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Integrated Management of Childhood Illness (IMCI)
SICK CHILD (2 months to 5 years old)
DANGER SIGNS:
• Unable to drink or ...
AGE OR WEIGHT
CHLORAMPHENICOL
Dose: 40 mg/kg
Add 5 ml sterile water to vial containing 1g
= 5.6 ml at 180mg/ml
2 – 4 month...
Is the child:
- Abnormally sleepy or difficult to awake?
- Restless and irritable
Look for sunken eyes.
Offer the child fl...
 SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE
USUAL FLUID INTAKE:
Up to 2 years 50 to 100 ml after each loos...
If DIRRHEA for 14 DAYS OR MORE:
SIGNS CLASSIFY AS TREATMENT
 dehydration present
SEVERE PERSISTENT
DIARRHEA
 treat dehyd...
OR
 Stiff neck
VERY SEVERE
FEBRILE DISEASE
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in...
 Treat the mouth ulcers twice daily
• Wash hands
• Wash child’s mouth clean using soft cloth wrapped around the finger an...
If with EAR PROBLEM:
SIGNS CLASSIFY AS TREATMENT
 Tender swelling behind the
ear MASTOIDITIS
 Give 1st
dose of an approp...
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...
AGE OR WEIGHT Albendazole
400 mg/tablet
Mebendazole
500 mg/tablet
12- 23 months ½ 1
24-59 months 1 1
WHEN TO RETURN:
FOLLO...
 advise mother how to give home care
 follow up in 2 days
INTRAMUSCULAR ANTIBIOTIC:
• Give 1st
dose of BOTH benzylpenici...
HOME CARE FOR YOUNG INFANT:
• Breastfeed frequently, as often and for as long as the infant wants, day and night,
during s...
- supporting infant’s whole body, not just neck and shoulders
 Show her how to help the infant to attach. She should:
- t...
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Ho6

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Transcript of "Ho6"

  1. 1. Integrated Management of Childhood Illness (IMCI) SICK CHILD (2 months to 5 years old) DANGER SIGNS: • Unable to drink or breastfeed • Frequent vomiting • Convulsion during the course of illness • Abnormally sleepy or difficult to awake  if any of these is present- considered SEVERE DISEASE  GIVE 1st dose of appropriate antibiotic and refer URGENTLY  except for diarrhea if Plan C can resolve the danger sign THEN ASK ABOUT THE MAIN SYMPTOMS:  Does the child have cough or difficulty breathing?  Does the child have diarrhea?  Does the child have fever?  Does the child have an ear problem?  Then check for malnutrition and anemia If with COUGH or DIFFICULTY BREATHING: Ask: How Long? Look, Listen: Count the breaths in one minute Look for chest indrawing Listen for stridor • Fast breathing if: 2 – 12 mos more than 50 bpm 12 mos up more than 40 bpm • Child must be CALM during assessment SIGNS CLASSIFY AS TREATMENT  any danger sign or  chest indrawing or  stridor SEVERE PNEUMONIA or VERY SEVERE DISEASE  give 1st 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  no signs of pneumonia or very severe disease NO PNEUMONIA COUGH OR COLD  if coughing for 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 2 days SEVERE PNEUMONIA: Appropriate antibiotic: INTRAMUSCULAR Chloramphenicol  for children who cannot take oral antibiotic  give the 1st dose then refer URGENTLY to hospital  if REFERRAL is NOT possible: • repeat the chloramphenicol injection every 12 hours for 5 days • then change to an appropriate oral antibiotic to complete 10 days of treatment
  2. 2. AGE OR WEIGHT CHLORAMPHENICOL Dose: 40 mg/kg Add 5 ml sterile water to vial containing 1g = 5.6 ml at 180mg/ml 2 – 4 months (4 - < 6 kg) 1 ml = 180 mg 4 – 9 months (6 - < 8 kg) 1.5 ml = 270 mg 9 – 12 months (8 - < 10 kg) 2 ml = 360 mg 1 – 3 years old (10 - < 14 kg) 2.5 ml = 450 mg 3 – 5 years old (14 – 19 kg) 3.5 ml = 630 mg VERY SEVERE DISEASE/ PNEUMONIA Appropriate antibiotic: ORAL 1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days) 2nd line antibiotic: AMOXYCILLIN (TID x 5 days) Age or weight Tablet Syrup 2 – 12 months (4 - < 10 kg) ½ 5 ml 1 – 5 years old (10 - < 19 kg) 1 10 ml GIVE VITAMIN A: 6 - 12 months 100, 000 IU/ cap 1 – 5 years old 200, 000 IU/ cap SOOTHE THE THROAT AND RELIEVE COUGH WITH SAFE REMEDY:  Breastmilk for exclusively breastfed infant  Tamarind, Calamansi and Ginger Harm full remedies to discourage:  Codeine cough syrup  Other cough syrup  Oral and nasal decongestant WHEN TO RETURN IMMEDIATELY: Pneumonia : presence of any danger sign Cough or Cold : presence of fast breathing or difficult breathing TREAT THE CHILD TO PREVENT LOW BLOOD SUGAR LEVEL:  If the child is able to breastfeed: Ask the mother to breastfeed the child.  If the child is not able to breastfeed but is able to swallow: Give expressed breastmilk or breastmilk substitute If neither of these is available, give sugar water Give 30-50 ml of milk or sugar water before departure • to make sugar water: Dissolve 4 level teaspoons of sugar (20grams) 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  If the child is difficult to awaken or unconscious, start IV infusion: Give 5 ml/kg of 10% of dextrose solution (D10) over a few minutes Or give 1 ml/kg of 50% (D50) by slow push If with DIRRHEA: ASK: How long? Is there blood in the stool? LOOK, FEEL: Look at the child’s general condition.
  3. 3. Is the child: - Abnormally sleepy or difficult to awake? - 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 SIGNS CLASSIFY AS TREATMENT Two of the following signs:  abnormally sleepy or difficult to awaken  sunken eyes  not able to drink or drinking poorly  skin pinch goes back slowly SEVERE DEHYDRATION  if the child has no other sever classification; • give fluid for severe dehydration (Plan C) Or;  if the child has another sever classification; • refer URGENTLY to hospital, with mother giving frequent sips of ORS on the way • advise the mother to continue breastfeedig  if the child is 2 years or older and there is cholera in the area, give antibiotic for cholera Two of the following signs:  restless, irritable  sunken eyes  drinks eagerly, thirsty  skin pinch goes back very slowly SOME DEHYDRATION  if the child has no other sever classification; • give fluid for severe dehydration (Plan B) Or;  if the child has another sever classification; • refer URGENTLY to hospital, with mother giving frequent sips of ORS on the way • advise the mother to continue breastfeedig  advise mother when to return immediately  follow up in 5 days if not improving  no enough signs to classify as some or severe dehydration NO DEHYDRATION  give fluid and food to treat diarrhea at home (Plan A)  give zinc supplements  advise mother when to return immediately  follow up in 5 days if not improving Plan A: Treat Diarrhea at Home Counsel the mother on the 4 rules of home Treatment: 1. Give Extra Fluid 2. Give zinc supplement 3. Continue Feeding 4. When to return 1. GIVE EXTRA FLUID  TELL THE MOTHER: - Breastfeed frequently and longer at each feeding - if the child is exclusively breastfed, give ORS or clean water in addition to breast milk. - if the child is not exclusively breastfed, give one or more of the following: ORS solution, food-based fluids (such as soup, rice water, or “buko juice”), clean water. It is especially important to give ORS at home when: - The child has been treated with Plan B or Plan C during the visit, or - The child cannot return to a health center if the diarrhea gets worse,  TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2 PACKETS OF ORS TO USE AT HOME.
  4. 4.  SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUID INTAKE: Up to 2 years 50 to 100 ml after each loose stool 2 years or more 100 ml to 200 ml after each loose stool Tell the mother: - Give frequent small sips from a cup. - If the child vomits, wait 10 minutes, then continue, but more slowly. - Continue giving extra fluid until the diarrhea stops. 2. GIVE ZINC SUPPLEMENTS • 10 mg per day in infants - < 6 mos. For 10-14 days • 20 mg per day in children 6 mos. -5 years old for 10-14 days 3. CONTINUE FEDING 4. WHEN TO RETURN Plan B: Treat Some Dehydration with ORS Give in health center recommended amount of ORS over 4-hour period DETERMINE AMOUNT OF ORS TO GIV DURING THE FIRST $ HOURS. AGE Up to 4 months 4 months up to12 months up to 2 years up to 12 months 2 years 5 years WEIGHT <6 kg 6 to -< 10 kg 10 to -< 12 kg 12 to 19 kg AMOUNT(ml) 200-400 400-700 700-900 900-1400  Use the child’s age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child’s weight (in kg0 times 75. • If the child wants more ORS than shown, give more. • For infants under 6 months of age who are not breastfed, also give 100-200 ml clean water during this period.  SHOW THE MOTHER HOW TO GIVE ORS SOLUTION. • Give frequent small sips from a cup. • If the child vomits , wait 10 minutes. Then continue, but more slowly. • Continue breastfeeding whenever the child wants.  IF THE MOTHER MUST LEAVE BEFORE COMLETING TREATMENT: • Show her how to prepare ORS solution at home. • Show her how much ORS to give her child to finish 4-hour treatment at home. • Give her enough ORS packets to complete rehydration. Also give her 2 packets, as recommended in Plan A. • Explain the 4 rules of home treatment: DYSENTERY Appropriate antibiotic: ORAL 1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days) 2nd line antibiotic: NALIDIXIC ACID (QID x 5 days) Cotrimoxazole Nalidixic Acid Age or weight Tablet Syrup Syrup 2 – 4 months (4 - < 6 kg) ½ 5 ml 1. 25 ml (1/4 tsp) 4 – 12 months (6 - < 10 kg) 2.5 ml (12 tsp) 1 – 5 years old (10 - < 19 kg) 1 10 ml 5 m l (1 tsp)
  5. 5. If DIRRHEA for 14 DAYS OR MORE: SIGNS CLASSIFY AS TREATMENT  dehydration present SEVERE PERSISTENT DIARRHEA  treat dehydration before referral unless the child has another severe classification  give Vitamin A  refer to hospital  no dehydration PERSISTENT DIARRHEA  Advise the mother on feeding a child who has PERSISTENT DIARRHEA  give Vitamin A  follow up in 5 days  advise the mother when to return immediately If with BLOOD IN THE STOOL: SIGNS CLASSIFY AS TREATMENT  blood in the stool DYSENTERY  treat for 5 days with an oral antibiotic recommended for shigella in your area  follow up in 2 days  advise mother when to return immediatelly If with FEVER: Identify MALARIA risk:  Living in malaria area  Has visited/ travelled in a malaria area in the past 4 weeks If with MALARIA RISK: SIGNS CLASSIFY AS TREATMENT  Any general danger sign OR  Stiff neck VERY SEVERE FEBRILE DISEASE/ MALARIA  Give 1st dose of quinine  Give 1st dose of appropriate antibiotic  Treat the child to prevent low blood sugar  Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)  Send a blood smear with the patient  Refer URGENTLY to hospital  Blood smear ( + ) If blood smear not done:  No runny nose, and  No measles, and  No other causes of fever MALARIA  Treat the child with oral anti-malarial  Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)  Advise the mother when to return immediately  Follow up in 2 days if fever persists  If fever is present every day for more than 7 days, refer for assessment  Blood smear ( - ) OR  Runny nose, OR  Measles, OR  Other causes of fever FEVER: MALARIA UNLIKELY  Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)  Advise the mother when to return immediately  Follow up in 2 days if fever persists  If fever is present every day for more than 7 days, refer for assessment  Treat other causes of fever If NO Malaria Risk: SIGNS CLASSIFY AS TREATMENT  Any general danger sign  Give 1st dose of appropriate antibiotic
  6. 6. OR  Stiff neck VERY SEVERE FEBRILE DISEASE  Treat the child to prevent low blood sugar  Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)  Refer URGENTLY to hospital  No signs of very severe febrile disease FEVER: NO MALARIA  Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)  Advise the mother when to return immediately  Follow up in 2 days if fever persists  If fever is present every day for more than 7 days, refer for assessment  Treat other causes of fever If with MEASLES now or within 3 months: SIGNS CLASSIFY AS TREATMENT  blood in the stool DYSENTERY  treat for 5 days with an oral antibiotic recommended for shigella in your area  follow up in 2 days  advise mother when to return immediatelly If with FEVER: Identify MALARIA risk:  Living in malaria area  Has visited/ travelled in a malaria area in the past 4 weeks If with MALARIA RISK: SIGNS CLASSIFY AS TREATMENT  Clouding of the cornea OR  Deep extensive mouth ulcers  Any general danger sign SEVERE COMPLICATED MEASLES  Give Vitamin A  Give 1st dose of appropriate antibiotic  If clouding of the cornea or pus draining from the eyes, apply tetracycline eye ointment  Refer URGENTLY to hospital  Pus draining from the eyes, OR  Mouth ulcers MEASLES WITH EYE OR MOUTH COMPLICATIONS  Give Vitamin A  If clouding of the cornea or pus draining from the eyes, apply tetracycline eye ointment  If mouth ulcers, teach the mother to treat with gentian violet  Follow up in 2 days  Advise the mother when to return immediately  Measles now or within the last 3 months MEASLES  Give Vitamin A  Advise the mother when to return immediately TREAT EYE INFECTION WITH TETRACYCLINE EYE OINTMENT  Clean both eyes 3 times daily • Wash hands • Ask child to close eyes • 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 ointment or drops, or put anything else in the eyes TREAT MOUTH ULCERS WITH GENTIAN VIOLET
  7. 7.  Treat the mouth ulcers twice daily • Wash hands • Wash child’s mouth clean using soft cloth wrapped around the finger and wet with salt water • Paint the mouth with half strength gentian violet, using cotton bud • Wash hands again Assessment for DENGUE HEMORRHAGIC FEVER: SIGNS CLASSIFY AS TREATMENT  Bleeding from nose or gums, OR  Bleeding in stools or vomitus, OR  Black stools or vomius, OR  Skin petechiae OR  Cold and clammy extremities OR  Capillary refill of > 3 secs  Persistent abdominal pain, OR  Persistent Vomiting, OR Tourniquet test positive SEVERE DENGUE HEMORRHAGIC FEVER  If persistent vomiting or persistent abdominal pain or skin petechiae or positive tourniquet test are the only signs, give ORS (Plan B)  If any signs of bleeding is positive, give fluids rapidly, as plan C  Treat the child to prevent low blood sugar  Refer all children URGENTLY to hospital  DO NOT GIVE ASPIRIN  No signs of severe Dengue Hemorrhagic Fever FEVER: DHF UNLIKELY  Advise the mother when to return immediately  Follow up in 2 days if fever persists  DO NOT GIVE ASPIRIN VERY SEVERE FEBRILE DISEASE/ MALARIA Appropriate antibiotic: INTRAMUSCULAR QUININE  Give the 1st dose of IM quinine and refer URGENTLY to hospital If Referral is NOT Possible:  The child should remain lying down for one hour  repeat the quinine injection at 4-8 hours later, and then every 12 hours until the child is able to take an oral antimalarial. Do not continue quinine injections for more than 1 week  Do not give quinine to a child less than 4 months of age AGE OR WEIGHT INTRAMUSCULAR QUININE 4 up to 12 months (6- <10 kg) 0.3 ml 1- 2 years old (10- <12 kg) 0.4 ml 2-3 years old (12- <14 kg) 0.5 ml 3-5 years old (14- 19 kg) 0.6 ml Appropriate antibiotic: ORAL ANTIMALARIAL  If CHLOROQUINE: - watched child for 30 minutes, if with vomiting within 30 minutes, repeat dose and return to the center for additional tablets - itching is a possible, but id not dangerous  If SULFADOXINE + PYRIMETHAMINE: - give a single dose in the health center 2 hours before intake of chloroquine  If PRIMAQUINE: - single doe on DAY 4 for P. falciparum; 14 days for P.vivax  If ARTEMETER+ LUMEFRANTINE: - combination; give for 3 days
  8. 8. If with EAR PROBLEM: SIGNS CLASSIFY AS TREATMENT  Tender swelling behind the ear MASTOIDITIS  Give 1st dose of an appropriate antibiotic  Give 1st dose of paracetamol for pain  Refer URGENTLY to hospital  Ear pain  Pus is seen draining from the ear, and discharge is reported for less than 14 days ACUTE EAR INFECTION  Give an antibiotic for 5 days  Give paracetamol for pain  Dry the ear by wicking.  Follow up in 5 days.  Advise mother when to return immediately  Pus is seen draining from the ear, and discharge is reported for more than 14 days CHRONIC EAR INFECTION  Dry the ear wicking.  Follow up in 5 days .  Advise mother when to return immediately.  No ear pain, and  No pus is seen draining from the ear NO EAR INFECTION  No additional treatment.  Advise mother when to return immediately. Appropriate antibiotic: ORAL 1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days) 2nd line antibiotic: AMOXYCILLIN (TID x 5 days) Age or weight Tablet Syrup 2 – 12 months (4 - < 10 kg) ½ 5 ml 1 – 5 years old (10 - < 19 kg) 1 10 ml 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 ear is dry If with MALNUTRITION and ANEMIA: SIGNS CLASSIFY AS TREATMENT  Visible severe wasting or  Edema of both feet or  Severe palmar pallor SEVERE MALNUTRITION OR SEVERE ANEMIA  Give Vitamin A  Refer URGENTLY to hospital  Some palmar pallor or  Very low weight for age ANEMIA OR 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 problem, follow up in 5 days  If some pallor: - Give iron - Give mebendazole/albendazole if the child is 12 months or older, and has AGE Sulfadoxine + pyrethamine Chloroquine Primaquine p. falcifarum p. vivax 2- 5 months ¼ ½ ½ ½ ----- ---- 5- 12 months ½ ½ ½ ½ ----- ---- 1-3 years old ¾ 1 1 ½ ½ 1/4 3-5 years old 1 1 ½ 1 ½ 1 ¾ ½
  9. 9. 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.  Not very low weight for age, and or other signs of malnutrition NO ANEMIA AND NOT VERY LOW WEIGHT  If the child is less than 2years old, assess the child’s feeding according to the FOOD box on the COUNSEL THE MOTHER chart - If feeding problem, follow up in 5 days  Advise mother when to return immediately RECOMMENDATIONS FOR FEEDING AND CARE FOR DEVELOPMENT: Birth up to 6 months 6 months to 12 months 12 months to 2 years 2 years and older FOOD: • Exclusively breastfeed as often as the child wants, day and night, at least 8 times in 24 hours • Do not give other foods or fluids FOOD: • Breastfeed as often as the child wants • Add any of the following: • lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely ground meat, eggyolk, bite-size fruits • 3 times per day of breastfed • 5 times if not FOOD: • Breastfeed as often as the child wants • Give adequate amount of family foods, such as: rice, camote, potato, fish, chicken, meat, monggo, steamed tokwa, pulverized roasted dilis, milk and eggs, dark green, leafy and yellow vegetables (malungay, squash) fruits (papaya, banana) • Add oil or margarine • 5 times per day • feed the baby nutritious snacks like fruits FOOD: • Give adequate aunt of family foods at 3 meals every day • Give twice daily nutritious foods, between meals such as:Boiled yellow camote, boiled yellow corn, peanuts, boiled saba, banana, taho, fruits, and fruit juices PLAY: • Provide an area where the child could move, play and develop his senses of sight, touch, and hearing • Have large, colorful things for your child to reach for and new things to see PLAY: • Give your child clean, safe household things to handle, bang, and drop PLAY: • Give your child things to stack up, and to put into containers, and take out PLAY: • Help your child count, name, and compare things • Make simple toys for your child COMMUNICATE: • Look into your child’s eyes and smile at him or her • When you are breastfeeding, it is a good time to talk to your child and get a conversation going with sounds or gestures COMMUNICATE: • Respond to your child’s sounds and interests. Tell your child the names of things and people COMMUNICATE: • Ask your child simple questions. Respond to your child’s attempts to talk. Play games like “bye” COMMUNICATE: • Encourage your child to talk, and answer your child’s questions. Teach your child stories, songs and games. GIVE MEBENDAZOLE/ALBENDAZOLE:  Give 500 mg Medendazole/ 400 mg Albendazole as a single dose in the health center if the child is 12 months up to 59 months and has not had a dose in the previous 6 months, with the following dose:
  10. 10. AGE OR WEIGHT Albendazole 400 mg/tablet Mebendazole 500 mg/tablet 12- 23 months ½ 1 24-59 months 1 1 WHEN TO RETURN: FOLLOW UP VISIT If the child has: Return for follow up in: Pneumonia Dysentery Malaria, if the fever persists Fever-Malaria Unlikely, if the fever persists Fever (No Malaria) if the fever persists Measles with Eye or Mouth Complications Dengue Hemorrhagic Fever Unlikely, if fever persists 2 days Persistent Diarrhea Acute Ear Infection Chronic Ear Infection Feeding Problems Many other Illnesses, if not improving 5 days Anemia 14 days Very Low Weight For Age 30 days WHEN TO RETURN IMMEDIATELY: Advise the mother to return immediately of the child has any of the these signs: Any Sick Child • Not able to drink or breastfeed • Becomes sicker • Develops a Fever If the child has NO PNEUMONIA: COUGH OR COLD, also return if: • Fast Breathing • Difficult Breathing If the child has Diarrhea, also return if: • Blood in stool • Drinking Poorly If the child has FEVER; DENGUE HEMORRHAGIC FEVER UNLIKELY, also return if: • Any signs of bleeding • Persistent abdominal pain • Persistent vomiting • Skin petechiae • Skin rashes SICK YOUNG INFANT (1 week to 2 months) SIGNS CLASSIFY AS TREATMENT  Convulsions OR  Fast breathing (>60 bpm) OR  Severe chest indrawing ) OR  Nasal Flarring OR  Grunting OR  Bulging Fontanelle OR  Pus draining from the ear OR  Umbilical redness extending to the skin OR  Fever (>37.5˚C), hypothermia (<35.5˚C) OR  Many or severe skin pustules OR  Abnormally sleepy or difficult to awaken OR  Less than normal movement POSSIBLE SERIOUS BACTERIAL INFECTION  Give first dose of intramuscular antibiotics  treat the child to prevent low blood sugar  advise mother how to keep the infant warm on the way to the hospital  refer URGENTLY to the hospital.  Red umbilicus or draining pus OR  Skin Pustules LOCAL BACTERIAL INFECTION  Give an appropriate antibiotic  treat the local infection in the health center, and teach the mother to treat local infection at home.
  11. 11.  advise mother how to give home care  follow up in 2 days INTRAMUSCULAR ANTIBIOTIC: • Give 1st dose of BOTH benzylpenicillin and gentamicin intramuscular • Referral is the BEST option for young infant classified as POSSIBLE SERIOUS BACTERIAL INFECTTION • If referral is NOT possible, give benzylpenicillin every 6 hours plus gentamicin one dose daily. WEIGHT Gentamicin Dose: 5 mg/kg Benzylpenicillin Dose: 50,000 units/kg 1 kg 0.5 ml 0.1 ml 2 kg 1.0 ml 0.2 ml 3 kg 1.5 ml 0.4 ml 4 kg 2.0 ml 0.5 ml 5 kg 2.5 ml 0.6 ml *dilution= gentamicin (6 ml for 80 mg) = benzylpenicillin (2.1 ml for 1 million units) MAKE SURE THE YOUNG INFANT STAYS WARM AT ALL TIMES: - In cool weather, cover the infant’s head and feet, and dress the infant with extra clothing APPROPRIATE ORAL ANTIBIOTIC: (Local Bacterial Infection) 1st line: COTRIMOXAZOLE (BID x 5 days) 2nd line: AMOXICILLIN (TID x 5 days) AGE OR WEIGHT Tablet Syrup Birth up to 1 month (<3 kg) -------- 1.25 ml 1-2 months (3- 4 kg) 1/4 2.5 ml TREATMENT FOR LOCAL INFECTION AT HOME: • SKIN PUSTULES o Wash hands o Gently wash off pus and crusts with soap and water o Dry the area o Paint with gentian violet o Wash hands • UMBILICAL INFECTION o Wash hands o Clean with 70% ethyl alcohol o Paint with gentian violet o Wash hands • ORAL THRUSH ( ulcers or white patches in the mouth) o Wash hands o Wash mouth with clean soft cloth wrapped around the finger and wet with salt water o Paint the mouth with half-strength gentian violet o Wash hands
  12. 12. HOME CARE FOR YOUNG INFANT: • Breastfeed frequently, as often and for as long as the infant wants, day and night, during sickness and health • When to return: Follow up visit: If infant has: Follow up in: LOCAL BASCTERIAL INFECTION ANY FEEDING PROBLEM THRUSH 2 days LOW WEIGTH FOR AGE 14 days When too return immediately: Advise the mother to return immediately if the young infants has any of these signs: Breastfeeding or drinking poorly Becomes sicker Develops a fever Fast breathing Difficult breathing Blood in stool DIARRHEA: same as for SICK CHILD FEEDING PROBLEMS OR LOW WEIGHT SIGNS CLASSIFY AS TREATMENT  Not able to feed OR  No attachment at all OR  Not sucking at all NOT ABLE TO FEED POSSIBLE SERIOUS BACTERIAL INFECTION  Give the 1st dose of intramuscular antibiotics  Treat to prevent low blood sugar level  Advise the mother how to keep the young infant warm on the way to the hospital  Refer URGENTLY to hospital  Not well attached to the breast OR  Not sucking 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 the mouth) FEEDING PROBLEM OR LOW WEIGHT  Advise the mother to breastfeed as often and for as long as the infant wants, day and night • if not well attached or not sucking effectively, teach correct positioning and attachment • if breastfeeding less than 8 times in 24 hours, advise to increase frequency of breastfeeding.  If receiving other foods or drinks, counsel mother about breastfeeding more, reducing other foods and drinks, and using a cup. • if not breastfeeding at all; - refer to breastfeeding counseling and possible relactation - advise about the correct preparing of breastmilk substitutes, and using a cup  If thrush, teach mother to treat thrush at home  Advise the 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  Not low weight for age, and no other signs of inadequate feeding NO FEEDING PROBLEM  Advise mother to give home care for the young infant  Praise the mother for feeding the infant well CORRECT POSITIONING AND ATTACHMENT:  Show the mother how to hold her infant. - with the infant’s head and body straight - facing her breast, with infant’s nose opposite her nipples - with infant’s body close to her body
  13. 13. - supporting infant’s whole body, 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 breast, aiming the infant’s lower lip well below the nipple  Look for signs of good attachment and effective sucking. If the attachment or sucking is good, try again.

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