IMCI Chart Booklet Trytry

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World Health Organization
Division of Child ,ealth and Develo#ment .C,D/
S# K H#/. AGE 2 MONTHS UP TO 0 %EA-S

TREAT THE CHILD, +ontin&ed
Gi'e E1tra Fl&id !or .iarrhoea and ontin&e Feeding Plan ': Treat for Diarrhoea at ,ome)))))))))))))))))))))))))34 Plan B: Treat for "ome Dehydration ith ($")))))))))34 Plan C: Treat for "evere Dehydration 7uickly))))))))))38 Gi'e Follo()&* are Pneumonia))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))39 !hee:e .first e#isode/))))))))))))))))))))))))))))))))))))))))))))))39 Diarrhoea still #resent after 4 days -------)39 Dysentery))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))39 Persistent Diarrhoea)))))))))))))))))))))))))))))))))))))))))))))))))3< 2alaria)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))3<
F AGE
ASSESS AND CLASSIFY THE SICK CHILD
ASSESS, CLASSIFY
Assess, lassi!" and #denti!" Treat$ent Check for 0eneral Danger "igns ))))))))))))))))))))))))))))))))))))) 1 Then 'sk 'bout 2ain "ym#toms: Does the child have cough or difficult breathing? )))))))))))))))) 1 Does the child have diarrhoea?)))))))))))))))))))))))))))))))))))))))) 5 Does the child have fever? )))))))))))))))))))))))))))))))))))))))))))))) 6 Classify malaria))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))6 Does the child have an ear #roblem?)))))))))))))))))))))))))))))))) 4 Then Check for 2alnutrition and 'naemia ))))))))))))))))))))))) 8 Then Check the Child&s Immuni:ation "tatus))))))))))))))))))) 8 'ssess (ther Problems)))))))))))))))))))))))))))))))))))))))))))))))))))) 8 Check for sym#tomatic ,I; infection ))))))))))))))))))))))))))))))) 9
Assess, lassi!" a Check for Possib Then ask: Does Then Check for F Then check feed Then Check for " Then Check the 'ssess (ther Pro 'ssess the moth
TREAT THE CHILD

Tea+h the $other to gi'e oral dr&gs at ho$e2 Treat the Child for !hee:ing)))))))))))))))))))))))))))))))))))))) > (ral 'ntibiotic )))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) > Co@trimoAa:ole )))))))))))))))))))))))))))))))))))))))))))))))))))))))))) > Pain relief for ,I; )))))))))))))))))))))))))))))))))))))))))))))))))))) 3B Iron for anaemia ))))))))))))))))))))))))))))))))))))))))))))))))))))))) 3B Co@artemether for malaria )))))))))))))))))))))))))))))))))))))))) 3B Paracetamol ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) 3B Tea+h the Mother to Treat /o+al #n!e+tions at Ho$e Dry the +ar by icking )))))))))))))))))))))))))))))))))))))))))))) 33 Treat for 2outh Clcers and Thrush )))))))))))))))))))))))))) 33 "oothe throat* relieve cough ith safe remedy ))))))) 33 Gi'e Pre'enti'e Treat$ents in lini+ 2ebenda:oleDalbenda:ole ----------)))31 ;itamin ' ------------------)31 #ersistent diarrhoea 14 Gi'e E$ergen+" Treat$ent in lini+ onl"
Fever= other cause))))))))))))))))))))))3<
+ar Infection))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))3< 'naemia))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))3> ?ot gro ing ell))))))))))))))))))))))))))))))))))))))))))))))))))))))))3> Feeding #roblem)))))))))))))))))))))))))))))))))))))))))))))))))))))))3> "ym#tomatic ,I;: 3st follo @u#))))))))))))))))))))))))))))))))))))))))))))))))1B $e#eat follo @u#)))))))))))))))))))))))))))))))))))))))))1B Palliative care)))))))))))))))))))))))))))))))))))))))))))))1B
Treat the %o&ng #n! (ral 'ntibiotic))))) Intramuscular 'n To Treat for Diarr Immunise +very Treat Local Infec Correct Positioni Common breastf Correct #re#arati ,o to feed a ba ,ome Care for %
COUNSEL THE MOTHER
'ssess the Child&s Feeding)))))))))))))))))))))))))))))))))))))))13 Feeding $ecommendations))))))))))))))))))))))))))))))))))))))11 Feeding recommendations for ,I; infected mother) 15 Counsel 'bout Feeding Problems))))))))))))))))))))))))))))16 "#ecial Feeding $ecommendations:
Gi'e Follo()&* a Local Bacterial In Thrush))))))))))))))))) Feeding Problem Lo !eight))))))))
Feeding advice for child ith

Poor a##etiteD mouth sores))))))))))))))))))))))))))))))))))))14 Feeding advice for ,I; infection))))))))))))))))))))))))))))14
-E O-.#NG FO-M S# K %O S# K
Increase fluid during illness (Aygen for severe #neumonia ))))))))))))))))))))))))))))))))) 35 ----------))18 'dvise Treat for stridorE nebulised mother hen to return 18 adrenaline ))))))))))))))))))))) 35 'dvise mother hen to return immediately)))))))))))))))18 Intramuscular 'ntibiotic )))))))))))))))))))))))))))))))))))))))))))) 35 Counsel the mother about her o n health))))))))))))))))19 Dia:e#am for convulsions ------)))----) 35 Prevent lo blood sugar -----------)))36 Treat lo blood
FG? I2CI guideline "e#tember 1BB1
ASSESS AN. UP /ASS#F% AGE 2 MONTHS TO 0 %EA-S THE S# K

.O -AP#. APP-A#SA/ ON A// WA#T#NG H#/.-EN '"F T,+ 2(T,+$ !,'T T,+ C,ILD" P$(BL+2" '$+) Determine if this is an initial or follo @u# visit for this #roblem % if follo @u# visit use the follo @u# instructions on #ages 39@1B % If initial visit assess the child as follo s:
H#/.
HE K FO- GENE-A/ .ANGE- S#GNS

OOK2 #s the +hild 3reast!eed4 a) lethargi+ or .oes the +hild 'o$it e'er"thing4 b) &n+ons+io&s Has the +hild had +on'&lsions d&ring this illness4 5i! +on'&lsing no( see *6178 ' child ith any general danger sign reHuires urgent attention: com#lete the assessment* start #re@referral treatment and refer urgently) Test for lo blood sugar= then treat or #revent) ASK2 #s the +hild a3le to drin, or
^ppb pp THEN ASK A9OUT MA#N S%MPTOMS2

#F %ES, ASK2 /OOK, /#STEN, FEE/: lassi!" OUGH or
.#FF# U/T 9-EATH#NG
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SE:E-E PNEUMON#A O- :E-% SE:E-E .#SEASE
% % % %
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Gi'e !irst dose o! a$*i+illin O- +e!tria1one #M6 5*617 8 #! +hild &nder ;$onths old2 gi'e 0 $ls +o)tri$o1azole stat Gi'e o1"gen 5*6 17 8 #! stridor2 gi'e ne3&lised adrenaline 5*617 8
.oes the +hild ha'e +o&gh or di!!i+&lt 3reathing4
An" general danger sign OChest indra ing ($ "tridor in calm child
% Test 3lood s&gar6 Then treat<*re'ent lo( 3lood s&gar 5*6 1= 8 % Kee* +hild (ar$, and re!er U-GENT/% to hos*ital6 % % % % % %
For ho
long?
Count the breaths in one minute) Look for chest indra ing) Look and listen
C,IL D 2C"T B+ C'L2
Fast breathing)
PNEUMON#A
0ive amoAycillin for 4 days .#)>/ "oothe the throat and relieve the cough .#)33/ Consider sym#tomatic ,I; .#)9/ If coughing for more than 13 days refer for #ossible TB or asthma 'dvise mother hen to return immediately .#)18/ Follo @u# in 1 days
for stridor or hee:e)
Is the
))))))))))))))))))))))))))))))))))))))))))))) )
AN. #F WHEE>E, ASK2
child a kno n asthmat ic?
?o signs of #neumonia or very severe disease)
OUGH O-
O/.
,as the child had a hee:e before this illness? Does the child have freHuent cough at night? ,as the child had a hee:e for more than a eek?
And i! (heeze +lassi!"2
% "oothe the throat and relieve cough .#)33/ % If coughing for more than 13 days refer for #ossible TB or
asthma % 'dvise
mother hen to return immediately .#)18/
% Follo
u# in 4 days if not im#roving
%es to any Huestion
-E U--E NT WHEE> E WHEE>E 5F#-ST EP#SO.E8
% % % % % %
'll other children ith hee:e
0ive salbutamol via s#acer for 4 days .#) >/ 0ive oral #rednisone for three days .#) >/) #! there is an" se'ere +lassi!i+ation, gi'e !irst dose o! *rednisone and sal3&ta$ol 3e!ore re!erral 0ive salbutamol via s#acer for 4 days . #) >/ #! an" se'ere +lassi!i+ation gi'e sal3&ta$ol 3e!ore re!erral Follo @u# in 4 days if still hee:ing 'dvise the mother to return if hee:e recurs
-ESP#-ATO-% -ATE #! the +hild is2 Fast 3reathing is2 1 months u# to 31 months: 0? or more breaths #er minute 31 months u# to 4 years =? or more breaths #er minute
Danger signsDCough 'ssess and classify
.oes the +hild ha'e diarrhoea4

lassi!" all +hildren (ith
T o of the follo ing signs:
% Start treat$ent !or se'ere deh"dration
Lethargic or unconscious "unken eyes ?ot able to drink or drinking #oorly "kin #inch goes back very slo ly)
.#A--HOEA W#TH SE:E-E .EH%.-AT#ON
% % % %
#F % E S, A S K2
5Plan *61;86 -EFE- U-GENT/% to hos*ital Gi'e !re@&ent si*s o! O-S on the (a" Ad'ise the $other to +ontin&e 3reast!eeding Kee* the +hild (ar$ on the (a" to hos*ital
F
o r h o l o n g ?
s or mo re* ha s the chi ld los t J e igh t?
/ O O K O F E E / :
L o o k a t t h e c h i l d & s g e n e r a l c o n d
i t i o n ) I s t h e c h i l d : @
u fluid) s Is the ? child: @ @ ? $ o e t s t a l b e l s e s a n d i r r i t a b l e ? t o d r i n k o r d r i n k i n g # o o r l y ? @ Drinkin
Is
I
f d i a r r h o e a f o r 3 6 d a y
ther e blo od in the sto ol? ha t tre at m en t is th e m ot he r giv ing ?
L e t h a r g i J c Lo ok o for r su nk u en n ey c es o n J s (ff c er i the o chi ld
g eag erly* thir sty ? Pinch the skin of the abdom en) l Do assi es it !" go .#A bac --H k: OEA @ slo ly ? @ or very slo ly ? .mo re tha n1 sec ond s/
J
diar rhoe a !or .EH% .-AT# ON
T o of the follo ing signs : $ es tle ss * irri ta bl e
gh signs to class ify as seve re or som e dehy drati on
lo ss .#A--HOEA W#TH SOME .EH%.-AT#ON
0 i v e f l u i d a n d f o o d t o t r e a t f o r s o m e d e h y d r a t i o n
NO :#S#9/E .EH%.-AT#ON
" un ke n ey es Dr in ks ea ge rly * thi rst y " ki n #i nc h go es ba ck sl o l y)
Dehy dratio n #rese nt ($ ,isto ry of eig ht loss
SE:E-E PE-S#STENT .#A--HOEA
PE-S#STENT .#A--HOEA
And i! diarrh oea 1= da"s or $ore +lassi! "2
? o d e h y d r a t i o n a n d
? ot e n o u
?o histor y of eig ht
. P l a n
ed B iat el # y ) .#) 3 18 4 / / % % Fo ' llo d @ vi u# s in e 1 m da ot ys h if er no to t c im o #r nt ov in in u g e br e % a 0i st ve fe flu e id di an n d g fo % od ' to d tre vi at s for e di th ar e rh m oe ot a h at er ho m h e e .P n la to n re ' tu #) rn 34 i / m % m '
d v i s e m o t h e r
G i' e :i ta $ in A & nl e h s e s n % a t d o S o r t s e a e t r h u t a r t s n r 3 i e e m a e m t n e $ gi d e ' i n e a t n t ! in e o t l r h y e . d la # e st ) h $ 1 " o 8 d n / r t % a h F t 5 o i *6 ll o 1 o n 2 8 @ 5 % u i on # ! sider i * s"$ n r *to$ 4 e ati+ d s H#: a e 5*6 y n A8 s t % if 8 Gi'e
n% o t i m # r o v i n g
! r e @ & e n t s i * s
eot !h eer ra b to o ut fe h e o di sn * g i .# o t )1 ! a4 O l/ -% S %0i ve o C vit n oa umi t nn h s' e eu l nl ( es a ts " ha % ed os - m
th . #) 3 1 /
%
vi se m ot he r he n to re tu rn im m ed iat el y .# )1 8/ D % i ' F s oll 3 o @ u# in 4 da ys
% Start treat$ent
C o n si d e r s y m #t o m at ic , I ; . #) 9 / % ' d
!or deh"dration i! *resent % -e!er U-GENT/% to hos*ital % Gi'e !re@&ent
si* s o! OS on the
( a "
reat for 4 days ith nalidiAic acid .#)>/
% 'dvise
the mother hen to return immediate ly .#)18/ % Follo @ u# in 1 days
An d i! 3lo od in stool +lassi! "2
E : E E . % S E N T E %
guideline
.oes the +hild ha'e !e'er4

By history* or tem#erature 59)4K C or above
lassi!" all +hildren (ith
'ny general danger "tiff neck

($ sign ($
SUSPE TE. MEN#NG#T#S
Bulging fontanelle)
% Gi'e !irst dose o! a$*i+illin #M or +e!tria1one #M 5*6178 % Test the 3lood s&gar, then treat or *re'ent lo( 3lood s&gar 5Page 1=8 % Gi'e one dose o! *ara+eta$ol !or !e'er 7BC or a3o'e 5*61?8 % -e!er U-GENT/% #F / lle !e ? l %ES O o 'e e , O g r ) AS K e !or K2 A n M L N er EN o al For . #N o FE d ho E/ G# k a 2 n T# lon g S f g? F er o o si r r g If o ns t mo a s h re n t e tha d i ? r n9 f o c da
ys* ha s fev er be en #re se nt ev ery da y?
n e c k a n d b u l g i n g f o n t a n e l
a u s e s o f f e v e r
s t i f f n e c k o r b u l g i n g f o n t a n e
F E:E -) OTH EA USE
% Tre at ca us e of fev er if fou nd % 0iv e #ar
ac et a m ol in th e cli ni c fo r hi g h
fev er 5< KC or ab ov e .#) 3B / % I f f
e v e r i s # r e s e n t
every day for more than 9 days refer for asses sment % 'dvise mother hen to return immediately .#)18/ % Follo @u# in 1 days if fever #ersists gative or not done/
)))))))) )))))))) )))))))) )))))))) THEN .E #.E THE H#/.DS MA/A-#A -#SK2
2alaria $isk means: Lives in 2alaria :one or vis@ ited a malaria :one in the #revious month) If in doubt* also classify for malaria)
'
l a s s i ! " F E : E -
n y g e n e r a l d a n g e r s i g n ( $
n t a n e ll e .2 a l a r i a r a # i d t e s t # o s i t i v e o r n e
$a#id malaria
test #ositive
Do a ra#id
malaria test if available
An d i! $al ari a ris , *re sen t +la ssi! "2
"
tif f n e c k ( $
B
ul gi n g fo
#! S+ Uh S il Pd Ea g Te Ed .o ' Se Er :o En -e E" e Ma A r2 /G Ai - '% # e A !i r s t d o s e Mo A! /+ Ao -) # a A rt e $ e t h e r ! o r s e ' e r e $
SP E TE . ME N# NG #T# S as a3 o' e % -e !er UGE NT /%
-e !er UGE NT c /% l !or i $a n lari i ac tre at a $e n nt d i! ag c ed o les n st tha i nn 12 u $o e nt hs a %t If the h chil o dm is e ov er f a
y e a r ol d gi v e fir st d o s e c o @ a rt e m et h e r in th e
o r 5 d a y s . # ) 3 B / % 0iv
e #ar ac eta mo l in the clin ic for hig h fev er 5<K C or ab
ov se e s .#) % 3B ' / dv % is ? e oti m fy ot co he nfi r rm ed he m n al to ari ret a ur ca n
imme diately .#)18/

%
Follo @u# in 1 days if fever #ersist s

%
mol in the clini c for feve
r B G 5<K / C or abo ve .#)3
Follo @u# if fever recurs ithin 36 days
POSS#9/E % MA/A-#A $ef er for ma lari a tes tin g. Do not giv e co@ art em eth er it ho ut a #o siti ve ra# id ma lari a tes t % 0ive #ara ceta
% Tre at - ) as OTHEfor AUSE F+ ;+ $@ (T ,+ $ C' C" + ab ov e)
F e A s
.oes the +hild ha'e an ear *ro3le$4

#F %ES, ASK2 /OOK AN. FEE/2
Tender s elling behind the ear
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Is there ear #ain? Is there ear discharge? If yes* for ho long?
Look for #us draining from the ear) Feel for tender s elling behind the ear)
% Gi'e a$*i+illin #M O- +e!tria1one #M 5*6178 % Gi'e !irst dose o! *ara+eta$ol 5*61?8 % -e!er U-GENT/% to hos*ital
lassi!" EAP-O9/EM
Pus seen draining from the ear and discharge is re#orted for less than 36 days* ($ +ar #ain
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% 0ive amoAycillin for 4 days .#)>/ % If ear discharge:
- Teach mother to clean ear by dry icking .#)33/ - Consider sym#tomatic ,I; .#)9/
% 0ive #aracetamol for #ain .#)3B/ % Follo @u# in 4 days if #ain or discharge #ersists
Pus is seen draining from the ear and discharge is re#orted for 36 days or more
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% % % %
Teach mother to clean ear by dry icking .#)33/ Consider sym#tomatic ,I; .#)9/ Tell the mother to come back if she sus#ects hearing loss Follo u# in 36 days if discharge #ersists
?o ear #ain '?D no #us seen draining from the ear
kl bô fkcb`qflk
% ?o additional treatment
+ar #roblem
'ssess and classify
FG? I2CI guideline

5
"e#tember 1BB1
q ebk èb`h clo jî krqofqflk

ASK2
,as the child lost eight?
;ery lo
eight ($
;isible severe asting ($ (edema of both feet
SE:E-E MA/NUT-#T#ON
Gi'e :ita$in A &nless a dose has 3een gi'en in *ast $onth 5*6128 % Test !or lo( 3lood s&gar, then treat or *re'ent 5*61=8 % -e!er U-GENT/% to hos*ital
%
/OOK and FEE/2

G-OWTH Plot the eight on the gro th chart: Is the child: Lo eight .belo 5rd centile/ ;ery lo eight .belo 8BL of eA#ected eight/ Look at the sha#e of the eight curve: Is the child: 0aining eight ell? 0aining eight but curve is flattening? Losing eight ?
lassi!" all +hildren !or G-OWTH
Kee* the +hild (ar$ 'ssess feeding M counsel about feeding .#)13/ Check for and treat thrush .#)33/ 0ive mebenda:ole if the child is older than one year and has not had a dose in the #ast siA months .#)31/ Follo ;itamin ' schedule .#)31/ Consider sym#tomatic ,I; infection .#)9/ 'dvise mother hen to return immediately .#) 18/ If feeding #roblem follo u# after 4 days If no feeding #roblem follo u# after 36 days
Lo
eight ($
Poor eight gain ($ 2other re#orts eight loss ($
NOT G-OW#NG WE//
% % % % % % % %
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?ot lo 0ood
eight '?D eight gain G-OW#NG WE//
% If child is less than 1 years* assess and counsel on feeding .#)13/ % If feeding #roblem* check for thrush* and treat .#)33/) Follo @u# in
five days
% 0ive mebenda:ole if the child is older than one year and has not % Follo
had a dose in the #ast siA months .#)31/ ;itamin ' schedule .#)31/
Look for visible severe
asting
Feel for oedema of both feet

ANAEM#A Look for #almar #allor) Is it: "evere #almar #allor? "ome #almar #allor?
And +lassi!" all +hildren For ANAEM#A
"evere #almar #allor ($ ,b N 8gDdl
pbs bob ^k^bjf^
% %
-e!er U-GENT/% to hos*ital Kee* the +hild (ar$
^k^bjf^
J "ome #almar #allor ($
If any #allor
check the haemoglobin .,b/ level
,b N3BgDdl kl ^k^bjf^ ?o #allor ($ ,b O3BgDdl
% 0ive iron .#)3B/ % Do a feeding assessment and counsel about feeding % Follo @u# in 36 days % ?o additional treatment
2alnutritionD 'naemia 'ssess and classify
#F THE

H#/.)
has a +lassi!i+ation toda" o! PNEUMON#A or PE-S#STENT .#A--HOEA or NOT G-OW#NG WE// OHas had an e*isode o! *ersistent diarrhoea in the *ast three $onths OHas had a dis+harging ear at an" ti$e
O#! the $other is ,no(n to 3e H#: *ositi'eE
ASSESS FO- S%MPTOMAT#

NOTE 5as a3o'e82
Does the child have
H#: #NFE T#ON E2

three or $ore
#ositive findings % Discuss reasons for classification ith mother and advise her to take the child for ,I; testing % 'rrange #re@test counselling and ,I; testing % 'ssess feeding and counsel .#)13/ % Counsel mother about her o n health % Follo @u# in 36 days as follo s: - i! $other agrees to have the child tested* discuss the result and arrange regular follo u# if #ositive .#)1B/
/OOK AN. FEE/ FO-2
SUSPE TE.
any P?+C2(?I' no ? ear discharge no ($ in lo #oor
enlarged lym#h glands in

t o or more of the follo ing sites: neck* aAilla or groin? oral thrush? #arotid gland enlargement?
S%MPTOM AT#
H#:
the #ast? eight for age? eight gain or eight loss? 'ny e#isode of #ersistent diar@ rhoea in the #ast three months?
/ASS#F% 3" +o&nting the n&$3er o! *ositi'e !indings
i! $other re!&ses testing* revie the child and for further discussion) (ffer treatment to the child including regular follo @u# and co@trimoAa:ole #ro#hylaAis if ,I; testing is refused .#)1B/)
less than
three #ositive findings S%MPTOMAT# UN/#KE/%
% If the mother is kno n ,I; #ositive: - give a##ro#riate feeding advice .#) 15/ if the child is &nder one "ear start co@trimoAa:ole #ro#hylaAis .#) >/ and test to determine hether the child is infected at age 31 months - if the child is o'er one "ear arrange testing to determine if the child is infected % Counsel mother about her o n health and about #revention of ,I; infection % If breastfeeding counsel about im#ortance of safe seA during breastfeeding to #revent ,I; transmission to the baby if the mother becomes infected hile breastfeeding
H#:
E#! the +hild has 3een +lassi!ied as s"$*to$ati+ H#: in the *ast and had a *ositi'e H#: test, do not assess again ) gi'e !ollo()&*
+are !or +on!ir$ed s"$*to$ati+ H#: 5*6 2?8
"ym#tomatic ,I; 'ssess and classify
THEN HE K THE
% % %
H#/.DS #MMUN#SAT#ON STATUS
Gi'e all $issed i$$&nisations toda"6 This in+l&des si+, +hildren 5&nless 3eing re!erred8 and those (itho&t their +ards #! there is no -TH gi'e a ne( one toda" Ad'ise the $other (hen to +o$e !or the ne1t i$$&nisation
^ db s ^` ` f kb
BC0 DPTP,IB@3 DPTP,IB@1 DPTP,IB@5 (P;@B (P;@3 (P;@1 (P;@5 ,e# ,e# B3 B1 :#TAM#N A P-OPH%/AF#S 0ive every child a dose of vitamin ' every siA months from the age of 8 months .#)31/) $ecord the dose on the $T,C -OUT#NE WO-M T-EATMENT 0ive every child mebenda:ole every 8 months from the age of one year) $ecord
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Birth 8 eeks 3B eeks 36 eeks > months 3< months 4 years
,e# B5 2easles 3
I dose if
Check vitamin ' and give
DPT@6 .#)31/
(P;@6
2easles 1
none given in #ast 8 months
the dose on the $T,C)
DT
(P;@4
ASSESS OTHE- P-O9/EMS2
$emember to ask if the child has any other #roblems like skin sores not covered in the I2CI assessment
MAKE SU-E H#/. W#TH AN% GENE-A/ .ANGE- S#GN #S -EFE--E. after first dose of an a##ro#riate antibiotic and other urgent treatments) Check the blood sugar in all children ith a general danger sign and treat or #revent lo blood sugar)
FG? I2CI 0uideline "e#tember 1BB1
Immunisation 'ssess and classify
"
A--% OUT THE T-EATMENT STEPS #.ENT#F#E. ON THE ASSESS AND CLASSIFY HA-T
T-EAT THE H#/.
TEA H THE MOTHE- TO G#:E O-A/ .-UGS AT HOME

Follo( the general instr&+tions 3elo( !or e'er" oral dr&g to 3e gi'en at ho$e6 Also !ollo( the instr&+tions listed (ith ea+h dr&gDs dosage ta3le6
For WHEE>E gi'e Sal3&ta$ol and Prednisone

SA/9UTAMO/
5-a*id a+ting 3ron+hodilator8 WE#GH T P-E.N#SON E .4mg/ (nce daily for three 1 tabs 5 tabs 6 tabs 4 tabs 8 tabs 9 tabs < tabs USE OF A SPA E' s#acer is a ay of delivering the bronchodilator drugs effectively into the lungs) ?o child under 4 years should be given an inhaler ithout a s#acer) ' s#acer orks as ell as a nebuliser if correctly used) S*a+ers +an 3e $ade in the !ollo(ing (a"2 % Cse a 4BBml cool drink bottle) % Cut a hole in the end or the to# of the bottle in the same sha#e as the mouth#iece of the inhaler) This can be done using a shar# knife % In a small baby a mask can be made by making a similar hole in a #lastic .not #olystyrene/ cu# % 'lternatively commercial s#acers can be used if available To &se an inhaler (ith a s*a+er2 % "hake the inhaler ell % Insert mouth#iece of the inhaler through the hole in the bottle or #lastic cu#) % The child should #ut the o#ening of the bottle into his mouth and breath in and out through the mouth % ' carer then #resses do n the inhaler and s#rays into the bottle hile the child continues to breath normally % !ait for three to four breaths and re#eat for total of five s#rays % For younger children #lace the cu# over the child&s mouth and use as a s#acer in the same ay +?"C$+ T,'T 'LL C'$+$" (F C,ILD$+? C"I?0 I?,'L+$" '$+ 'BL+ T( C"+ '? I?,'L+$ '?D "P'C+$ +FF+CTI;+L%
% % % % % % % % %
.eter$ine the a**ro*riate dr&gs and dosage !or the +hildDs age or (eight Tell the $other the reason !or gi'ing the dr&g to the +hild .e$onstrate ho( to $eas&re a dose Wat+h the $other *ra+tise $eas&ring a dose 3" hersel! As, the $other to gi'e the !irst dose to her +hild E1*lain +are!&ll" ho( to gi'e the dr&g Ad'ise the $other to store the dr&gs sa!el" E1*lain that all the ta3lets or s"r&* $&st 3e &sed to !inish the +o&rse o! treat$ent, e'en i! the +hild gets 3etter he+, the $otherDs &nderstanding 3e!ore she lea'es the +lini+
6@8kg O8@>kg O>@31kg O31@ 36kg O36@ 39kg O39@ 3>kg O3>@ 1Bkg
For H#: #NFE T#ON gi'e o)tri$o1azole to Pre'ent #n!e+tions

% %
"albutamol metered dose inhaler .3BBugD#uff/ 4 #uffs ith a s#acer for 4 days
",(CLD ?(T B+ 0I;+? T( B'BI+" C?D+$ 8 !++F" (F '0+ For 3a3ies o! $others (ho are H#: in!e+ted, give co@trimoAa:ole once daily for five days a eek from the age of 8 eeks) If the baby has no sym#@ toms at 31 months arrange ,I; testing to determine if child is infected
%
For +hildren (ith s"$*to$ati+ H#: in!e+tion give once daily five days #er eek .can be given even if mother refuses ,I; testing/
For PNEUMON#A and A UTE EA-
AGE
WE#GH T
AMOF% #// #N S%-UP .314 mg #er 4 ml/ 0ive three
For .%SENTE-% gi'e Nalidi1i+ A+id
1 to 31 mon ths 31 months to 4 years
6@4 kg O4= 3B kg O3B= 36 kg O36@1B kg
1*4 ml 4 ml 9)4 ml 3B ml
AGE or WE#G HT
SUSPENS# ON .14B mg D 4 ml)/ 0ive four
NA/#.#F # A #.
31@16 months #9@ N34kg/ 1@4 years .34@ N1Bkg/
1)4 ml
4 ml
#NFE T#ON gi'e A$o1"+illin
O)T-#MOFA>O/E S%-UP 5 =?<2??$g<0$l8

On+e dail" !i'e da"s *er (ee, WE#GHT 6@4 kg O4= 3B kg O3B= 36 kg O36@1B kg .OSE 1)4 ml 4ml 4 ml 9)4 ml
'ntibiotics !hee:e
TEA H THE MOTHE- TO G#:E O-A/ .-UGS AT HOME

Follo( the instr&+tions 3elo( !or e'er" oral dr&g to 3e gi'en at ho$e Also !ollo( the instr&+tions listed (ith ea+h dr&gDs dosage ta3le
For ANAEM#A gi'e #ron

% % % %
% %
Gi'e Para+eta$ol !or +hroni+ *ain relie! 5stage 18 Add reg&lar odeine !or +hroni+ se'ere *ain 5stage 28
"afe doses of Paracetamol can be slightly higher for #ain) Cse the table and teach mother to measure the right dose) 0ive Paracetamol every 8 hours if #ain ."tage 3/ #ersists)
Check the strength and dose of the iron syru#D tablet very carefully 0ive t o doses daily for 1 months) Follo @u# every 36 days for 1 months 0ive Iron syru# ith food) Iron may make the stools black) (verdose ith iron is dangerous* caution the mother to kee# it out of reach of children)
AGE or WE#GHT #-ON S%-UP Ferrous gluconate 0ive t ice daily 4 dro#s 3B dro#s 1B dro#s
1 months u#to 6 months .6 @ N8 kg/ 6 months u#to 16 months .8@N34kg/ 1R4 years .34 @ 15 kg/
% %
Stage 2 *ain is chronic severe #ain as might ha##en in illnesses such as 'ID") % "tart treating "tage 1 #ain ith regular .not #rn/ #aracetamol) % In older children* Q Paracetamol tablet can re#lace 3B ml syru# % If the #ain is not controlled* add regular .not #rn/ codeine) % "tart Codeine on the lo er dose* gradually increasing de#ending on the child&s re@ s#onse* to the maAimum dose)
WE#GHT 5age8 3B = 34kg .3@4 years/ (ver 34kg AGE .(nly if you do not kno the eight/ Cnder 1 months 1 u# to 8 months 8 u# to 31 months 3 u# to 5 years 5 u# to 6 years (ver 6 years Pain Stage 1 Para+eta $ol ; hrl" 1 m 1)4 ml 4 m 9)4 ml 3B ml 31)4 ml Pain Stage 2 Add odeine Phos*hate s"r&* 20 $g *er 0 $l ; hrl" #nitial dose Ma1i$&$ B)1 ml B)5 ml B)4 ml 3)B ml 3)4 ml 1 ml 3)B ml 1)B ml 5 m 4 m 8 m < m
For MA/A-#A Gi'e
o)arte$ether
% -EFE- A// H#/.-EN UN.E- ONE %EA- U-GENT/% TO HOSP#TA/ % 0ive the first dose of co@artemether in the clinic and observe for one hour6 If child vomits ithin an hour re#eat the dose % "econd dose should be taken at home < hours later % Then t ice daily for further t o days % Co@artemether should be taken ith food
O) A-TEMET HE3 tablet 1 tablets TOTA/ NUM9EOF TA9/ETS 8 31
WE#GH T 1 @ N5 kg 5 @ N4 kg 4 @ N< kg < @ N31 kg 31 @ N38 kg 38 @ N1B kg
For High Fe'er or Ear Pain gi'e Para+eta$ol

% 0ive single dose in the clinic for high fever % For ear #ain: give #aracetamol every 8 hours until ear #ain is gone) % Te#id s#onging can also bring do n the tem#erature
PA-A ETAMO/ AGE or WE#GHT 1 months u# to 5 years .6 @ N36 kg/ 5 years u# to 4 years .36 @ N15 kg/ S%-UP 512? $g < 0 $l8 4 ml 3B ml TA9/ET 50?? $g8
R
3D1
(ral drugs at home Treat the child
1%
TEA H THE MOTHE- TO T-EAT /O A/ #NFE T#ONS AT HOME

% E1*lain to the $other (hat the treat$ent is and (h" it sho&ld 3e gi'en % .es+ri3e the treat$ent ste*s listed in the a**ro*riate 3o1 % Wat+h the $other as she does the !irst treat$ent in the +lini+ 5e1+e*t re$ed" !or +o&gh or sore throat8 % Tell her ho( o!ten to do the treat$ent at ho$e6 % #! needed !or treat$ent at ho$e, gi'e $other a s$all 3ottle o! gentian 'iolet or n"statin % he+, the $otherDs &nderstanding 3e!ore she lea'es the +lini+
lear the Ear 3" .r" Wi+,ing

%
Treat !or Mo&th Ul+ers (ith Gentian :iolet

% Treat !or $o&th &l+ers t(i+e dail" !ash hands !et a clean soft cloth ith salt ater and use it to ash the child&s mouth Paint the mouth ith B*4 L gentian violet .0;/ !ash hands again Continue using 0; for 6< hours after the ulcers have been cured 0ive #aracetomol for #ain relief .#)3B/
.r" the ear at least 7 ti$es dail" $oll clean absorbent cloth or soft* strong tissue #a#er into a ick Place the ick in the child&s ear $emove the ick hen et $e#lace the ick ith a clean one and re#eat these ste#s until the ear is dry The ear should not be #lugged bet een dry ickings
Soothe the Throat, -elie'e the o&gh (ith a Sa!e -e$ed"
"afe remedies to recommend: - Breastmilk for eAclusively breastfed infant - ,oney and lemon
Treat !or Thr&sh (ith N"statin or Gentian :iolet

% Treat !or thr&sh !o&r ti$es dail" !or A da"s !ash hands !et a clean soft cloth ith salt ater and use it to ash the child&s mouth Instill nystatin 3ml four times a day or #aint ith 0; as above for 9 days 'void feeding for 1B minutes after medication If breastfed check mother&s breasts for thrush) If #resent treat ith nystatin or 0; 'dvise mother to ash breasts after feeds) If bottle fed advise change to cu# and s#oon If severe* recurrent or #haryngeal thrush consider sym#tomatic ,I; .#) 9/ 0ive #aracetamol if needed for #ain .#)3B/
- ,erbal smoke inhalation - ;icksS dro#s by mouth
,armful remedies to discourage:
; Local infections at home Treat the child
11
G#:E THESE P-E:ENT#:E T-EATMENTS #N /#N#

% % %
E1*lain to the $other (h" the dr&g is gi'en .eter$ine the dose a**ro*riate !or the +hildDs (eight 5or age8 Meas&re the dose a++&ratel"
Gi'e :ita$in A to all hildren e'er" ; $onths

%
P-E:ENT#ON2 0ive ;itamin ' to all children to prevent severe illness - First dose at 8 eeks in a child that is not being breastfed - First dose in breastfed children to be given any time after 8 months of age - Thereafter vitamin ' should be given e'er" si1 $onths to 'LL C,ILD$+? T-EATMENT2 0ive an eAtra dose of ;itamin ' .same dose/ for treatment if the child has "+;+$+ 2'L?CT$ITI(? or P+$"I"T+?T DI'$$,(+') If the child has had a dose of vitamin ' ithin the #ast month* D( ?(T 0I;+ ;IT'2I? ')
Gi'e Me3endazole or Al3endazole to all hildren E'er" ; Months

% 0ive 4BB mg mebenda:ole .or 6BBmg albenda:ole/ as a single dose in clinic if: - the child is 3 year of age or older* and - has not had a dose in the #revious 8 months)
% Check the strength of ;itamin ': - ;itamin ' ca#sules come in 4B BBBIC* 3BB BBBIC* and 1BB BBBIC - If 3BB BBBIC is reHuired* and only the 1BB BBBIC ca#sules are available* cut o#en the ca#sules using a sterile needle and given the child every second dro# % 'l ays chart the dose of ;itamin ' given on the $T,C)
#MMUN#SE E:E-% S# K H#/., AS NEE.E.
Age
N8 months 8@ N31 months (ne year and older
:#TAM#N A .OSE
4B BBBIC 3BB BBBIC 1BB BBBIC
0ive treatments in clinic only Treat the child
12
G#:E EME-GEN % T-EATMENTS #N /#N# ON/%

% % % % E1*lain to the $other (h" the dr&g is gi'en .eter$ine the dose a**ro*riate !or the +hildDs (eight 5or age8 Use a sterile needle and sterile s"ringe (hen gi'ing an inGe+tion Meas&re the dose a++&ratel"
Gi'e An #ntra$&s+&lar Anti3ioti+
% G#:E TO H#/.-EN 9E#NG -EFE--E. U-GENT/% % 0ive either CeftriaAone ($ 'm#icillin* hichever is available in your clinic % !herever #ossible use the eight of the child to calculate the dose
Gi'e O1"gen to a hild (ith Se'ere Pne&$onia

% (Aygen should be given to all children ith "+;+$+ P?+C2(?I' ($ ;+$% "+;+$+ DI"+'"+ ith or ithout a hee:e) % Cse nasal #rongs or cannulae ith flo rate of 1 LDmin
% % % %
Dose of ceftriaAone is 4Bmg #er kilogram Dilute 14Bmg vial ith 3ml of sterile ater .14BmgDml/ IF $+F+$$'L I" ?(T P(""IBL+ ($ D+L'%+D* re#eat the ceftriaAone inTec@ tion every 16 hours Where there is a strong s&s*i+ion o! MEN#NG#T#S the dose o! +e!tria1one $a" 3e do&3led
EFT-#AFONE
AGE
1 = 6months 6= 31months 3 = 5yrs 5@4years
WE#GHT
6 = N8kg 8 = N3Bkg 3B = N34kg 34 = 3>kg
.OSE EFT-AFONE < $g

14B mg 4BB mg 94B mg 3g
.OSE EFT-#AFONE < $ls

3 ) 1 ) 5 ) 6)B .give 1ml in each thigh/
Gi'e Ne3&lised Adrenaline to a hild (ith Stridor

% 'dd 3ml of 3:3BBB adrenaline .one vial/ to 3ml of saline and give as a nebuliser % $e#eat every 1B minutes until the child is transferred
4@ N 3Bkg 3B@ N 34kg 34= 3> kg 8@ N 31 months 3@ N 5 years 6@ N 4years 3)B mls 3)4mls 1)B mls
Gi'e .iaze*a$ to Sto* a on'&lsion

% Turn the child to hisDher side and clear the air ay) 'void #utting things in the mouth % 0ive B)4mgDkg dia:e#am inTection solution #er rectum using a small syringe ith@ out a needle .like a tuberculin syringe/ or using a catheter % Check for lo blood sugar* then treat or #revent .#) 36/ % 0ive oAygen and $+F+$
WE#GHT N 4kg AGE N8 months .OSE OF .#A>EPAM 53BmgD1mls/ B)4 mls
% If convulsions have not sto##ed after 3B minutes re#eat dia:e#am dose
% % % %
Check strength of am#icillin) Csually 14Bmg vials but other strengths are avail@ able) Dilute 14Bmg vial ith 3ml of sterile ater .14BmgDml/ IF $+F+$$'L I" ?(T P(""IBL+ ($ D+L'%+D* re#eat the am#icillin inTection every 8 hours Where there is a strong s&s*i+ion o! $eningitis the dose o! a$*i+illin +an 3e in+reased = ti$es WE#GHT
6 = N8kg 8 = N3Bkg 3B = N34kg 34 = 3>kg
AMP# #//#N
AGE
1 = 6months 6 = 31months 3 = 5yrs 5@4years
.OSE AMP# #//#N<$g

314 mg 14B mg 594 mg 4BB mg
.OSE AMP# #//#N< $ls

B) 4 3) B 3) 4 1) B
Clinic treatments Treat the child
13
G#:E THESE T-EATMENTS #N /#N# ON/%

%
E1*lain to the $other (h" the treat$ent is 3eing gi'en
Pre'ent /o( 9lood S&gar 5H"*ogl"+ae$ia8 d&ring Trans!er to Hos*ital

% #! the +hild is a3le to s(allo(2 If breastfed: ask the mother to breastfeed the child* or give eA#ressed breastmilk If not breastfed2 give a breastmilk substitute or sugar ater) 0ive 5B@4B ml of milk or sugar ater before de#arture To make sugar water: Dissolve 4 level teaspoons of sugar (20 grams) in a 200-ml cup of clean water % #! the +hild is not a3le to s(allo(2 Insert nasogastric tube and check the #osition of the tube 0ive 4Bmls of milk or sugar ater before transfer
Treat the +hild !or /o( 9lood S&gar

/OW 9/OO. SUGA- #S /ESS THAN 7 $$ol<l #N A H#/. O- /ESS THAN 260 $$ol<l #N A %OUNG #NFANT
% S&s*e+t lo( 3lood s&gar in an" in!ant or +hild that2 is convulsing or unconscious ($ has a tem#erature belo 54*4UC* ($ is dro sy and s eating ($ is lethargic* flo##y or Tittery R #articularly hen less than 1 months old Children ith k ashiorkor are #articularly likely to be hy#oglycaemic % Confirm lo blood sugar using blood glucose testing stri#s % Treat
3BL 0lucose @ 0ive 4ml 3BL 0lucose for every kilogram body Fee# the child arm $efer urgently and continue feeds during transfer To make 3BL glucose if this is not available:
ith:
eight @ by nasogastric tube ($ intravenous line
miA 6 mls of 4BL glucose ith 38 mls sterile ater in a 1B ml syringe or miA 1 mls of 4BL glucose ith 3< mls of 4L glucose in a 1B ml syringe
Lo blood sugar Treat the child
1&
G#:E EFT-A F/U#. FO- .#A--HOEA AN. ONT#NUE FEE.#NG

Plan A2 Treat !or .iarrhoea at Ho$e
o&nsel the $other on the 7 -&les o! Ho$e Treat$ent2 1' Gi'e E1tra Fl&id, 26 ontin&e Feeding, When to -et&rn 76
Plan 92 Treat !or So$e .eh"dration (ith O-S

Gi'e in +lini+ re+o$$ended a$o&nt o! O-S o'er =)ho&r *eriod
% .ETE-M#NE AMOUNT OF O-S TO G#:E .U-#NG F#-ST = HOU-S6
0ive 1Bmls of ($" for each kg of body eight every hour

U* to = $onths N 8 kg 1BB @ 64B = $onths &* to 12 $onths 8 @ N 3B kg 64B @ <BB
1' GIVE E TRA FLUID .as much as the child

% TE// THE MOTHE-2
ill take/
AGEE
Breastfeed freHuently and for longer at each feed If the child is eAclusively breastfed* give sugar@salt solution ."""/ in addition If the child is not receiving breastmilk or is not eAclusively breastfed* give one or
more of the follo ing: food@based fluids such as soft #orridge* amasi .maas/* """ or ($") to breastmilk
WE#GHT A$o&nt o! !l&id o'er = ho&rs in $ls
12 $onths &* to 2 "ears 3B @ N 31 kg <BB @ >8B
2 "ears &* to 0 "ears 31 @ N1Bkg >8B @ 38BB
#t is es*e+iall" i$*ortant to gi'e O-S at ho$e (hen2 the child has been treated ith Plan B or Plan C during this visit the child cannot return to a clinic if the diarrhoea gets orse
% TEA H THE MOTHE- HOW TO M#F AN. G#:E SSS or O-S2
V Use the chil !s age onl" when "ou o not know the weight. The appro#imate amount of $%& re'uire (in ml) can also (e calculate (" multipl"ing the chil !s weight in kg times 20 an give this amount of flui ever" hour (20mls) kg). $ne teacup is appro#imatel" 200mls
% SHOW THE MOTHE- HOW TO G#:E O-S SO/UT#ON6
To make """:
3 litre boiled .or clean/ ater P < teas#oons sugar P half a teas#oon salt
0ive freHuent small si#s from a cu# If the child vomits* ait 3B minutes) Then continue* but more slo Continue breastfeeding henever the child ants If the child ants more ($" than sho n* give more
% AFTE- = HOU-S2 $eassess the child and classify the child for dehydration
ly
% SHOW THE MOTHE- HOW MU H F/U#. TO G#:E #N A..#T#ON TO THE
USUA/ F/U#. #NTAKE2 C# to 1 years: 4B to 3BB ml after each loose stool 1 years or more: 3BB to 1BB ml after each loose stool Tell the $other to2 0ive freHuent small si#s from a cu#) If the child vomits* ait 3B minutes) Then continue* but more slo ly Continue giving eAtra fluid until the diarrhoea sto#s SSS is the sol&tion to 3e &sed at ho$e to prevent deh"dration O-S sa+hets $i1ed (ith +lean (ater are &sed to +orre!t deh"dration6
"elect the a##ro#riate #lan to continue treatment Begin feeding the child in clinic
% #F THE MOTHE- MUST /EA:E 9EFO-E OMP/ET#NG T-EATMENT2 "ho her ho to #re#are ($" solution at home
"ho her ho much ($" to give to finish 6@hour treatment at home 0ive her instructions ho to #re#are """ for use at home +A#lain the 5 $ules of ,ome Treatment:
See COUNSEL THE MOTHER +hart 5*621)2A8
2' CONTINUE FEEDING 3' "HEN TO RETURN
1' GIVE E TRA FLUID
2' CONTINUE FEEDING

Diarrhoea@Plan ' and B Treat the child
3' "HEN TO RETURN
See Plan A !or re+o$$ended !l&ids
and See COUNSEL THE MOTHER +hart 5*621)2A8
15
G#:E EFT-A F/U#. FO- .#A--HOEA AN. ONT#NUE FEE.#NG

Plan 2 Treat !or Se'ere .eh"dration H&i+,l"
% cliil( qeb ôol( p) fc
^kp( bo f p *vbp+ , dl ^òl pp) fc *kl+, dl al( k)
J Start #: !l&id i$$ediatel") If the child can drink* give ($" by mouth hile the dri# is set u#) 0ive 1B mlDkg $inger&s Lactate "olution .or* if not available* normal saline/ every hour
Plan !or the ne1t 0 ho&rs2 0ive 1B ml I; for each kilogram eight* every hour hile the child is in the clinic a aiting transfer) 2onitor and record ho much fluid the child receives
#n the !irst hal! ho&r2 0ive 1B ml I; for each kilogram eight* before referral -e*eat this amount if brachial #ulse is eak or not detectable6 "T'$T ,+$+ Can you give intravenous .I;/ fluid immediately? vb#
kl
Arrange &rgent re!erral to hos*ital !or !&rther $anage$ent -eassess the +hild e'er" 1) 2 ho&rs (hile a(aiting trans!er6 If hydration status is not im#roving* give
the I; dri# more ra#idly)
'lso give ($" .about 4 mlDkgDhour/ as soon as the child can drink: usually after 5@6 hours .infants/ or 3@ $eassess an infant after 5
Is I; treatment available nearby . ithin 5B minutes/?
1 hours .children/)
hours if he is still at the clinic) Classify dehydration) Then choose the a##ro#riate #lan .'* B* or C/ to continue treatment) If you cannot refer observe for at least 8 hours after the child has been fully rehydrated
vb
-e!er U-GENT/% to hos*ital !or #: treat$ent) If the child can drink* #rovide the mother ith ($" solution and sho
during the tri# or give ($" by naso@gastic tube)
her ho to give freHuent si#s
k 're you trained to use a naso@gastric .?0/ tube for rehydration? kl
vb
Can the child drink?
kl $efer C$0+?TL% to hos#ital for I; or ?0 treatment
Start reh"dration 3" t&3e 5or $o&th8 (ith O-S sol&tion: give 1B mlDkgDhour for 8 hours .total of 31B
mlDkg/)
Arrange &rgent re!erral to hos*ital !or !&rther $anage$ent -eassess the +hild e'er" 1)2 ho&rs (hile (aiting trans!er2 'fter 8 hours reassess the child if he is still at the clinic) Classify dehydration) Then choose the
a##ro#riate #lan .'* B* or C/ to continue treatment) )If there is re#eated vomiting or abdominal distension* give the fluid more slo ly)
NOTE2
If the child is not referred to hos#ital* observe the child at least 8 hours after rehydration to be sure
the mother can maintain hydration giving the child ($" solution by mouth)
Diarrhoea@#lan C Treat the child
16
G#:E FO//OW)UP A-E

%
are !or the +hild (ho ret&rns !or !ollo()&* &sing A// the 3o1es that $at+h +hildDs *re'io&s +lassi!i+ations6
#! the +hild has an" ne( *ro3le$, assess, +lassi!" and treat the ne( *ro3le$ as on the ASSESS AND CLASSIFY +hart6
PNEUMON#A
A!ter 2 da"s2 Check the child for general danger signs) 'ssess the child for cough or difficult breathing) As,2 @ Is the child breathing slo er? Is there less fever? Is the child eating better?
%
#WW X##b ## C YiX##fcv
.#A--HOEA
A!ter 2 da"s 5diarrhoea (ith so$e deh"dration8 or 0 da"s 5no 'isi3le deh"dration8, i! diarrhoea *ersists2 'ssess the child for general danger signs and diarrhoea) As,2 ) 're there fe er stools? @ Is the child eating better?
% %
+ZF(F
#WW X##b ## C YiX##fcv
Treat$ent2
%
If +hest indra(ing or a general danger sign* give first dose of ceftriaAone or am#icillin I2I) Then -EFE- U-GENT/% to hos*ital6 #! 3reathing rate, !e'er and eating are the sa$e, or (orse -EFE- .unless the child has not been taking the antibiotics correctly/) #! 3reathing slo(er, less !e'er, or eating 3etter, com#lete the 4 days of antibiotic) -e$ind the $other to gi'e one e1tra $eal dail" !or a (ee,6
Treat$ent2 #! +hild is deh"drated no(, treat !or deh"dration and -EFEIf diarrhoea same as before and classified as ?( ;I"IBL+ D+,%D$'TI(? continue ith #lan ' at home and revie again in 4 days) If diarrhoea still continuing after a further 4 days* treat for #ersistent diarrhoea and $+F+$ If diarrhoea im#roving continue ith home treatment
% .%SENTE-%2
A!ter 2 da"s2
'ssess the child for diarrhoea) 2 &ee *&&+&& , -.*&&/01 (p3) As,2 - 're there fe er stools? - Is there less blood in the stool? - Is there less fever? - Is there less abdominal #ain? - Is the child eating better? Treat$ent2
% If the child is deh"drated* treat for dehydration .#)34 M 38/ and -EFE% If n&$3er o! stools, 3lood in the stools, !e'er, a3do$inal *ain, or eating is
WHEE>E 5F#-ST EP#SO.E8

A!ter 2 or 0 da"s i! still (heezing2 Check the mother is using the inhaler and s#acer correctly 'ssess and classify the child for cough or difficult breathing and treat according tc classification) .see *&&+&& , -.*&&/01 #)1/ 'sk: @ ,as the child&s breathing im#roved? Treatment:
% If the child is still % If the child is still
hee:ing and the mother is using the inhaler correctly $+F+$) hee:ing* and the mother is not using the inhaler correctly= sho her ho to use it and let her #ractise until she feels confident) $evie in another five days) If still hee:ing after a further 4 days refer) % If the hee:ing has sto##ed advise the mother to kee# the inhaler and s#acer at home and use it if the hee:ing recurs) "he should bring the child back if the hee:e recurs)
(orse or the sa$e -EFE% #! !e(er stools, less !e'er, less a3do$inal *ain, and eating 3etter 4 continue
giving nalidiAic acid until finished
Ens&re that ) the $other &nderstands the oral reh"dration $ethod !&ll" ) the $other &nderstands the need !or an e1tra $eal ea+h da" !or a (ee,
Pneumonia* diarrhoea* hee:e* dysentery 0ive follo u# care
dfs b cliil( -r. `ôb

are !or the +hild (ho ret&rns !or !ollo()&* &sing all the 3o1es that $at+h the childDs *re'io&s +lassi!i+ations6 % #! the +hild has an" ne( *ro3le$, assess, +lassi!" and treat the ne( *ro3le$ as on the ASSESS AND CLASSIFY +hart6 %
% FE:E- ) OTHE-
AUSE
#! !e'er *ersists a!ter 2 da"s2 Do a full reassessment of the child for fever) 2 &ee *&&+&& , -.*&&/01 (p. 4) 'ssess for other causes of fever) Treat$ent2 % If the child has an" general danger sign or sti!! ne+, or 3&lging !ontanelle * treat as for "C"P+CT+D 2+?I?0ITI" .#) 6/ and -EFE- &rgentl"
% If the child has any identi!ied +a&se o! !e'er give treatment % If no +a&se o! !e'er is !o&nd, -EFE% #! !e'er has 3een *resent e'er" da" !or A da"s * -EFE-
PE-S#STENT .#A--HOEA
A!ter 0 da"s2
As,2 @ @ ,as the diarrhoea sto##ed? ,o many loose stools is the child having #er day?
Treat$ent2 % If the diarrhoea has not sto**ed .child is still having 5 or more loose stools #er day/) Treat for dehydration if #resent) Then -EFE- to hos#ital)
%
If the diarrhoea has sto**ed .child having less than 5 loose stools #er day)4 counsel on feeding .#)13@16/ and tell the mother to gi'e one e1tra $eal e'er" da" !or one (ee,
% EA- #NFE T#ON

A!ter 0 da"s i! *ain or dis+harge *ersists2 $eassess for ear #roblem) O &ee *&&+&& , -.*&&/01 chart. ( p. 5) Check for fever Treat$ent2 A UTE EA- #NFE T#ON2
% If there is tender s(elling 3ehind the ear or high !e'er .5<KC or above/* re!er U-)
NOTE2 Attention to the diet is an essential *art o! the $anage$ent o! the +hild (ith *ersistent diarrhoea)
MA/A-#A
#! !e'er *ersists a!ter 2 da"s, or ret&rns (ithin 1= da"s: Do a full reassessment of the child for fever) &ee *&&+&& , -.*&&/01 (p 4) Treat$ent2 % If the child has an" general danger sign, 3&lging !ontanelle or sti!! ne+, * treat as "C"P+CT+D 2+?I?0ITI" .#)6/ and -EFE-6
% #! $alaria ra*id test (as *ositi'e at initial 'isit and fever #ersists or recurs -EFE-
GENT/% to hos#ital
% If ear *ain or dis+harge (orse than before -EFE% If ear *ain or dis+harge the sa$e or 3etter* treat
ith 4 more days of amoAycillin) Con@ tinue dry icking) Follo @u# in 4 days= if still no im#rovement after a further 4 days refer)
H-ON# EA- #NFE T#ON2

% If there is tender s(elling 3ehind the ear or high !e'er .5<KC or above/* re!er U-)
GENT/% to hos#ital
% If no i$*ro'e$ent or #ersistent #ain or foul smelling discharge* -EFE% If so$e i$*ro'e$ent* check that the mother is
the child to hos#ital
% If the child has any +a&se o! !e'er other than $alaria* give treatment
icking the ear correctly) Continue dry icking* and revie in further 36 days) If still discharging in a further 36 days -EFE-
o&nsel2 about #revention of malaria including the im#ortance of insecticide@treated bed nets
P e r s i s
% If no ear *ain or dis+harge* #raise the mother) 'sk about child&s hearing) If hearing loss
sus#ected* -EFE-6
t e n t d
i a r r h o e a * m a l a r i a * F e v e r = o t h e r c a u s e * e a r i n f e c t i o n ) 0 i v e
f o ll o u # c a r e
1 "
G#:E FO//OW)UP A-E

% are !or the +hild (ho ret&rns !or !ollo()&* &sing all the 3o1es that $at+h the +hildDs *re'io&s +lassi!i+ations6 % #! the +hild has an" ne( *ro3le$, assess, +lassi!" and treat !or the ne( *ro3le$ as on the ASSESS AND CLASSIFY +hart6
% FEE.#NG P-O9/EM
A!ter 0 da"s2
% NOT G-OW#NG WE//

A!ter 1= da"s2
@ !eigh the child and determine if the child is still lo
- 'ssess feeding .#)13/ and counsel .#)13@16/) - $evie the feeding #roblem identified at the last visit - If you counsel her to make further changes to her child&s feeding
follo u# again in another 4 days - Check on available resources and ensure that advice is a##ro#riate
% $evie
- Determine eight gain - $eassess feeding .#)13/ and counsel .#)13@16/
eight for age)
every 5B days until the child is gaining eight
Treat$ent2 % If the child gaining (eight (ell* #raise the mother) $evie monthly for gro th monitoring)
% If the child is still lo( (eight !or age, counsel the mother about feeding) 'sk the mother
% ANAEM#A
A!ter 1= da"s2
Treat$ent2
%
to return in 36 days) $evie monthly until the child is feeding ell and gaining eight regularly or is no longer lo eight for age) ,I; .#)9/) 'ssess feeding and if there is a feeding #roblem counsel and revie 36 days) If #oor eight gain continues after another 36 days -EFE-
% If the +hild has not gained (eight or has lost (eight * check for #ossible sym#tomatic
@ Check haemoglobin*
in further
#! hae$oglo3in lo(er than 3e!ore, -EFEIf the hae$oglo3in has not i$*ro'ed or the child has #almar #allor after one month* -EFE- for assessment If hae$oglo3in is higher than 3e!ore, continue iron) $evie in 36 days) Continue giving iron every day for 1 months
% E#!ept$%n: If you do not think that feeding
ill im#rove* refer the child)
% %
IF '?% 2($+ F(LL(!@CP ;I"IT" '$+ ?++D+D* 'D;I"+ T,+ 2(T,+$ (F T,+ NEFT FO//OW)UP :#S#T 'D;I"+ T,+ 2(T,+$ WHEN TO -ETU-N #MME.#ATE/% 5*62;8
Chronic +ar infection* feeding #roblem* 'naemia* ?ot gro ing ell Follo u# care
1$
dfs b cliil( -r. `ôb clo qeb èfia ( fqe pr p.b`qba pvj.qlj^qf` efs lo h kl( k efs
%FO//OW)UP FOSUSPE TE. S%MPTOMAT# H#: 5!irst ret&rn 'isit onl"8
If child has had an ,I; test* check results #! testing not done2 % 'dvise the mother about benefits of ,I; testing and refer for further counselling if necessary) % 'rrange ,I; counselling and testing if mother agrees) % Tell mother about available su##ort structures and if acce#table* #ut her in contact ith these #eo#le) % If mother refuses testing #rovide ongoing care for the child according to routine monthly follo @u# of all ,I; infected children .this #age/) Discuss ith the mother hether she ishes the child to have co@ trimoAa:ole) #! H#: test *ositi'e2 % +nsure that the mother receives #ost@test counsel@ ling) % Discuss ith her any other orries or Huestions that she has) % Tell her about organisations* su##ort grou#s or focal #eo#le that could #rovide su##ort) % Treat according to routine monthly follo @u# of all ,I; infected children .this #age/ % If child is belo 31 months the test ill need to be re#eated after 31 months of age to confirm infection #F H#: test negati'e % Counsel mother on #reventing ,I; infection and about her o n health % If breastfeeding advise her about the im#ortance of safe seA during breastfeeding
%FO//OW)UP MONTH/% FOSUSPE TE. O- ONF#-ME. H#: #NFE T#ON

For all +hildren +on!ir$ed H#: *ositi'e or (here there is SUS) PE TE. S%MPTOMAT# H#: and the stat&s is still &n,no(n % "tartDcontinue co@trimoAa:ole #ro#hylaAis .#)>/ % 'ssess and classify the child at each visit and treat according to classifications % 'ssess feeding* and check eight and eight gain) - +ncourage breastfeeding mothers to continue breastfeeding - Poor a##etite and lo eight are common in these children* advise on any ne or continuing feeding #roblems .#)13@16/ - Check for oral thrush and mouth sores and treat .#)33/ - If any history of diarrhoea* check for na##y rash and treat % 0ive ;itamin ' according to schedule .#)31/) % Provide #ain relief if the child is in any #ain .#)3B/) % Tell the mother about community su##ort structures and if ac@ ce#table* #ut her in contact ith them) % 'dvise about home care - 'dvise mother to bring the child back if any ne illness develo#s because it is im#ortant to treat infections - 'dvise the mother about the im#ortance of hygiene in the home* in #articular hen #re#aring food for the child) % Follo @u# monthly % 2onitor the health of the mother) - 'dvise about safe seA and family #lanning - If the mother is #regnant refer her for counselling her about #revention of transmission of ,I; and feeding choices for her ne baby)
%PA//#AT#:E A-E FOS%MPTOMAT# H#: #NFE T#ON

% This should hel# the family care for the child ith as little suffering as #ossible) This starts at the time of diagnosis and continues throughout the illness % 2edical thera#y may be discontinued because it is leading to unnecessary suffering and se#aration of the child from his family) T,I" D+CI"I(? ",(CLD B+ 2'D+ 'T T,+ $+F+$$'L C+?T$+ 'FT+$ T,+ C,ILD ,'" B++? FCLL% '""+""+D) % 'fter this decision has been made #alliative care alone can be offered at #rimary care level) Cntil then #alliative care should be offered together ith routine medical treatment Palliati'e +are sho&ld 3e gi'en as !ollo(s: % If the child has #ain #rovide adeHuate *ain relie!) ' 5 stage #rocess may be used .#)3B/: % "tage 3: #aracetamol % "tage 1 .if #ain is not ell controlled/: codeine #hos #hate % "tage 5 .if #ain relief still not ell controlled/: mor#hine may be used as #rescribed by the doctor)
% % % %
o&nsel the mother so that: the child remains nourished and ell hydrated the child remains clean* dry and comfortable any skin lesions .abscesses or ulcers/ are dressed and ke#t clean
S&**ort the mother and other family members: % $efer to community su##ort structures .if acce#table/ % Provide information and counselling to hel# the family ith Huestions and fears they may have % The familyDmother should make a decision about here it is best for the child to die % Counsel the mother about her o n health
"ym#tomatic ,I; Infection 0ive follo u# care
2%
`lrkpbi qeb jlqebo

% Assess
the Feeding o! Si+, hildren &nder 2 "ears 5or i! ANAEM#A or NOT G-OW#NG WE// 8
'sk Huestions about the child&s usual feeding and feeding during this illness) Com#are the mother&s ans ers to the Feed$n& Re!%mmendat$%n' for the child&s age on # 3>
ASK ( Ho( are "o& !eeding "o&r +hild4

#! the 3a3" is re+ei'ing an) 3reast$il,* ASK2 #! 3a3" is re+ei'ing re*la+e$ent $il,, ASK2
,o many times during the day? Do you also breastfeed during the night?
!hat re#lacement milk are you giving? ,o many times during the day and night? ,o much is given at each feed? ,o is the milk #re#ared? ,o is the milk being given? Cu# or bottle? ,o are you cleaning the utensils? If still breastfeeding as ell as giving re#lacement milk could the mother give eAtra breastmilk instead of re#lacement milk .es#ecially if the baby is belo 8months/
Does the child take any other food or fluids?
#! lo( (eight !or age, ASK2
!hat food or fluids? ,o many times #er day? !hat do you use to feed the child?
- ,o large are servings? Does the child receive his o n serving? - !ho feeds the child and ho ?
During this illness* has the child&s feeding changed? If yes* ho
Feeding advice Counsel the mother
FG? I2CI guideline 'ugust 1BB1
21
`lrkpbi qeb jlqebo

FEE.#NG -E OMMEN.AT#ONS #N S# KNESS AN. #N HEA/TH
NOTE: These feeding recommendations should be followed for infants of all mothers who DO NOT KNOW their HIV status
U* to ; Months o! Age ; Months &* to 12 Months 12 Months &* to 2 %ears 2 %ears and Older
Continue to breastfeed as
often as the child ants
Continue to breastfeed
as often as the child ants) Breastmilk is still an im#ortant food at this age and hel#s #revent infections
Breastfeed as often as the child

day and night*
ants*
0ive 7 ser'ings of
nutritious com#lementary foods) Al(a"s miA margarine* fat* oil* #eanut butter or ground nuts ith #orridge) 'lso add: chicken* egg* beans* fish or full cream milk* or mashed fruit and vegetables* at least once each day)
0ive the child her o
Feed at least < times in 16 hours)
0ive at least 4 adeHuate nutritious feeds)

Increase the variety and Huantity ith family foods: 2iA margarine* fat* oil* #eanut butter or ground nuts ith #orridge 0ive egg* meat* fish or beans daily 0ive fruit or vegetables t ice every day 0ive milk every day* es#ecially if no longer breast feeding) Feed actively ith her o n serving
n serving of family foods 5 times a day) snacks such as bread ith #eanut butter* full cream milk or fresh fruit be@ t een meals
Do not give other foods or fluids
In addition* give 1 nutritious
If baby is not breastfed* give 5 cu#s .5 A 1BB ml/

of full cream milk as ell) feeds #er day
Continue active feeding
If baby gets no milk* give 8 com#lementary
objbj/bo ql bk`lro^db cbbafkd arofkd fiikb pp ^ka ql âsf pb ql dfsb ^k b0 qo^ jbî ^ a^v clo lkb ( bbh ^cqbo ^k fiikbppF
Feeding recommendations Counsel the mother
22
FEE.#NG -E OMMEN.AT#ONS #F MOTHE- #S H#: POS#T#:E

U* to ; Months o! Age Sa!e transition !ro$ e1+l&si'e 3reast!eeding ; Months &* to 12 Months 12 Months &* to 2 %ears
Sa!e transition means ra#idly changing from all breast milk* to none V) 9reast!eed e1+l&si'el" as often as the child ants* day and night) Feed at least < times in 16 hours) Do not give other foods or fluids .2iAed feeding could lead to ,I; transmission/ "afe transition to re#lacement milk and com#lementary feeds at 6 to 8 months O- 5i! !easi3le and sa!e8 For$&la !eed e1+l&si'el" .no breast milk at all V/) 0ive formula or modified co &s milk (ther foods or fluids are not necessary Pre#are correct strength and amount Tust before use .#)58/) Cse milk ithin an hour and discard any left .a fridge can store formula for 16 hours/ Cu# feeding is safer than bottle Clean the cu# and utensils ith soa# If using a bottle* also boil 4 minutes or sterilise after each use 0ive formula 8 to < times a day .#)58/ 'void miAing breast milk ith other food or fluids .this increases risk of ,I; transmission/) "uggest transition some time bet een 6 and 8 months* or earlier if mother can safely do so) Do not breast feed after 8 months) Hel* $other *re*are !or transition2 2other should discuss eaning ith her family if #ossible +A#ress milk to #ractice cu# feeding Find a regular su##ly of formula or other milk Learn ho to safely #re#are and store milk at home Hel* $other $a,e the transition2 Teach mother to cu# feed her baby .#)58/ "tart giving only formula or co s milk) "to# breastfeeding com#letely) +A#ress and discard some breastmilk* to kee# comfortable till lactation sto#s) 0ive com#lementary feeds from 8 months Do not breast feed after siA months unless the child is already kno n to be infected) 0ive 5 servings of nutritious com#lementary foods) 'l ays miA margarine* fat* oil* #eanut butter or ground nuts ith #orridge) 'lso add: chicken* egg* beans* fish or full cream milk* or mashed fruit and vegetables* each day) 0ive at least 4 adeHuate nutritious feeds) Increase the variety and Huantity ith family foods: 2iA margarine* fat* oil* #eanut butter or ground nuts ith #orridge 0ive egg* meat* fish or beans daily 0ive fruit or vegetables t ice every day 0ive milk every day Feed actively ith her o n serving
0ive at least 5 cu#s .5 A 1BB ml/ of full cream milk .or infant formula/ #er day) 0ive milk ith a cu#* not a bottle) If no milk available* give 8 com#lementary feeds #er day
1E1+e*tion2 onl" heat treated or 3oiled

3reast $il, +an still 3e gi'en
1E1+e*tion2 onl" heat treated or
3oiled 3reast $il, +an still 3e gi'en
Feeding recommendations for ,I; Counsel the mother
23
% o&nsel the Mother A3o&t Feeding Pro3le$s

#! the +hild is not 3eing !ed as in re+o$$endations, +o&nsel the $other a++ordingl"6 #n addition2 #! $other re*orts di!!i+&lt" (ith 3reast!eeding, assess 3reast !eeding6 5See YOUNG INFANT +hart *67? 8 o Identify the reason for the mothers concern and manage any breast #roblem
o o
If needed* sho
correct #ositioning and attachment
Build the mother&s confidence) 'dvise her that freHuent feeds im#rove lactation)
#! the +hild is less than ; $onths old and is ta,ing other $il, or !oods2 o Build mother&s confidence that she can #roduce all the breastmilk that the child needs) !ater and other milk are not necessary
o o o o o o
o
If she has sto##ed breastfeeding* refer her to a breastfeeding counsellor to hel# ith re@lactation "uggest giving more freHuent* longer breastfeeds* day or night* and gradually reducing other milk or foods)
#! other $il, needs to 3e +ontin&ed, +o&nsel the $other to2 o Breastfeed as much as #ossible* including at night .unless mother is ,I; Pve and has chosen eAclusive formula feeding/
2ake sure the other milk is infant formula or breastmilk substitute) Pre#are other milk correctly and hygienically* and give adeHuate amounts) Finish #re#ared milk ithin an hour) +ncourage her to give milk feeds first If the infant is 6 @ 8 months* advise her to continue to give 3 @ 1 nutritious com#lementary feeds #er day)
#! she has started +o$*le$entar" !eeds
#! the $other is &sing a 3ottle to !eed the +hild o $ecommend a cu# instead of a bottle
o "ho mother ho
to feed the child ith a cu# .#)58/
#! the +hild is not 3eing !ed a+ti'el" o "it ith the child and encourage eating
o 0ive the child an adeHuate serving in a se#arate #late or bo l
#! the +hild has a *oor a**etite, or is not !eeding (ell d&ring this illness o Breastfeed more freHuently and for longer if #ossible
Cse soft* varied* favourite foods to encourage the child to eat as much as #ossible) o 0ive foods of a suitable consistency* not too thick or dry o (ffer small* freHuent feeds) Try hen the child is alert and ha##y* and give more food if he sho s interest o Clear a blocked nose if it interferes ith feeding o If the child has a sore mouth* suggest soft foods that don&t burn the mouth e)g) eggs* mashed #otatoes* #um#kin or avocado) o 0ive #hysical hel# @ a s#oon the right si:e* food ithin reach* child sitting on caregiver&s la# hile eating o +A#ect the a##etite to im#rove as the child gets better
#! there is no !ood a'aila3le in the ho&se o ,el# mother to get a Child "u##ort 0rant for all her children under 9 years
Put her in touch ith a "ocial !orker and local organisations that may assist o 0ive her vegetables from the clinic garden o "u##ly milk and "u#er Porridge from the P+2 scheme o 0ive mother reci#es for locally a##ro#riate "u#er Porridge
Feeding #roblems
Counsel the mother
"e#tember 1BB1
FG? I2CI guideline

2&
S*e+ial Feeding -e+o$$endations % Feeding Ad'i+e !or the Mother o! a hild (ith S%MPTOMAT# H#: #NFE T#ON
% % % % % The child ith sym#tomatic ,I; infection should be encouraged to breastfeed) There is no danger of infection through breastmilk hen the child has sym#@ toms The child should be fed according to the feeding recommendations for his age .#)11/ These children often suffer from #oor a##etite and mouth sores* give a##ro#riate advice .this #age/ If the child is being fed ith a bottle encourage the mother to use a cu# as this is more hygienic and ill reduce e#isodes of diarrhoea Inform the mother about the im#ortance of hygiene hen #re#aring food because her child can easily get sick) "he should ash her hands after going to the toilet and before #re#aring food If the child is not gaining eight ell* the child can be given an eAtra meal each day and the mother can encourage him to eat more by offering him snacks that he likes if these are available 'dvise her about her o n nutrition and the im#ortance of a ell balanced diet to kee# herself healthy) +ncourage her to #lant vegetables to feed her family)
#! the +hild has a *oor a**etite2
Plan small freHuent meals) 0ive milk rather than other fluids eAce#t here there is diarrhoea ith some dehy@ dration 0ive foods ith a high energy content) 0ive snacks bet een meals) Check for oral thrush or mouth ulcers) Consider ,I; if the a##etite remains #ersistently #oor)
Feeding -e+o$$endations For PE-S#STENT .#A--HOEA
If still breastfeeding* give more freHuent* longer breastfeeds* day

and night)
If taking other milk: - 3st choice: re#lace - 1nd choice: re#lace -
#! the +hild has $o&th sores2
ith increased breastfeeding ($ ith fermented milk #roducts* such as amasi .maas/ or yoghurt ($ 5rd choice: re#lace half the milk ith nutrient@rich semisolid food .like mashed fruit or vegetables)/
$ecommend soft foods that don&t burn the mouth e)g) eggs* mashed #otatoes* #um#kin or avocado) 'void s#icy* salty and rough foods) Cho# foods finely and give cold drinks or crushed ice* if available)
For other foods* follo feeding recommendations for the child&s age 'void very s eet foods or drink 0ive small* freHuent meals at least 8 times a day
Feeding advice for ,I; Infection
Counsel the mother
25
% Ad'ise the Mother to #n+rease Fl&id .&ring #llness

FO- AN% S# K H#/.2 % If child breastfed* breastfeed more freHuently and for longer at each feed) If child is taking breastmilk substitutes* increase the amount of milk given % Increase other fluids) For eAam#le* give soft #orridge* amasi* """ or clean ater) FO- H#/. W#TH .#A--HOEA2 % 0iving eAtra fluid can be lifesaving) 0ive fluid according to Plan ' or Plan B .#)34/
Ad'ise the Mother When to -et&rn to Health Wor,er

FO//OW)UP :#S#T 'dvise the mother to come for follo @u# at the earliest time listed for the child&s #roblems)
#! the +hild has2
-et&rn !or !ollo() &* in2
P?+C2( ?I' D%"+?T+ $% 2'L'$I'* P+$"I"T+?T DI'$$,(+' C,$(?IC +'$ I?F+CTI(? F++DI?0 P$(BL+2 !,++G+ .FI$"T +PI"(D+/* if still hee:ing '?% (T,+$ ILL?+""* if not '?'+2I' ?(T 0$(!I?0 !+LL @ but no feeding #roblem "C"P+CT+D "%2PT(2'TIC ,I; "%2PT(2'TIC ,I; .confirmed/
1 day s 4 day s 36 days 36 days 36 days mont
WHEN TO -ETU-N #MME.#ATE/%
Ad'ise $other to ret&rn i$$ediatel" i! the +hild has an" o! these signs2 'ny sick child
If child has C(C0, ($ C(LD* return if:
Becomes sicker ?ot able to drink or breastfeed ;omiting everything Develo#s a fever Fast breathing Difficult breathing !hee:ing Blood in stool
If child has Diarrhoea* return if:
NEFT WE//) H#/. :#S#T 'dvise mother hen to return for neAt immunisation according to immunisation schedule) +ncourage monthly visits for gro th monitoring
!hen to return Counsel the mother "e#tember 1BB1
FG? I2CI guideline

26
o&nsel the $other A3o&t Her O(n Health

% If the mother is sick* #rovide care for her* or refer her for hel#)
% % % %
If she has a breast #roblem .such as engorgement* sore ni##les* breast infection/* #rovide care for her or refer her for hel# .#)54/) 'dvise her to eat ell to kee# u# her o n strength and health) Check the mother&s immunisation status and give her tetanus toAoid if needed) 2ake sure she has access to:
% %
Family #lanning Counselling on "TD and 'ID" #revention
+ncourage mother to s#eak about social #roblems If the mother is ,I; #ositive give her advice about her o n health and consider starting her on co@trimoAa:ole
-EMEM9E- THAT THE HEA/TH OF A H#/. .EPEN.S ON THE HEA/TH OF THE MOTHE-6 A/WA%S TH#NK OF THE MOTHE-S HEA/TH WHEN %OU A-E A-#NG FO- A S# K H#/.
2others health Counsel the mother
ASSESS,
.O A -AP#. AP-A#SA/ OF A// WA#T#NG
/ASS#F% AN. T-EAT THE S# K %OUNG #NFANT

AGE 1 WEEK UP TO 2 MONTHS
H#/.-EN USE A// 9OFES THAT MAT H #NFANTDS S%MPTOMS AN. P-O9/EMS TO /ASS#F% THE #//NESS6
ASK THE MOTHE- WHAT THE %OUNG #NFANTDS P-O9/EMS A-E Determine if this is an initial or follo @u# visit for this #roblem)
if follo @u# visit* use the follo @u# instructions on #age 5< if initial visit* assess the young infant as follo s:
HE K FO- POSS#9/E 9A TE-#A/ #NFE T#ON
S#GNS
/ASS#F% AS
T-EATMENT
I
ASK2
,as the infant had

convulsions?
,as the infant had any
/OOK, /#STEN, FEE/2

%(C?0 I?F'?T 2C"T B+ C'L2
lassi!" A// %OUNG #NFANTS
attacks here he sto#s breathing* becomes JCount the breaths in one minute) stiff and blue .a#noea/? $e#eat the count if elevated) JLook for severe chest indra ing) JLook for nasal flaring) JListen for grunting)
Is the infant convulsing no
Convulsing or Previous Convulsions ($ Fast breathing .O8B #er minute/* ($ "evere chest indra ing ($ ?asal flaring or grunting ($ Bulging fontanelle ($ Pus draining from the ear ($ Cmbilical redness eAtending
to the skin andDor draining #us ($
%Gi'e re+tal diaze*a$ i! +on'&lsing at *resent 5*6178
POSS#9/E SE-#OUS 9A TE-#A/ #NFE T#ON
% Gi'e o1"gen 5*6178
% Gi'e !irst dose o! i$ +e!tria1one 5*6778 % Test !or lo( 3lood s&gar, and treat or *re'ent 5*61=8 % -e!er U-GENT/% to hos*ital % Ad'ise $other to +ontin&e 3reast!eeding and ,ee* the in!ant
Fever .59)4KC aAilla or above or feels hot/

or lo body tem#erature .less than 54)4K C aAilla or feels cold/ ($ 2any or severe skin #ustules ($
Is the infant taking

feeds ell?
as the result?
JLook and feel for full or bulging fontanelle) JLook at the umbilicus) Is it red or draining #us? Does the redness eAtend to the skin?
,as the mother ever
had an ,I; test? !hat
J2easure tem#eratur e .or feel for fever or lo body
tem#erature/) JLook for skin #ustules) 're there many or severe #ustules?
Look for #us draining from the eye or ear)
JLook at the young infant&s general condition) Is the young infant lethargic or unconscious? JLook at the young infant&s movements) 're they less than normal?
Lethargic or unconscious or less than normal

movements ($
(ar$ on the (a" to the hos*ital
'#noea attacks ($ [aundice getting orse or still #resent after 1

($ ?ot taking feedsDtaking feeds #oorly
eeks
Look for Taundice: ask

if it is getting orse)
$ed umbilicus "kin #ustules Pus draining from the eye
/O A/ 9A TE-#A/ #NFE T#ON
NO 9A TE-#A/ #NFE T#ON ?one of the above signs
% 0ive erythromycin for 9 days .#)55/ % Teach the mother to treat local inf ection s at home .#)56/ % 'dvise mother to give home care for the young infant % If #us draining from the eye give single dose im ceftriaAone .#) 55/ % Follo @u# in 1 days % If mother ,I; #ositive give a##ro#riate feeding advice and start the baby on co@ trimoAa:ole from the age of 8 eeks .#) >/
% Check mothers health % Counsel about general hygiene and care
% If mother is ,I; #ositive give a##ro#riate feeding advice and start the baby on co@ trimoAa:ole from the age of 8 eeks .#)>/
( Possible Bacterial Infection 'ssess and classify: The %oung Infant
2"
Lethargic or
unconscious
"unken eyes "kin #inch goes
.#A--HOEA W#TH SE:E-E .EH%.-AT#ON
back very slo ly)

%
-e!er U-GENT/% to hos*ital (ith intra'eno&s in!&sion 5see *lan *61 ; 86 Gi'e the !irst dose o! +e!tria1one #M# 5*6778 Gi'e !re@&ent si*s o! O-S on the (a", i! *ossi3le6 9reast!eeding +an +ontin&e Kee* the +hild 0ive fluid for some dehydration B #)34 / 'dvise the mother to continue breastfeeding Follo u# in 1 days
$estless* irritable "unken eyes "kin #inch goes

back slo ly)
.#A--HOEA W#TH SOME .EH%.-AT#ON
% %
?ot
enough signs to classify as some or severe dehydration)
NO :#S#9/E .EH%.-AT#ON
% %
0ive fluids to treat for diarrhoea at home .Plan ' #)34/ Follo u# in 1 days) If eAclusively breastfed do not other fluids eAce#t """
gi v e
.oes the "o&ng in!ant ha'e diarrhoea4

#F %ES, ASK: /OOK AN. FEE/2
!or .EH%.-AT#ON
For ho
Look at the young infant&s general

condition) Is the infant: @Lethargic or unconscious? @$estless and irritable?
long?
Is there blood
in the stool?
Look for sunken eyes) Pinch the skin of the

abdomen) Does it go back: @;ery slo ly .longer than 1 seconds/? @or "lo ly?
lassi!" .#A--HOEA
and i! diarrhoea 1= da"s or $ore
J Diarrhoea lasting
36 days or more)
SE:E-E PE-S#STENT .#A--HOEA
-EFE- and treat for dehydration if #resent) % Fee# the baby arm on the ay to hos#ital)
%
Blood in the stool)

Y
POSS#9/E SE-#OUS A9.OM#NA/ P-O9/EM
% -e!er U-GENT/% to hos*ital % Kee* (ar$ on the (a" to hos*ital
and i! 3lood in stool
Diarrhoea 'ssess and classify: The %oung Infant
2$
THEN HE K FO- FEE.#NG P-O9/EM O/OW WE#GHT #N 9-EASTFE. 9A9#ESE2
?ot able to feed or
NOT A9/E TO FEE.
Gi'e !irst dose o! +e!tria1one #M# 5*6778 % he+, 3lood s&gar then treat or
%
ASK : ,
o
ar e y o u fe e di n g th e b a b y ? , o is fe e di n g g oi n g ? , o m a n y ti m e s
d ui L O o dsO in K , y ad o ditL I u io S T n E b to N , r br F e eaE E a st L s mi: t lk P f ar e e l e yoo d u t gi t i vi h n nge to 1 ba 6 bye ? i h @if g yes o hoh t u often? o is it @ ho r n s given? ? @@ @ @t ! @ @h h @ @e a @@ t @ @$ @ @T f @ @, o @ @C o @@ d @ @t s @ @o @@ a @ @d n @ @e d @@ t @ @e f r l m
i n e t h e e i g h t f o r a g e )
L
o o k f o r h i t e # a t c h e s i
n the mouth .thrush/
lassi!" FEE.#NG
?
o a t t a c h m e n t a t a l l o r
)))))))))))) )))))))))))) ))))))
a tt a c h e d t o b r e a st o r
*re' ent lo( 3loo d s&g ar6 5*6 1= 8 A d 'i s e th e $ ot h er h o ( to , e e *
T / % t o h o s * i t a l
o t h e r t o b r e a s t f e e d
c h e d o r n o t s u c k l i n g
y * t e a c h c o r r e c t # o s it i o n i n g a n d +6T4 .$$7 t 0$%: h e touching i (reast n f open a n turne t outwar a visi(le a(ove b than (elow l the mouth e .'ll t signs o should be #resent if a the t attachment t good)/ is a c I h s ?
no attachment at all not well it attache goo attachment h
Is the infa nt suc klin g effe ctiv ely .tha t is* slo
6
%
?
o t s u c kl in g e ff e ct iv el y o r
?
o t s u c k l i n g a t a l l )
' d v i s e t h e
t h e
" o & n g in !a nt ( ar $ o n th e ( a " to th e h o s *i ta l6 % -e!er U-GEN
# F A N
a s e f o f f e t c e t \ n i v a e n l
?
o t e l l
# N F A N T 2 H a s a n " d i! !i + & lt " ! e e d i n g , O
2 o t h e r sali e A ne # e dro ri e n #s c i if it n g int # r erf o b l ere e m s s f it e e h d i n bre g o ast r
6 hours or
$ecei
ves other foods or drinks or
E E .# N G O 9 M O N O T G O W # N G W E / /
NG PO9 /E M
Lo
eight for age or
!
e i g h t g a i n i s u n s a ti s f a c t o r y o r
fee L
e s h a n < b r e a s tf e e d s i n 1
dee # suc ks* so met ime s #au
din s g) t
Thrus
h .ulcer s or hite #atch es in mout h/
N O F E E . #
attachment) \ If breastfeeding less than < times in 16 hours* advise to increase freHuency of feeding) @ If mother has a breastfeeding #roblem see advice for common breastfeeding #roblems .#)54/ % If receiving other foods or drinks* counsel mother about breastfeeding more* reducing other foods or drinks* and using a cu#)
%
. # ) 5 9 /
%
e d i n g
n 1 days) Follo @u# lo eight for age in 9 days)

%
F o l l o @ u # a n y f e
If thrush* teach the mother to treat for thrush at home) .#) 56/ 'dvise mother to give home care for the young infant)
# r o % 'dvise mother to b give l home e care for m the young infant) .#) o 59/ r t % Praise the h mother r for u feeding s the infant h ell) i
E Use this *age to assess !eeding i! the in!ant is re+ei'ing an) 3reast$il,
Feeding #roblem= breastfed infants 'ssess and 3% classify: The %oung Infant F
THEN HE K FO- FEE.#NG P-O9/EM O/OW WE#GHT #N 9A9#ES -E E#:#NG NO 9-EASTM#/KE2
?ot able to feed or ?ot sucking at all)
NOT A9/E TO FEE. )
Treat as *ossi3le se'ere 3a+terial in!e+tion 5*62B8 Gi'e !irst dose o! +e!tria1one #M# 5*6778 -e!er U-GENT/% to hos*ital
LOOK, LISTEN,FEEL :
g re t as ? tfe ed ,o V? m u c h i s g i v e n a t e a c h f e e d ? # r e # a r i n g t h e m i l k ? @ ra te or e A #l ai n h o a fe e d is #r e # ar e d* a n d h o it is gi v e n to th e b
,o a r e y o u f e e d i n g t h e b a b y ?
g o i n g ! ? ha t ! mil h k a ar t e yo m u a giv d in e g? y o u d e c i d e , o is fe e di n n o t t o b
,o
m an y ti m es du rin g ,o th e da a y r an e d y ni o gh u
aby
!hat foods and fluids in addition to re#lacement milk is given? ,o is the milk being given? Cu# or bottle ,o are you cleaning the utensils?
Plot the eight on the $T,C to determine the eight for age) Look for ulcers or hite #atches in the mouth .thrush/)
2ilk
incorrec tly or unhygie nically #re#are d or
!
e i g h t g a i n i s u n s a t i s f a c t o r y
eHuate feeding)
la s si !" F E E . # N G
0iving
ina##ro #riate re#lace ment milk or other foodsDfl uids or
F E E . # N G P O 9 / E M O N O T G O W # N G W E / /
0i
vin g ins uffi cie nt re# lac em ent fee ds or
?
ot lo ei gh t fo r ag e an d no ot he r si gn s of in ad
Csing a
feeding bottle or
Thrus
h .ulcer s or hite #atch es in the mouth / or
Lo
eight for age or
N O F
fee n C dinmil o g k u .#)bei n 58 ng P s / giv - %e en O l %Ide 9 a ntif'd / b y vis E o mo e M u the the t f rs mo e an the e d r d fa to i milus n y&se a g co cu nc # % er rat + ns he A ab r # out tha l fee n a dinbot i g) tle n "uto gg fee g estd u tha the i t ba d mo by e the an l r d i gr sh n ad o e ualhe s ly r de ho f cre o as to r es do s the thi a am s f ou .#) e nt 58 of / r foo % e d If # or thr l fluius a ds h* tea c oth ch
E E . # N G
% ent tha h
e m o t h e r t o t r e a t f o r t h r u s h a t h o m e . # ) 5 6 /
em er t
f e e d i n g
in 1 d a y s
# r F o ol b lo l e u # m% in
' edi e dv ng* isan t ed h men e otsur he m ergo o tood t co hy h nti gie e n ne r u% e Pr feais
3 r e a s t ! e d 3 e + a & s e t h e $ o t h e r i s H # : i n ! e + t e d 6
E N O T E 2 A + h i l d $ a " n o t 3 e
%
F ol lo @ u # a n y
#! th is is n ot th e re a s o n, + o n si d er re st ar ti n g 3r e a st !e e di n g or re !e rr al to a 3r e a st
! e e d i n g + o & n s e l l o r i ! a ' a i l a 3 l e
F e ' s
THEN CHECK I THE !O"N# IN $NT H$% $N! %&ECI$' (I%K $CTO(%
I
the infant as #remature or lo birth eight % there as birth as#hyAia % the infant is not breastfed % the mother is a young adolescent % the mother is kno n to be ,I; #ositive % there is severe socioeconomic de#rivation
%
This infant is at high risk and s#ecial care should be taken to ensure that there are no feeding #roblems and the child is gaining eight ell) 'rrange a##ro#riate regular follo @u# ith the mother $efer to an a##ro#riate su##ort grou# if #ossible)
THEN HE K THE %OUNG #NFANTDS #MMUN#SAT#ON STATUS2

AGE :A #NE (P ;@B (P ;@3 (P ;@1 ,e# B 3 ,e# B 1
:#TAM#N A
1BB BBB IC to the mother at delivery 4B BBB IC for infants at 8 eeks if not 3reast!ed
#MMUN#SAT#O N S HE.U/E2
Birth 8 eeks 3B eeks
BC0 DPTP,I B@3 DPTP,I B@1
% % % %
Gi'e all $issed doses on this 'isit6 Include sick babies and those ithout a $T,C If the child has no $T,C* issue a ne one to@day) 'dvise the caretaker hen to return for the neAt dose)
ASSESS OTHE- P-O9/EMS
eg6 N&tritional stat&s and anae$ia, +ontra+e*tion et+6 he+, h"giene *ra+tises
ASSESS THE MOTHE-DS HEA/TH NEE.S
"#ecial risk factors Immunisation status 'ssess and classify %oung Infant
32
T-EAT THE %OUNG #NFANT

%
Treat /O A/ 9A TE-#A/ #NFE T#ON (ith Er"thro$"+in s"r&*

E(!TH(O)!CIN %!("&
%
3ive (hree (i.es dail4 for seve5 da4s +rythromy cin "yru# 314 mg in 4 ml 3)14 ml 1)4 ml
AGE or WE#GHT
Birth u# to 3 month .N 5 kg/ 3 month u# to 1 months .5@6kg/
Treat POSS#9/E SE-#OUS 9A TE-#A/ #NFE T#ON (ith #ntra$&s+&lar

%
e!tria1one
0ive first dose of CeftriaAone I2I before the infant is referred urgently) 0ive a single dose of cetfriaAone to an infant ith #us draining from the eye
EFT-#AFONE #NIE T#ON

WE#GHT 1 @5 kg O5 @ 8 kg e!tria1one 14Bmg in 3ml B)4 ml 3 ml
% %
The dose of CefriaAone is 4Bmg #er kilogram Dilute 14Bmg vial ith 3ml of sterile ater
'ntibiotics Treat the young infant
33
T-EAT THE %OUNG #NFANT

%To Treat !or .iarrhoea, See T-EAT THE
If there is DI'$$,(+' !IT, "+;+$+ D+,%D$'TI(? or DI'$$,(+' !IT, "(2+ D+,%D$'TI(? .#)34@38/) If there is ]severe dehydration^ commence intravenous rehydration* give the first dose of ceftriaAone I2I .#)55/ and $+F+$ urgently)
H#/., *610)1;
%#$$&nise E'er" Si+, %o&ng #n!ant, as Needed6
% Tea+h the Mother to treat /o+al #n!e+tions At ho$e

+A#lain ho the treatment is given) % !atch her as she does the first treatment in the clinic)
%
% Treat !or E"e #n!e+tion (ith hlora$*heni+ol E"e Oint$ent
"he should return to the clinic if the infection orsens)
The eyes must be cleaned ith a clean cloth then Chloram#henicol or tetracycline eye ointment is instilled inside the
lo er eyelid
The mother should ash hands before and after treatment
Four times #er day
% To Treat !or S,in P&st&les or U$3ili+al #n!e+tion

The mother should do the treatment t ice daily: % !ash hands % 0ently ash off #us and crusts ith soa# and ater % Dry the area % Paint ith #olyvidone iodine lotion or gentian violet % !ash hands
% Treat !or Thr&sh (ith N"statin or Gentian :iolet

The mother should: % !ash hands % !ash mouth ith clean soft cloth ra##ed around the finger and et ith salt ater % 0ive nystatin 3 ml 6 times a day or #aint ith diluted B)4L gentian violet % !ash hands % 'dvise the mother on breast care % Check bottle or other utensil in use for hygiene)
Diarrhoea
Local infections at home Treat the
young infant
3&
OUNSE/ THE MOTHE% Tea+h orre+t Positioning and Atta+h$ent !or 9reast!eeding
% the mother must be seated comfortably % "ho the mother ho to hold her infant ith the infant&s head and body straight facing her breast* ith infant&s nose o##osite her ni##le - ith infant&s body close to her body su##orting infant&s hole body* not Tust neck and shoulders)
% "ho her ho to hel# the infant to attach) "he should:
touch her infant&s li#s ith her ni##le ait until her infant&s mouth is o#ening ide move her infant Huickly onto her breast* aiming the infant&s lo er li# ell belo the ni##le)
% Look for signs of good attachment and effective suckling) If the attachment or suckling is not good* try again) % 2ost of the common breastfeeding #roblems eA#ressed by mothers are related to #oor #ositioning and attachment .see belo /
OMMON 9-EAST FEE.#NG P-O9/EMS2

JNOT ENOUGH M#/KK
The commonest reason hy mothers add other feeds early or sto# breastfeeding) Csually the mother has enough milk but lacks confidence that it is enough) Wh" does the $other thin, the 3a3" is not getting eno&gh $il,4 The baby may cry a lot* or ant to feed often and for a long time* or her breasts do not feel very full) "he may have tried giving a formula feed and noticed that the baby sle#t for longer after ards) .oes she gi'e the 3a3" an" other !ood or !l&ids4 This ill reduce breast milk #roduction but if she breastfeeds more there ill be more milk) 'dvise her to gradually sto# giving other foods or fluids and increase the number of breastfeeds) "he should breastfeed as often as the child ants* at least eight times in 16 hours both day and night) he+, *osition and atta+h$ent@ if the baby is not ell at@ tached* he may not be getting enough milk and ant to feed often and for a long time) If the baby is gro ing ell you can reassure the mother that she has enough milk and the baby is getting enough food)
SO-E N#PP/ES
O-
-A KE.
THE 9A9% FEE.S OFTEN or -#ES A /OT

This may be because the infant is #oorly attached and not suckling effectively so that he is Huickly hungry again) 'ssess breastfeeding* check the #ositioning and attachment and advise the mother If the baby is feeding often or the mother thinks the child is more settled after a formula feed* this may be because the feeding #attern is different in a formula fed baby* not because the child is hun@ gry) Breastfed infants may feed more often and also suckle for comfort) Formula milk is more difficult for the baby to digest hich makes the interval bet een feeds longer but this does not mean it is better for the baby)
Sore ni**les are +a&sed 3" *oor atta+h$ent d&ring s&+,) ling and can lead to breastfeeding failure if it is so #ainful that the mother is reluctant to feed) The baby is not getting much milk and ants to feed more often) Breastfeeding should not be #ainful) ' #oorly attached infant is suckling on the sensi@ tive ni##le rather than taking the hole breast in the mouth) !hen you re#osition the infant so that it is ell attached there is immediate relief and the baby begins to suckle effectively) If the #oorly attached baby continues to suck* cracks may de@ velo# in the ni##le) 's you im#rove attachment* the #ain is less and the mother may continue to breastfeed as the cracks heal) If the #ain is too severe* eA#ress breastmilk until the ni#@ #le has healed and feed the baby from the other breast or ith eA#ressed milk in a cu#) Putting a dro# of hindmilk on the ni#@ #le after feeding ill also hel# healing) "oreness may also be caused by thrush infection* #articularly if #ain develo#s after a #eriod of #ain free feeding) Treat both the mother and baby ith nystatin dro#s or cream)
35
FG? I2CI guideline
"e#tember 1BB1
OUNSE/ THE MOTHE%%afe &re*aration of ormula )il+

Al6a4s 0se a .arked c0p or 7lass a5d spoo5 (o .eas0re 6a(er a5d (he scoop (o .eas- 0re (he for.0la po6der' !ash 4o0r ha5ds before prepari57 a feed 8ri57 (he 6a(er (o (he boil a5d (he5 le( i( cool' )eep i( covered 6hile i( cools' 9eas0re (he for.0la po6der i5(o a .arked c0p or 7lass' 9ake (he scoops level' :0( i5 o5e scoops for ever4 25 .ls of 6a(er' Add a s.all a.o05( of (he cooled boiled 6a(er a5d s(ir' Fill (he c0p or 7lass (o (he .ark 6i(h (he 6a(er' ;(ir 6ell' Feed (he bab4 0si57 a c0p' !ash (he 0(e5sils'
%Ho( to !eed a 3a3" (ith a +&*

% ,old the baby sitting u#right or semi@u#right on your la# % ,old a small cu# of milk to the baby&s li#s - ti# the cu# so the milk Tust touches the baby&s li#s - the cu# rests gently on the baby&s lo er li# and the edges of the cu# and touch the outer #art of the baby&s u##er li# - the baby becomes alert and o#ens his mouth and eyes % Do not #our the milk into the baby&s mouth) [ust hold the cu# to his li#s and let him take it himself % !hen the baby has had enough he closes his mouth and ill not take any more
%A**ro1i$ate a$o&nt o! !or$&la needed *er da"
'ge in mon ths
!eigh t in kilos
'##roA) amount of formula in 16 hours
Previousl y boiled ater #er feed
?umber of scoo#s #er feed
'##roA) num@ ber of feeds
Breastfeeding !hen to return Counsel the mother FG? I2CI guideline "e#tember 1BB1
36
% Ad'ise Mother to Gi'e Ho$e are !or the %o&ng #n!ant

1' F/U#.S Breastfeed freHuently* as often and for as long as the infant
ants* day or night* during sickness and health)
When to -et&rn #$$ediatel":

Ad'ise the +areta,er to ret&rn i$$ediatel" i! the "o&ng in!ant has an" o! these signs2
2' WHEN TO -ETU-N

#! the in!ant has2 -et&rn !or !ollo()&* in2 ( _àb
L(C'L B'CT+$I'L I?@ F+CTI(? '?% F++DI?0 P$(BL+2 T,$C", L(! !+I0,T F($ '0+ Follo()&* :isit
T _àb
76 MAKE SU-E THAT THE %OUNG #NFANT #S KEPT WA-M AT A// T#MES6
In cool eather cover the infant&s head and feet and dress the infant ith eAtra clothing)
% Breastfeeding #oorly or drinking #oorly % Becomes sicker % Develo#s a fever % Fast breathing % Difficult breathing % Blood in stool % ;omits everything % Irritable or lethargic % Convulsions
G#:E FO//OW)UP A-E FO- THE S# K %OUNG #NFANT

If there is a ne #roblem@ assess* classify and treat the ne #roblem as on the '""+"" '?D CL'""IF% chart
% LOCAL *ACTERIAL INFECTION

'fter 1 days: Look at the umbilicus) Is it red or draining #us? Does redness eAtend to the skin? Look at the skin #ustules) 're there many or severe #ustules? Look at the #us draining from the eye) ,as the eye im#roved? Is there less #us draining? Treatment: % If +ondition re$ains the sa$e or is (orse* refer to hos#ital) % If +ondition is i$*ro'ed* tell the mother to continue giving the 4 days of antibiotic and continue treating for the local infection at home)
% THRUSH
'fter 1 days: Look for hite #atches in the mouth .thrush/) $eassess feeding) O "ee ]Then Check for Feeding Problem or Lo !eight^ above .#) 5B/) %
%
If thr&sh is (orse check that treatment is being given correctly* consider ,I; .#)9/ If the infant has *ro3le$s (ith atta+h$ent or s&+,ling* refer to hos#ital) If thrush is the same or better* and the baby is feeding ell * continue ith nystatin .or gentian violet/ for a total of 4 days)
Local bacterial infection Thrush Follo u# care
3"
G#:E FO//OW)UP A-E FO- THE S# K %OUNG #NFANT

% FEE.#NG P-O9/EM
'fter 1 days: $eassess feeding #)5B 'sk about any feeding #roblems found on the initial visit) % % % Counsel the mother about any ne or continuing feeding #roblems) If you counsel the mother to make significant changes in feeding* ask her to bring the young infant back again after 4 days) If the young infant is lo eight for age* ask the mother to return after a further 4 days after the initial visit to measure the young infant&s eight gain) Continue follo @u# until the infant is gaining eight ell) if the young infant has lost (eight* $+F+$ the child)
E#!ept$%n: If you do not think that feeding ill im#rove* refer the child)
% NOT G-OW#NG WE//

'fter 9 days: !eigh the young infant and determine if the infant is still lo eight for age) $eassess feeding) 2 "ee ]Then Check for Feeding Problem or Lo !eight^ above) % If the infant is no longer lo( (eight !or age* #raise the mother and encourage her to continue)
% If the infant is still lo( (eight !or age, 3&t is gaining (eight* #raise the mother) 'sk her to have her infant eighed again ithin 36 days or hen she returns for immunisation)* hichever is the earlier) % If the infant is still lo( (eight !or age and has not gained (eight $+F+$) E#!ept$%n: If you do not think that feeding ill im#rove* or if the young infant has lost (eight* refer to hos#ital)
Feeding #roblem Lo eight Follo care
FG? I2CI guideline "e#tember 1BB1 u#
3$

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World Health Organization

Division of Child ,ealth and Develo#ment .C,D/

S# K H#/. AGE 2 MONTHS UP TO 0 %EA-S

ASSESS AND CLASSIFY THE SICK CHILD

TREAT THE CHILD

Fever= other cause))))))))))))))))))))))3<

COUNSEL THE MOTHER

Gi'e Follo()&* a Local Bacterial In Thrush))))))))))))))))) Feeding Problem Lo !eight))))))))

Feeding advice for child ith

FG? I2CI guideline "e#tember 1BB1

ASSESS AN. UP /ASS#F% AGE 2 MONTHS TO 0 %EA-S THE S# K

HE K FO- GENE-A/ .ANGE- S#GNS

^ppb pp THEN ASK A9OUT MA#N S%MPTOMS2

.oes the +hild ha'e +o&gh or di!!i+&lt 3reathing4

C,IL D 2C"T B+ C'L2

for stridor or hee:e)

AN. #F WHEE>E, ASK2

child a kno n asthmat ic?

?o signs of #neumonia or very severe disease)

And i! (heeze +lassi!"2

mother hen to return immediately .#)18/

u# in 4 days if not im#roving

%es to any Huestion

-E U--E NT WHEE> E WHEE>E 5F#-ST EP#SO.E8

'll other children ith hee:e

Danger signsDCough 'ssess and classify

FG? I2CI guideline "e#tember 1BB1

.oes the +hild ha'e diarrhoea4

T o of the follo ing signs:

% Start treat$ent !or se'ere deh"dration

.#A--HOEA W#TH SE:E-E .EH%.-AT#ON

s or mo re* ha s the chi ld los t J e igh t?

u fluid) s Is the ? child: @ @ ? $ o e t s t a l b e l s e s a n d i r r i t a b l e ? t o d r i n k o r d r i n k i n g # o o r l y ? @ Drinkin

ther e blo od in the sto ol? ha t tre at m en t is th e m ot he r giv ing ?

L e t h a r g i J c Lo ok o for r su nk u en n ey c es o n J s (ff c er i the o chi ld

diar rhoe a !or .EH% .-AT# ON

T o of the follo ing signs : $ es tle ss * irri ta bl e

gh signs to class ify as seve re or som e dehy drati on

lo ss .#A--HOEA W#TH SOME .EH%.-AT#ON

" un ke n ey es Dr in ks ea ge rly * thi rst y " ki n #i nc h go es ba ck sl o l y)

Dehy dratio n #rese nt ($ ,isto ry of eig ht loss

SE:E-E PE-S#STENT .#A--HOEA

And i! diarrh oea 1= da"s or $ore +lassi! "2

eot !h eer ra b to o ut fe h e o di sn * g i .# o t )1 ! a4 O l/ -% S %0i ve o C vit n oa umi t nn h s' e eu l nl ( es a ts " ha % ed os - m

vi se m ot he r he n to re tu rn im m ed iat el y .# )1 8/ D % i ' F s oll 3 o @ u# in 4 da ys

!or deh"dration i! *resent % -e!er U-GENT/% to hos*ital % Gi'e !re@&ent

reat for 4 days ith nalidiAic acid .#)>/

the mother hen to return immediate ly .#)18/ % Follo @ u# in 1 days

An d i! 3lo od in stool +lassi! "2

.oes the +hild ha'e !e'er4

'ny general danger "tiff neck

SUSPE TE. MEN#NG#T#S

ys* ha s fev er be en #re se nt ev ery da y?

F E:E -) OTH EA USE

% Tre at ca us e of fev er if fou nd % 0iv e #ar

fev er 5< KC or ab ov e .#) 3B / % I f f

An d i! $al ari a ris , *re sen t +la ssi! "2

#! S+ Uh S il Pd Ea g Te Ed .o ' Se Er :o En -e E" e Ma A r2 /G Ai - '% # e A !i r s t d o s e Mo A! /+ Ao -) # a A rt e $ e t h e r ! o r s e ' e r e $

SP E TE . ME N# NG #T# S as a3 o' e % -e !er UGE NT /%

-e !er UGE NT c /% l !or i $a n lari i ac tre at a $e n nt d i! ag c ed o les n st tha i nn 12 u $o e nt hs a %t If the h chil o dm is e ov er f a

e #ar ac eta mo l in the clin ic for hig h fev er 5<K C or ab

ov se e s .#) % 3B ' / dv % is ? e oti m fy ot co he nfi r rm ed he m n al to ari ret a ur ca n

imme diately .#)18/

!or deh"dration i! resent % -e!er U-GENT/% to hosital % Gi'e !re@&ent

-e!er U-GENT/% to hosital Kee the +hild (ar$