UC Nursing CESDEV Imci

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UC Nursing CESDEV Imci

  1. 1. IMCI Integrated Management of Childhood Illnesses Community Extension Services and Development
  2. 2. ASSESS AND CLASSIFY THE SICK YOUNG CHILD AGED 2 MONTS TO 5 YEARS
  3. 3. <ul><li>ASSESS </li></ul><ul><li>Ask the mother what the child’s problems are: </li></ul><ul><li>Determine if this is an initial or follow visit for this problem . </li></ul><ul><ul><li>- If follow-up visit, use the follow up instructions in the follow-up </li></ul></ul><ul><li>slides </li></ul><ul><li>- If initial visit, assess the young infant as follows : </li></ul>
  4. 4. CHECK FOR GENERAL DANGER SIGNS <ul><li>ASK : LOOK: </li></ul><ul><li>Is the child not able to drink or breastfeed? </li></ul><ul><li>Look if the child is abnormally sleepy </li></ul><ul><li>or difficult to awaken. </li></ul><ul><li>Does the child vomit everything he or she takes </li></ul><ul><li>in? </li></ul><ul><li>Has the child had convulsions? </li></ul>IF YES
  5. 5. <ul><li>MAKE SURE THE CHILD WITH ANY GENERAL DANGER SIGNS IS REFERRED TO A HOSPITAL </li></ul><ul><li>After he or she is given the first dose of an appropriate antibiotic and other urgent treatments. </li></ul><ul><li>EXCEPTION : The rehydration of the child according to PLAN C may resolve the danger signs, making referral unnecessary. </li></ul>
  6. 6. ASK ABOUT THE MAIN SYMPTOMS
  7. 7. Does the child have cough or difficulty in breathing?
  8. 8. <ul><li>If yes, ask: LOOK, LISTEN: </li></ul><ul><li>* For how long has * Count the child’s </li></ul><ul><li>the child had breaths in one </li></ul><ul><li>it ? minute. </li></ul><ul><li> * Look for chest indrawing. </li></ul><ul><li> * Look and listen fo stridor. </li></ul><ul><li> </li></ul>THE CHILD MUST BE CALM Classify Cough or Difficulty In breathing
  9. 9. If the child is : Fast breathing is : 2 – 12 months old * 50 or more breaths per minute 12 months old * 40 or more breaths per minute <ul><li>If coughing has been present for more than 30 days, refer the child to a hospital for assessment. </li></ul><ul><li>Soothe the throat and relieve the cough with a safe remedy. </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center. </li></ul><ul><li>Follow up in 5 days if the child’s condition is not improving </li></ul>NO PNEUMONIA : COUGH OR COLD * No signs of pneumonia or a very severe disease <ul><li>Give the child an appropriate antibiotic for 5 days. </li></ul><ul><li>Soothe the throat and relieve the cough with a safe remedy. </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center </li></ul><ul><li>Follow up in 2 days. </li></ul>PNEUMONIA * Fast Breathing <ul><li>Give the first dose of an appropriate antibiotic </li></ul><ul><li>Treat the child to prevent the lowering of his or her blood sugar level. </li></ul><ul><li>Refer the child URGENTLY to a hospital.* </li></ul>SEVERE PNEUMONIA OR VERY SEVERE DISEASE <ul><li>Any general danger sign or </li></ul><ul><li>Chest indrawing or </li></ul><ul><li>Stridor in a calm child </li></ul>Treatment (Urgent pre-referral treatments are in bold print) Classify as Signs
  10. 10. Does A CHILD have DIARRHEA
  11. 11. <ul><li>If yes, ask: LOOK and FEEL: </li></ul><ul><li>For how long has the child * Look at the child’s general condition </li></ul><ul><li>had it ? Is the child : </li></ul><ul><li> - abnormally sleepy or difficult to awaken? </li></ul><ul><li> - restless and irritable? </li></ul><ul><li>Is there blood in the stool ? * Look for sunken eyes? </li></ul><ul><li> * Offer the child fluid. Is the child: </li></ul><ul><li> - not able to drink or drinking poorly? </li></ul><ul><li> - drinking eagerly, thirsty? </li></ul><ul><li> * Pinch the skin of the abdomen. </li></ul><ul><li> Does it go back to its original state: </li></ul><ul><li> - very slowly (longer than 2 seconds?) </li></ul><ul><li> - slowly? </li></ul>For DEHYDRATION If there has been Diarrhea for 14 Days or more? And if there is Blood in the Stool? Classify for
  12. 12. Classify for DEHYDRATION <ul><li>If the child has no other severe </li></ul><ul><li>classification : (PLAN C) </li></ul><ul><li>+ Give fluid for severe dehydration </li></ul><ul><li>If the child has other severe classification: </li></ul><ul><li>Refer him URGENTLY to a hospital, with the mother giving the child frequent sips of ORS on the way </li></ul><ul><li>Advise the mother to continue breastfeeding the child. </li></ul><ul><li>If the child is aged 2 years or older and there is cholera in your area, give an antibiotic for cholera. </li></ul>SEVERE DEHYDRATION <ul><li>Two or more of the following signs: </li></ul><ul><li>Abnormally sleepy or difficult to awaken </li></ul><ul><li>sunken eyes </li></ul><ul><li>not able to drink or drinking poorly </li></ul><ul><li>pinch the skin goes back to its original state very slowly </li></ul>
  13. 13. <ul><li>Give fluid and food to treat diarrhea at home (PLAN A) </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center </li></ul><ul><li>Follow up in 5 days if the child’s condition is not improving. </li></ul>NO DEHYDRATION Not enough signs to allow classification as some or sever dehydration <ul><li>Give fluid and food for some dehydration ( PLAN B): </li></ul><ul><li>If the child has a severe classification: </li></ul><ul><li>+ Refer him URGENTLY to a hospital, with the mother giving the child frequent sips of ORS on the way. </li></ul><ul><li>+Advise the mother to continue breastfeeding the child. </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center. </li></ul><ul><li>Follow up in 5 days if the child’s condition is not improving. </li></ul>SOME DEHYDRATION <ul><li>Two of the following signs: </li></ul><ul><li>Restless, irritable </li></ul><ul><li>Sunken eyes </li></ul><ul><li>Pinch skin goes back to its original state very slowly </li></ul>
  14. 14. And if there has been diarrhea for 14 days or more <ul><li>Advise the mother regarding the feeding of a child who has PERSISTENT DIARRHEA </li></ul><ul><li>GIVE VITAMIN A </li></ul><ul><li>Follow up in 5 days </li></ul>PERSISTANT DIARRHEA <ul><li>No dehydration </li></ul><ul><li>Treat dehydration before referral to a hospital unless the child has another severe classification. </li></ul><ul><li>GIVE VITAMIN A </li></ul><ul><li>Refer the child to a hospital </li></ul>SEVERE PERSISTENT DIARRHEA <ul><li>Dehydration present </li></ul>
  15. 15. And if there is blood in the stool <ul><li>Treat the child for 5 days with an oral antibiotic </li></ul><ul><li>Recommended for shigella in your area. </li></ul><ul><li>Follow up in 2 days </li></ul>DYSENTERY * Blood in the stool
  16. 16. DOES THE CHILD HAVE FEVER?
  17. 17. CLASSIFY FEVER DECIDE IF THERE IS MALARIA RISK If the child has MEASLES or had it within the last 3 months DECIDE IF THERE IS DENGUE RISK : YES or NO
  18. 18. IF THERE IS MALARIA RISK <ul><li>ASK : </li></ul><ul><li>Does the child live in a malaria-risk area? </li></ul><ul><li>Has the child travelled and stayed overnight in a malaria-risk area or received blood transfusion in the last 6 months? </li></ul><ul><li>If the answer to either is YES, obtain a blood smear. </li></ul><ul><li>ASK : LOOK AND FEEL: </li></ul><ul><li>For how long has the child had fever? * Look or feel for stiff neck </li></ul><ul><li>If the child has had fever for more than </li></ul><ul><li> 7 days, has the fever been present </li></ul><ul><li>EVERYDAY? </li></ul><ul><li>Did the child have measles within the * Look for signs of MEASLES : </li></ul><ul><li>last 3 months? - general rashes and </li></ul><ul><li>- one of these : cough, runny nose or </li></ul><ul><li> red eyes </li></ul>
  19. 19. MALARIA RISK <ul><li>Give 1 dose of paracetamol in the health center for high fever </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center </li></ul><ul><li>Follow up in 2 days if fever persists </li></ul><ul><li>If fever has been present everyday for more than 7 days, refer the child to a hospital for assessment. </li></ul>FEVER: MALARIA UNLIKELY <ul><li>Blood smear (-) </li></ul><ul><li>Runny nose or </li></ul><ul><li>Measles or </li></ul><ul><li>Other causes of fever </li></ul><ul><li>Treat the child with an oral anti malarial </li></ul><ul><li>Give one dose of paracetamol in the health center for high fever (38.5 and above) </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center </li></ul><ul><li>Follow up in 2 days if the fever persists. </li></ul><ul><li>If fever has been present every day for more than 7 days, refer the child to a hospital for assessment </li></ul>MALARIA <ul><li>Blood Smear (+) </li></ul><ul><li>If a blood smear test was not done </li></ul><ul><li>NO runny nose. NO measles, and NO other causes of fever </li></ul><ul><li>* Give the first dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours) </li></ul><ul><li>Give the 1at dose of an appropriate antibiotic </li></ul><ul><li>Treat the child to prevent the lowering of his blood sugar level </li></ul><ul><li>Give one dose of paracetamol in the health center for high fever(38.5 or above) </li></ul><ul><li>Send a blood smear of the child to the referral hospital </li></ul><ul><li>Refer the child URGENTLY to a hospital. </li></ul>VERY SEVERE FEBRILE DISEASE / MALARIA <ul><li>Any general danger sign or </li></ul><ul><li>Stiff neck </li></ul>
  20. 20. NO MALARIA RISK <ul><li>Give 1 dose of paracetamol in the health center for high fever </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center. </li></ul><ul><li>Follow up in 2 days if the fever persists </li></ul><ul><li>If fever has been present every day for more than 7 days, refer the child to a hospital for assessment. </li></ul>FEVER : NO MALARIA <ul><li>No signs of a very severe febrile disease </li></ul><ul><li>Give the first dose of an appropriate antibiotic </li></ul><ul><li>Treat the child to prevent the lowering of his or her blood sugar level </li></ul><ul><li>give 1 dose of paracetamol in the health center for high fever </li></ul><ul><li>Refer the child URGENTLY to a hospital </li></ul>VERY SEVERE FEBRILE DISEASE <ul><li>Any general danger sign or </li></ul><ul><li>Stiff neck </li></ul>
  21. 21. IF THE CHILD HAS MEASLES OR HAD IT WITHIN THE LAST THREE MONTHS <ul><li>Look for mouth ulcers </li></ul><ul><li>Are they deep and extensive? </li></ul><ul><li>Look for pus draining from the eye </li></ul><ul><li>Look for clouding of the cornea </li></ul>Classify
  22. 22. ** Temp. are based on axilliary temperature. *** Other important complications of measles – pneumonia, stridor, diarrhea, ear infection - malnutrition <ul><li>Give Vitamin A </li></ul>MEASLES <ul><li>Measles now or within the last 3 months </li></ul><ul><li>Give Vitamin A </li></ul><ul><li>If there is pus draining from the eye, apply tetra eye ointment </li></ul><ul><li>If there are mouth ulcers, teach the mother how to treat these with Gentian violet </li></ul><ul><li>Follow up in 2 days </li></ul>MEASLES WITH EYE OR MOUTH COMPLICATIONS*** <ul><li>Pus draining from the eye </li></ul><ul><li>Mouth ulcers </li></ul><ul><li>Give Vitamin A </li></ul><ul><li>Give the 1 st dose of an appropriate antibiotic </li></ul><ul><li>If there is clouding of the cornea or pus draining from the eye, apply tetra eye ointment </li></ul><ul><li>Refer the child URGENTLY to the hospital </li></ul>SEVERE COMPLICATED MEASLES <ul><li>Clouding of the cornea or </li></ul><ul><li>Deep or extensive mouth ulcers </li></ul>
  23. 23. DECIDE IF THERE IS DENGUE RISK: YES OR NO <ul><li>ASK : LOOK AND FEEL: </li></ul><ul><li>Has the child had any bleeding + Look for bleeding from the nose or </li></ul><ul><li>from the nose or gums, or in the or gums. </li></ul><ul><li>vomitus or stool? </li></ul><ul><li>Has the child has black vomitus ? + Look for skin petechiae? </li></ul><ul><li>Has the child evacuated black + Feel for cold and clammy </li></ul><ul><li>stool? Extremities? </li></ul><ul><li>Has the child had persistent + Check for slow capillary refill. If </li></ul><ul><li>abdominal pain? None of the above ASL, LOOK </li></ul><ul><li> and FEEL signs is present, and </li></ul><ul><li> Fever has been present for more than 3 days : </li></ul><ul><li> CONDUCT A TORNIQUET TEST </li></ul><ul><li>Has the child been vomiting </li></ul><ul><li>persistently? </li></ul>
  24. 24. If there is DENGUE risk, classify : <ul><li>Advise the mother regarding when to return immediately to the health center. </li></ul><ul><li>Follow up in 2 days if the fever persists or if the child shows signs of bleeding </li></ul><ul><li>DO NOT GIVE ASPIRIN </li></ul>FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY <ul><li>No signs of severe dengue hemorrhagic fever </li></ul><ul><li>If skin petechiae, persistent abdominal pain, persistent vomiting, or positive tourniquet test are the only positive signs, give ORS </li></ul><ul><li>If any other sign of bleeding is positive, give fluids rapidly, as in PLAN C </li></ul><ul><li>Treat the child to prevent the lowering of his or her blood sugar level </li></ul><ul><li>Refer the child URGENTLY to a hospital </li></ul><ul><li>DO NOT GIVE ASPIRIN </li></ul>SEVERE DENGUE HEMORRHAGIV FEVER <ul><li>Bleeding from the nose or gums </li></ul><ul><li>Bleeding in the stool or vomitus </li></ul><ul><li>Black stool or vomitus </li></ul><ul><li>Skin petechiae </li></ul><ul><li>Cold, clammy extremities </li></ul><ul><li>Slow capillary refill (more than 3 sec) </li></ul><ul><li>Persistent abdominal pain </li></ul><ul><li>Persistent vomiting </li></ul><ul><li>Positive torniquet test </li></ul>
  25. 25. Does the child have ear problem
  26. 26. <ul><li>If YES : LOOK AND FEEL : </li></ul><ul><li>Is there ear pain? + Look for pus draining from the ear </li></ul><ul><li>Is there ear discharge? * Feel if there is tender swelling behind the ear. </li></ul><ul><li>If yes, for how long has it been </li></ul><ul><li>present? </li></ul>Classify the ear problem
  27. 27. <ul><li>No additional treatment needed </li></ul>NO EAR INFECTION <ul><li>No ear pain and </li></ul><ul><li>No pus is seen draining from the ear </li></ul><ul><li>Dry the ear by wicking. </li></ul><ul><li>Follow up in 5 days </li></ul>CHRONIC EAR INFECTION <ul><li>Pus is seen draining from the ear, and there has been discharge for 14 days or more. </li></ul><ul><li>Give an antibiotic for 5 days </li></ul><ul><li>Give paracetamol for pain </li></ul><ul><li>Dry the ear by wicking </li></ul><ul><li>Follow up in 5 days </li></ul>ACUTE EAR INFECTION <ul><li>Pus is seen draining from the ear, and there has been discharge for less than 14 days </li></ul><ul><li>Ear pain </li></ul><ul><li>Give the first dose of an appropriate antibiotic </li></ul><ul><li>Give the first dose of paracetamol for pain. </li></ul><ul><li>Refer the child URGENTLY to a hospital. </li></ul>MASTOIDITIS <ul><li>Tender swelling behind the ear </li></ul>
  28. 28. Check for MALNUTRITION and ANEMIA <ul><li>LOOK AND FEEL : </li></ul><ul><li>Look for visible severe wasting </li></ul><ul><li>Look for edema on both feet </li></ul><ul><li>Look for palmar pallor . is it: </li></ul><ul><li>- severe palamr pallor? </li></ul><ul><li>- some palmar pallor? </li></ul><ul><li>Determine the weight for age </li></ul>Classify The NUTRITIONAL STATUS
  29. 29. Classify The NUTRITIONAL STATUS
  30. 30. <ul><li>If the child is less than 2 years old, assess the child’s feeding and counsel the mother regarding the child’s feeding according to the FOOD box on the counsel the mother CHART. </li></ul><ul><li>- If there is feeding problem, follow up in 5 days. </li></ul><ul><li>Advise the mother regarding when to return immediately to the health center. </li></ul>NO ANEMIA AND NOT VERY LOW WEIGHT FOR AGE <ul><li>Not very low weight for age, and no other signs of malnutrition. </li></ul><ul><li>Assess the child’s feeding and counsel the mother regarding the child’s feeding accdg. To the FOOD box on the COUNSEL THE MOTHER chart. </li></ul><ul><li>If there is some pallor: </li></ul><ul><li>- give iron </li></ul><ul><li>- give albendazole if the child is aged 12 months or older, or if he did not have a dose in the previous 6 months. </li></ul><ul><li>If the weight for age is very low: </li></ul><ul><li>- Give Vitamin A </li></ul><ul><li>- Follow up in 30 days </li></ul><ul><li>Advise the mother when to return immediately to the health center </li></ul>ANEMIA OR VERY LOW WEIGHT FOR AGE <ul><li>Some palmar pallor or </li></ul><ul><li>Very low weight for age </li></ul><ul><li>Give Vitamin A </li></ul><ul><li>Refer the child URGENTLY to a hospital </li></ul>SEVERE MALNUTRITION OR SEVERE ANEMIA <ul><li>Visible severe wasting or </li></ul><ul><li>edema on both feet </li></ul><ul><li>Severe palmar pallor </li></ul>
  31. 31. CHECK THE CHILD’S IMMUNIZATION STATUS
  32. 32. IMMUNIZATION SCHEDULE AGE VACCINE Birth BCG 6 wks DPT-1 OPV-1 Hep B-1 10 wks DPT-2 OPV-2 Hep B-2 14 wks DPT-3 OPV-3 Hep B-3 9 months Measles
  33. 33. CHECK THE CHILD’S VITAMIN A STATUS
  34. 34. VITAMIN A SUPPLEMETATION SCHEDULE : The first dose at 6 months or above. Subsequent doses every 6 months.
  35. 35. ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT AGED 1 WEEK TO 2 MONTHS
  36. 36. CHECK FOR POSSIBLE BACTERIAL INFECTION <ul><li>ASK : LOOK, LISTEN, FEEL : </li></ul><ul><li>Has the infant had + Count the infant’s breaths in one minute. </li></ul><ul><li>convulsions? Repeat the count if the infant is elevated. </li></ul><ul><li>+ Look for severe chest indrawing. </li></ul><ul><li>+ Look for nasal flaring. </li></ul><ul><li>+ Look and listen for grunting. </li></ul><ul><li>+ Look and feel for bulging fontanelle. </li></ul><ul><li>+ Look for pus draining from the ear. </li></ul><ul><li>+ Look at the umbilicus. Is it red or draining pus? </li></ul><ul><li> Does the redness extend to the skin? </li></ul><ul><li>+ Measure the infant’s temperature. </li></ul><ul><li>+ Look for skin pustules. Are there many or severe? </li></ul><ul><li>+ See if the infant is abnormally sleepy or difficult </li></ul><ul><li> to awaken? </li></ul><ul><li>+ Look at the infant’s movements? Are they not </li></ul><ul><li> normal? </li></ul>
  37. 37. <ul><li>Give an appropriate oral antibiotic. </li></ul><ul><li>Treat the local infection in the health center, and teach the mother to treat local infections at home. </li></ul><ul><li>Advise the mother regarding how to give home care to the infant. </li></ul><ul><li>Follow up in two days </li></ul>LOCAL BACTERIAL INFECTION <ul><li>Red umbilicus or draining pus </li></ul><ul><li>Skin pustules </li></ul><ul><li>Give the infant the first dose of intramuscular antibiotics </li></ul><ul><li>Treat the infant to prevent the lowering of his blood sugar level. </li></ul><ul><li>Advise the mother regarding how to keep the infant warm on the way to the hospital. </li></ul><ul><li>Refer the infant URGENTLY to a hospital. ** </li></ul>POSSIBLE SERIOUS BACTERIAL INFECTION <ul><li>Convulsions or </li></ul><ul><li>Fast breathing (60 breaths or more) or </li></ul><ul><li>Severe chest indrawing or </li></ul><ul><li>Nasal flaring or grunting </li></ul><ul><li>Bulging fontanelle </li></ul><ul><li>Pus draining from the ear </li></ul><ul><li>Umbilical redness extending to the skin </li></ul><ul><li>Fever (37.5 or above or feels hot) or low body temperature (less than 35.5 or feels cold) </li></ul><ul><li>Many of severe skin pustules or </li></ul><ul><li>Abnormally sleepy or difficult to awaken </li></ul><ul><li>Abnormal movement </li></ul>TREATMENT CLASSIFY SIGNS
  38. 38. Does the young infant have diarrhea?
  39. 39. CLASSIFY FOR DEHYDRATION <ul><li>Give the infant fluid to treat the diarrhea at home </li></ul>NO DEHYDRATION <ul><li>Not enough signs to allow classification as some or severe dehydration </li></ul><ul><li>Give the infant fluid and food for some dehydration </li></ul><ul><li>If the infant has a POSSIBLE SERIOUS BACTERIAL INFECTION OR DYSENTERY </li></ul><ul><li>+ Refer the infant URGENTLY to a hospital, with the mother giving the infant frequent sips of ORS </li></ul><ul><li>+ Advise the mother to continue breastfeeding </li></ul>SOME DEHYDRATION <ul><li>2 of the following signs : </li></ul><ul><li>Restless, irritable </li></ul><ul><li>sunken eyes </li></ul><ul><li>Pinched skin goes back to its original state very slowly </li></ul><ul><li>If the infant does not have a POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY </li></ul><ul><li>Give the infant fluid for sever dehydration </li></ul><ul><li>If the infant has a POSSIBLE SERIUS BACTERIAL INFECTION OR DYSENTERY </li></ul><ul><li>+ refer the infant URGENTLY to a hos[ital, with the mother giving the infant frequent sips of ORS on the way. </li></ul><ul><li>+ Advise the mother to continue breastfeeding. </li></ul><ul><li>+ Advise the mother regarding how to keep the infant warm on the way to the hospital. </li></ul>SEVERE DEHYDRATION <ul><li>2 or more of the following signs : </li></ul><ul><li>Abnormally sleepy or difficult to awaken </li></ul><ul><li>Sunken eyes </li></ul><ul><li>Pinched skin goes back to its original state very slowly </li></ul>TREATMENT CLASSIFY AS SIGNS
  40. 40. If there has been diarrhea for 14 days or more And if there is blood in the stool <ul><li>If the young infant has dehydration, treat the dehydration before referral to a hospital unless the infant has a POSSIBLE SERIOUS BACTERIAL INFECTION. </li></ul><ul><li>Refer the infant to a hospital. </li></ul>SEVERE PERSISTENT DIARRHEA * Diarrhea lasting for 14 days or more TREATMENT CLASSIFY ASSESS <ul><li>Refer the infant URGENTLY to a hospital, with the mother giving the infant frequent sips of ORS on the way. </li></ul><ul><li>Advise the mother to continue breastfeeding the infant. </li></ul>DYSENTERY * Blood in the stool TREATMENT CLASSIFY ASSESS
  41. 41. CHECK FOR FEEDDING PROBLEMS OR A LOW WEIGHT FOR AGE
  42. 42. <ul><li>IF YES , ASK : LOOK, LISTEN, FEEL : </li></ul><ul><li>Is it difficult to feed the infant? + Determine the infant’s weight for age. </li></ul><ul><li>Is the infant being breastfed? If yes, </li></ul><ul><li>how many times is he being breastfeed </li></ul><ul><li>in 24 hours. </li></ul><ul><li>Does the infant usually receive any food </li></ul><ul><li>or drink? If yes, how often does he receive </li></ul><ul><li>it? </li></ul><ul><li>What do you use in feeding the infant? </li></ul><ul><li>------------------------------------------------------------------------------------------------- </li></ul><ul><li>IF AN INFANT : Has difficulty in feeding. </li></ul><ul><li>Is breastfeeding less than 8 times in 24 hours? </li></ul><ul><li>Is taking any food or drink </li></ul><ul><li>Has a low weight for AGE, and </li></ul><ul><li>If there are no indications that the infant should be referred </li></ul><ul><li> urgently TO a hospital. </li></ul>
  43. 43. <ul><li>ASSESS THE INFANT’S BREASTFEEDING : </li></ul><ul><li>Did the infant breastfeed in the previous hour? </li></ul><ul><li>+ If the infant did not feed in the previous hour, as the mother to position her infant against her breast. Observe the breastfeed for 4 minutes. </li></ul><ul><li>+ Is the infant able to attach? </li></ul><ul><li>No attachment – not well attached-good attachment </li></ul><ul><li>To check for attachment, look for : </li></ul><ul><li>Chin touching the breast </li></ul><ul><li>mouth wide open </li></ul><ul><li>lower lip turned outward </li></ul><ul><li>more areola visible above than below the mouth </li></ul><ul><li>+ Is the infant suckling effectively (slow, deep sucks, something pausing?) </li></ul><ul><li>+ Clear the infant’s blocked nostrils if they are intefering with breastfeeding. </li></ul><ul><li>+ Look for ulcers or white patches in the mouth. </li></ul>
  44. 44. <ul><li>Advise mother how to give home care to infant </li></ul><ul><li>Praise the mother for feeding the infant well. </li></ul>NO FEEDING PROBLEM * Does not have low weight and no other sign <ul><li>Advise the mother to breastfeed the infant often and for as long as the infant wants to be breastfed, day and night. </li></ul><ul><li>+ If the infant is not well attached or not suckling effectively, teach the mother the correct positioning and attachment. </li></ul><ul><li>+ If the infant is breastfeeding less than 8 times in 24 hours, advise the mother to increase the frequency of feeding. </li></ul><ul><li>If the infant is receiving other foods or drinks, counsel the mother about breastfeeding the infant more, reducing the infant’s intake of food and drinks, using a cup. </li></ul><ul><li>If the infant is not breastfeeding at all: </li></ul><ul><li>+ Refer the mother to breastfeeding counselling and possibly relactation </li></ul><ul><li>+ Advise the mother about the correct preparation of breastmilk substitutes. </li></ul><ul><li>If the infant has thrush, teach the mother how to treat it. </li></ul><ul><li>Followup any feeding problem or thrush in 2 days </li></ul><ul><li>Follow up low weight for age in 14 days. </li></ul>FEEDING PROBLEM OR WEIGHT LOW FOR AGE <ul><li>Not well attached to the mother’s breast </li></ul><ul><li>Not suckling effectively </li></ul><ul><li>Breastfeeds less than 8 times in 24 hours </li></ul><ul><li>Receives other foods or drinks </li></ul><ul><li>Has thrush </li></ul><ul><li>Give the infant the first dose of intramuscular antibiotics </li></ul><ul><li>Treat the infant to prevent the lowering of his blood sugar level. </li></ul><ul><li>Advise the mother regarding how to keep the infant warm on the way to the hospital </li></ul><ul><li>Refer the infant URGENTLY to a hospital. </li></ul>POSSIBLE SERIOUS BACTERIAL INFECTION <ul><li>Not able to feed or </li></ul><ul><li>No attachment at all </li></ul><ul><li>Not suckling at all </li></ul>
  45. 45. Check the infant’s Immunization Status DPT – 1 OPV – 1 Hep B-1 6 weeks BCG Birth Immunization Schedule VACCINE AGE

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