospital  DO NOT GIVE ASPIRIN SEVERE DENGUE HEMORRHAGIC FEVER FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY  Advise mother when to return immediately  Follow-up in 2 days if fever persists or child shows signs of bleeding  DO NOT GIVE ASPIRIN . Classify Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or Skin petechiae or Cold and clammy extensions or Capillary refill more than 3 seconds or ‡ Abdominal pain or ‡ Vomiting or ‡ Tourniquet test positive ‡ No signs of severe dengue hemorrhagic fever ‡ ‡ ‡ ‡ ‡ ‡  If skin petechiae or abdominal pain or vomiting or positive tourniquet test are the only positive signs give ORS (Plan B)  If any other signs of bleeding are positive.If DENGUE Risk.

or ‡ Ear pain ‡ Pus is seen draining from the ear and discharge is reported for 14 days or more ‡ No ear pain and ‡ No pus seen draining from the ear ACUTE EAR INFECTION CHRONIC EAR INFECTION  Dry the ear by wicking  Follow-up in 5 days  No additional treatment NO EAR INFECTION .Classify EAR PROBLEM ‡ Tender swelling behind the ear MASTOIDITIS  Give first dose of an appropriate antibiotic  Give first dose of paracetamol for pain  Refer URGENTLY to hospital     Give an antibiotic for 5 days Give paracetamol for pain Dry ear by wicking Follow-up in 5 days ‡ Pus is seen draining from the ear and discharge is reported for less than 14 days.

THEN CHECK FOR MALNUTRITION & ANEMIA LOOK AND FEEL: ‡ Look for visible severe wasting ‡ Look for edema of both feet ‡ Look for palmar pallor. Is it: Severe palmar pallor? Some palmar pallor? ‡ Determine weight for age .

follow-up in 5 days  Advise mother when to return immediately ‡ Not very low weight for age and no other signs of malnutrition NO ANEMIA AND NOT VERY LOW WEIGHT . assess the child¶s feeding and counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart ‡ If feeding is a problem. follow-up in 5 days  If some pallor: ‡ Give iron ‡ Give Mebendazole/Albendazole if child is 2 years or older and has not had a dose in the previous 6 months ‡ Follow-up in 14 days  If very low weight for age: ‡ Give Vitamin A ‡ Follow-up in 30 days  Advise mother when to return immediately  If the child is less than 2 years old.Classify NUTRITIONAL STATUS ‡ Visible severe washing or ‡ Edema of both feet or ‡ Severe palmar pallor SEVERE MALNUTRITION OR SEVERE ANEMIA ANEMIA OR VERY LOW WEIGHT  Give Vitamin A  Refer URGENTLY to hospital ‡ Some palmar pallor or ‡ Very low weight for age  Assess the child¶s feeding and counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart ‡ If feeding problem.

Subsequent doses every 6 months.THEN CHECK THE CHILD¶S IMMUNIZATION STATUS: IMMUNIZATION SCHEDULE: AGE Birth 6 weeks 10 weeks 14 weeks 9 months VACCINE BCG DPT-1 DPT-2 DPT-3 Measles OPV-1 OPV-2 OPV-3 Hep B-1 Hep B-2 Hep B-3 THEN CHECK THE VITAMIN A STATUS VITAMIN A SUPPLEMENTATION SCHEDULE: The first dose at 6 months or above. .

Explain carefully how to give the drug. If more than one drug will be given. collect. Demonstrate how to measure a dose. then label and package the drug. ‡ Explain that all the oral drug tablets or syrups must be used to finish the course of treatment. count and package each drug separately. Tell the mother the reason for giving the drug to the child. even if the child gets better. Ask the mother to give the first dose to her child. .TREAT THE CHILD CARRY OUT THE TREATMENT STEPS IDENTIFIED ON THE ASSESS AND CLASSIFY CHART TEACH THE MOTHER TO GIVE ORAL DRUGS AT HOME ‡ ‡ ‡ ‡ ‡ ‡ ‡ Determine the appropriate drugs and dosage for the child¶s age or weight. Watch the mother practice measuring a dose by herself. ‡ Check the mother¶s understanding before she leaves the health center.

5 ml (1/2 tsp) 5 ml (1 tsp) . FOR DYSENTERY: Give antibiotic recommended for Shigella in your area for 5 days. 4 months up to 12 months (6 -<10 kg) 12 months up to 5 years (10-19 kg) SYRUP 250 mg/5 ml 1.25 ml (1/4 tsp) 2. FIRST-LINE ANTIBIOTIC FOR SHIGELLA: SECOND-LINE ANTIBIOTIC FOR SHIGELLA: COTRIMOXAZOLE NALIDIXIC ACID COTRIMOXAZOLE (trmethoprim + suphamethoxazole)  Give two times daily for 5 days NALIDIXIC ACID  Give four times daily for 5 days AGE or WEIGHT 2 months up to 4 months (4 -<6 kg) See doses from the previous slide.

4 months up to 12 months (6 -<10 kg) 1/4 12 months up tp 5 years (10-19 kg) 1/2 . FIRST-LINE ANTIBIOTIC FOR CHOLERA: SECOND-LINE ANTIBIOTIC FOR CHOLERA: TETRACYCLINE COTRIMOXAZOLE COTRIMOXAZOLE (trimethoprim + suphamethoxazole)  Give two times daily for 3 days TETRACYCLINE  Give four times daily for 3 days AGE or WEIGHT CAPSULE 250 mg 2 months up to 4 months (4 -< 6 kg) See doses from the previous slide. FOR CHOLERA: Give antibiotic recommended for cholera in your area for 3 days.

CHLOROQUINE and PRIMAQUINE SULFADOXINE and PYRIMETHAMINE ‡  IF SULFADOXINE + PYRIMETHAMINE: Give single dose in health center. she should repeat the dose and return to the health center for additional tablets. If the child vomits within 30 minutes. Explain that itching is a possible side effect of the drug. falciparum TABLET (15 mg base) PRIMAQUINE  Give daily for 14 days for P. Give an Oral Antimalarial FIRST-LINE ANTIMALARIAL: SECOND-LINE ANTIMALARIAL:  IF CHLOROQUINE: ‡ Explain to the mother that she should watch her child carefully for 30 minutes after giving a dose of chloroquine. but is not dangerous. vivax SULFADOXINE + PYRIMETHAMINE  Give single dose in health center TABLET (500 mg sulfadoxine) 25 mg pyrimethamine TABLET (150 mg base) AGE 2 months up to 5 months 5 months up to 12 months 12 months up to 3 years 3 years up to 5 years DAY 1 DAY 2 DAY 3 TABLET (15 mg base) 1/2 1/2 1 1½ 1/2 1/2 1 1½ 1/2 1/2 1/2 1 1/2 3/4 1/4 1/2 1/4 1/2 3/4 1 . CHLOROQUINE  Give for 3 days PRIMAQUINE  Give single dose in health center for P.

AND past six months AGE 6 months up to 12 months 12 months up to 5 years VITAMIN A CAPSULE 200.000 IU 1/2 capsule 1 capsule . Give Paracetamol for High Fever (38.Child is six months of age or older.5ºC or more) or Ear Pain  Give paracetamol every 6 hours until high fever or ear pain gone PARACETAMOL AGE or WEIGHT 2 months up to 3 years (4 -<14 kg) 3 years up to 5 years (14-19 kg) TABLET (500 mg) 1/4 1/2 SYRUP (120 mg/5 ml) 5 ml (1 tsp) 10 ml (2 tsp)  Give Vitamin A TREATMENT  Give one dose in the health center SUPPLEMENTATION  Give one dose in health center if: .

 Give Iron 
Give one dose daily for 14 days.

IRON/FOLATE TABLET AGE or WEIGHT
Ferrous sulfate 200 mg + 250 mcg Folate (60 mg elemental iron)

IRON SYRUP
Ferrous sulfate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml (1/2 tsp) 4 ml (3/4 tsp)

2 months up to 4 months (4-<6 kg) 4 months up to 12 months (6-<10 kg) 12 months up to 3 years (10-< 14 kg) 3 years up to 5 years (14-19kg) 1/2 tablet 1/2 tablet

5 ml (1 tsp) 7.5 ml (1½ tsp) 

Give Mebendazole / Albendazole 
Give 500 mg Mebendazole/ 400 mg Albendazole as a single dose in health center if: ‡ hookworm/whipworm are a problem in children in your area, and ‡ the child is 2 years of age or order, and ‡ the child has not had a dose in the previous 6 months

TEACH THE MOTHER TO TREAT LOCAL INFECTIONS AT HOME

‡ Explain to the mother what the treatment is and why it should be given. ‡ Describe the treatment steps listed in the appropriate box. ‡ Watch the mother as she does the first treatment in the health center (except remedy for cough or sore throat). ‡ Tell her how often to do the treatment at home. ‡ If needed for treatment at home, give mother the tube of tetracycline ointment or small bottle of gentian violet. ‡ Check the mother¶s understanding before she leaves the health center.

 Treat Eye Infection with Tetracycline Eye Ointment 
Clean both eyes 3 times daily. ‡ Wash hands. ‡ Ask child to close the eye. ‡ Use clean cloth and water to gently wipe away pus.  Then apply tetracycline eye ointment in both eyes 3 times daily. ‡ Ask the child to look up. ‡ Squirt a small amount of ointment on the inside of the lower lid. ‡ Wash hands again.  Treat until redness is gone.  Do not use other eye ointments or drops, or put anything else in the eye.

 Dry the Ear by Wicking 
Dry the ear at least 3 times daily. ‡ Roll clean absorbent cloth or soft, strong tissue paper into a wick. ‡ Place the wick in the child¶s ear. ‡ Remove the wick when wet. ‡ Replace the wick with a clean one and repeat these steps until the ear is dry. 

Treat Mouth Ulcers with Gentian Violet 
Treat the mouth ulcers twice daily. ‡ Wash hands. ‡ Wash the child¶s mouth with clean soft cloth wrapped around the finger and wet with salt water. ‡ Paint the mouth with half-strength gentian violet. ‡ Wash hands again.

Relieve the Cough with a Safe Remedy  Safe remedies to recommend: ‡ Breastmilk for exclusively breastfed infant. ‡ Tamarind.  Harmful remedies to discourage: ‡ Codeine cough syrup ‡ Other cough syrups ‡ Oral and nasal decongestants . Calamansi and Ginger. Soothe the Throat.

‡ Give the drug as an intramuscular injection. ‡ If children cannot be referred. follow the instructions provided on the next slides. Measure the dose accurately. ‡ Use a sterile needle and sterile syringe.GIVE THESE TREATMENTS IN HEALTH CENTER ONLY ‡ Explain to the mother why the drug is given. . ‡ Determine the dose appropriate for the child¶s weight (or age).

5 ml = 270 mg 2.0 ml = 360 mg 2.0 ml = 180 mg 1.6 ml at 180 mg/ml 1. CHLORAMPHENICOL AGE or WEIGHT Dose: 40 mg per kg Add 5.5 ml = 630 mg 2 months up to 4 months (4-<6 kg) 4 months up to 9 months (6-< 8kg) 9 months up to 12 months (8-<10 kg) 12 months up to 3 years (10-< 14 kg) 3 years up to 5 years (14-<19 kg) .0 ml sterile water to vial containing 1. Then change to an appropriate oral antibiotic to complete 10 days of treatment.000 mg = 5. Give An Intramuscular Antibiotic FOR CHILDREN BEING REFERRED URGENTLY WHO CANNOT TAKE AN ORAL ANTIBIOTIC:    Give first dose of intramuscular chloramphenicol and refer child urgently to hospital. IF REFERRAL IS NOT POSSIBLE: Repeat the chloramphenicol injection every 12 hours for 5 days.5 ml = 450 mg 3.

IF REFERRAL IS NOT POSSIBLE:  Give first dose if intramuscular QUINNE.4 ml 0. Do not continue QUINNE injections for more than 1 week. and then every 12 hours until the child is able to take an oral antimalarial.3 ml 0.6 ml .  DO NOT GIVE QUINNE TO A CHILD LESS THAN 4 MONTHS OF AGE. Give Quinine for Severe Malaria FOR CHILDREN BEING REFERRED WITH VERY SEVERE FEBRILE DISEASE/MALARIA:  Give first dose of intramuscular QUINNE and refer child urgently to hospital.  The child should remain lying down for one hour.  Repeat the QUINNE injection at 4 and 8 hours later. INTRAMUSCULAR QUINNE AGE OR WEIGHT 300 mg/ml* (in ml ampoules) 4 months up to 12 months (6-<10 kg) 12 months up 2 years (10-<10 kg) 2 months up to 3 years (12-<14 kg) 3 years up to 5 years (14-<19 kg) * quinine salt 0.5 ml 0.

Give 30-50 ml of milk or sugar water before departure. Treat the Child to prevent Low Blood Sugar  If the child is able to breastfeed: Ask the mother to breastfeed the child. if neither of these is available.  If the child is not able to breastfeed but is able to swallow Give expressed breastmilk or a breastmilk substitute. give sugar water. . To make sugar water: Dissolve 4 level teaspoons of sugar (20 grams) in a 200-ml cup of clean water.  If the child is not able to swallow: Give 50 ml of milk or sugar water by nasogastric tube.

When to Return 1. ‡ If the child is not exclusively breastfeed. food-based fluids (such as soup. ‡ If the child is exclusively breastfeed. Continue Feeding. or clean water. GIVE THE MOTHER 2 PACKETS OF ORS TO USE AT HOME. . ‡ The child cannot return to a health center if the diarrhea gets worse. rice water. TEACH THE MOTHER HOW TO MIX AND GIVE ORS. Give EXTRA FLUID (as much as the child will take) TELL THE MOTHER: ‡ Breastfeed frequently and for longer at each feed. or ³buko juice´). give one or more of the following: ORS solution. give ORS or clean water in addition to breastmilk. It is especially important to give ORS at home when: ‡ The child has been treated with Plan B or Plan C during the visit. Plan A: Treat No Dehydration at Home Counsel the mother on the 3 Rules of Home Treatment: Give Extra Fluid.

CONTINUE FEEDING See COUNSEL THE MOTHER chart 3. WHEN TO RETURN . 50 to 100 ml after each loose stool 100 to 200 ml after each loose stool 2. Plan A: Treat Some Dehydration with ORS SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUID INTAKE: Up to 2 years 2 years or more Tell the mother to: ‡ Give frequent small sips from a cup. Then continue. ‡ Continue giving extra fluid until the diarrhea stops. wait 10 minutes. ‡ If the child vomits. but more slowly.

 SHOW THE MOTHER HOW TO GIVE ORS SOLUTION. give more. ‡ If the child wants more ORS than shown. wait 10 minutes. ‡ Continue breastfeeding whenever the child wants. also give 100-200 ml clean water during this period. . ‡ If the child vomits. Then continue. Plan B: Treat Some Dehydration with ORS Give in health center recommended amount of ORS over 4-hour period  DETERMINE AMOUNT OR ORS TO GIVE DURING FIRST 4 HOURS AGE WEIGHT In ml Up to 4 months < 6 kg 200 ± 400 4 months up to 12 months 6 -< 10 kg 400 ± 700 12 months up to 2 years 10 -< 12 kg 700 ± 900 2 years up to 5 years 12 -19 kg 900 ± 1400 * Use the child¶s age only when you do not know the weight. but more slowly. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child¶s weight (in kg) times 75. ‡ Give frequent small sips from a cup. ‡ For infants under 6 months who are not breastfeed.

‡ Explain the 3 rules of home Treatment. ‡ Give her enough ORS packets to complete rehydration.  IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT: ‡ Show her how to prepare ORS solution at home. GIVE EXTRA FLUID 2. Also give her 2 packets as recommended in Plan A. ‡ Begin feeding the child in health center. Plan B: Treat Some Dehydration with ORS  AFTER 4 HOURS: ‡ Reassess the child and classify the child for dehydration. 1. WHEN TO RETURN See Plan A for recommended fluids and See COUNSEL THE MOTHER chart . CONTINUE FEEDING 3. ‡ Show her how much ORS to give to finish 4-hour treatment at home. ‡ Select the appropriate plan to continue treatment.

GIVE VITAMIN A SUPPLEMENTATION AS NEEDED IMMUNIZE EVERY SICK CHILD AS NEEDED .

assess.GIVE FOLLOW-UP CARE ‡ Care for the child who returns for follow-up using all the boxes that match the child¶s previous classifications ‡ If the child has any new problem. classify and treat the new problem as on the ASSESS AND CLASSIFY chart. .

complete the 5 days of antibiotic. Then refer URGENTLY to hospital. give a dose of second-line antibiotic or intramuscular chloramphenicol.)  If breathing slower.  If breathing rate. Ask: ‡ Is the child breathing slower? ‡ Is there less fever? ‡ Is the child eating better? Treatment:  If chest indrawing or a general danger sign. See ASSESS & CLASSIFY chart. change to the second-line antibiotic and advise the mother to return in 2 days or refer. refer. or eating better. less fever. (If this child had measles within the last 3 months. . and eating are the same. fever. PNEUMONIA After 2 days: Check the child for general danger signs. Assess the child for cough or difficult breathing.

. Give any treatment needed.  If the diarrhea has stopped (child having less than 3 loose stools per day). do a full reassessment of the child. tell the mother to follow the usual recommendations for the child¶s age. PERSISTENT DIARRHEA After 5 days: Ask: ‡ Has the diarrhea stopped? ‡ How many loose stools is the child having per day? Treatment:  If the diarrhea has not stopped (child is still having 3 or more loose stools per day). Then refer to hospital.

less fever. less blood in the stools. if number of stools. or ‡ Had measles within the last 3 months  If fewer stools. Give it for 5 days. continue giving the same antibiotic until finished. abdominal pain. fever. amount of blood in stools. or eating is the same or worse: Change to second-line oral antibiotic recommended for Shigella in your area. Exceptions ± if the child: ‡ Is less than 12 months old. Ask: ‡ Are there fewer stools? ‡ Is there less blood in the stool? ‡ Is there less fever? Treatment:  If the child is dehydrated. Advise the mother to return in 2 days. DYSENTERY After 2 days: Assess the child for cough or difficult breathing. > See ASSESS & CLASSIFY chart. less abdominal pain. and eating better. treat dehydration. or ‡ Was dehydrated on the first visit. Refer to hospital ‡ Is there less abdominal pain? ‡ Is the child eating better? .

provide treatment. > See ASSESS & CLASSIFY chart. refer for assessment.  If malaria is the only apparent cause of fever: ‡ Take a blood smear. ‡ Give second-line oral antimalarial without waiting for result of blood smear.  If the child has any cause of fever other than malaria. . refer with blood smear for reassessment. or returns within 14 days: Do a full assessment of the child. Treatment:  If the child has any general danger signs or stiff neck. MALARIA If fever persists after 2 days. ‡ Advise mother to return in 2 days if fever persists. ‡ If fever persists after 2 days treatment with second line oral antimalarial. ‡ If fever has been present for 7 days. treat as VERY SEVERE FEBRILE DISEASE/MALARIA.

‡ Treat with the first-line oral antimalarial. . > See ASSES & CLASSIFY chart. Treatment:  If the child has any general danger signs or stiff neck. treat as VERY SEVERE FEBRILE DISEASE/MALARIA. Assess for other causes of fever. ‡ If fever has been prevent for 7 days.  If malaria is the only apparent cause of fever: ‡ Take a blood smear. refer for assessment. Advise the mother to return again in 2 days if the fever persists. FEVER-MALARIA UNLIKELY If fever persists after 2 days: Do a full reassessment of the child.

take blood smear. if possible. > See ASSESS & CLASSIFY chart. treat as VERY SEVERE FEBRILE DISEASE. Make sure that there has been no travel to malarious area. ‡ If no apparent cause of fever. Treatment:  If there has been travel to a malarious area and the blood smear is positive or there is no blood smear ± classify according to fever with Malaria Risk and treat accordingly. . provide treatment. advice the mother to return again in 2 days if fever persists. If there has been travel. FEVER (NO MALARIA) If fever persists after 2 days: Do a full assessment of the child. ‡ If fever has been present for 7 days. ‡ If the child has any apparent cause of fever. refer for assessment.  If there has been no travel to malarious area or blood smear is negative: ‡ If child has any general danger signs of stiff neck.

refer to hospital. Look at mouth ulcers. If treatment has not been correct. If treatment has been correct. MEASLES WITH EYE OR MOUTH COMPLICATION After 2 days: Look for red eyes and pus draining from the eyes.  If no pus or redness. Treatment for Mouth Ulcers:  If mouth ulcers are worse. Smell the mouth Treatment for eyes Infection:  If pus is draining from the eye. ask the mother to describe how she has treated the eye infection. continue the treatment. or there is a very foul smell from the mouth.  If mouth ulcers are the same or better.  If the pus is gone but redness remains. continue using half-strength gentian violet for a total of 5 days. . teach mother correct treatment. stop the treatment. refer to hospital.

Treatment:  If the child has any signs of bleeding.  Advise mother to make sure child is given more fluids and is eating. . or signs of shocks.  If fever has been present for 7 days. Do a tourniquet test. refer for assessment. or abdominal pain or vomiting treat as SEVERE HEMORRHAGIC FEVER. advise the mother to return daily until the child had no fever for at least 48 hours. Assess for other causes of fever. FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY If fever persists after 2 days: Do a full reassessment of the child. > See ASSESS & CLASSIFY chart. including skin petechiae or a positive tourniquet test.  If the child has any other apparent cause of fever.  If no apparent cause of fever. provide treatment.

Encourage her to continue.  Acute ear infection: If ear pain discharge persists. EAR INFECTION After 5 days: Reassess for ear problem. 5ºC or above).  If no ear pain or discharge. praise the mother for her careful treatment. > See ASSESS & CLASSIFY chart Measure the child¶s temperature. tell her to use all of its before stopping . . treat with 5 more days of the same antibiotic. treat as MASTOIDITIS. If she has not yet finished th e 5 days of antibiotic. Follow-up in 5 days  Chronic ear infection: Check that the mother is wicking the ear correctly. Treatment:  If there is tender swelling behind the ear or high fever (38. Continue wicking to dry the ear.

ask her to bring the child back again. FEEDING PROBLEM After 5 days: Reassess feeding.  Counsel the mother about any new or continuing feeding problems.  ANEMIA After 5 days:  Given iron.  If the child is very low weight for age. ask the mother to return 30 days after the initial visit to measure the child¶s weight gain. Advise mother to return in 14 days for more iron.  Continue giving iron every day for 2 months with follow-up every 14 days. Ask about any feeding problems found on the initial visit.  If the child has any palmar pallor after 2 months. . If you counsel the mother to make significant changes in feeding. > See questions at the top of the COUNSEL chart. refer for assessment.

or if the child has lost weight refer the child. Continue to see the child monthly until the child is feeding well and gaining weight regularly or is no longer very low weight for age. Exception: If you do not think that feeding will improve. Treatment  If the child is no longer very low weight for age. > See question at the top of the COUNSEL chart. Reassess feeding.  If the child is still very low weight for age. . VERY LOW WEIGHT After 30 days: Weight the child and determine if the child is still very low weight for age. praise the mother and encourage her to continue. counsel the mother about any feeding problem found.

(See COUNSEL CHART. ADVISE THE MOTHER WHEN TO RETURN IMMEDIATELY. ADVISE THE MOTHER OF THE NEXT FOLLOW-UP VISIT ‡ ALSO.) .IF ANY MORE FOLLOW-UP VISITS ARE NEEDED BASED ON THE INITIAL VISIT OR THIS VISIT.

how? . Compare the mother¶s answer to the Feeding Recommendations for the child¶s age in the box below. ASK:  Do you breastfeed your child? ‡ How many times during the day? ‡ Do you also breastfeed during the night?  Does the child take any other food or fluids? ‡ What food or fluids? ‡ How many times per day? ‡ What do you use to feed the child? ‡ If very low weight for age: How large are servings? Does the child receive his own serving? Who feeds the child and how?  During this illness has the child µs feeding charged? If yes.COUNSEL THE MOTHER FOOD Assess the Child¶s Feeding Ask questions about the child¶s usual feeding and feeding during this illness.

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including at night. longer breastfeeds. ‡ Make sure other milk is correctly and hygienically prepared and given in adequate amounts. give only when necessary. discard. show the mother correct positioning and attachment for breastfeeding. If other milk needs to be continued. . and gradually reducing other milk or foods. ‡ Suggest giving more frequent. ‡ Prepare only an amount of milk which the child can consume within an hour. (See YOUNG INFANT chart). assess breastfeeding. Counsel the Mother About Feeding Problems  If the mother reports difficulty with breastfeeding. ‡ Make sure other milk is a locally appropriate breastmilk substitute. day and night.  If the child is less than 4 months old and is taking other milk or foods: ‡ Build mother¶s confidence that she can produce all the breastmilk that the child needs. counsel the mother to: ‡ Breastfeed as much as possible. If there is some left-over milk. As needed.

varied. counsel the mother to: ‡ Sit with the child and encourage eating. and offer frequent small feedings. . ‡ Clear a blocked nose if it interferes with feeding. ‡ Give the child and adequate serving in a separate plate or bowl.  If the child is not feeding well during the illness. favorite foods to encourage the child to eat as much as possible. ‡ Observe what the child likes and consider these in the preparation of his/her food.  Follow-up any feeding problem in 5 days. ‡ Expect that appetite will improve as child gets better. ‡ Use soft. ‡ Show the mother how to feed the child with a cup. appetizing.  If the child is not being fed actively. If the mother is using a bottle to feed the child: ‡ Recommended substituting a cup for bottle. counsel the mother to: ‡ Breastfeed more frequently and for longer if possible.

rice water. For example. give soup. buko juice or clean water. .  Increase fluid.FLUID  Advise the Mother to Increase Fluid During Illness FOR ANY SICK CHILD:  Breastfeed more frequently and for longer at each feed. FOR CHILD WITH DIARRHEA:  Giving extra fluid can be lifesaving. Give fluid according to Plan A or Plan B on TREAT THE CHILD chart.

if fever persists MEASLES WITH EYE OR MOUTH COMPLICATIONS DENGUE HEMORRHAGIC FEVER UNLIKELY. if not improving ANEMIA VERY LOW WEIGHT FOR AGE Return for Follow-up in: 2 days 5 days 5 days 30 days NEXT WELL-CHILD VISIT Advise mother when to return for next immunization according to immunization schedule. If the child has: PNEUMONIA DYSENTERY MALARIA. if fever persists FEVER (NO MALARIA). if fever persist PERSISTENT DIARRHEA ACUTE EAR INFECTION CHRONIC EAR INFECTION FEEDING PROBLEM ANY OTHER ILLNESS. . if fever persists FEVER-MALARIA UNLIKELY.WHEN TO RETURN  Advise the Mother When to Return to Health Worker FOLLOW-UP VISIT Advise the mother to come for follow-up at the earliest time listed for the child¶s problems.

‡ Abdominal pain ‡ Vomiting Also return if: .WHEN TO RETURN IMMEDIATELY Advise mother to return immediately if the child has any of these signs: ‡ Not able to drink or breastfeed ‡ Becomes sicker ‡ Develops a fever ‡ Fast breathing ‡ Difficult breathing ‡ Blood in stool ‡ Drinking poorly Any sick child If child has NO PNEUMONIA: COUGH OR COLD. also return if: If child has diarrhea. also return if: ‡ Any sign of bleeding If child has FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY.

If she has a breast problem (such as engorgement. sore nipples. breast infection). Check the mother¶s immunization status and give her Tetanus Toxoid if needed. provide care for her or refer her for help. Advise her to eat well to keep up her own strength and health. or refer her for help. provide care for her. Make sure she has access to:  Family Planning  Counseling on STD and AIDS prevention . Counsel the Mother About Her Own Health  If the mother is sick.

use the followup instruction in the follow-up section. ± If initial visit. CLASSIFY AND TREAT THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS ASSESS ASK THE MOTHER WHAT THE YOUNG INFANT¶S PROBLEM ARE ‡ Determine if this is an initial or follow-up visit for this problem ± If follow-up visit. assess the young infant as follows: CLASSIFY USE ALL BOXES THAT MATCH THE INFANT¶S SYMTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS IDENTIFY TREATMENT .ASSESS.

Are there many or severe pustules? ‡ See if the young infant is abnormally sleepy or difficult to awaken? ‡ Look at the young infant¶s movements Are they less than normal? . LISTEN. Is it red or draining pus? Measure temperature (or feel for fever or low body temperature) ‡ Look for skin pustules. FEEL: ‡ Has the infant ‡ Count the breaths in one minute had convulsions? Repeat the count if elevated ‡ Look for severe chest indrawing ‡ Look for nasal flaring ‡ ‡ ‡ ‡ ‡ YOUNG INFANT MUST BE CALM Look and listen for grunting Look and feel for bulging fontanelle Look for pus draining from the ear Look at the umbilicus.CHECK FOR POSSIBLE BACTERIAL INFECTION ASK: LOOK.

5°C or feels cold) or ‡ Many or severe skin pustules or ‡ Abnormally sleepy or difficult to awaken or ‡ Less than normal movement ‡ Red umbilicus or draining pus or ‡ Skin pustules  Give first dose of intramuscular antibiotics  Treat to prevent low blood sugar  Advise mother how to keep the infant warm on the way to the hospital  Refer URGENTLY to hospital POSSIBLE SERIOUS BACTERIAL INFECTION LOCAL BACTERIAL INFECTION  Give an appropriate oral antibiotic  Treat local infection in the health center and teach the mother to treat local infections at home  Advise mother to give home care for the young infant  Follow-up in 2 days .Classify ALL YOUNG INFANTS ‡ Convulsions or ‡ Fast breathing (60 breaths per minute or more) or ‡ Severe chest indrawing or ‡ Nasal flaring or ‡ Grunting or ‡ Bulging fontanelle or ‡ Pus draining from ear or ‡ Umbilical redness extending to the skin or ‡ Fever (37.

Does it go back: ± Very slowly (longer than 2 seconds)? ± Slowly? . ASK: ‡ For how long? LOOK AND FEEL: ‡ Look at the young infant¶s general condition.THEN ASK: Does the young infant have diarrhea? IF YES. Is the child: ± Abnormally sleepy or difficult to awaken? ± Restless and irritable? ‡ Look for sunken eyes ‡ Pinch the skin of the abdomen.

 Give fluid and food to treat diarrhea at home (Plan A) ‡ Not enough signs to classify as some or severe dehydration NO DEHYDRATION .Classify DIARRHEA for DEHYDRATION Two of the following signs: ‡ Abnormally sleepy or difficult to awaken ‡ Sunken eyes ‡ Skin pinch goes back very slowly SEVERE DEHYDRATION  If infant does not have POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY: ‡ Give fluid for severe dehydration (Plan C) OR  If infant also has POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY: ‡ Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way ‡ Advise mother to continue breastfeeding ‡ Advise mother how to keep the infant warm on the way to the hospital Two of the following signs: ‡ Restless. Advise mother to continue breastfeeding. irritable ‡ Sunken eyes ‡ Skin pinch goes back slowly SOME DEHYDRATION  Give fluid and food for some dehydration (Plan B)  If child also has POSSIBLE SERIOUS BACTERIAL INFECTION OR DYSENTERY: ‡ Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way.

Classify DIARRHEA and if diarrhea 14 days or more ‡ Diarrhea lasting 14 days or more SEVERE PERSISTENT DIARRHEA  If the young infant has dehydration. treat dehydration before referral unless the infant has also POSSIBLE SERIOUS BACTERIAL INFECTION  Refer to hospital Classify DIARRHEA and if blood in stool ‡ Blood in the stool DYSENTERY  Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding .

Is taking any other foods or drinks. Is breastfeeding less than 8 times in 24 hours. or Is low weight for age. how often? ‡ What do you use to feed the infant? IF AN INFANT: LOOK: ‡ Determine weight for age Has any difficulty feeding.THEN CHECK FOR FEEDING PROBLEMS OR LOW WEIGHT: IF YES. AND Has no indications to refer urgently to hospital: . ASK: ‡ Is there any difficulty feeding? ‡ Is the infant breastfed? If yes. how many times in 24 hours? ‡ Does the infant usually receive any other foods or drinks? If yes.

‡ Look for ulcers or white patches in the mouth (thrush) . ask the mother if she can wait and tell you when the infant is willing to feed again) ‡ Is the infant able to attach? no attachment at all not well attached good attachment TO CHECK ATTACHMENT. Observe the breastfeed for 4 minutes. ask the mother to put her infant to the breast. (If the infant was fed during the last hour. LOOK FOR: ‡ Chin touching breast ‡ Mouth wide open ‡ Lower lip turned outward ‡ More areola visible above than below the mouth (All of the signs should be present if the attachment is good) ‡ Is the infant suckling effectively (that is. sometimes pausing)? not suckling at all not suckling effectively suckling effectively Clear a blocked nose if it interferes with breastfeeding. slow deep sucks.ASSESS BREASTFEEDING: ‡ Has the infant breastfed in the previous hour? If the infant has not fed in the previous hour.

reducing other foods or drinks.Classify FEEDING ‡ Not able to feed or ‡ No attachment at all or ‡ Not suckling at all NOT ABLE TO FEED ____ POSSIBLE SERIOUS BACTERIAL INFECTION  Give first dose of intramuscular antibiotics  Treat to prevent low blood sugar  Advise the mother how to keep the young infant warm on the way to the hospital  Refer URGENTLY to hospital  Advise the mother to breastfeed as often and for as long as the infant wants. teach correct positioning and attachment ‡ If breastfeeding less than 8 times in 24 hours. ‡ If not breastfeeding at all: > Refer for breastfeeding counseling and possible relactation > Advise about correctly preparing breastmilk substitutes and using a cup ‡ Not well attached to breast or ‡ Not suckling effectively or ‡ Less than 8 breastfeeds in 24 hours or ‡ Receives other foods or drinks or ‡ Low weight for age or ‡ Thrush (ulcers or white patches in mouth) FEEDING PROBLEM OR LOW WEIGHT Continuation in the next slide. advise to increase frequency of feeding  If receiving other foods or drinks. and using a cup. . day and night ‡ If not well attached or not suckling effectively. counsel mother about breastfeeding more.

Classify FEEDING FEEDING PROBLEM OR LOW WEIGHT ‡ Not low weight for age and no other signs of inadequate feeding     If thrush. teach the mother to treat thrush at home Advise mother to give home care for the young infant Follow-up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days NO FEEDING PROBLEM  Advise mother to give home care for the young infant  Praise the mother for feeding the infant well .

THEN CHECK THE YOUNG INFANT¶S IMMUNIZATION STATUS: IMMUNIZATION SCHEDULE: AGE Birth 6 weeks VACCINE BCG DPT-1 OPV-1 Hep B-1 ASSESS OTHER PROBLEMS .

TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER .

 Give an Appropriate Oral Antibiotic For local bacterial infection: First-line antibiotic: Second-line antibiotic: COTRIMOXAZOLE AMOXICILLIN AMOXYCILLIN  Give three times daily for 5 days COTRIMOXAZOLE (trimethoprim + sulphamethoxazole)  Give two times daily for 5 days AGE or WEIGHT Adult Tablet single strength (80 mg trimethoprim + 400 mg sulphamethoxazole Syrup (40 mg trimethoprim +200 mg sulphamethoxazole Tablet 250 mg Syrup 125 mg in 5 ml Birth up to 1 month (< 3 kg) 1 month up to 2 months (3-4 kg) 1/4 1.25 ml* 2. .5 ml 1/4 1.5 ml *Avoid cotrimoxazole in infants less than 1 month of age who are premature or jaundiced.25 ml 2.

1 ml 0.2 ml 0. . Give First Dose Intramuscular Antibiotics  Give first dose of both benzylpenicillin and gentamicin intramuscular GENTAMICIN Dose: 5 mg per kg BENZYLPENICILLIN Dose: 50.0 ml* 2.0 ml at 400.0 ml *Avoid using undiluted 40 mg/ml gentamicin.6 ml sterile water = 2.8 ml 1.5 ml* 2.000 units per kg To a vial of 600 mg(1. Give benzylpenicillin every 6 hours plus gentamicin one dose daily.5 ml at OR water = 4.5 ml* 0.1 ml sterile Add 3.000 units): Add 2. If referral is not possible.2 ml 0.4 ml 0. give benzylpenicillin and gentamicin for a least 5 days.000.0 ml* 1.5 ml* 1.4 ml 0.  Referral is the best option for a young infant classified with POSSIBLE SERIOUS BACTERIAL INFECTION.000 units/ml 250.5 ml 0.6 ml 0.6 ml 0.000 units/ml WEIGHT Undiluted 2 ml vial containing 20 mg = 2 ml at 10 mg/ml Add 6 ml sterile water to 2 ml vial containing 80 mg* = 8 ml at 10 mg/ml OR 1 kg 2 kg 3 kg 4kg 5 kg 0.

± Watch her as she does the first treatment in the health center. as Needed.‡ To treat Diarrhea. See TREAT THE CHILD chart. ‡ Teach the Mother to Treat Local Infections at Home ± Explain how the treatment is given. ± Tell her to do the treatment twice daily. To Treat Skin Pustules The mother should: ± Wash hands ± Gently wash off pus and crusts with soap and water ± Dry the area ± Paint with gentian violet ± Wash hands To Treat Umbilical Infection The mother should: ± Wash hands ± Clean with 70% ethyl alcohol ± Paint with gentian violet ± Wash hands To Treat Oral Thrush (ulcers or white patches in mouth) The mother should: ± Wash hands ± Wash mouth with clean soft wrapped around the finger and wet with salt water ± Paint the mouth with half strength gentian violet ± Wash hands . ‡ Immunize Every Sick Young Infant. She should return to the health center if the infection worsens.

try again. .‡ Teach Correct Positioning and Attachment for Breastfeeding  Show the mother how to hold her infant ‡ with the infant¶s head and body straight ‡ facing her breast. not just neck and shoulders  Show her how to help the infant to attach. She should: ‡ touch her infant¶s lips with her nipple ‡ wait until her infant¶s mouth is opening wide ‡ move her infant quickly onto her breast. with infant¶s nose opposite her nipple ‡ with infant¶s body close to her body ‡ supporting infant¶s whole body. aiming the infant¶s lower lip well below the nipple  Look for signs of good attachment and effective suckling. If the attachment or suckling is not good.

WHEN TO RETURN Follow-up Visit If the infant has: LOCAL BACTERIAL INFECTION ANY FEEDING PROBLEM THRUSH LOW WEIGHT FOR AGE When to Return Immediately: Return for follow-up in: 2 days 14 days Advise the mother to return immediately if the young infant has any of these signs: ‡ ‡ ‡ ‡ ‡ ‡ Breastfeeding or drinking poorly Becomes sicker Develops a fever Fast breathing Difficult breathing Blood in stool  MAKE SURE THE YOUNG INFANT STAYS WARM AT ALL TIMES ‡ In cool weather.‡ Advise Mother to Give Home Care for the Young Infant  FOOD  FLUID Breastfeed frequently. during sickness and health. . cover the infant¶s head and feet and dress the infant with extra clothing. day or night. as often and for as long as the infant wants.

GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT .

or if the young infant has lost weight. LOCAL BACTERIAL INFECTION After 2 days: Look at the umbilicus. ask her to bring the young infant back again.  Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding. Ask about any feeding problems found on the initial visit. tell the mother to continue giving the 5 days of antibiotic and continue treating the local infection at home. Exception: If you do not think that feeding will improve.  FEEDING PROBLEM After 2 days: Reassess feeding. Are there many or severe pustules? Treatment:  If the pus or redness remains or is worse. Is red or draining pus? Does redness extend to the skin? Look at the skin pustules. . refer to hospital. ask the mother to return 14 days after the initial visit to measure the young infant¶s weight gain.  If the young infant is low weight for age. refer to hospital. > See ³Then Check for Feeding Problem or Low Weight´ above.  If pus and redness are improved.

and if the infant is feeding well.  ORAL THRUSH After 2 days: Look for ulcers or white patches in the mouth (thrush). Reassess feeding. > See ³Then Check for Feeding Problem or Low Weight´ above. refer to hospital. Reassess feeding. continue half-strength gentian violet for a total of 5 days.  If the infant is no longer low weight for age. or if the infant has problems with attachment or suckling. Ask the mother to return again in 14 days (or when she returns for immunization. praise the mother and encourage her to continue. counsel the mother about the feeding problem. Continue to see the young infant every few weeks until the infant is feeding well and gaining weight regularly or is no longer low weight for age.  If the infant is still low weight for age and still has a feeding problem. if this is within 2 weeks). Exception: If you do not think that feeding will improve.  If thrush is worse. Ask her to come again within a month or when she returns for immunization. praise the mother. but is feeding well. . or if the young infant has lost weight.  If the infant is still low weight for age.  If thrush is the same or better. > See ³Then Check for Feeding Problem or Low Weight´ above. refer to hospital. LOW WEIGHT After 14 days: Weight the young infant and determine if the infant is still low weight for age.

WEIGHT FOR AGE CHART .