rll ill ill ,ll ,ll 'll ,ll 'll ,ll ,ll ,ll ,ll ([l ,ll 'll

,ll ,l[,[[,fnt[[ntf

/Jel gh?Lrr,3 oo)d5r

UT' eil_l

i,}il OOl _I_1,_L,I.,JLSS

-,r[ftfl lfl ttm.rl'tr:nil:tnnil:mr]tl:H--il--HllrTnr

(, Lun4
f l?t 'v

rT),

I r rir

rt,Erl:.ttv

st. Luric.s uojifrlc uj ,rrr",ug

OF 4SlA

i,oro,,

/t-,,-07

SIGK CHILD AGED 2 MONTHS TO 5 YEARS

ASSESS AND CLASSIFY THE SICK CHILD

TREAT THE CHILD, continued Give Extra Fluid for Diarrhea and Gontinue Feeding Plan A: Treat Diarrhea at Home .............. .... .. ...12
Plan B: Treat Some Dehydration with ORS .......... 12 Plan C: Treat Severe Dehydration euickly .... . ... 13

SICK YOUNG INFANT AGED 1 WEEK TO 2 MONTHS

ASSESS, CIASS'FY AND TREAT THE SICK YOUNG INFANT

Assess, Classify, and ldentify the Treatment

Check for General Danger Signs ...._......... ...................... 2 Then Ask About the Main Symptoms: Does the child have cough or difficult breathing? ......2 Does the child have .-.......... 3 Does the child have fever? ..........................................

Assess, Classify, and ldentify the Treatment Check for Possible Bacterial lnfection
Then Ask: Does the Young lnfant have Diarrhea? Then Check for Feeding Problems or Low Weight ........... Check the Young lnfant's lmmunization Status ._...._....,..... Assess Other Prob1ems..................... 24 25

4 lmmunize Every Sick Child, as Needed ................ 13 Classify malaria .........................".4 Give Every Sick Ghild Vitamin A, as Needed ....... 13 Classify measles.......... ................ 4 Classify dengue ........................... 4 Give Follow_up Gare Does the child have an ear problem?.......... .. .... ... 5 pneumonia ........ .............14 Then Check for Malnutrition and Anemia persistent Diarrhea 6 .."...................14 Then Check the Child's lmmunization Status Dysentery "............... 6 ......,........14 Then Check the Child's Vitamin A Status 6 Malaria ............. .................... 15 Assess Other Prob|ems................................................... 6 Fever: Malaria Unlikely .... ...".. .... 15 Fever: No Malaria .......................... 15 TREAT THE CHTLD Measles with Eye or Mouth Complications........... 16 Hemorrhagic Fever Unlikelv " " 16 Teach the Morher How to Give orar Drugs ar Home E::::r"T,:?'" 16
oral

diarrhea?

z6
26

Treat the Young lnfant and Counsel the Mother Oral Antibiotics ..................... ........................ 27 lntramuscular Antibiotics ............................. 27 To Treat Diarrhea, See TREAT THE CHILD Chart........".... 28 lmmunize Every Sick Young lnfant, as Needed .... .... .... 28 Treat Umbilical lnfections in the Health Center................." 28 Treat Local lnfections at Home . .................2g Correct Positioning and Attachment for Breastfeeding...... 2g Home Care for the Young lnfant .."......".......".............."........ 29

Antibiotics..............
. . " .. ,r.

'

:::ii::'i:i'^'

"

". "" "'"

"

Give Follow-up Care for the Sick young lnfant

Local Bacterial lnfection Feeding Problem Low Weight.... Thrush ...........
...............".............. .................. ..."................... ....................... 30
31 31 31

; "" '. r', " "" 8 ;f;; .-: ... .. ........":: ti". " "" "" "" B tron................. .. i:,"....,. ... B Mebendazore .. . .....::,;.-....:......,...X .. ... ..:: '\,
paracetamor

l^Ii'l'l.;. Verv Low

,;;^' Weisht

............................17

"""'-'

17

couNsEL rHE M,THER

Food

RECORDING FORMS SICK YOUNG INFANT SICK CHILD

WEIGHT-FOR-AGE

JJ

53

CHART

on the inside back cover

unrc ef@)
"6, ffi
DEPAR MENT OF HEALTH Republic of the Philippines

w
w
Association of Philippine
Schools of Midwifery, lnc.

ASSESS AND CLASSIFY

[REAT

rl

I I

FonowuF

ASSESS AND GLASSIFY THE SIGK GHILD AGED 2 MONTHS UP TO 5 YEARS

ASSESS
ASK THE MOTHER WHAT THE CHILD'S PROBLEMS ARE . Determine if this is an initial or follow-up visit for this problem. - if follow-up visit, use the follow-up instructions on the IREAT THE CHILD chart.

CLASSIFY
USE ALL BOXES THAT MATCH THE CHILD'S SYMPTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS.

IDENTIFY TREATMENT

if initial visit, assess the child as follows:

*lf referral is not possrb/e, manage the child as described in Management of Childhood lllness, Treat th6 Child, Annex: Where Roferral is Not Posslb/6, and WHO guidelines for in-patient care_

JI

I H I HI
I I

IJ

I IHII|JLLHITI$THITII.,JII.,'IILTI

rIl

,Ll

,Ll

,U ,L[ '[l

,u

-,rr,r[tl,tntnu:lnntnll:t.il]lrunf
Tl?lNf rY I tNt\rFfistTY ntr AslA

St Lultc'$ t,ous5c or Nur$tn6 LrDrarl

A$K: Doee the child have
:,,,t, t:;t;,i
I

],

ltr:,

..

t.

IF YES, ASK;

LOOKAND FEEL:

. .

For how long?

.
in

for
DEHYDRATION

Look at the child's general condition. ls the child:

ls there blood the stool?

. . .

Abnormally sleepy or difficult to

awaken? Restless and irritable? Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly

Look for sunken eyes. Offer the child fluid. ts the child: Not able to drink or drinking poorly? Drinking eagerly, thirsty?

r
>
SOME DEHYDRATION

Give ORS, zinc supplements and food for some

dehydration (Plan B). lf child also has another severe classification: Refer URGENTLY to hospital, with mother giving frequentsips ofORS on theway. Advise mother to antinue breastfeeding. Advise the mother when to relurn immediately. Foilow up in 5 days if not improving.

. . . .

Pinch the skin of the abdomen. Does it go back:

>

- Very slowly (longer than 2 seconds)? Slowlv?

and if diarrhea for 14 days or more

No dehydration

> Advise the mother on feeding a child who

has

) ) r
and if blood in stool

PERSISTENT DIARRHEA. Give Vitamin A. Follow up in 5 days. Advise mother when to return immediately.

Blood in the stool

> Treat for 5 days with an orat antibiotic

recommended for Shigella in your area.

Follow up in 2 days.
immediately.

> Advise mother when to return

DANGER SIGNS, COUGH, DIARRHEA ASSESS AND CLASSIFY

rREAT

I{S

II

FOLLOW.UF

?Hl

rttolltli

THEN A$K; Does the child have fever?

(by history, or feels hot or if tsmperaturs is 37,S0C*n or above)
(including travel or overnight stay in Decide Malaria Risk
Ask.' Does the child live in a malaria area?

MALARIA,RI$K

. .

Has the child visited or stayed overnight in a malaria area in

the past 4 weeks?

Blood smear (+) lf blood smear not done: NO runny nose, and NO measles, and NO other causes of fever

>
>

) ) )

Treat the child with an oral antimalarial. Give one dose of paracetamol in health center for high fever (38.5oC or above). Advise 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.

lf Yes to either, obtain a blood smear.

,. . .

For how long has the child

had '

LOOK AND FEEL:

lf more than 7 days, has the fever been present every day?
Has the child had
within the last 3

'

Look or feel for stiff neck Look for runny nose.

months?

measles

LookforsignsofMEASLES:

Generalized rash and One ofthese: cough, runny nose,

No Malaria Risk

or red eyes

lf the child has measles now or

within the last three months:

Look for Are they Look for Look for

mouth ulcers. deep and extensive? pus draining from the eyes. clouding of the cornea.

lf

MEASLES now

or within last 3 months, classify

Pus draining from the eye or l\ilouth ulcers

Assess Dengue Hemorrhagic Fever ASK;

>

LOOK AND FEEL:

. . . .

Has the child had any bleeding from the nose or gums. or in the vomitus or stools? Has the child had black vomitus? Has the child had black stools? Has the child had persistent abdominal pain? Has the child had persistent vomiting?

Look for bleeding from nose or

gu ms.

Look for skin petechiae. Feel for cold and clammy extremities. Checkforslow capillary refill. lf none of the above ASK, LOOK, and FEEL

) ) )

>

lf

Give Vitamin A.

pus draining from the eye, apply tetracycline eye ointment. lf mouth ulcers, teach the mother to treat with gentian violet.

Follow up in 2 days. Advise mother when to return immediately.

signs are present & the child is 6 months or older & fever present for
more than 3 days. Perform the tourniquet test.

*".

".

Thesetemperaturesarebasedonaxillarytemperature.Rectaltemperaturereadingsareapproximatety0.s"Chigher.
Other important complications of measles-pneumonia, stridor, diarrhea, ear infection, and malnutrition-are ctassified in other tables

iil:il:rErnrl:il:il:il:il:ilTrilT:tnnnil:iliUtlliIntr
Other Causes of Fever:

. pneumonia . dysentery . severe complicated measles . measles with eye or mouth complications ' measles

. . . .

severe dengue hemorrhagic fever mastoiditis acute ear infection

abscess, cellulitis, osteomyelitis

Severe pneumonia or very severe disease

IF

. .

YES:

ls there ear ls there ear discharge? lf yes, for how

pain?

LOOK, FEEL:

long?

. .

Look for pus draining from the ear Feel fortenderswelling behind the ear.

. .

Ear pain Pus is seen draining from the ear, and discharge is reported for less than 14 days Pus is seen draining from the ear, and discharge is reported for 14 days or
more

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.

Dry the ear by wicking. Follow up in 5 days. Advise mother when to return immediately.

CHRONIC EAR
INFECTION

FEVER, MALARIA, MEASI ES, FAR PROBLEM

TREAT

Ns tl

trtl I Aw rlt

h..mml-r +-

THEN CHECK FOR MALNUTRITION ANDANEMIA

LOOK, FEEL:

. .

Look for visible severe wasting. Look and feel for edema

of

both

Some palmar pallor or Very low weight for age

ANEMIA

ORVERYLOW
WEIGHT

feet
Look for palmar pallor. ls it: - Severe palmar pallor? - Some palmar pallor?

Give one dose of paracetamol in health cenler for high fever (38.5"C or above). Assess the child's feeding and counsel the
mother on feeding according to the FOOD box on the COUTVSEL THE MOTHER charl.
lf feeding problem, follow up in 5 days. lf some pallor:

Give iron.

Determine weight for age.

Give mebendazole/albendazole if the child is 1 2 months or older, and has not had a dose in the previous 6 months. Follow up in 14 days. lf very low weight for age: Give Vitamin A. Follow up in 30 days. Advise mother when to return immediately.

IMMUNIZATIONSCHEDULE: 6 weeks DPT-1 OPV-1 Hep B-2 10 weeks DPT-2 OPV-2 14 weeks DPT-3 OPV-3 Hep B-3
9 months Measles

AGE Birth

VACCINE

BCG

Hep B-1

VITAMIN A SUPPLEMENTATION SGHEDULE: The first dose at 6 months or above. Subsequent doses every 6 months.

IHIIHIIIIILIIJIIHIIIH|JIL

'|r'r

rr rr rl rl 'rl ,rtlil|tlltl:tEtntE[nlnil"iJ|1F':ll'lll"illt'iil
CARRY OUT THE TREATMENT STEPS IDENTIFIED ON THE ASSESS AND CTASSTFY CHART

TREAT THE CHILD

Give an Appropriate Oral Antibiotic )

FOR PNEUMONIA, ACUTE EAR INFECTION, VERY SEVERE DISEASE, MNSTOIOITiS, FIRST-L|NEANTIBtOTtC COTRTMOXAZOLE

SECOND-L|NEANTIB|OT|C

j :

AMOXYC|LL|N
COTRIMOXAZOLE (trimethoprim + sulphamethoxazole)

AGE OR WEIGHT

>

Give two times datly for 5 days.

AMOXYCILLIN
Give throe tinlos dailv for 5 davs

ADULT TABLET
80 mg trlmethoprim
+ 400 mg sulphamethoxazole

SYRUP
40 mg trimethoprim + 200 mo sulDhamethoxazole npr A

TABLET 250 mg
1t2

SYRUP 125 m9 pr

2 months up to 12 months (4 - <10 ks) 12 months up to 5 years

1t2

5ml
10 ml

_51
5ml
10 ml
1

(10-<19kg)
) FOR DYSFNTtrPV.

boiiiro xAzoLE :,5T;t, $ i 3|Tl?t_olic1gl,sf c"e u_n'' secoNro_r_rNenNrrerorrcroBsHrcELLR,

r

Give antibiotic recommended for Shigella in your area for 5 davs.

-, -"

ilillli,Ji".,ts

COTRIMOXAZOLE
(trimethoprim + sulphamethoxazole) Give two times daily for 5 davs.

NALIDIXICACID

AGE OR WEIGHT 2 months up to 4 months (4

4 months up to 12 months (6
_

Give four times daily for 5 days.

SYRUP
_ <6 kg)

250 mq/s ml

<10 kg)

See doses Above.

1.25 ml (1t4 tsp) 2.5 ml (112 tsp) 5 ml (1 tsp)

12 months up to 5 years (10 - <19 ko)

)
2 months up to 4 months 4 months up to 12 months

Give four times daily for 3 days

Give two times daily for 5 days.

(4 _ <6 kg) (6 _ <i0 kg)

_

12 months up to 5 years (10

<19 kg)

MALNUTRtTt0N and ANEMtA,

IMMUNIZATION AND VITAMIN A STATUS ANTIBIOTICS

TREAT

fs

J I

FoLLow-uP

Tt{E TYIOTHER

-i

FI

RST-LINE ANTIIVALARIAL:

CHLOROQUINE. PRIMAQUINE, SULFADOXINE AND PYRIMETHAMINE

Pain (give every 6 hrs until fever or ear pain is gone)

TABLET (500 ms) SYRUP (120 m9/5 ml)

SECOND-LINE ANTIMALARIAL: ARTEMETER-LUMEFANTRINE

>

IF CHLOROQUINE:

. .

Explain to the mother that she should watch her child carefully for 30 minutes after giving a dose of chloroquine. lf the child vomits wiihin 30 minutes, she should repeat the dose and return to the health center for additional tablets. Explain that itching is a possible side effect ofthe drug, but is not dangerous. before intake of Chloroquine.

2 months up to 3 Vears (4 - <14 kg) 3 years up to 5 years (14 - <19 kg)

5 ml (1 tsp) 10 ml (2 tsp)

> lF SULFADOXINE + PYRIMETHAMINE: Give a single dose in the health center 2 hours > lF PRIMAQUINE: Give single dose on Day 4 for P. falciparum > lF ARTEMETER-LUMEFANTRINE combination: Give for 3 days.

> Give one dose daily for 14 days

IRON/FOLATE TABLET IRON SYRUP Ferrous sulfate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml (1/2 tsp) IRON DROPS

CHLOROQUINE Give for 3 days

>

PRIMAQUINE Give single dose in health center for P falciparum TABLET (1 5 mg base)

PRIMAQUINE > Glve daily for 14 days for P vivax TABLET (15 mg base)

>

SULFADOXINE + PYRIMETHAMINE Give single dose in healtl center

Ferous sulfate 200 mg +

250 mcg Folate (60 mg elemental iron) 2 months up to 4 months (4 - <6 ks)

Ferous sulfate
25 mg (25 mg elemental iron per ml)

TABLET (150 mg base) AGE 2 months up to 5 months (4 - <7 kg) 5 months up to 1 2 months

TABLET
(500 mg sulfadoxine) 25 mg pyrimethamine %

DAY
t/,

months up to 12 months (6 -<10 kg)

12 months up to 3 years (10 -<14 ko) 3 years up to 5 years 5 ml (1 tsp)

DAY 2
%

DAY 3
%
:;;;.:.:!r :!:,r:;ii i.;,:l,:f :,;:i!:.:!:t;:1;i.,i,::.:;:

(7-<10kg)
1

,/,

.. : 1...--: ::::1: ;j.:,..:: ::. :"':"'t .. --- -.t.::t".". f,;t.ii:-!: " -.: l!l:,:!i:::;!:;lai;!1,:;.:!:ia:r:,e:ii:t:.1!!;!i:!l !' :i"'" -."...: : :." d; .l:,::-:,: :-: . i;r;i!.::3!:.:!:i,:::;:n);,1e:er,:;i,f ri,:::iri! r;ri,;i,:::3:;;i!:r!rrt!;ij,i,r1e!:;i.iii:;:;lri!
i;r,:::1,:9:5:J:a:!::,:l;:i11;i,::r:t!t:!i!r:i:;t:i:l!

7.5 ml (1 1/2 tsp)

(14 - <19 kg)

2 months up to 3 years (10 - <14 kg)

3

I 1% 1%

TREATMENT
>
Give one dose in the
1

years up to 5 years (14 - <19 kg)

health

center.
AGE

SUPPLEMENTATION > Give one dose in health center if: child is six months of age or older, AND - child has not received a dose of Vitamin A in

the past six

months.

VITAMIN A CAPSULES
100,000 tu 200,000 lu
1/2 capsule 1 capsule

Adults and Children above

13 years old

Pediatrics

to 13 years
3 tabs 3 tabs 3 tabs BID 3 tabs BID
g

4 to

years

to 3 years
1 tab 1 tab
'1

months up to 12 months

Day 8 hrs after

1

Day 2 Day 3 Day 4

4 tabs 4 tabs 4 tabs BID 4 tabs BID

give
primaquine

2 tabs 2 tabs 2 tabs BID 2 tabs BID

ive primaquine
g

12 months up to 5 years

2 capsules

tab

BID

1 tab BID

ive
u

Give 500 mg l\4ebendazole/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

primaq

ine

months, with the following dose. AGE OR WEIGHT

12 months up to 24 months
24 months up to 59 months

Given if drugs for all parasitological treatment fail (chloroqurne & sulfadoxine/pyrimethamine) Preferably taken with high fat diei Not recommended during pregnancy, lactation and in infant <'1 year, and is severe malaria See other table for primaquine dosage.

Albendazole 400 mg tablet % or a 200 mg{ablet

1

Mebendazole 500 mg tablet

,II N'[I TIILIL]ILIL]ILILILIL]ILII]ILIIILILILILIL'IL

il[il'iltr.r.rnrl:rI:il:il:il:nu:il]il:tnIl:Il:tnnil:F
INFHCTION$ AT HOME

>

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"

>

Treat Eye Infection with retracycline Eye ointment

. . .
Clean both eyes 3 times daily. Wash hands. Ask child to close eyes. Use clean cloth and water to genfly wipe away pus.

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. . Using a cotton bud, paint the mouth with 0.25% Gentian violet. . Wash hands again.

with a Safe Remedy

. . . . .
Safe remedies to recommend: Breastmilk for exclusively breastfed infant Tamarind, calamansi and ginger

Then apply Tetracycline eye ointment in both eyes 3 times daily. . Ask the child to look up. . Squirt a small amount of oitment on the inside of the lower lid. . Wash hands again. Treat until redness is gone.
Do not use other eye ointments or drops, or put anything else in the eye.

Harmful remedies to discourage: Codeine cough syrup Other cough syrups Oral and nasal decongestants

ORAL DRUGS
LOCAL INFECTIONS

I I

FolLow-up

ICOUNTIL THE

MOTHER

10

GIVE THE$H TRHATMHNT$ IN THH HHATTH CHNTHR ONLY

lrfir,rflrT,I[Il'It
)
Treat the Ghild to Prevent Low Blood Sugar
trdreffiisa&bffied:
As|(fte rndrerb
trnhe

br#ed

fte child-

ffiis notdb b trasifeed trtt frs a& b si;rzrlbyz: Ghte elryM brednilk or a brednilk subslihrte_ lf meiffilerdfte is **tlb, gire sugarwabr_
GiFre flD-SO

nil

d nfl< q

srrlgar

y2br bebre

deparfure-

To

nde srynrden llissofue 4 lerel fucpoons Lrail+rilopddeanr#r.

d nflr q

of sugar (2o grams|

fffllcdflisnofa&bsrak
Girre 50 nil sr1gm nater by

nqmhb

fube-

tr ilrc

ffi

frs

dfurlt b ffiqt trmoonsionq statt lll infusiorlt:

. .

Orliue I rdtbds0% ddsrkesohrilirm bysbrrpsh

(tsre5 nilllqg d1(I!6 ddeftosesolulirn oreraftry minutes

MIRMnlffiII,iR'TTBf'Irc

m[RrEflrc[firRqrc
UWil-(xl'SGNR

FoLLow-uP

FouNrEL?]flrnoTili t

12

GIVE EXTRA FLUID FOR DIARRHEAAND CONTINUE FEEDING

$ee FOOD advlce on COUIV$EL THE MQTHER chart

Plan A: Treat Diarrhea at Home

GIVE EXTRA FLUID (as much as the child will take)

Counsel the Mother on the 4 Rules of Home Treatment: Give Extra Fluid, Give Zinc Supplements, Continue Feeding, When to Return

)
}

PIan B: Treat Some Dehydration with ORS

DETERMINE AMOUNT OF ORS TO GIVE DURING THE FIRST 4 HOURS, AGE-

Give in health center recommended amount of ORS over 4-hour period

1.

Up to 4 months

>

TELLTHE MOTHER:

4 months up to 12 months
6 - <'10 kg 400-700

12 months up to 2 years
10

2 years up to
5

years

Breastfeed frequently and longer at each feeding. lf the child is exclusively breastfed, give ORS or clean water in addition to breastmilk. lf 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"), or clean water.

WEIGHT AMoUNT (ml)

<6 kg 200-400

<12 kg

12 - <19 kg
900-1 400

700-900

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 kg) times 75.

It is especially important to give ORS af 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.

. .

lf 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.

> >

TEACH THE MOTHER HOW TO MIXAND GIVE ORS. GIVE THE MOTHER 2 PACKETS OF ORS TO USE AT HOME" SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUID INTAKE:

SHOW THE MOTHER HOW TO GIVE ORS SOLUTION. . Give frequent small sips from a cup. . lf the child vomits, wait 10 minutes. Then continue, but more slowly. . Continue breastfeeding whenever the child wants. AFTER 4 HOURS. . Reassess the child and classify the child for dehydration. . Select the appropriate plan to continue treatment. . Begin feeding the child in health center. . Give zinc supplements.
IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT

years 2 years or more

Up to 2

50 to 100 ml after each loose stool 100 to 200 ml after each loose stool

Tell the mother to:

2, 3. 4. . .

Give frequent small sips from a cup. lf the child vomits, wait 10 minutes. Then continue, but more slowly" Continue giving extra fluid until the diarrhea stops.

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

. . . .

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:

CONTINUE FEEDING WHEN TO RETURN

1. GIVE EXTRA FLUID ) 2. GMZINC SUPPIEMETVIS t 3. CONTTNUE FEEDING f 4" KNOWWHEN TO RETURN t

See Plan A for the recommended fluids and zinc supplementation

and See the COUNSEL THE MOTHER chart.

FOLLOW THE ARROWS, IF ANSWER IS "YES,'' GO ACROSS. IF "NO,'' GO DOWN,

START HERE
Can you give intravenous (lV fluid immediately?

Plan C: Treaf Seyere Dehydration euickly

YES +

start lV fluid immediately. lf the child can drink, give oRS by mouth while the drip is set up. Give 100 ml/kg Ringer's Lactate Solution (or, if not available, normal saline), divided as follows: AGE

First give
30 ml/kg in:

Then give 70 ml/kg in: 5 hours

lnfants (under 12 months)

Children (12 months up to 5 years)
NO

hour*

30 minutes.

IMMUNIZE EVERY SICK CHILD AS NEEDED

112

hours

Repeat once if radial pulse is stilt very weak

or not detectabte.

Reassess the child every 1-2 hours. lf hydration status is not improving, give the lV drip more rapidly. Also give ORS (about 5 ml/kg/hr) as soon as the child can drink: usually after 3-4 hours (infants) or 1-2 hours (children). Reassess an infant after 6 hours and a child after 3 hours. classify the dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment.

GIVE VITAMIN A SUPPLEMENTATION AS NEEDED

YES

. . . .

Refer URGENTLY to hospital for lV treatment. lf the child can drink, provide the mother with ORS solution and show her how to give frequent sips during the trip.

Are you trained to use

rehydration?

nasogastric (NG) tube for

Start rehydration by tube (or mouth) with ORS solution: give 20 ml/kg/hr for 6 hours (total of 120 ml/kg). Reassess the child every 1-2 hours: - lf there is repeated vomiting or increasing abdominal distension, give more fluid

Can the child drink?

'

lf hydration status is not improving after 3 hours, send the child for lV therapy. After 6 hours, reassess the child. classify dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment.

slowly.

NOTE:

Refer urgently to a hospital for lV or NG treatment-

'

lf possible, observe the child at least 6 hours after rehydration to be sure that the mother can maintain hydration, giving the child ORS solution by mouth.

PLAN

A'

PLAN B' PLAN

r6ll6w.ur

lrE-::----:------

>

PNEUMONIA
,, .l

After 2 days:

After 2 days:
n.

il""ilJH"T f.til,t"lffi i:lflr"J;i1l"*,.

Ask:

see

sSESS & cLA s S/Fy charr.

Assess the child for diarrhea. > See ASSESS & CLASS/FY charf.
Ask:

- ls the child's breathing slower? - ls there less fever?

- ls the child eating better?
Treatment:

Are there fewer stools?

- ls there less blood in the stool? - ls there less fever? - ls there less abdominal pain?

- ls the child eating better? indrawing or a general danger srgn, give a dose of second-line antibiotic or
Treatment:

> lf clrest > > >

intramuscular chloramphenicol. Then refer URGENTLY to hospital.

lt breathing rate, fever, and eating are the same, change to the second-line antibiotic and
advise the mother to return in 2 days or refer. (lf this child had measles within the last 3 months, refer.)

> lf the child is dehydrafe4 treat dehydration. > lf number of sfools, amount of blood ,n stoors, fever,
or eating
rls fhe same

abdominal pain,

or worse.'

Change to second-line oral antibiotic recommended for Shigella in your area, Give it for 5 days. Advise the mother to return in 2 days.

lf breathing slower,Iess fever, or eating better, complete the 5 days of antibiotic.

Exceptions - if the child:

lf cough is more than 30 days, refer for assessment.

is less than 12 months old, or was dehydrated on the first visit, or had meas/es within the last 3 months

) )I

Refer fo hosptta/

> PERSISTENT
After 5 days:
Ask:

DIARRHEA

) lf fewerstools, less blood in fhe sfools, less fever, less abdomlnal paln,
and eating betfer, continue giving the same antibiotic until finished.

- Has the diarrhea stopped? - How many loose stools is the child having per day?

Treatment:

lf the diarrhea has not stopped (child is still having less fDan 3 or more loose sfoo/s per day), do a full reassessment of the child. Give any treatment needed. Then refer to hospital.

) lf the diarrhea

has stopped (child having /ess fhan 3 loose sfoors per day), tell the

mother to follow the usual recommendations for the child's age.

JITILItJIUILIHIIHTILI

r,rr,rr,rl-lil.r1tr[illiltt.rllil-tl:rr]THElnll:llllilnillil
GIVH FOtIOW.UP CARE

>

FEVER: MALARIA UNLIKELY

lf fever persists after 2 days; Do a full assessment of the child. > See ASSESS & CLASS/Fy charl. Assess for other causes of fever. Treatment:

>

lf the child has any general danger sign

*$*ll*

) )

DISEASE/MALARIA. lf the child has any cause of fever other than malaria, provide treatment.

or stiff neck, treat as VERy SEVERE

FEBRTLE

lf malaria is the only apparent cause of fever.

> MALARIA
lf fever persists after 2 days, or returns within 14 days: Do a full assessment of the child. > See ASSESS & CTASS/Fy chart. Treatment: lf the child has any general danger sign SEVERE FEBRILE DISEASE/MALARIA.

Take a blood smear. Treat with the first-line oral antimalarial. Advise the mother to return again in 2 days if the fever persists. lffever has been present for 7 days, refer for assessment.

>

FEVER: NO MALARIA

or stiff neck,

treat as VERy

lf fever persists after 2 days: Do a full assessment of the child. > See ASSESS & CLASS/Fy chart. Make sure that there has been no travel to malaria area and overnight stay in malaria area. lf there has been travel and overnight stay, take blood smeal if posiible. Treatment: ) lf there has been travel and overnight stay to a malaria area and the blood smear is positive or there is no blood smear-classify according to Fever with Malaria Risk and treat accordingly. ) lf there has been no travel to malaria area or blood smear is negative:

)
>

treatment.

lf the child has any cause of fever other than malaria, provide

lf malaria is the only apparent cause of fever.

Take a blood smear.

Give second-llne orar antimarariar without waiting for resurt of brood smear. Advise mother to return if fever persists.

lf fever persists after 2 days treatment with second_line oral antimalarial, refer with blood smear for reassessment. lf fever has been present for 7 days, refer for assessment"

FEBRILE DISEASE. lf the child has any apparent cause of fever, provide treatment. persists. lf fever has been present for 7 days, refer for assessment.

lf the child has any general danger sign or stiff neck, treat as vERy SEVERE

lf no apparent cause of fever, advise the mother to return again in 2 days if fever

PNEUMONIA, PERSISTENT DIARRHEA, DYSENTERY MALARIA, FEVER: MALARJA UNLIKELY, FEVER: NO MALARIA

FOLLOW-UP

rHE

MoTHER

t--.

f,HF

;61 I filr-lrt

> FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

lf fever persists after 2 days: Do a full assessment of the child. > See ASSESS & CLASStFy chaft. Do a tourniquet test. Assess for the other causes of fever.

Treatment:

>

> MEASLES WITH EYE OR MOUTH

COMPLICATIONS
After 2 days;
Look for red eyes and pus draining from the eyes. Look at mouth ulcers. Smell the mouth. Treatment for Eye lnfection:

) > ) )

lf the child has any signs of bleeding, including skin petechiae or a positive tourniquet fesf, orstgns of shock, or persistent abdominal pain or persistent vomiting treat as SEYERE DENGUE HEMORRHAGIC FEVER. lf the child has any other apparent cause of fever, provide treatment. lf fever has been present for Z days, refer for assessment. lf no apparent cause of fever, advise the mother to return daily until the child has had no fever for at least 48 hours. Advise mother to make sure child is given more fluids and is eating.

>

>

EAR INFECTION

she has treated the eye infection. lf treatment has been correct, refer to hospital. lf treatment has not been correct, teach mother correct treatment.

lf pus is draining from the eye, ask the mother to describe how

After 5 days: Reassess for ear problem. > See ASSESS & CLASSIFy chaft. Measure the child's temperature.

) lf pus is gone but redness remains, continue the treatment. ) lf no pus or redness, stop the treatment.
Treatment for Mouth Ulcers: lf mouth ulcers are worse, or there is a very foul smell from the mouth, refer to hospital. ) lf mouth ulcers are the same or better, continue using 0.25% gentian violet for a total of 5 days.

) ) ) )

Treatment:

lf there is tender swelling behind the ear or high fever (38.5"C or above), treat as MASTOIDITIS. Acute ear infection: if ear pain or discharge persists, treat with 5 more days of the same antibiotic. Continue wicking to dry the ear. Follow up in 5 days. Chronic ear infection'Check that the mother is wicking the ear correcfly. Encourage her to continue. If no ear pain or discharge, pralse the mother for her careful treatment. lf she has not yet finished the 5 days of antibiotic, tell her to use all of it before stopping.

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GIVE FOLLOW.UP CARE
) )
care for the child who returns for follow'up using all the boxes that match the chlld,s prevlous classlflca,on. lf the child has any problem, assessn classifyn and treat the new problem as on the As$E$s AND clAsslFy chart.

[''|
I

>

FEEDING PROBLEM

> VERY LOW WEIGHT

After 30 days:

After 5 days:
Reassess feeding. > See quesfio ns at the top of the COIJNSEL chart. Ask about any feeding problems found on the initial visit.

) >

weigh the child and determine if the chird stiil is very row weight for age Reassess feeding. > see quesfio ns at the top of the coiNSEL c;art
Treatment:

counsel the mother about any new or continuing feeding probrems. rf you counsel the mother to make significant changes in teeOing, ask her to bring the child back again. lf- the child is very low weight for age, ask the mother to return 30 days after the initial visit to measure the child's weight gain.

lf the child is no longer very row weight encourage her to continue.

for

age, praise the mother and

>

lf the child is very row weightfor age, counser the mother about any feeding problem found. continue to see the chird monthry untir the chird is feeding well and gaining weight regulady or is no longer very low weight for age.

Exception:

>
) )

ANEMIA

the child.

lf you do not think that feeding wiil improve, or if the chird has rost weight, refer

After 14 days:
Give iron. Advise mother to return in 14 days for more iron. Continue giving iron every day for 2 months with follow-up every 14 days. pallor after 2 months, refer for assessment.
IF

ANY MORE FOLLOW-UP VISITS ARE NEEDED BASED ON THE INITIAL VISIT OR THIS VISIT, ADVISE THE MOTHER OF THE NEXT FOLLOW.UPVISIT.

> lf the child has any palmar

o
ALSO, ADVISE THE MOTHER WHEN TO RETURN IMMEDIATELY. (See the COUNSEL THE MOTHER chart.)

IVEASLES, FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY EAR INFECTION, FEEDING PROBLE[/, ANEMIA,
VERY LOW WEIGHT,

couNSEL THE MOTHER

jorr.r,

AND

.LASSTFv

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18

COUNSEL THE MOTHER

Assess fhe Child's Feeding

Ask questions about the child's usual feeding and feeding during

Assess fhe Child's Care for Development

Observe and ask questions about how mother cares for her child. Compare the mother's answers to the Recommendations for Care forDevelopment.

this illness. Compare the mother's answers to the Feeding

Recommendations for the child's age in the box below.
ASK..

OBSERVE: How the mother plays and communicates with her

How many times during the day? Do you also breastfeed during the night? child.

Then
What food or fluids? How many times per day? What do you use to feed the child? lfverylowweightforage: How large arethe servings? Does the child receive his own serving? Who feeds the child and how?

ASK:

How do you play with your child? How do you communicate with your child?

Sample Feeding Problems

1. difficulty in breastfeeding 2. child less than 4 months taking other milk/food 3. use of breastmilk substitute/cow's milk/evaporated milk 4. use of feeding bottles 5. lack of active feeding 6. not feeding well during illness 7. complementary food not enough in quantity/quality/variety 8. child 6 months above not yet given complementary foods
f

lf yes, how?

infant not exclusively breastfed

10. improper handling and use of breastmilk substitute

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Recommendations for Feeding and Care for Development
Birth up to 6 Months
6

months to 12 months

12 months to 2 yeare

2 yeara and older

Give adequate amount of family foods at

Breastfeed as often as the child wants.
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.

Add any of the following: Lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely ground meat, egg yolk, bite-size fruits 3 times per day if
breastfed 5 times per day if not breastfed

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 dllls, milk and eggs, dark-green, Ieafy and
yellow vegetabl es (m al u nggay, squash), fruits (papaya, banana) Add oil or margarine. 5 times per day

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.

PIay:

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.

Feed the baby nutritious snacks like fruits.

PI

Pl

. .

ay:
Give your child clean, safe household things to handle, bang, and drop.

.
PIay:

ay: Help your child count, name, and compare

things.

Communicate: . Look into your child's eyes

. .

and smile at him or her, When you are breastfeedino. it f a good time io tatt< r{ffi to your child oet a conversation going with sounds or

Communicate:
Respond to your child's sounds and interests. Tell your child the names of things and people.

Give your child things to stack up, and to put into containers, and take out.

. .

Make simple toys for

your child.

is

Communicate:
Ask your child
simple questions. Respond to your child's attempts to talk. Play games like "bye."

Communicate:

and W* \

Encourage yout child to talk, and

answer your child's
questions. Teach your child stories, songs, and
games.

gestures.

Feeding Recommendations for a child who has PERSISTENT DTARRHEA > lf still breastfeeding, give more frequent, longer breastfeeds, day and night.

>

lf taking other milk such as milk supplements; . Replace these with increased breastfeeding, or

Replace half the milk with nutrient-rich, semi-solid foods. Do not use condensed or evaporated filled milk. For other foods, follow the feeding recommendations for the child's age 19

ASSESS FEEDING, FEEDING RECOIVMENDATIONS

couNsEL rHE MoTHER

AND

clAssrFv

FoLLow'uP

20

Counsel the Mother

About

Feeding Problems

lf the child is not being fed as described in the above recommendations, counsel the mother accordingly. ln addition: lf the mother reports difficulty with breastfeeding, assess breastfeeding. (See YOUNG INFANT chart ) As needed, show the mother correct positioning and attachment for breastfeeding. lf the child is less than 6 months old and is taking other milk or foods: - Build mother's confidence that she can produce all the breastmilk that the child needs. - Suggest giving more frequent, longer breastfeeding, day and night, gradually reducing other milk or foods.
lf other milk needs to be continued, counsel the mother to:

Breastfeed as much as possible, including at night. Make sure that other milk is a locally appropriate breastmilk substitute, give only when necesarry. Make sure other milk is correctly and hygienically prepared and given in adequate amounts. Prepare only an amount of milk which the child can consume within an hour. lf there is some left-over milk, discard.

) lf the mother is using a bottle to feed the child:

- Recommend substituting a cup for

>

bottle.

- Show the mother how to feed the child with a cup.

lf the child is not being fed actively, counsel the mother to:
- Sit with the child and encourage eating. - Give the child an adequate serving in a separate plate or bowl. - Observe what the child likes and consider this in the preparation of his/her food.

>

lf the child is not feeding well during illness, counsel the mother to:
- Breastfeed more frequently and longer if possible.

- Use soft, varied, appetizing, favorite foods to encourage the child to eat as much as possible, and offer frequent small
feeding. - Clear a blocked nose if it interferes with feeding. - Expect that appetite will improve as child gets better.

) Follow up any feeding problem in 5 days.

II

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,[[,[[ ,ll ,ll ,lI lt ,l[ ,lf,lflf I[ il ,lt ,l[ ,l[ ,lf,[l ,il .lt ,[/ ,U ,U
FLUID

Advise the Mother to lncrease Fluid During l//ness

FOR ANY SIGK CHILD:

) Breastfeed more frequently and longer at each feed.

) lncrease fluid. For example, give soup, rice water, buko juice or clean water.
FOR CHILD WITH DIARRHEA: ) Giving an extra fluid can be lifesaving. Give fluid according to Plan A or Plan B on TREAT THE CHILD charL.

Advise the Mother When to Return to Health Worker

FOLLOW-UP VISIT
Advise the mother to come for follow-up at the earliest time listed for the child's problems.
If the child has:
PNEUMONIA

Return for follow-up in:

2 days

DYSENTERY

MALARIA, if fever persists FEVER: MALARIA UNLIKELY if fever persists FEVER: NO MALARIA if fever persists
MEASLES WITH EYE OR MOUTH COMPLICATIONS DENGUE HEMORRHAGIC FEVER UNLIKELY if fever persists PERSISTENT DIARRHEA ACUTE EAR INFECTION CHRONIC EAR INFECTION FEEDING PROBLEMS ANY OTHER ILLNESS, if not improving ANEMIA VERY LOW WEIGHT FOR AGE
5 days

WHEN TO RETURN IMMEDIATELY

Advise the mother to return immediately if the child has any of these signs:
Any sick child
Not able to drink or breastfeed Becomes sicker Develops a fever

lf the child has NO PNEUMONIA: COUGH OR COLD, also return if:

14 days 30 days

Fast breathing Difficult breathing Blood in stool Drinking poorly Any sign of bleeding Persistent abdominal pain Persistent vomiting Skin petechiae Skin rash

lf the child has Diarrhea. also return if:

lf the child has FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY also return if:

21

FEEDING PROBLEMS, FLUTD, WHEN TO RETURN

I

ASSESS AND CLASSIFY

r-

FOLLOW UI]

22

)
.

Care for Development

Assess the Ghild's Gare for Development
Ask questions about how mother cares for her child. Compare the mother's answers to the Recommendations for Care and Development for child's age. OBSERVE

. . . .

How mother plays with the child? How mother communicates with the child?

ASK
How do you play with your child? How do you communicate with your child?

Counsel the Mother about Her Own Health

lf she has a breast problem (such as engorgement, sore nipples, breast infection), provide care for her or refer her for help.

Advise her to eat well to keep her own strength and health.
Check the motherns immunization status and give her Tetanus Toxoid if needed. Make sure she has access to:

. .

Family Planning Counseling on STD and AIDS prevention.

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ASSESS, CLASSIFY AND TREAT THE SICK INFANT AGED 1 WEEK UP TO 2 MONTHS
CLASSIFY
USE ALL BOXES THAT MATCH THE INFANT'S SYMPTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS.

ASSESS
ASK THE MOTHER WHAT THE YOUNG INFANT'S PROBLEMS ARE

IDENTIFY TREATMENT

'

Determine if this is an initiar or foilow-up visit for this problem. lf follow-up visit, use the follow-up instructions in the follow-up section. lf initial visit, assess the young infant as follows:

CHECK FOR POSSIBLE BACTERIAL INFECTION

CLASSIFYAS
ASK:
Has the infant had convulsions?

TREATMENT

LOOK, LISTEN:

. . . .

Counl the breaths in one minute Repeat the count if elevated_

CHILD MUST BE CALM

Lookforchestindrawing.
Look for nasal flaring. Look and listen forgrunting.

Look and feel for bulging fontanel.

Look for pus draining from the ear.

Look at the umbilicus. ls it red or draining pus?

Does the redness extend to the skin? Measure temperature (orfeel for fever or low body temperature) Look for skin pustules. Are there many or severe pustules?

See if the young infant is abnormally sleepy or difficult to awaken.

Look at the young infant's movements.

Are they less than normal?

* These thresholds are based on axiltary temperature. The thresholds for rectal temperature readings are approximately o.soc higher. *' lf referrel is not possibte, manage the chird as described in Manageietnt ot chirdhood ilness. Treat the Child, Annex: Where Referral is /Vot possib/e.

23
MOTHER'S HEALTH BACTERIAL INFECTION

'

AssEss AND

clAssrFv

[rser-

FOLLOW-UP

24

for
DEHYDRATION

Give fluid for some dehydration (Plan B). If infant a/so has POSSTBLE SER/OUS

BACTERIAL INFECTION or DYSENTERY: Refer URGENTLY to hospital with mother giving frequenf sips of ORS on the way. , Advise mother to continue breastfeeding.

and if diarrhea for 14 days or more

and if blood

in stool

,IIHIIHIIIJIIIH

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LOOK:
. Dok)ililiilo w0irlltl l0r lrrlr:

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anublollat,

THEN CHECK FOR FEEDING PROBLHMS OR LOW WEIGHT

/F YFS, ASK:

. . .

C/assify
FEEDING

Not rblo to food or

No attachm6nt ut oll or

NOI ABLE TO

ll;

llrclr itrry rlillir:irlty lcr:rlirri;'i

po$stFLE

FEEO

ls the inlant breastferl? lf yes, how many times in 24 hours'1 Does lhe inlanl usually receive any other food or dnnk? lf yes, how often?

Nol $uckllng st all

sIRtou$
BACTERIAT
INFECTION

Tratt to pnvant low hlood tuEtr, Advls0 th. mothat how to fu.p ,h. young lnfanl warm on lh. way ta tho hotptlil
Refor URSfiIVlly fo hospttor,

What do you use to feed the infant?

IFAN

INFANI

Has any difficutty feeding.

ls breastfeeding less than g times in 24 hours, ls taking any other foods or drinks, or ls low weight for age,
AND

Has no indications to refer urgenfly to hospital:

ASSESS BREASTFEEDING:

'

in the previous

Hastheinfantbreastfed lf the infant has not fed in the previous hours, ask the hour?
for 4 minutes.
mother to put her infant to the breast. observe the breastfeed

(lf the infant was fed during the last hour, ask the mother if she.can wait, and to tell you when the infant is willing to feeJ again.) ls the infant able to attach?
no attachment at

all

not well

attached

good attachment

, , , .

TO CHECK ATTACHMENT, LOOK FOR: Chin touching the breast Mouth wide open Lower lip turned outward More areola visibte above than below

the mouth

(All these signs should be present if the attachment is good.)

ls the infant suckling effectively (that is, slow, deep sucks, sometimes pausjng)?

notsrcKingatall notsucklingeffectively
Clear a blocked nose

sucklingetredivety

if it interferes with breastfeeding.

Look for ulcers or white patches in the mouth (thrush).

DIARRHEA FEEDING PROBLEMS

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26

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Give an Appropriate Oral Antibiotic
For local bacterial infection:
f irst-line antibiotic: Second-line antibiotic: COTRIMOXAZOLE AMOXYCILLIN COTRIMOXAZOLE (trimethoprim + sulfamethoxazole) > Give two times daily for 5 days AGE OR WEIGHT Birth up to 1 month
ADULT TABLET
single strength (80 mg trimethoprim

,llltlll[Il'llr

TREAT THE YOUNG INFANT AND COUN$EL THE MOTHER

AMOXYCILLIN

Give three trmes daily for 5 days

SYRUP
40 mg trimethoprim + 200 mg sulfamethoxazole per 5 ml

TABLET

400 mg sulfamethoxazole)

250 mg

SYRUP 125 mg per 5 ml

1.25 ml

(.3

kS) 1t4

1.25 ml-

1 month up to 2 months

" (3-a ks)

Avoid cotrimoxazole in infants less than

2.5 ml

1t4

2.5 ml

I month

of age who are premature or jaundiced.

)
r

Give First Dose of Intramuscular Antibiotics

Give the first dose of both benzylpenicillin and gentamicin intramuscular.
GENTAMICIN
Dose: 5 mg per kg

BENZYLPENICILLIN
Dose: 50,000 units per kg Add 6 ml sterile water to 2 ml vial containing 80 mg. = 8 mt at 10 mg/mt To a vial of 600 mg Add 2.1 mi sterile water
(1

WEIGHT

Undiluted 2 vial 2O mg = 2 ml at 10

ml containing mg/ml

Of
0.5 ml.
1.0 ml* 1.5 ml"

2.5m|

= at400,000units/ml

OR

,000,000 units): Add 3.6 ml sterile water =

4.0m| at250.000units/mt

1kg

2kg 3kg 4kg 5kg

*

2.0 ml2.5 ml-

ml 0.2 ml 0.4 ml 0.5 ml 0.6 ml

0.1

0.2 ml 0.4 ml 0.6 ml 0.8 ml

1.0 ml

Avoid using undiluted 40 mg/ml gentamicin.

'

>

Referral is the best option for a young infant classified with POSSIBLE SERIOUS BACTERIAL INFECTION. lf referral is not possible, give benzylpenicillin and gentamicin for at least 5 days. Give benzylpenicillin every 6 hours plus gentamicin one dose daily.

IMMUNIZATION

STATUS

ANTIBIOTICS

TREATAND COUNSEL

IRE
I

FOLLOW-UP

) )

fo teat Diarrhea, See TREAT THE CHILD chart.

lmmunize Every Sick Young tnfant as Needed,

Teach the Mother How to Treat Locat lnfections at Home

) ) )
Explain how the treatment is given.

Watch her as she does the first treatment in the health center. Tell her to do the treatment twice daily. She should return to the health center if the infection worsens.

To Treat Skin Pustules The mother should: ) Wash hands.

To Treat Umbilical Infection

To Treat Oral Thrush (ulcers or white patches in mouth)

The mother should: ) Wash hands.

) ) ) )

The mother should: ) Wash hands.

Gently wash off pus and crusts with soap and water. Dry the area. Paint with 0.5% gentian violet.

>

) )

Clean with 70% ethyl alcohol Paint with 0.5% gentian violet.

) ) )

Wash hands.

Wash mouth with clean soft cloth wrapped around the finger and wet with salt water. Paint the mouth with 0.25% gentian violet.

Wash hands.

Wash hands.

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Teach Correct Positioning and Attachment

) Show the mother how to hold her infant.
- with the infant's head and body straight.

for

Breastfeeding

- facing her breast, with infant's nose opposite her nipples

- with infant's body close to her body

- 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 suckling. lf the attachment or suckling is not good, try again.

Advise Mother to Give Home care for the young lnfant > FOOD I Breastfeed frequently, as often and for as long as the infant wants, > FLUID t Aay and night, during sickness and health. > WHEN TO RETURN
Follow-upVisit lf the infant has:
LOCAL BACTERIAL INFECTION ANY FEEDING PROBLEM

When to Return lmmediately: Return for follow-up in:

Advise the mother to return immediately if the young infant has any of these signs:
Breastfeeding or drinking poorly Becomes sicker Develops a fever Fast breathing Difficult breathing
Blood in stool

days

THRUSH LOWWEIGHTFORAGE
14 days

>

MAKE SURE THE YOUNG INFANT STAYS WARM ATALL TIMES. ln cool weather, cover the infant's head and feet. and dress the infant with extra clothing.

LOCAL INFECTIONS
? :__l BREASTFEEDING HOME CARE

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GIVE FOttOW.UP CARE FOR THH SICK YOUNG INFANT

>

FEEDING PROBLEM
After 2 days: Reassess feeding. > See "Then check for Feeding problem or Low weight" above. Ask about any feeding problems found on the initial visit. ) Counsel the mother about any new or continuing feeding problems. lf you counsel the mother to make significant changes in feeding, ask her to bring the young infant back again. ) lf the young infant is low weight for age, ask mother to return in 14 days after the initial visit to measure the young infant's weight gain.

Exception

lf you do not think that feeding will improve, or if young infant has lost weight, refer the child

LOW WEIGHT
After '14 days:
Weigh the young infant and determine if the infant is still low weight for age. Reassess feeding. > See "Then Check for Feeding Problem or Low Weight" above.

) ) >

lf the infant is no longer low weight for age, praise the mother and encourage her to continue. lf the young infant is still low weight for age, but is feeding well, praise the mother. Ask her to come again within a month or when she returns for immunization. lf the young infant is still low weight for age and stilt has a feeding prohlem, counsel the mother about ihe feeding problem. Ask the mother to return again in 14 days (or when she returns for immunization, if this is within 2 weeks). Continue to see the young infant every few weeks until rnfant is feeding well and gaining weight regularly or is no longer low weight for age. Exception: lf you do not think that feeding will improve, or if young infant has lost weight, refer to hospital.

ORAL THRUSH
After 2 days: Look for ulcers or white patches in the mouth (thrush). Reassess feeding. > See "Then Check for Feeding problem or Low Weight,' above. > lf thrush is worse, or if the infant has problems with attachment or suckling, refer to hospital. > I'f thrush is the same or hetter, and if the infant is feeding rarel/, continue 0.25% Gentian violet for a total of 5 days.

31
FEEDING PROBLEM, LOW WEIGHT FOR AGE, THRUSH

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