Diagnosis and Management of children with throat problem with reference to IMNCI (Integrated Management of Neonatal and Childhood Illness)

1. A practical approach to the child with
Throat Problem
Background, Assessment and Management
Prof. Imran Iqbal
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

3. IMNCI
A Strategy for
Outpatient Case Management
of Children
under five years of age

4. Step 1
General Danger Signs
General Danger Signs indicate severe disease
Presence of any one of the General Danger Signs
means that the child needs to be
referred / admitted to the emergency

5. Check for General Danger Signs
• Unable to drink or breastfeed
• Vomiting everything
• Lethargic or unconscious
• Convulsions
• General Danger Signs indicate severity of illness
• Not diagnostic but suggests acuity of situation

6. Step 2
Assess for
Cough or Difficult Breathing

7. Step 3
Assess for
Diarrhoea

8. Step 4
Assess for
Sore Throat

9. Assess for Sore Throat
• ASK: Does the child have Throat Problem ?
• IF YES
• ASK: Does the child have sore throat ?
• ASK: Is the child able to drink ?
• ASK: Does the child have fever ?
• Look and Feel:
Fever (temperature 37.5 C or above)
 Feel the front of neck for tender enlarged lymph nodes
 Look for red, enlarged tonsils
 Look for exudate on the throat
 Throat and Ear examination of Child needs appropriate position and should be performed last in
the sequence of physical examination

10. Causes of Sore Throat in Children
• Viral Infections –
URTI -- (runny nose, pain in throat)
Viral pharyngitis -- (diffuse redness in throat)
Herpangina – (small ulcers in throat)
• Bacterial Infections – Streptococcal Tonsillitis (High Fever)
-- Diphtheria (Not able to drink)
• Throat Abscess – Rare (unable to drink)
• Allergy – seen after intake of cold water, ice-cream, sour food

11. Diphtheria
• Caused by Corynebacterium diphtheria
• Age 2 – 15 years, can occur in adults
• Fever, sore throat
• Enlarged cervical lymph nodes with edema – bull neck
• Unilateral Thick, Greyish Exudate (pseudo-membrane) seen on posterior
pharynx
• Laryngeal diphtheria causes stridor and Respiratory Obstruction requiring
Tracheostomy
• Diphtheria toxin causes Myocarditis and Neuropathy
• Management is Anti-diphtheria serum and antibiotics
• Mortality is high

12. Streptococcal Tonsillitis
• Causative agent is a bacteria
which is carried and
transmitted from the throat
• Gram positive streptococci
• Streptococcus pyogenes
• Group A beta Hemolytic
Streptococci

13. Streptococcal Tonsillitis
 Common in children from 1 to 15 years of age
 Recurrent attacks in a year can occur
 Good response to appropriate antimicrobial therapy
 Streptococcal Infection can result in Rheumatic fever which is
a multi-system inflammatory disease seen at 5-15 years of age
 Tonsillectomy may be indicated in very frequent attacks of
Streptococcal tonsillitis or very large infected tonsils in
children more than five years of age

14. Streptococcal Tonsillitis
 Red enlarged tonsils
 Exudate on the tonsils
 Tender, enlarged cervical lymph nodes
 Presence of 2 of 3 signs gives a clinical
diagnosis of Streptococcal tonsillitis

15. Bacterial Throat Infections
Streptococcal Tonsillitis Diphtheria

16. Viral Sore Throat
• Caused by Adeno virus, Corona virus, Parainfluenza virus
• Pain in throat
• Painful swallowing
• Small ulcers on faucial pillars
• No fever or low grade fever
• Runny nose may be present
• Diffuse redness in throat is seen
• Recovers in 3-5 days

17. Assess for Sore Throat
• ASK: Does the child have Throat Problem ?
• IF YES
• ASK: Does the child have sore throat ?
• ASK: Is the child able to drink ?
• ASK: Does the child have fever ?
• Look and Feel:
Fever (temperature 37.5 C or above)
 Feel the front of neck for tender enlarged lymph nodes
 Look for red, enlarged tonsils
 Look for exudate on the throat
 Throat and Ear examination of Child needs appropriate position and should be performed last in
the sequence of physical examination

18. Classify Throat Problem

19. Classify Throat Problem

20. Treat Throat Problem
• Sore Throat and Not able to Drink – Admit / Refer urgently
• Streptococcal Sore Throat -- Amoxycillin (oral)
or Amoxycillin IV in severe cases
-- Paracetamol (oral)
• Viral Sore Throat -- Paracetamol (oral)
-- safe, soothing remedies

21. PREVENTION

22. Prevention of Throat Problems
• Vaccination – EPI
Penta (DPT, Hib, Hep B),
Influenza
• Social distancing, use masks
• Avoid contact with persons having fever or cough
• Hand washing
• Avoid chilled water, ice-cream, sour foods

23. 3-Jul-20 Prepared By: Medical and Compliance 23
Prevention:Vaccination
Age Vaccine
At Birth BCG and OPV-0
6 Week Penta-I, Pneumo-I and OPV-I
10 Week Penta-II, Pneumo-II and OPV-II
14 Week Penta-III, Pneumo-III, IPV and OPV-III
9 Months Measles-I
15 Months Measles-II
http://epi.gov.pk/?page_id=139
EPI: Expanded Program on Immunzation (Pakistan)