y All sick children must be examined for General

Danger Signs

y All sick children must be routinely assessed for Major

Symptoms

y Assessed for Nutritional Status, Immunization

Status, & Vitamin A Status

y Only a limited number of carefully selected clinical

signs are used.

y IMCI management procedures use a limited number

of essential drugs & encourage active participation of caretakers.

y An essential component of the IMCI guidelines is the

counseling of caretakers.

Ask the Mother what the child s problems are?

IF YES

REFER URGENTLY + 1st DOSE of APPROPRIATE ANTIBIOTICS & Other URGENT TREATMENT

y Does the child have Cough or Difficult Breathing?

IF YES: ASK: How Long?

LOOK & LISTEN: RR Chest Indrawing Stridor

1. Fast Breathing?

2. No Signs of PNM

3. Danger Signs + Chest Indrawing and Stridor

SIGNS

CLASSIFY AS SEVERE PNEUMONIA OR VERY SEVERE DISEASE

TREATMENT ANTIBIOTIC VIT. A TREAT TO PREVENT LOW BLOOD SUGAR REFER! Antibiotic (5 days) Soothe the throat When to Return Follow up in 2 days Soothe the throat When to Return Follow up in 5 days

CUVACS

Fast Breathing

PNEUMONIA

No signs of PNM or Very Severe Disease

NO PNEUMONIA: COUGH OR COLD

SIGNS

CLASSIFY AS

TREATMENT

CUVACS

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

1st Dose of Antibiotic Refer * Treat Low Blood Sugar at Vit A Antibiotic (3 days) (+) Wheezing = Rapid acting Bronchodilator (5 days) More than 3 weeks (BAKA TB) Soothe the throat When to Return Follow up in 2 days (+) Wheezing = Rapid acting Bronchodilator (5 days) More than 3 weeks (BAKA TB) Soothe the throat When to Return Follow up in 5 days

Fast Breathing

PNEUMONIA

No signs of PNM or Very Se ere Disease

NO PNEUMONIA: COUGH OR COLD

y Does the child have Diarrhea?

IF YES: ASK: How Long? Is there a blood in the stool?

LOOK & LISTEN: General Condition Sunken Eyeball Not able to drink or eagerly Pinch skin (very slow or slow)

 Dehydration  If Diarrhea is for 14 days and more  If presence of blood in the stool

Dehydration 1. Thirsty Sunken Eyes Slow Skin Pinch 2. Abnormally Sleepy Sunken Eyes Very Slow Skin Pinch

3. No enough signs and symptoms

DEHYDRATION 2 of the following signs Sunken eyeball Skin pinch = ery slow Unable to drink Abnormally sleepy 2 of the following signs Sunken eyeball Skin pinch = slow Drinks eagerly Restless Not enough signs to classify as some or se ere dehydration No other se ere classification: Plan C REFER! (ORS/BF) 2 yrs old + (+) cholera in area = Antibiotic Plan B When to Return Follow up in 5 days If not impro ing Plan A Zinc Supplement When to Return Follow up in 5 days

SEVERE DEHYDRATION

SOME DEHYDRATION

NO DEHYDRATION

DEHYDRATION 2 of the following signs Sunken eyeball Skin pinch = ery slow Unable to drink Abnormally sleepy 2 of the following signs Sunken eyeball Skin pinch = slow Drinks eagerly Restless Not enough signs to classify as some or se ere dehydration No other se ere classification: Plan C REFER! (ORS/BF) 2 yrs old + (+) cholera in area = Antibiotic Plan B Zinc Supplement When to Return Follow up in 5 days If not impro ing Plan A Zinc Supplement When to Return Follow up in 5 days

SEVERE DEHYDRATION

SOME DEHYDRATION

NO DEHYDRATION

Diarrhea of 14 days and more 1. 14 days Sunken Eyes Abnormally Sleepy 2. 14 days Sunken Eyes Slow Skin Pinch Restless 3. 14 days No sunken eyes Skin pinch goes back fast

If Diarrhea is 14 days or more

(+) Dehydration

SEVERE PERSISTENT DIARRHEA

Treat Dehydration Vit. A REFER! Ad ise on feeding Vit. A Follow up in 5 days When to Return

(-) Dehydration

PERSISTENT DIARRHEA

If Diarrhea is 14 days or more

(+) Dehydration

SEVERE PERSISTENT DIARRHEA

Treat Dehydration REFER! * Vitamin A Ad ise on feeding Gi e multi itamins and minerals + zinc for 14 days Follow up in 5 days *When to Return

(-) Dehydration

PERSISTENT DIARRHEA

(+) Blood in the Stool

Blood in the stool

DYSENTERY

Antibiotic (5 days) Follow up in 2 days When to Return

(+) Blood in the Stool

Blood in the stool

DYSENTERY

Ciprofloxacin (3 days) Follow up in 2 days *When to Return

UPDATE

y Does the child have fever?

ASK:

Does the child live in a malaria area? Has the child visited/travelled in a malaria area in the past 4 weeks?

YES to EITHER: OBTAIN BLOOD SMEAR

IF YES: ASK:

How long? If more than 7 days

Fever = everyday?

(+) Measles within the last 3 months

LOOK & LISTEN:

Stiff neck, Runny nose Generalized Rash, Cough, Runny Nose, Red Eyes

Malaria Risk 1. Li es in Palawan (-) Blood Smear (+) Measles 2. Stayed in Palawan for 1 month (+) Blood Smear CUVAS 3. Had a Vacation in Palawan for 2 months (+) Blood Smear No danger signs and stiff neck

MALARIA RISK Quinine Antibiotic Low Blood Sugar Paracetamol Send the blood smear with client REFER! Oral Antimalarial Paracetamol When to Return Follow up in 2 days

CUVAS

VERY SEVERE FEBRILE DISEASE

(+) Blood smear > If BS is not done: (-) runny nose (-) measles (-) other cause of fe er (-) Blood smear (+) runny nose (+) measles (+) other cause of fe er

MALARIA

FEVER: MALARIA UNLIKELY

Paracetamol When to Return Follow up in 2 days

No Malaria Risk

1. Caregi er reported no tra elling for the past year Con ulsion Stiff Neck 2. Caregi er reported of 38 degree celsius temperature of her child with the use of a rectal thermometer

NO MALARIA RISK Antibiotic Low Blood Sugar Paracetamol REFER! Paracetamol When to Return Follow up in 2 days

CUVAS

VERY SEVERE FEBRILE DISEASE

No signs of ery se ere febrile disease

FEVER: NO MALARIA

y If the child has measles now or within the last 3

months ASK:

Measles within last 3 months?

LOOK & LISTEN: Signs of measles (cough, runny nose, red eyes) Mouth Ulcers Pus draining from eyes Clouding of cornea

Measles 1. Cough Coryza Conjuncti itis NOW 2. Pus draining from the eye Mouth Ulcer 3. Danger Signs Clouding of the Cornea Deep Mouth Ulcer

Clouding of cornea Deep or extensi e mouth ulcers CUVA

SEVERE COMPLICATED MEASLES

Antibiotic Vit. A Tetracycline or Gentian Violet REFER! Vit. A Tetracycline or Gentian Violet Follow up in 2 days When to Return Vit. A When to Return

Pus draining from the eye Mouth ulcers

MEASLES WITH EYE/MOUTH COMPLICATION

Measles now or within the last 3 months

MEASLES

y If DENGUE risk
ASK: Has the child had any bleeding from nose or gums Has the child had black vomitus? Persistent vomiting? Black stools? Persistent abdominal pain

LOOK & LISTEN: Bleeding in nose and gums Skin petechiae Cold & clammy extremities Tourniquet test

Dengue Hemorrhagic Fe er 1. (-) Persistent Vomiting (-) Tourniquet test 38.1 degree Celsius (-) Melena 2. (+) Black Vomitus (+) Melena (+) Abdominal Pain Epistaxis 3. (+) Tourniquet Test (+) Vomiting (+) Abdominal Pain

BLEEDING Skin petechiae + Tourniquet Test Cold and Clammy ext. Persistent abd pain Persistent omiting Bleeding in Stool

SEVERE DENGUE HEMORRHAGIC FEVER

(+)VAST: Plan B Signs of Bleeding: Plan C Low Blood Sugar NO ASPIRIN! REFER!

No signs of SDHF

FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

NO ASPIRIN! Follow up in 2 days if fe er persist or (+) signs of Bleeding When to Return

y Does the child have an Ear Problem?

IF YES:
ASK: Is there Ear Pain? Ear Discharge? How Long?

LOOK & LISTEN: Pus Tender swelling behind ear

Ear Problem 1. No Tender Swelling Behind ear No pus draining No pain

2. More than 14 days of pus draining from the ear

3. 12 days complain of ear pain and pus draining

4. Tender Swelling Behind Ear

Tender swelling behind the ear

MASTOIDITIS

Antibiotic Paracetamol REFER! Antibiotic (5 da s) Paracetamol Dr the ear b wicking Follow u in 5 da s When to Return Dr the ear b wicking Follow u in 5 da s When to Return

Discharge of ess than da s Ear ain

ACUTE EAR INFECTION

Discharge of more

da s or

CHRONIC EAR INFECTION

No ear ain No discharge

NO EAR INFECTION

No additional treatment

UPDATE Antibiotic Paracetamol REFER! Antibiotic (5 days) Paracetamol Dry the ear by wicking Follow up in 5 days When to Return Dry the ear by wicking Treat with Topical Quinolone Follow up in 5 days When to Return

Tender swelling behind the ear

MASTOIDITIS

Discharge of Less than 14 days Ear pain

ACUTE EAR INFECTION

Discharge of 14 days or more

CHRONIC EAR INFECTION

No ear pain No discharge

NO EAR INFECTION

No additional treatment

LOOK & LISTEN: Visible severe wasting Edema on both feet Palmar pallor: Severe or some? Weight
y Classify nutritional status

VES

SEVERE MALNUTRITION OR SEVERE ANEMIA

Vit. A REFER! Paracetamol Assess childs feeding: Follow up in 5 days (FEEDING PROBLEM) Iron and Mebendazole (12 months + (-) 6 months) Follow up in 14 days Vit. A: Follow up in 30 days (LOW WEIGHT)

Some Palmar pallor Very low weight for age

ANEMIA OR VERY LOW WEIGHT

Not ery low weight for age

NO ANEMIA OR Not VERY LOW WEIGHT

Assess childs feeding: Follow up in 5 days

UPDATE

VE

SEVERE MALNUTRITION

Treat to pre ent LOW BLOOD SUGAR REFER!

Very low weight for age

VERY LOW WEIGHT

Assess childs feeding: Follow up in 30 days

Not ery low weight for age

NOT VERY LOW WEIGHT

Assess childs feeding: Follow up in 5 days

UPDATE

Se ere Palmar Pallor

SEVERE ANEMIA

REFER! Gi e Iron Mebendazole Anti Malarial (Malaria Risk) Follow 14 days

Some Palmar Pallor

ANEMIA

No Palmar Pallor

NO ANEMIA

Assess childs feeding: Follow up in 5 days

IMMUNIZATION SCHEDULE
AGE Birth 6 weeks 10 weeks 14 weeks 9 months VACCINE BCG DPT1, OPV1, Hep-B1 DPT2, OPV2, Hep-B2 DPT3, OPV3, Hep-B3 Measles

Vitamin A Supplementation Schedule y Give the first dose at 6 months or above. y Give subsequent doses every 6 months.

Give an Appropriate Oral Antibiotic

For Pneumonia, Acute Ear Infection, or Very Severe Disease
y First-line antibiotic: y Second-line antibiotic:

COTRIMOXAZOLE (2 X daily for 5)

AGE/WEIGHT ADULT TAB 80 mg Trimethoprim + 400 mg sulphamethoxazole 1 SYRUP 40 mg T + 200 mg S /5ml 5 10

2 mos 12 mos (4-<10kg) 12 mos 5 years (10-19 kg)

AMOXYCILLIN (3 x daily for 5)

AGE/WEIGHT 2 mos 12 mos (4-<10 kg) 12 mos 5 years (10-19 kg) TABLET 250 mg 1 SYRUP 125 mg/5ml 5 10

UPDATE

Give an Appropriate Oral Antibiotic

For Pneumonia, Acute Ear Infection, or Very Severe Disease
y First-line antibiotic: Amoxicillin/Co - Tri y Second-line antibiotic:

Give an Appropriate Oral Antibiotic

For Dysentery
y First-line antibiotic: y Second-line antibiotic:

COTRIMOXAZOLE
y SAME with above doses

NALIDIXIC ACID (4 x a day for 5)

AGE/WEIGHT 2 mos 4 mos (4-<6 kg) 4 mos 12 mos (6-<10kg) 12 mos 5 years (10-19 kg) SYRUP 250 mg/5ml 1.25 2.5 5

UPDATE

Give an Appropriate Oral Antibiotic

For Dysentery
y First-line antibiotic: CIPROFLOXACIN (BID x 3) y Second-line antibiotic:

Give an Appropriate Oral Antibiotic

For Cholera
y First-line antibiotic: y Second-line antibiotic:

TETRACYCLINE (4 x a day for 5)

AGE/WEIGHT 2 mos 4 mos (4-<6 kg) 4 mos 12 mos (6-<10 kg) 12 mos 5 years (10-19 kg) CAPSULE (250 mg)

COTRIMOXAZOLE
y Same with above doses

UPDATE

Give an Appropriate Oral Antibiotic

For Cholera
y First-line antibiotic: Tetracycline y Second-line antibiotic: ERYTHROMYCIN (4x for 3)

y Determine appropriate drugs and dosage for child s age and weight y Tell the reason for giving drugs y How to measure y Watch mother perform measuring dose herself y 1st dose y Explain carefully how to give drugs, then label y Finish all course of tx y Check the mother s understanding before she leaves

Give an Oral Antimalarial

y First-line Antimalarial: y Second-line Antimalarial: Artemeter

CHLOROQUINE
Remember!
y Watch the child carefully for 30 mins. y Itching is a possible side effect but is not dangerous.

SULFADOXINE & PYRIMETHAMINE

Remember!
y If the child with some palmar pallor is receiving the

antimalarial Sulfadoxine-Pyrimethamine (Fansidar), do not give Iron/Folate until a follow up in two weeks.

CHLOROQUINE (3 days)
AGE DAY 1 2 mos 5 mos (4-<7 kg) 5 mos 12 mos (7-<10 kg) 12 mos 3 yrs (10-<14 kg) 3 yrs 5 yrs (14-<19 kg) 1/2 1/2 1 1 1/2 TABLET ( 150 mg base ) DAY 2 1/2 1/2 1 1 1/2 DAY 3 1

PRIMAQUINE
AGE/WEIGHT P (Single Dose in HC for P.Falcifarum) Tablet (15 mg base) 2 mos 5 mos (4-<7 kg) 5 mos 12 mos (7-<10 kg) 12 mos 3 yrs (10-<14 kg) 3 yrs 5 yrs (14-<19 kg) 1/2 3/4 P (Give Daily for 14 days for P. vivax) Tablet (15 mg base)

SULFADOXINE + PYRIMETHAMINE (Single dose)

AGE/WEIGHT 2 mos 5 mos (4-<7 kg) 5 mos 12 mos (7-<10 kg) 12 mos 3 yrs (10-<14 kg) 3 yrs 5 yrs (14-<19 kg) TABLET (500 mg S + 25 mg P) 1

UPDATE

Give an Oral Antimalarial

y First-line Antimalarial: Co Artemeter Lumefantrine y Second-line Antimalarial:

 Artemeter is 20 mg while Lumefantrine is 120 mg  5 months 3 years (1 tab): 0h, 8h, 24h, 36h, 48h, 60h  3 years 5 years (2 tabs): 0h, 8h, 24h, 36h, 48h, 60h

Give Paracetamol
y High Fever y Ear pain

y Give paracetamol every 6 hours

Give Vitamin A (100,000; 200,000 IU)

y 6 months to 1 year old: y 1 year old to 5 years:

Give Iron
y Give one dose daily for 14 days.

Give Mebendazole/Albendazole
y Give 500 mg Mebendazole as a single dose in health

A (400 mg): M (500 mg): 1 24 mos 59 mos: A (400 mg): 1 M (500 mg): 1

center if: 12 mos 23 mos:

EYE INFECTION
y Treat Eye Infection 3 times daily y Tetracycline Eye Oinment

EAR INFECTION
y Dry the Ear by wicking atleast 3 times daily

MOUTH ULCERS
y Treat Mouth ulcers with Gentian Violet y Treat the mouth ulcers twice daily

COUGH
y Soothe the Throat, Relieve the Cough with Safe

Remedy
y BF, Tamarind, Calamansi, Ginger

Do not give:
y Codeine cough syrup y Other cough syrups y Oral and nasal decongestants y Antitussives

Give an Intramuscular Antibiotic

y For children being referred urgently who cannot take

an oral antibiotic:
y GIVE 1st DOSE of IM CHLORAMPHENICOL
UPDATE

Ampicillin 50mg/kg Gentamicin 7.5 mg/kg

Give an Intamuscular Antibiotics

y If Referral is not possible: y Repeat chloramphenicol injection q 12 hours for 5 days y Change to oral antibiotics to complete 10 days tx

Give Quinine for Severe Malaria

y For children being referred with very severe febrile

disease/ malaria:
y GIVE 1st DOSE OF IM QUININE

y If Referral is not possible: y Give 1st IM QUININE y Remain lying down for 1 hour y Repeat injection 4-8 hours, then 12 hours until child is able to take oral anti malarial

REMEMBER!!!
y DO NOT GIVE QUININE TO A CHILD LESS THAN 4

MONTHS OF AGE.

TREAT HYPOGLYCEMIA
y If the child is able to breastfeed: y If unable to breastfeed, but able to swallow: y Give EXPRESSED MILK/BREASTMILK SUB y SUGAR WATER y Make sugar water: 20gms sugar + 200ml water

y If unable to swallow: y 50 ml of milk or sugar water thru NGT y If unconscious & NGT is not possible: y Give D10 IV y Give D50 slow push

PLAN A: 3 Rules of Home Treatment

y Give extra Fluid y BF y ORS y FLUID INTAKE
y y

Up to 2 years 50 to 100 ml each stool 2 years & more 100 -200 ml each stool

y Continue Feeding y When to Return

PLAN B: 4 Hours ORS Treatment

y Give ORS during the first 4 hours

Age Weight In ml

0-4mos < 6 kg 200-400

4mos1year 6-<10 kg 400-700

1-2 years 10-<12 kg 700-900

2-5 years 12-19 kg 900-1400

y For infants under 6 months who are not breastfed, also

give 100-200 ml clean water during this period.

Things to Remember!
y What if the child vomits? y What will you do after 4 hours? y Reassess child classify DHN y Select app. Plan to continue TX y Begin feeding the child in health center y If the Mother must leave before completing treatment: y Prepare ORS, Give enough ORS packs, Plan A Rules

PLAN C: I.V. Treatment

y Start IV fluid Immediately y Give 100 ml/kg Ringer s Lactate solution
1st give 30 ml/kg in: 1 hour 30 minutes Then give 70 ml/kg in: 5 hours 2 hours

Age 0-1 year 1-5 years

y Reassess an infant after 6 hours and a child after 3

hours.

PNEUMONIA
y After 2 days y If (+) chest indrawing or a general danger sign:

URGENT REFERRAL
y If breathing, fever,& eating are the same:

2nd Line Antibiotics

y If breathing is slower, less fever or eating better:

COMPLETE 5 days Antbiotics

PERSISTENT DIARRHEA
y After 5 days y If the diarrhea has not stopped: REASSESS, TREAT,

then REFER
y If the diarrhea has stopped: Inform the mother to

follow USUAL RECOMMENDATION for child s age

DYSENTERY
y After 2 days y If the child is dehydrated: 2nd line antibiotics for 5

days, FFUP 2 days

y If condition becomes better: Continue giving same

antibiotics

MALARIA
y If fever persists after 2 days, or returns after 14 days:

FULL ASSESSMENT, CLASSIFY

y If (+) CUVAS: Treat as VERY SEVERE MALARIA y If (+) other cause of fever other than malaria: y Provide Treatment y If Malaria is the only apparent cause of fever: y Blood Smear, 2nd line antimalarial

FEVER-MALARIA UNLIKELY
y If fever persists after 2 days: ASSESS, CLASSIFY y If (+) CUVAS: Treat as VERY SEVERE MALARIA y If Malaria is the only apparent cause of fever: y Blood smear, 1st line antimalarial

FEVER (NO MALARIA)

y If fever persists after 2 days: ASSESS, CLASSIFY y If (+) travel to a malarious area and blood smear(+):

Treat accordingly
y If (-) travel to a malarious area and blood smear(-): y +CUVA - Refer

MEASLES WITH EYE OR MOUTH COMPLICATION

y After 2 days

Eye Infection y If (+) pus draining from the eye: Correct tx=refer, wrong tx=teach mother correct tx
y If (-) pus but (+) redness : Continue tx y If (-) pus & (-) redness: Stop Tx

Mouth Ulcers
y If ulcers are worse: REFER y If ulcers are the same or better: CONTINUE HALF

STRENGTH GENTIAN VIOLET

FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

y If fever persists after 2 days: ASSESS, CLASSIFY y If the child has any apparent cause of fever: y Provide Treatment y If (+) fever for 7 days: y Refer for assessment

y If no apparent cause of fever: y Advise mother to return daily until child has had no fever for at least 48 hours

EAR INFECTION
y After 5 days: ASSESS, CLASSIFY y If (+) tender swelling behind the ear or high fever:

Treat as MASTOIDITIS
y Acute ear infection: If ear pain or discharge

persists: CONTINUE WICKING

y Chronic Ear infection: CONTINUE EAR WICKING y If no ear pain or discharge: FINISH ANTIBIOTIC,

PRAISE HER!!!

FEEDING PROBLEM
y After 5 days y Counsel the mother for any new or continuing feeding

problem
y If the child is very low weight for age: Ask mother to

return in 30 DAYS

ANEMIA
y After 14 days y Give Iron y If the child has any palmar pallor after 2 months:

REFER

VERY LOW WEIGHT

y After 30 days: WEIGH y If no longer low weight for age: PRAISE THE

MOTHER!!!
y If still low weight for age: COUNSEL

Feeding Recommendations
0-4mos
Breastfeed Do

4-6mos
Breastfeed

6-12mos
Breastfeed

12mos-2yrs
Breastfeed Gi

2 years & above e adequate amount of food at 3 meals each day

Gi

not gi e Gi e other foods complement or fluids ary foods

e complement ary foods

Gi

e complement ary foods

Feeding Recommendation for a Child with Persistent Diarrhea

y If still breastfeeding: CONTINUE, DAY and NIGHT y If taking other milk: REPLACE this INCREASED BF y DO NOT USE CONDENSED OR EVAPORATED MILK

FOLLOW-UP VISITS If the child has: Pneumonia Dysentery Malaria, If fe er persists Fe er-Malaria Unlikely, If fe er persists Fe er (No Malaria), If fe er persists Measles with eye/mouth complications Dengue Hemorrhagic Fe er Unlikely, If fe er persists Persistent Diarrhea Acute & Chronic Ear Infection Feeding Problem Anemia ery ow weight for age Return for follow-up in:

2 days

5 days

14 days 30 days

WHEN TO RETURN IMMEDIATELY Any sick child

Unable

to drink or breastfeed Becomes sicker De elops a Fe er

Fast

No Pneumonia: Cough or Cold Child with Diarrhea Fe er: Dengue Hemorrhagic Fe er Unlikely

breathing Difficult breathing

Blood

in stool Drinking poorly

Any

sign of bleeding Abdominal pain Vomiting

CLASSIFICATIONS NEEDING VITAMIN A

Severe e ia r Very Severe Disease ersiste t Diarr ea Severe ersiste t Diarr ea Severe C licate Measles licati s Measles it ye M t C Measles Severe Mal triti Severe e ia ei t y e Very

CLASSIFICATIONS NEEDING ANTIBIOTIC

Severe PNM or VSD PNM Severe DHN (with cholera in the Area) Dysentery VSFD/ Malaria VSFD Severe Complicated Measles Mastoiditis Acute Ear Infection

REMINDERS
y All sick children with any of the CUVA should receive

IM antibiotics not oral antibiotic.

y All sick children with severe classification must be

referred urgently to hospital except for Severe DHN & Severe Persistent Diarrhea.

Ask the Mother what the infant s problems are?

ASK:

Has the infant had CONVULSION?

LOOK & LISTEN: RR, Chest Indrawing, Nasal Flaring, Bulging Fontanelles, Pus in ear, Draining pus at the umbilicus, Temperature, Skin Pustules, abnormally asleep
y Classify all Young Infants

CUVA ALL MAJOR SIGNS (+)

Red

POSSIBLE SERIOUS BACTERIAL INFECTION LOCAL BACTERIAL INFECTION

IM Antibiotic Glucose Warmth REFER! Antibiotic (5 days) Treat Local Infection Follow-up in 2 days

Umbilicus or draining pus Skin pustules

CUVA ALL MAJOR SIGNS (+)

Red

POSSIBLE SERIOUS BACTERIAL INFECTION LOCAL BACTERIAL INFECTION SEVERE DISEASE/ LOCAL BACTERIAL INFECTION UNLIKELY

IM Antibiotic Glucose Warmth REFER! Antibiotic (5 days) Treat Local Infection Follow-up in 2 days Ad ise Mother to gi e home care

Umbilicus or draining pus Skin pustules

No

Signs of Very Se ere Disease or Local Bacterial Infection

y Does the young infant have Diarrhea?

Classify Diarrhea - dehydration - If diarrhea 14 days or more - If blood in stool

DEHYDRATION

SAME

SEVERE DEHYDRATION

Plan C or REFER! Plan B or REFER!

SAME

SOME DEHYDRATION

Not enough signs to classify as some or se ere dehydration.

NO DEHYDRATION

Plan A

If Diarrhea is 14 days or more

Diarrhea lasting 14 days or more

SEVERE PERSISTENT DIARRHEA

Treat dehydration if dehydrated REFER!

(+) Blood in the Stool

Blood in the stool

DYSENTERY

REFER!

Not

able to feed No attachment at all Not sucking at all

NOT ABLE TO FEEDPOSSIBLE SERIOUS BACTERIAL INFECTION

IM antibiotic Glucose Warmth REFER! ise mother on breastfeeding Treat Thrush Follow-up feeding problem or thrush in 2 days Follow up low weight for age in 14 days Home care Praise the mother
Ad

well attached Not sucking effecti ely < 8 breastfeeds in 24 FEEDING hours PROBLEM OR Low weight for age LOW WEIGHT Thrush

Not

Not low weight for age and no other signs of inadequate feeding

NO FEEDING PROBLEM

UPDATE

No More NOT ABLE TO FEED: POSSIBLE SERIOUS BACTERIAL INFECTION

IMMUNIZATION SCHEDULE
AGE irt 6 weeks VACCINE CG DPT1, OPV1, Hep1

Give an Appropriate Oral Antibiotic

For Local Bacterial Infection:
y First line antibiotic: y Second line antibiotic:

COTRIMOXAZOLE (2 x a day for 5)

AGE/WEIGHT Birth 1 month (<3kg) 1 2 months (3-4 kg) 1/4 ADULT TAB SYRUP 1.25 ml 2.5

AMOXYCILLIN (3 x a day for 5)

AGE/WEIGHT Birth 1 month (<3kg) 1 2 months (3-4 kg) 1/4 TABLET (250 mg) SYRUP (125 mg/5 ml) 1.25 ml 2.5 ml

REMEMBER!!!
y Avoid cotrimoxazole in infants less than 1 month of

age who are premature jaundiced.

Give 1st dose of Intramuscular Antibiotic

y Give 1st dose of both Benzylpenicillin and

Gentamicin IM.
UPDATE

Give 1st dose of Gentamicin and Ampicillin

TREAT LOCAL INFECTION AT HOME

y Treat Skin Pustules twice daily y GENTIAN VIOLET

TREAT LOCAL INFECTION AT HOME

y Treat Umbilical Infection twice daily y GENTIAN VIOLET

TREAT LOCAL INFECTION AT HOME

y Treat Thrush twice daily y WET WITH SALT WATER y PAINT with HALF STRENGTH GENTIAN VIOLET

Correct Positioning & Attachment for Breastfeeding

y Infant s head & body straight y Facing her breast, with infant s nose opposite her

nipple y Infant s body close to her body y Support infant s whole body y Touch infant s lips with her nipple

y Wait until her infant s mouth is opening wide y Move the infant quickly onto the breast

Signs of Good Attachment

y Chin touching the breast y Mouth wide open y Lower lip turned outward y More areola visible above than below the mouth

Give Home Care

y Breastfeed frequently, as often and as long as the

infant wants, day or night, during sickness and health.

FOLLOW-UP VISITS If the child has: Local bacterial Infection Any Feeding Problem Thrush Low weight for age Return for follow-up in: 2 days 14 days

WHEN TO RETURN IMMEDIATELY Breastfeeding or drinking poorly Becomes sicker De elops a fe er Fast breathing Difficult breathing Blood in stool

Keep the Infant Warm at all times

y In cool weather, cover the infant s head and feet &

dress the infant with extra clothing

LOCAL BACTERIAL INFECTION

y After 2 days y If Pus or redness remains or is worse: REFER y If pus and redness are improved: y CONTINUE ANTIBIOTICS FOR 5 DAYS

FEEDING PROBLEM
y After 2 days y Counsel the mother for any new or continuing feeding

problem: BRING CHILD BACK

y If the child is low weight for age: RETURN CHILD 14

DAYS

LOW WEIGHT
y After 14 days y If no longer low weight for age: PRAISE y If still low weight for age, but is feeding well: y COME AGAIN y If still low weight for age & still has a feeding problem:

RETURN IN 14 DAYS

THRUSH
y After 2 days y If Thrush is worse or (+) problems with attachment or

suckling: REFER
y If Thrush is the same or better and is feeding well:

CONTINUE HALF STRENGTH GENTIAN VIOLET