Dr. Dhruvendra Pandey
INTRODUCTION
 Almost 19,000 children under 5 yrs of age, died
everyday across the world. 50% of it occurs in just five
co...
 WHO and UNICEF recognized the need to strengthen child-
health activities in the country and decided to launch IMCI.
 T...
 Inclusion of 0-7 days age group (as against 1 week to 5 years
in IMCI) to address the neonatal mortality challenge.
 Th...
Difference B/w IMCI and IMNCI
Features Generic IMCI India IMNCI
Coverage of 0 – 6 days No Yes
Basic health worker
module
N...
Malnutrition*
54%
MAJOR CAUSES OF
NEONATAL AND
CHILDHOOD MORBIDITY
43%
27%
17%
13%
Malnutrition
Fever
ARI
Diarrhoea
What is IMNCI ?
• IMNCI is an integrated approach to child health that focuses
on the well-being of the whole child. IMNCI...
• In health facilities, the IMCI strategy promotes
the accurate identification of childhood
illnesses in outpatient settin...
IMNCI Plus
(National health programs of India, J Kishore 11th edition)
New born and child health
C
A
R
e
at
B
I
R
T
h
I
M
...
Why is IMNCI better than single
condition approaches?
• Children brought for medical treatment are often found
suffering f...
Objectives
1) Reducing infant mortality.
2) Reducing the incidence and seriousness of
illnesses and health problems.
3) Im...
Components of integrated
approach
IMNCI includes both preventive and curative interventions. The
strategy has the followin...
Work distribution
Case Management Process
 In IMNCI, only a limited number of carefully-selected clinical
signs are considered, based on th...
 A sick young infant up to 2 months of age is
assessed for
Possible bacterial infections, diarrhoea ,
jaundice
 Children...
ELEMENTS:-
Assess
Danger signs, nutrition and immunization status
Other problems
Classify
as per Color Coding
Identify
Spe...
ASK:-
•Does the child have diarrhea?
• IF YES THEN , FOR HOW LONG?
LOOK AND FEEL:-
•Look at the general conditions. Is he/...
it is a sign commonly used by health care workers to assess the
degree of fluid loss or dehydration.
I. Locate the area on...
TURGOR SIGN
When released, the skin pinch goes back either
• very slowly (longer than 2 seconds),
• slowly (skin stays up ...
SIGNS OF DIARRHOEA
Classification:
Signs Classify treatment
Two of the
following
signs:
Lethargic or
unconscious
Sunken eyes
Skin goes
back v...
Two of the
following
signs:
• Restless,
irritable
• Sunken eyes
• Skin pinch
goes
back slowly.
SOME
DEHYDRATIO
N
If infant...
•Not enough signs to
classify as some or
severe dehydration
NO
DEHYDRATION
Give fluids to treat diarrhea at
home
Advise ...
•Diarrhea lasting 14 days or
more
SEVERE
PERSISTENT
DIARRHOEA
 Give first dose of intramuscular
ampilicin and gentamicin ...
•Blood in the stools SEVERE
DYSENTERY
Give first dose of intramuscular
ampilicin and gentamicin if infant
has low weight ...
COUNSEL THE MOTHER ON THE 4 RULES OF HOME TREATMENT
1 GIVE EXTRA FLUID( AS MUCH AS THE CHILD WILL TAKE )
Breastfeed freque...
Tell the mother to:
* Wash the hands with soap & clean water first.
* In a clean container, first empty the entire packet ...
 Give in clinic recommended amount of ORS over 4-hr
period (which is 200-400 ml for a child whose age is <
4 months or wh...
Start iv fluid immediately. If child can drink
give ORS by mouth while the drip is set
up.
Give 100ml/kg ringer lactate so...
Diarrhoea
If persists If stopped
Assess and manage as per intial visit Reinforce exclusive breastfeeding
After two days
(I...
Assessment Of Feeding Problem
And Malnutrition
Ask the mother:-
Is there any difficulty in feeding?
Is the infant breastfed?
If yes - how many times in 24
hours?
Does...
Look , Feel:-
Determine weight for age
-Mid Upper Arm
Circumference(MUAC)
MUAC TAPE
(IMNCI Module 2 WHO, UNICEF, MOHFW)
Assess Breast Feeding :-
•Has the infant breastfed in previous hour?
•Is the infant able to attach?
To check attachment , ...
 If the infant has not feed in the previous hour, ask the
mother to put her infant to the breast. Observe her
breastfeed ...
 Clear a blocked nose if it interferes with
breastfeeding
 Look for ulcers or white patches in the
mouth(thrush)
If yes,...
SIGNS
CLASSIFY
AS
TREATMENT
•Not able to feed or
•No attachment or
•Not suckling at all
or
•Very low wt for age
Not able t...
Not well attached to
breast or
• Not suckling effectively
or
• Less than 8
breastfeeds
in 24 hours or
• Receives other foo...
If breast or nipple problem, teach the
mother to treat breast or nipple
problems.
If low weight for age, teach the
mother ...
FOLLOW –UP CARE
(IMNCI Module 2 WHO, UNICEF, MOHFW)
Feeding Problem
Reassess feeding
Ask about any feeding problems found
on the initial visit.
Counsel the mother, ask her...
Teach correct positioning and
attachment for breastfeeding.
 Show the mother how to hold
her infant
 With the infant he...
Show her how to help
the infant to attach.
Infant’s chin should touch
her breast
Mouth should be wide open.
Upper areo...
Look for signs of effective
suckling.
The baby takes slow and deep sucks (the
pauses are to allow more milk to flow into
...
SUMMARY:-
CHECK FOR POSSIBLE
BACTERIAL
INFECTIONS/JAUNDICE
ASK:-
•Has the infant had convulsions ?
LOOK ,LISTEN ,FEEL:-
•Count the breaths in one minute .repeat the count
•Look for ...
SIGNS CLASSIFY
AS
IDENTIFY TREATMENT
•Convulsions or
•Fast breathing(60 breaths per
minute or more)
•Severe chest indrawin...
Look for chest indrawing when child breaths IN.
The child has indrawing if the lower chest goes in when the child breathes...
•Umbilicus red or
draining pus
•Pus discharge from ear
or
•< 10 skin pustules
LOCAL
BACTERIA
L
INFECTION
Give oral co-
tr...
SIGNS CLASSIFYAS IDENTIFY
TREATMENT
•Palms &soles yellow
•Age <24hrs or
•Age >=14 days
SEVERE JAUNDICE Treat to prevent lo...
•Temperature
between 35.5-36.5
degree Celsius
LOW BODY
TEMPERATURE
Warm the young infant by
skin contact for 1 hr
Treat ...
Teach the mother to give oral drugs at
home
Tell the mother the reason for giving the
drug to infant.
Demonstrate how to...
Local bacterial infections
Umbilicus red or draining pus
>10 or big boil
<10 and no big boil
Remains or worse
refer to hos...
Follow up
Jaundice
Are the palms and soles yellow
If yes or age 14 days or more If no or age<14 days
Refer to hospital Adv...
CHECK FOR POSSIBLE
HYPOTHERMIA
If a baby has a temperature of less than 36.5°C the
baby has ‘hypothermia’.
1) Mild hypothermia (36.0°C to 36.4°C)
2) Mod...
Large surface area of babies compared to their weight.
• Limited heat generation mechanism.
• Vulnerability to getting exp...
Axillary (standard method)
• Rectal
• Skin
• Human touch-
• abdomen, feet and hands are warm- Normal
• abdomen is warm but...
Warm Chain- It is a sequence of ten steps-
1) Warm delivery room
2) Warm Resuscitation
3) Immediate drying
4) Skin to skin...
Kangaroo mother care for low birth
weight babies, was introduced in
COLUMBIA in 1979, by Dr’s Hector
Martinez and Edzar Re...
• Skin-to-skin contact between mother and baby
is called Kangaroo Mother Care.
• It is the most practical, preferred metho...
PROCEDURE-
•Provide privacy to the mother. If mother is not
available then it may be provided by father or
any other adult...
•Reassess after 1 hour.
 Look for signs of possible serious bacterial
infection.
 Measure axillary temperature (or feel ...
1) Mild hypothermia (36.0°C to
36.4°C)
 Skin-to-Skin contact is the best way to
keep a baby warm and the best way to ‘re-...
3) Severe hypothermia (<32°C)
Remove cold or wet clothing. Dress in warm clothes and a cap,
and cover with a warm blanket....
Counsel The Mother FOR HOME
CARE
Advice mother to give home care for the
young infant:
 Food and fluids
 Breastfeed freq...
Follow-Up Visit
If the infant has Return for follow up in
•Local bacterial infection
•Jaundice
•Diarrhea
•Any feeding prob...
When To Return Immediately
 If the young infant has any of this signs:
 Breastfeeding or drinking poorly
 Becomes sicke...
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months
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Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months

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Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months, Difference between IMCI and IMNCI, Objective, Elements, Management of Diarrhea, Bacterial Infections, Jaundice, Hypothermia, Feeding problem, counseling of mothers, followup

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Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months

  1. 1. Dr. Dhruvendra Pandey
  2. 2. INTRODUCTION  Almost 19,000 children under 5 yrs of age, died everyday across the world. 50% of it occurs in just five countries i.e. India, Nigeria, Congo, Pakistan and China.  In India, there are nearly 16.55 lakhs child deaths during 2011 and we rank top among the countries with highest child mortality.  India IMR - 42/1000 live births. (46 – Rural, 28 - Urban)  M.P. IMR - 56/1000 live births (60 – Rural, 37 Urban) (SRS 2013) 2/3rd children of M.P. are malnourished.
  3. 3.  WHO and UNICEF recognized the need to strengthen child- health activities in the country and decided to launch IMCI.  The generic IMCI guidelines were adapted and the Indian version was named Integrated Management of Neonatal and Childhood Illness (IMNCI).  IMNCI strategy is one of the main interventions under RCH- II/NRHM, that focuses on preventive, promotive and curative aspects of program.  Every year more than 10 million children die in developing countries before they reach their fifth birthday.  Perinatal conditions, acute respiratory infections (ARI), diarrhea, measles and malnutrition are the commonest causes of morbidity in young children. (Textbook of PSM, Park’s 22nd edition)
  4. 4.  Inclusion of 0-7 days age group (as against 1 week to 5 years in IMCI) to address the neonatal mortality challenge.  The order of training was reversed, starting from the young infant (0-2 months) to the older child (2 months-5 years).  The total duration of training was reduced from 11 days to 8 days out of which, half of the training time was earmarked for the management of the young infants, 0 to 2 months.  Incorporating National guideline on Malaria, Anemia, Vit. A supplementation and Immunization schedule.  Home-based care of newborns and young infants was included. nd The major highlights of Indian adaptations were as follows:
  5. 5. Difference B/w IMCI and IMNCI Features Generic IMCI India IMNCI Coverage of 0 – 6 days No Yes Basic health worker module No Yes Home visit module by provider for care of newborn and young infants No Yes Home visit training No Yes Duration of training on newborn and young infants 2 to 11 days 4 to 8 days Sequence of training, behavior change communication Child first than young infants Newborn/ young infants than child
  6. 6. Malnutrition* 54% MAJOR CAUSES OF NEONATAL AND CHILDHOOD MORBIDITY 43% 27% 17% 13% Malnutrition Fever ARI Diarrhoea
  7. 7. What is IMNCI ? • IMNCI is an integrated approach to child health that focuses on the well-being of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. • IMNCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. •The strategy includes three main components: Improving case management skills of health-care staff Improving overall health systems Improving family and community health practices.
  8. 8. • In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counseling of caretakers, and speeds up the referral of severely ill children. • In the home setting, it promotes appropriate care seeking behaviors, improved nutrition and preventative care, and the correct implementation of prescribed care. • (Textbook of PSM, Park’s 22nd edition)
  9. 9. IMNCI Plus (National health programs of India, J Kishore 11th edition) New born and child health C A R e at B I R T h I M m U N I Z A T ion Home and community level Preventive, Promotive care Management of mild illness Facility care Out patient care Inpatient care IMNCI Health system strenthening BCC & community participation
  10. 10. Why is IMNCI better than single condition approaches? • Children brought for medical treatment are often found suffering from more than one morbid condition, making a single diagnosis impossible. These children require a combined therapy for successful treatment. Thus, the need of the hour is an integrated strategy that combines the treatment of major childhood illnesses. •Cost effective •Emphasizes on -Prevention of disease -Promotion of Child health and development -Provision of Standard Case management (Textbook of PSM, Park’s 22nd edition)
  11. 11. Objectives 1) Reducing infant mortality. 2) Reducing the incidence and seriousness of illnesses and health problems. 3) Improving growth and development during the first five years of a child's life (Textbook of PSM, Park’s 22nd edition)
  12. 12. Components of integrated approach IMNCI includes both preventive and curative interventions. The strategy has the following three components: 1.Health-worker component: Improvements in the case- management skills of health staff through the provision of locally adapted guidelines 2.Health-service component: Improvements in the overall health system required for effective management of neonatal and childhood illness 3.Community component: Improvements in family and community health care practices. (National health programs of India, J Kishore 11th edition)
  13. 13. Work distribution
  14. 14. Case Management Process  In IMNCI, only a limited number of carefully-selected clinical signs are considered, based on their sensitivity and specificity, to detect the disease. A combination of these signs helps in arriving at the child's classification, rather than a diagnosis.  Classification(s) also indicates the severity of the condition. The classifications are color coded: A. PINK CLASSIFICATION: suggests hospital referral or admission (Child needs urgent referral) B. YELLOW CLASSIFICATION: indicates initiation of treatment (Child needs specific medical treatment and advise) C. GREEN CLASSIFICATION: calls for home treatment (Child needs no medicine, advise home care) (National health programs of India, J Kishore 11th edition)
  15. 15.  A sick young infant up to 2 months of age is assessed for Possible bacterial infections, diarrhoea , jaundice  Children of age 2 months to 5 years: Cough or difficult breathing, diarrhoea, fever &ear problems  Active participation of caretakers in the treatment  Use of limited number of essential drugs (National health programs of India, J Kishore 11th edition)
  16. 16. ELEMENTS:- Assess Danger signs, nutrition and immunization status Other problems Classify as per Color Coding Identify Specific Treatment Provide Treatment Pre referral Medical treatment Home Management Counsel Feeding problems Mother’s health Follow-up care( Textbook of PSM, Park’s 22nd edition)
  17. 17. ASK:- •Does the child have diarrhea? • IF YES THEN , FOR HOW LONG? LOOK AND FEEL:- •Look at the general conditions. Is he/she -lethargic or unconscious? -restless and irritable? •Look for sunken eyes •Pinch the skin of abdomen , and notice how it goes back: -very slowly( longer than two seconds)? -slowly? -immediately? (IMNCI Module 2 WHO, UNICEF,
  18. 18. it is a sign commonly used by health care workers to assess the degree of fluid loss or dehydration. I. Locate the area on the child's abdomen halfway between the umbilicus and the side of the abdomen; then pinch the skin using the your thumb and finger. II. Place your hand in such a way that when the skin is pinched, the fold of skin will be in a line up and down the child's body and not across the child's body. III. It is important to firmly pick up all of the layers of skin and the tissue under them for fifteen to thirty seconds and then release it. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  19. 19. TURGOR SIGN When released, the skin pinch goes back either • very slowly (longer than 2 seconds), • slowly (skin stays up even for a brief instant), • immediately.
  20. 20. SIGNS OF DIARRHOEA
  21. 21. Classification: Signs Classify treatment Two of the following signs: Lethargic or unconscious Sunken eyes Skin goes back very slowly SEVERE DEHYDRATION If infant has low weight or another severe classification: Give first dose of intramuscular ampicillin and gentamicin - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise mother to continue breast feeding - Advise mother to keep the young infant warm on the way to the hospital OR If infant does not have low weight or any other severe classification: - Give fluid for severe dehydration (Plan C) and then refer to hospital after rehydration (IMNCI Module 2 WHO, UNICEF, MOHFW
  22. 22. Two of the following signs: • Restless, irritable • Sunken eyes • Skin pinch goes back slowly. SOME DEHYDRATIO N If infant has low weight or another severe classification: - Give first dose of intramuscular ampicillin and gentamicin - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise mother to continue breast feeding -Advise mother to keep the young infant warm on theway to the hospital If infant does not have low weight or another severe classification: - Give fluids for some dehydration (Plan B) - Advise mother when to return immediately(IMNCI Module 2 WHO, UNICEF, MOHFW)
  23. 23. •Not enough signs to classify as some or severe dehydration NO DEHYDRATION Give fluids to treat diarrhea at home Advise mother when to return immediately Follow up in 5 days if not improving <PLAN A> (IMNCI Module 2 WHO, UNICEF, MOHFW)
  24. 24. •Diarrhea lasting 14 days or more SEVERE PERSISTENT DIARRHOEA  Give first dose of intramuscular ampilicin and gentamicin if infant has low weight if the young infant has low weight, dehydration or another severe classification. Refer to hospital Advise to keep the baby warm Treat to prevent low blood sugar (IMNCI Module 2 WHO, UNICEF, MOHFW)
  25. 25. •Blood in the stools SEVERE DYSENTERY Give first dose of intramuscular ampilicin and gentamicin if infant has low weight if the young infant has low weight, dehydration or another severe classification. Refer to hospital Advise to keep the baby warm Treat to prevent low blood sugar (IMNCI Module 2 WHO, UNICEF, MOHFW)
  26. 26. COUNSEL THE MOTHER ON THE 4 RULES OF HOME TREATMENT 1 GIVE EXTRA FLUID( AS MUCH AS THE CHILD WILL TAKE ) Breastfeed frequently and for longer at each feed. Give ORS and clean water in addition to breast milk 2. GIVE ZINC SUPPLEMENTS (Not for infant below 2 months) 3. CONTINUE BREAST FEEDING 4. TELL HER WHEN TO RETURN (IMNCI Module 2 WHO, UNICEF, MOHFW)
  27. 27. Tell the mother to: * Wash the hands with soap & clean water first. * In a clean container, first empty the entire packet of mixture and go on adding water while stirring with a clean spoon to not allow lumps to be formed * If the child vomits, wait 10 minutes. Then continue, but more slowly. * Up to 2 years 50 to 100 ml after each loose stool * Give from a clean bowl/ cup with a clean spoon from the angle of the mouth to < 2 yrs age child. * Make fresh daily & use within 24 hrs. Taste of tears (not more salty than that). (IMNCI Module 2 WHO, UNICEF, MOHFW)
  28. 28.  Give in clinic recommended amount of ORS over 4-hr period (which is 200-400 ml for a child whose age is < 4 months or whose weight is <6 kgs.)  If the child wants more, give more.  After 4 hrs, reassess the child and classify for dehydration & select the appropriate plan to continue treatment.  Begin feeding the child at the clinic. If mother has to leave before 4 hrs, show her how to prepare ORS, tell & ask how much to give in 4 hrs, explain the above mentioned 4 rules of home treatment. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  29. 29. Start iv fluid immediately. If child can drink give ORS by mouth while the drip is set up. Give 100ml/kg ringer lactate solution(if not available then N.saline) in dose divided as: 30ml/kg in first hour And rest 70ml/kg in 5 hour .. Reassess the child in every 15-30 mins . (IMNCI Module 2 WHO, UNICEF, MOHFW)
  30. 30. Diarrhoea If persists If stopped Assess and manage as per intial visit Reinforce exclusive breastfeeding After two days (IMNCI Module 2 WHO, UNICEF, MOHFW)
  31. 31. Assessment Of Feeding Problem And Malnutrition
  32. 32. Ask the mother:- Is there any difficulty in feeding? Is the infant breastfed? If yes - how many times in 24 hours? Does the infant usually receive any other food or drinks? If yes - how often? What do you use to feed the(IMNCI Module 2 WHO, UNICEF, MOHFW)
  33. 33. Look , Feel:- Determine weight for age -Mid Upper Arm Circumference(MUAC) MUAC TAPE (IMNCI Module 2 WHO, UNICEF, MOHFW)
  34. 34. Assess Breast Feeding :- •Has the infant breastfed in previous hour? •Is the infant able to attach? To check attachment , look for: Chin touching breast Mouth wide open Lower lip turned outward More areola visible above than below . (IMNCI Module 2 WHO, UNICEF, MOHFW)
  35. 35.  If the infant has not feed in the previous hour, ask the mother to put her infant to the breast. Observe her breastfeed for 4 minutes.  If the infant was fed during the last hour, 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  Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)? not suckling at all not suckling effectively suckling effectively (IMNCI Module 2 WHO, UNICEF, MOHFW)
  36. 36.  Clear a blocked nose if it interferes with breastfeeding  Look for ulcers or white patches in the mouth(thrush) If yes, look and feel for: Flat or inverted nipples, or sore nipples Engorged breasts or breast abscess • Does the mother have pain while breastfeeding?(IMNCI Module 2 WHO, UNICEF, MOHFW)
  37. 37. SIGNS CLASSIFY AS TREATMENT •Not able to feed or •No attachment or •Not suckling at all or •Very low wt for age Not able to feed – Possible serious bact. infection or Severe malnutrition Give first dose of intramuscular ampicillin and gentamicin Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5oC (or feels cold to touch) while arranging referral Advise mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to hospital (IMNCI Module 2 WHO, UNICEF, MOHF
  38. 38. Not well attached to breast or • Not suckling effectively or • Less than 8 breastfeeds in 24 hours or • Receives other foods or drinks or • Moderately underweight (< -2SD to -3SD) or • Thrush (ulcers or white patches in mouth) or • Breast or nipple problems Feeding problem or low weight for age If not well attached or not suckling effectively, teach correct positioning and attachment If breastfeeding less than 8 times in 24 hours, advise to increase frequency of feeding. If receiving other foods or drinks, counsel mother about breastfeeding more, reducing other foods or drinks, and using a cup and spoon. • If not breastfeeding at all advise mother about giving locally appropriate animal milk and teach the mother to feed with a cup and spoon. If thrush, teach the mother to treat thrush at home. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  39. 39. If breast or nipple problem, teach the mother to treat breast or nipple problems. If low weight for age, teach the mother how to keep the young infant with low weight warm at home Advise the mother to give home care for the young infant Advise mother when to return immediately Follow up any feeding problem or thrush in 2 days Follow up low weight for age in 14 days •Not low weight for age and no signs of inadequate feeding No feeding problem Advise the mother to give home care for theyoung infant Advise mother when to return immediately (IMNCI Module 2 WHO, UNICEF, MOHFW)
  40. 40. FOLLOW –UP CARE (IMNCI Module 2 WHO, UNICEF, MOHFW)
  41. 41. Feeding Problem Reassess feeding Ask about any feeding problems found on the initial visit. Counsel the mother, ask her to return back again in 2 days. Exception :If you do not think that feeding will improve or if young infant has lost weight: - refer to hospital. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  42. 42. Teach correct positioning and attachment for breastfeeding.  Show the mother how to hold her infant  With the infant head and body straight.  Facing her breast, with infant’s nose opposite her nipple  With infant’s body close to her body.  Supporting infant’s whole body. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  43. 43. Show her how to help the infant to attach. Infant’s chin should touch her breast Mouth should be wide open. Upper areola should be visible more than the lower areola. Lower lip should be turned outward. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  44. 44. Look for signs of effective suckling. The baby takes slow and deep sucks (the pauses are to allow more milk to flow into the lactiferous sinuses/ milk ducts) You can see or hear baby swallowing The baby cheeks are not drown inwards and are rounded during feed To treat thrush (ulcers or white patches in mouth) Apply gentian violet 0.25% paint twice daily. The mother should : •Wash hands •Wash mouth •Paint the mouth with gentian violet.(IMNCI Module 2 WHO, UNICEF, MOHFW)
  45. 45. SUMMARY:-
  46. 46. CHECK FOR POSSIBLE BACTERIAL INFECTIONS/JAUNDICE
  47. 47. ASK:- •Has the infant had convulsions ? LOOK ,LISTEN ,FEEL:- •Count the breaths in one minute .repeat the count •Look for severe chest indrawing •Look for nasal flaring •Look and listen for grunting •Look and feel bulging fontanelle •Look for pus draining from the ear •Look at the umbilicus-is it red or draining pus ? •Look for skin pustules. Are there 10 or more skin pustules or a big boil •Measure axillary temp. •See if the young infant is lethargic or unconscious •Look at the young infant’s movements. Are they less than normal? •Look for jaundice. Are the palms and soles yellow?(IMNCI Module 2 WHO, UNICEF, MOHFW)
  48. 48. SIGNS CLASSIFY AS IDENTIFY TREATMENT •Convulsions or •Fast breathing(60 breaths per minute or more) •Severe chest indrawing •Nasal flaring •Grunting •Bulging fontanelle •10 or more skin pustules or a big boil If axillary temp>= 37.5 or temp<=35.5 degree celsius •Lethargic or unconscious •Less than normal movements POSSIBLE SERIOUS BACTERIAL INFECTION Give first dose of intramuscular ampicillin and gentamicin Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5°C (or feels cold to touch) while arranging referral Advise mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to (A) CLASSIFY ALL YOUNG INFANTS
  49. 49. Look for chest indrawing when child breaths IN. The child has indrawing if the lower chest goes in when the child breathes in Chest indrawing occurs when the effort required to breathe in,is much greater than normal CHEST INDRAWING (IMNCI Module 2 WHO, UNICEF, MOHFW)
  50. 50. •Umbilicus red or draining pus •Pus discharge from ear or •< 10 skin pustules LOCAL BACTERIA L INFECTION Give oral co- trimoxazole or amoxycillin for 5 days Teach mother to treat local infections at home Follow up in two days Umbilicus red Draining pus (IMNCI Module 2 WHO, UNICEF, MOHFW)
  51. 51. SIGNS CLASSIFYAS IDENTIFY TREATMENT •Palms &soles yellow •Age <24hrs or •Age >=14 days SEVERE JAUNDICE Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5°C (or feels cold to touch) while arranging referral Advise mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to hospital •Palms& soles not yellow JAUNDICE Advise mother to give home care for the young infant JAUNDICE (IMNCI Module 2 WHO, UNICEF, MOHFW)
  52. 52. •Temperature between 35.5-36.5 degree Celsius LOW BODY TEMPERATURE Warm the young infant by skin contact for 1 hr Treat low blood sugar (C) IF THE TEMPERATURE IS BETWEEN 35.5- 36.5 DEGREE CELCIUS 12 (IMNCI Module 2 WHO, UNICEF, MOHFW)
  53. 53. Teach the mother to give oral drugs at home Tell the mother the reason for giving the drug to infant. Demonstrate how to measure a dose. Watch the mother practice measuring a dose by herself. Ask the mother to give the first dose to her infant. Explain that all the oral drug tablets or syrups must be used to finish the course of treatment. Treat The Young Infant For Local Infections At Home (IMNCI Module 2 WHO, UNICEF, MOHFW)
  54. 54. Local bacterial infections Umbilicus red or draining pus >10 or big boil <10 and no big boil Remains or worse refer to hospital Improved,continue treatment Skin pustules Ear Discharge Refer to hospital Continue treatment Continue wicking dry the ear Follow-Up Care (IMNCI Module 2 WHO, UNICEF, MOHFW)
  55. 55. Follow up Jaundice Are the palms and soles yellow If yes or age 14 days or more If no or age<14 days Refer to hospital Advice home care (IMNCI Module 2 WHO, UNICEF, MOHFW)
  56. 56. CHECK FOR POSSIBLE HYPOTHERMIA
  57. 57. If a baby has a temperature of less than 36.5°C the baby has ‘hypothermia’. 1) Mild hypothermia (36.0°C to 36.4°C) 2) Moderate hypothermia (32°C to 36.0°C) 3) Severe hypothermia (<32°C) WHAT IS HYPOTHERMIA
  58. 58. Large surface area of babies compared to their weight. • Limited heat generation mechanism. • Vulnerability to getting exposed. • Decreased subcutaneous fat and brown fat. • Poorer homeostatic response to hypothermia and early exhaustion of metabolic store like glucose. CAUSES OF HYPOTHERMIA
  59. 59. Axillary (standard method) • Rectal • Skin • Human touch- • abdomen, feet and hands are warm- Normal • abdomen is warm but feet and hands are cold- Cold stress •abdomen, feet and hands are cold- Hypothermia METHODS OF TEMPERATURE MEASUREMENT
  60. 60. Warm Chain- It is a sequence of ten steps- 1) Warm delivery room 2) Warm Resuscitation 3) Immediate drying 4) Skin to skin contact 5) Breastfeeding 6) Bathing postponed 7) Appropriate clothing 8) Mother and baby together 9) Professional alertness 10) Warm transportation PREVENTION OF HYPOTHERMIA-
  61. 61. Kangaroo mother care for low birth weight babies, was introduced in COLUMBIA in 1979, by Dr’s Hector Martinez and Edzar Rey. KANGAROO MOTHER CARE
  62. 62. • Skin-to-skin contact between mother and baby is called Kangaroo Mother Care. • It is the most practical, preferred method of warming a hypothermic infant in a primary health care facility.
  63. 63. PROCEDURE- •Provide privacy to the mother. If mother is not available then it may be provided by father or any other adult. •Request the mother to sit comfortably. •Undress the baby gently and place the baby prone on mother`s chest in upright and extended posture, between her breast, in skin to skin contact, turn baby`s head to one side to keep airway clear. • cover the baby with mother`s gown and wrap the baby mother duo with an added blanket or shawl. • if possible warm the room(>25 c) with a heat device. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  64. 64. •Reassess after 1 hour.  Look for signs of possible serious bacterial infection.  Measure axillary temperature (or feel for low body temperature) • If signs present or temperature still below 36.50c refer urgently after giving pre-referral treatment. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  65. 65. 1) Mild hypothermia (36.0°C to 36.4°C)  Skin-to-Skin contact is the best way to keep a baby warm and the best way to ‘re- warm’ a baby who is cold to touch. 2) Moderate hypothermia (32°C to 36.0°C) Warm the young infant using Skin to Skin contact . If Skin to Skin contact is not possible, radiant warmer may be used if available. Encourage mother to breastfeed more frequently. If the baby’s temperature is not up to 36.50C or more after 2 hours of ‘rewarming’,reassess the baby for other problems. MANAGEMENT OF HYPOTHERMIA
  66. 66. 3) Severe hypothermia (<32°C) Remove cold or wet clothing. Dress in warm clothes and a cap, and cover with a warm blanket. Warm immediately using a pre warmed radiant warmer. Check and treat for hypoglycemia . Treat for sepsis. Start IV fluids. Provide oxygen if indicated . Monitor temperature of the baby every ½ hourly.
  67. 67. Counsel The Mother FOR HOME CARE Advice mother to give home care for the young infant:  Food and fluids  Breastfeed frequently as often and for as long as the infant wants.  Make sure the young infant stays warm at all times. (IMNCI Module 2 WHO, UNICEF, MOHFW)
  68. 68. Follow-Up Visit If the infant has Return for follow up in •Local bacterial infection •Jaundice •Diarrhea •Any feeding problem •Thrush 2 days •Low weight for age 14 days (IMNCI Module 2 WHO, UNICEF, MOHFW)
  69. 69. When To Return Immediately  If the young infant has any of this signs:  Breastfeeding or drinking poorly  Becomes sicker  Develops a fever or feels cold to touch  Fast breathing  Difficult breathing  Yellow palms and soles  Diarrhoea with blood in stool. (IMNCI Module 2 WHO, UNICEF, MOHFW)

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