Danger signs in children

1. IMCI PROGRAM AND
GENERAL DANGER SIGNS IN
CHILDREN
BY VYSHNAVI MALLADI
GM 20-115

2. IMCI AND IT’S REGULATIONS
• IMCI IS INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS.
• IT’S APPROACH IS TO FOCUS ON THE HEALTH AND WE’LL BEING OF THE CHILD, BY
REDUCING MORTALITY RATE AND MINIMIZE ILLNESS AND DISABILITY AND BY
PROMOTING HEALTHY GROWTH AND DEVELOPMENT IF NEW BORN BABIES UNDER
FIVE YEARS OF AGE.
• IT’S STRATEGY INCLUDES THREE MAIN COMPONENTS;
(A) IMPROVING CASE MANAGEMENT SKILLS OF HEALTHCARE PROVIDERS.
(B) IMPROVING HEALTH SYSTEMS TO PROVIDE QUALITY CARE
(C) IMPROVING FAMILY AND COMMUNITY HEALTH PRACTICES FOR HEALTH, GROWTH
AND DEVELOPMENT.

3. STAGES OF MANAGEMENT ACCORDING TO
IMCI
• EMERGENCY TRIAGE
• EMERGENCY TREATMENT
• HISTORY TAKING
• EXAMINATION
• LABORATORY DIAGNOSIS
• DIFFERENTIAL DIAGNOSIS
• TREATMENT
• SUPPORTIVE CARE AND MONITORING
• PLANNING DISCHARGE

4. EMERGENCY TRIAGE
• IT IS A RAPID SCREENING TEST IN ORDER TO IDENTIFY THE CASE OF THE CHILD
BY FOLLOWING SIGNS MENTIONED:
• WITH EMERGENCY SIGNS, REQUIRE IMMEDIATE EMERGENCY TREATMENT.
• THOSE WITH PRIORITY SIGNS, GIVEN PRIORITY FIRST IN THE QUEUE FOR
TREATING THEM WITHOUT DELAY.
• NON-URGENT CASES, WHO HAVE NO SIGNS MENTIONED ABOVE.

5. • EMERGENCY SIGNS ARE AS FOLLOWS:-
• OBSTRUCTION OF BREATH
• SEVERE RESPIRATORY DISTRESS
• CENTRAL CYANOSIS
• SIGNS OF SHOCK LIKE- COLD HANDS, 3 SEC LONGER CAPILLARY REFILL TIME,
HIGH HR WITH WEAK PULSE, LOW OR U MEASURABLE BLOOD PULSE.
• COMA OR SERIOUSLY REDUCED LEVEL OF CONSCIOUSNESS
• CONVULSIONS
• SIGNS OF SEVERE DEHYDRATION WITH DIARRHOEA

6. HISTORY TAKING
• IN YOUNGER INFANTS, THE HISTORY OF PREGNANCY AND BIRTH ARE VERY
IMPORTANT. THE FEEDING HISTORY OF INFANTS AND YOUNGER CHILDREN IS
REQUIRED, SO WE CAB ASSESS IN CASE OF MALNUTRITION.
• FOR OLDER CHILDREN, COLLECTING THE INFO ON THEIR DEVELOPMENT IS
IMPORTANT.
• TAKING A HISTORY GENERALLY STARTS WITH UNDERSTANDING THE PRESENT
COMPLAIN. IT PROGRESSES TO THE HISTORY OF THE PRESENT ILLNESS.

7. APPROACH TO THE SICK CHILD AND CLINICAL
EXAMINATION
• ABD HE APPROACH OF EXAMINING CHILDREN SHOULD BE FLEXIBLE, AND ORGANIZED
IN A WAY TO NOT UPSET THE CHILD.
• OBSERVE AS MANY AS SIGNS POSSIBLE BEFORE TOUCHING THE CHILD
• CHECK FOR FOLLOWING SIGNS:
• DOES THE CHILD SPEAK, CRY OR MAKE ANY SOUNDS
• IS THE CHILD ALERT, INTERESTED AND LOOKING ABOUT
• DOES THE CHILD APPEAR DROWSY
• IS THE CHILD IRRITABLE
• IS THE CHILD VOMITING
• IS THE CHILD ABLE TO BREASTFEED
• ARE THEY CYANOSED OR PALE
• ANY SIGNS OF RESPIRATORY DISTRESS
• DOES THEY USE AUXILIARY MUSCLES TO BREATH
• AND MORE SIGNS.

8. LABORATORY INVESTIGATIONS
• THEY ARE TARGETED ON THE BASIS OF THE HISTORY AND EXAMINATION AND
HELP NARROW THE DIFFERENTIAL DIAGNOSIS, THEY SHOULD BE AVAILABLE IN
EVEN SMALL PAEDIATRIC CLINICS.
• THEY ARE :
• HB OR PACKED CELL VOLUME
• FULL BLOOD COUNT
• BLOOD SMEAR FOR MALARIA PARASITES
• BLOOD GLUCOSE
• CSF MICROSCOPY
• URINANALYSIS
• HIV TESTING
• BLOOD GROUPING AND CROSS MATCHING
• IN CASE OF SICK NEWBORNS (<1 WEEK) BLOOD BILIRUBIN IS ALSO REQUIRED TO
CHECK.

9. DIFFERENTIAL DIAGNOSIS AND TREATMENT
• AFTER THE ASSESSMENT HAS BEEN COMPLETED, CONSIDER THE VARIOUS
CONDITIONS THAT COULD CAUSE THE CHILD’S ILLNESS AND MAKE A LIST OF
POSSIBLE DIFFERENTIAL DIAGNOSIS.
• AFTER DETERMINING THE DIAGNOSIS, TREATMENT MUST BE PLANNED AND
STARTED.
• IF THERE IS ONE OR MORE DIAGNOSIS TREATMENT MIGHT HAVE TO BE GIVEN
TOGETHER.
• THE LIST OF DIFFERENTIAL DIAGNOSES SHOULD BE REVIEWED AFTER OBSERVING
THE RESPONSE TO THE TREATMENT OR AFTER NEW CLINICAL FINDINGS.

10. DANGER SIGNS IN NEWBORNS AND YOUNG
INFANTS
• THESE SIGNS INCLUDE:
• NOT FEEDING WELL
• CONVULSIONS
• DROWSY OR UNCONSCIOUSNESS
• LESS MOVEMENTS
• FAST BREATHING
• GRUNTING
• SEVERE CHEST INDRAWING
• RAISED TEMPERATURE, >38°C
• HYPOTHERMIA, <35.5°C
• CENTRAL CYANOSIS

11. EMERGENCY MANAGEMENT OF DANGER
SIGNS
• OPEN AND MAINTAIN AIRWAY, GIVE OXYGEN BY NASAL PRONGS IF THE INFANT
IS CYANOSED OR IN SEVERE RESPIRATORY DISTRESS OR HYPOXAEMIC.
• GIVE BAG AND MASK VENTILATION WITH OXYGEN IF THERE IS APNOEA, GASPING
OR RESPIRATORY RATE IS TOO SLOW.
• INSERT VENOUS CANNULA
• GIVE ANTIBIOTICS, AMPICILLIN OR GENTAMICIN
• IF DROWSY, UNCONSCIOUS OR CONVULSING, CHECK BLOOD GLUCOSE LEVEL. IF
GLUCOSE IS < 2.2 MMOL/L, THEN GIVE 10% GLUCOSE AT 2 ML/KG IV. AND
FURTHER DOSES BY GIVEN CONDITIONS.
• GIVE VITAMIN K
• GIVE PHENOBARBITAL IF CONVULSING.
• MONITOR THE INFANT FREQUENTLY BY ADMITTING INTO CLINIC.

12. • IF THE MENTIONED EMERGENCY SIGNS AREN‘T FOUND THEN SEE FOR PRIORITY
SIGNS, THOSE ARE:
• TINY INFANT OR ANY SICK CHILD AGED < 2 MONTHS
• TEMPERATURE (HIGH)
• TRAUMA OR URGENT SURGICAL CONDITION
• PALLOR (SEVERE)
• POISONING (HISTORY)
• SEVERE PAIN
• RESPIRATORY DISTRESS
• RESTLESS, LETHARGY CONTINUITY
• MALNUTRITION
• OEDEMA OF BOTH FEET
• BURNS (MAJOR)

13. THANK YOU.