MAKE SURE CHILD WITH ANY GENERAL DANGER SIGN IS REFERRED after first
ASK: dose of an appropriate antibiotic and other urgent treatments.
LOOK:
• Is the child not able to drink or • See if the child is
breastfeed? abnormally sleepy or difficult
IF YES Exception: Re-hydration of the child according to Plan C may resolve danger signs so
• Does the child vomit everything? that referral is no longer needed.
to awaken
• Has the child had convulsions
A child with any general danger sign needs URGENT attention. Complete the
assessment and any pre–referral treatment so referral is not delayed.
Treatdehydration
Treat dehydration
before referral
before unless
referralthe
unless
childthe
SEVERE has another
child hassevere
another
classification.
severe classification.
if diarrhea 14 • Dehydration present PERSISTENT
days or more Give
Givevitamin
vitaminA.A.
DIARRHEA Refer
Refertotohospital.
hospital.
Decide Dengue Risk: Yes or No • Any general danger sign Give Vitamin A.
If Dengue risk: If MEASLES now or • Clouding of cornea or SEVERE Give first dose of an appropriate antibiotic.
within last 3 months • Deep or extensive mouth COMPLICATED If clouding of the cornea or pus draining from the eye,
THEN ASK: LOOK AND FEEL: Classify ulcers MEASLES apply tetracycline eye ointment
• Has the child had any bleeding from • Look for bleeding from Refer URGENTLY to hospital
the nose or gums or in the vomitus or nose or gums. • Pus draining from the eye or M E A S L E S W IT H Give Vitamin A.
stools? • Look for skin petechiae • Mouth ulcers EYE OR M OUTH If pus draining from the eye, apply tetracycline eye
• Has the child had tarry black stools? • Feel for cold and clammy ………………………… C O M P L IC A T IO N ointment.
• Has the child had abdominal pain? extremities. If mouth ulcers, teach the mother to treat with gentian
………………………… violet.
• Has the child been vomiting? • Check for slow capillary
refill. ……. now or within the
• Measles Give vitamin A.
last 3 months MEASLES Advise mother when to return immediately.
If none of the above ASK or
LOOK and FEEL signs are
present and the child is 6 months if DENGUE Risk, • Bleeding from nose or gums or If persistent vomiting or persistent abdominal pain or
or older and fever present for Classify • Bleeding in stools or vomitus or skin petachiae or positive tourniquet test are the only
more than three days: • Black stools or vomitus or positive signs, give ORS (Plan B)
SEVERE
- Perform the tourniquet test. • Skin petechiae or DENGUE If any other signs of bleeding are positive, give fluids
• Cold and clammy extremities or HEMORRHAGIC rapidly as in Plan C.
• Capillary refill more than 3 FEVER Treat the child to prevent low blood sugar.
seconds or Refer all child URGENTLY to hospital.
• Persistent abdominal pain or DO NOT GIVE ASPIRIN.
• Persistent vomiting or
• Tourniquet test positive
• No signs of severe dengue F E V E R :D E N G U E Advise mother when to return immediately.
hemorrhagic fever. H E M O R R H A G IC Follow up in 2 days if fever persist or child shows sign of
F E V E RU N L IK E L Y bleeding.
DO NOT GIVE ASPIRIN.
Other Causes of fever:
Severe dengue hemorrhagic fever
• Pneumonia Mastoiditis
• Dysentery Acute ear infection
• Severe complicated measles Abscess, cellulitis, steomyelitis
• Measles with eye or mouth complications Severe pneumonia or very severe disease
• measles
• Ear pain.
…………………………………………… ………………... …………………………………………………
• Pus is seen draining from the ear and CHRONIC Dry the ear by wicking
discharge is reported for 14 days or EAR
Follow –up in 5 days
more INFECTION
THEN CHECK THE CHILD”S IMMUNIZATION STATUS THEN CHECK THE VITAMIN A STATUS
VITAMIN A SUPPLEMENTATION SCHEDULE:
AGE VACCINE
IMMUNIZATION SCHEDULE Birth BCG HEP B-1
SUPPLEMENTATION: The first dose at 6 months or above.
6 weeks DPT-1 OPV-1 HEP B-2
Subsequent doses every 6 months.
10 weeks DPT-2 OPV-2 TREATMENT: 1 CAPSULE TODAY
14 weeks DPT-3 OPV-3 HEP B-3
1 CAPSULE TOMORROW
9 months Measles
1 CAPSULE AFTER 2 WEEKS
TETRACYCLINE COTRIMOXAZOLE
Give four times daily for 3 (Trimethoprim+sulphamethoxazole)
days Give two times daily for 5 days
2 months up to 4 months (4-<6 kg) CAPSULE250 mg
TEACH THE MOTHER TO GIVE ORAL 2 months up to 4 months (4-<6 kg) TETRACYCLINE NOT RECOMMENDED
See doses above
DRUGS AT HOME 4 months up to 12 months (6-<10kg) 1/2
12 months up to 5 years (10-19 kg.) 1
Follow the instructions below for every oral drug to be given at home.
Also follow the instructions listed with each drug’s dosage.
TEACH
Give an THE MOTHER HOW TO TREAT LOCAL
Oral Antimalarial INFECTIONS AT HOME
Give Vitamin A
FIRST-LINE ANTIMALARIAL: CHLOROQUINE AND PRIMAQUINE
SECOND –LINE ANTIMALARIAL: SULFADOXINE AND PYRIMETHAMINE TREATMENT SUPPLEMENTATION
TREATMENT
IF CHLOROQUINE: Give one dose in health center if:
Give one dose in the health center
• Explain to the mother that she should watch her child carefully for 30 minutes after giving a dose of - child is six months of age or older.
choloroquine. If the child vomits within 30 minutes, she should repeat the dose and return to the health - child has not received a dose of
center for additional tablets. Vitamin A in the past six months.
• Explain that itching is a possible side effect of the drug, but it is not dangerous.
Age VITAMIN A CAPSULES
IF SULFADOXINE + PYRIMETHAMINE: Give single dose in health center.
100,000 IU 200,000 IU
TABLETS
AGE 150 mg base
TABLET TABLET TABLET
DAY 1 DAY 2 DAY 3
15 mg base 15 mg base (500 mg sulfadoxine)
25 mg pyrimethamine
Give Iron
Give one dose daily for 14 days.
2 months up to 1/2 1/2 1/2 1/4
5 months IRON/FOLATE IRON SYRUP IRON DROPS
TABLET Ferrous sulfate 150 Ferrous sulfate 25
AGE OR WEIGHT mg
5 months up to 1/2 1/2 1/2 Ferrous sulfate 200 mg
1/2 Per 5 m l Per 5 m l
12 months mg +
250 m cg Folate (6 mg elemental ( 2 5 m g e le m e n t a l ir o n
3 months up to 4 months 2.5 ml (1/2 0.6 ml
12 months up 1 1 1/2 1/2 1/4 3/4 (4-< 6 kg) tsp)
to 3 years
4 months up to 12 months 4 ml (3/4 tsp) 1.0 ml
(6-< 10 kg)
3 years up to 5 1 1/2 1 1/2 1 3/4 1/2 1
years 12 months up to 3 years 1/2 tablet 5 ml (1 tsp) 1.5 ml
(10-<14 kg)
3 years up to 5 years (14 - 1 tablet 10 ml (1 1/2 2.0 ml
19 kg) tsp)
24 months up to 59 months 1 1
3 years up to 5 years (14-19 kg) 1/2 10 ml (2 tsp)
Explain to the mother what the treatment is and why it should be given.
GIVE THESE
Describe TREATMENTS
the treatment IN HEALTH
steps listed in the appropriate box. CENTER ONLY
Watch the mother as she does the first treatment in the health center. Dry the Ear by Wicking
• (except
Explain remedy
to the for why
mother cough
theordrug
soreisthroat)
given.
Dry the ear at least 3 times daily.
• Tell
Determine theher how
dose often to dofor
appropriate the treatment
the at home.
child’s weight (or age).
• Roll clean absorbent cloth or soft, strong tissue paper into a wick.
• If needed
Usea sterile needlefor
andtreatment at home,
sterile syringe. give mother
Measure the tube
the dose of tetracycline
accurately.
• Place the wick in the child’s ear.
• ointment
Give the drugoras
a an
small bottle of gentian
intramuscular violet.
injection.
• Remove the wick when wet.
• childCheck
If the thebemother’s
cannot referred,understanding before she
follow the instructions leaves the health center.
provided.
• Replace the wick with a clean one and repeat these steps until the ear is dry.
*quinine salt
Treat the Child to Prevent
Low Blood Sugar
If the child is able to breastfeed:
PLAN A: Treat Diarrhea at Home PLAN B: Treat Some Dehydration with ORS
Counsel the Mother on the 3 Rules of Home Treatment: Give in health center recommended amount of ORS over a 4-hour period
Give Extra Fluid, Continue Feeding, When to Return
1. DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS.
• Start IV fluid immediately. If 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:
START HERE AGE First give Then give
30 ml/kg 70 ml/kg in:
GIVE Can
FOLLOW-UP
you give
intravenous (IV) fluid
CARE
YES in:
Infants (under 12 months) 1 hour 5 hours
Careimmediately?
for the child who returns for follow-up using all the boxes that match the child’s previous classifications.
If the child has any new problem, assess, classify
Children and treat the new problem as on the ASSESS AND CLASSIFY chart.
(12 months up to 5 years 30 minutes 2 ½ hours
NO
NOTE:
If possible, observe the child at least 6 hours after re-hydration
to be sure the mother can maintain hydration by giving the child
Refer URGENTLY to ORS Solution by mouth
hospital for IV or NG
treatment.
PNUEMONIA
After 2 days
PERSISTENT DIARRHEA - Change to second –line oral antibiotic recommended for Shigella in your area.
After 5 days: - Give it for 5 days. Advise the mother to return in 2 days.
If the child has any new problem, assess, classify and treat the new FEVER-MALARIA UNLIKELY
problem as on the ASSESS AND CLASSIFY chart.
If fever persists after 2 days:
Treatment:
If the child has any general danger sign or stiff neck, treat as VERY
MALARIA SEVERE FEBRILE DISEASE/MALARIA.
If fever persists after 2 days, or returns within 14 days:
If malaria is the only apparent cause of fever
Do a full re-assessment of the child. (See ASSESSS & CLASSIFY chart)
Assess for other cause of fever. - Take a blood smear.
- Treat with the first-line oral antimalarial. Advise the mother to return again in 2
Treatment: days if the fever persists.
- If fever has been present for 7 days, refer for assessment.
If the child has any general danger sign or stiff neck, treat as VERY
SEVERE FEBRILE DISEASE/MALARIA.
If the child has any cause of fever other than malaria, provide treatment. FEVER (NO MALARIA)
If malaria is the only apparent cause of fever If fever persists after 2 days:
- Take a blood smear. Do a full re-assessment of the child. (See ASSESSS & CLASSIFY chart)
- Give second-line oral antimalarial without waiting for result of blood smear. Make sure that there has been no travel and/or overnight stay in a malaria area.
- Advise mother to return in 2 days if fever persists. If there has been travel and/or overnight stay, take blood smear if possible.
- If fever persists after 2 days of treatment with second-line oral antimalarial,
refer with blood smear for reassessment. Treatment:
If there has been travel and/or 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.
- If the child has any general danger signs or stiff neck treat as VERY
SEVERE FEBRILE DISEASE
- If the child has any apparent cause of fever, provide treatment.
- If no apparent cause of fever, advise the mother to return again in 2 days if fever
persists.
- If fever has been present for 7 days, refer for assessment.
GIVE FOLLOW-UP CARE
Care for the child who returns for follow-up using all the boxes that
match the child’s previous classification.
If the child has any new problem, assess, classify and treat the new
problem as on the ASSESS AND CLASSIFY chart.
FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY
If fever persists after 2 days:
Treatment for eye Infection: If fever has been present for 7 days, refer for assessment.
If pus is draining from the eye, ask the mother to describe how she has treated If no apparent cause of fever, advise the mother to return daily until the child has had
the eye infection. If treatment has been correct, refer to hospital. If treatment has not no fever for at least 48 hours.
been correct, teach mother correct treatment.
Advise mother to make sure child is given more fluids and is eating.
If the pus is gone but redness remains, stop the treatment.
If 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 for 5 or more days with
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 correctly.
Encourage her to continue.
If no ear pain or discharge, praise the mother for her careful treatment. If she has
not yet finished the 5 days of antibiotic, tell her to use all of it before stopping.
If the child has any new problem, assess, classify and treat
the new problem as on the ASSESS AND CLASSIFY chart.
FEEDING PROBLEM VERY LOW WEIGHT
After 5 days: After 30 days:
Reassess feeding. (See questions at the top of the COUNSEL chart) Weigh the child and determine if the child is still very low weight for age.
Ask about any feeding problems found on the initial visit. Reassess feeding. (See questions at the top of the COUNSEL chart)
Counsel the mother about any new or continuing feeding problems. If Treatment:
you counsel the mother to make significant changes in feeding, ask her
to bring the child back again. If the child is no longer very low weight for age, praise the mother and
encourage her to continue.
If 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. If the child is very low weight for age, counsel the mother about any
feeding problem found. Continue to see the child monthly until the child is
feeding well and gaining weight regularly or is no longer very low weight for
age.
Exception:
ANEMIA If you do not think that feeding will improve, or if the child has lost weight,
After 14 days: refer the child.
FOOD
During this illness has the child’s feeding changed? If yes, how?
• Breastfeed as often as the child wants. Breastfeed as often as the child wants. • Give adequate amount of family food at
• Exclusively breastfeed as often as 3 meals a day
• Add any of the following • Give adequate amount of family
the child wants, day and night at
foods such as: rice, camote, potato,
least 8 times in 24 hours. o Lugaw with added oil, mashed fish chicken, meat, mongo, steamed • Give twice daily
vegetables or beans, steamed tokwa, tokwa, pulverized roasted dilis, milk nutritious food
• Don not give other foods or fluids. flaked fish, pulverized roasted dilis, between
and eggs, dark green leafy and yellow
finely ground meat, eggyolk, bite-size meals such as,
Birth up to 6 months fruits.
vegetables (malunggay, squash), fruits
Boiled yellow
(papaya, banana)
camote, boiled
o 3 times per day if • Add oil or yellow corn,
Play: breastfed margarine peanuts, boiled saba, banana,
• Provide an area where the child o 5 times per day if taho, fruits and fruit juices.
5 times per day
could move, play and develop his not breastfed
senses of sight, touch and hearing. • Feed the baby 2 years and olfder
• Have large colorful things for your 6 months to 12 months nutritious snacks like fruits
child to reach for and new things to Play:
see. Play: 12 months to 2 years • Help your child count, name and
compare things.
Communicate: • Give your child clean, safe household
Play: • Make simple toys
things to handle, bang and drop.
• Look into your child’s eyes and smile • Give your child things to stack up and for your child
at him or her. to put into container and take out
• When you are breastfeeding it is a Communicate:
good time to talk to your child
• Encourage your
and get a Communicate: child to talk and
conversation • Ask your child answer your
going with Communicate: simple questions. child’s questions.
sounds or • Respond to your child’s sounds and Respond to your Teach your child
gestures interest. Tell your child the names of child’s attempts to talk. Play games stories, song and
things and people. like “bye” games
If the mother reports difficulty with breastfeeding, assess breastfeeding. (See YOUNG INFANT chart)
As needed, show the mother correct positioning and attachment for breastfeeding.
If 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 breastfeeds, day and night, and gradually reducing other milk or
foods
- 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. If there is some
left-over milk, discard.
If the child is not being fed actively, counsel the mother to:
If the child is not feeding well during illness, counsel the mother to:
FLUID
WHEN TO RETURN
Advise the Mother to Increase Fluid During Illness
FOR ANY SICK CHILD:
Breastfeed more frequently and for longer at each feed.
Increase fluid. For example, give soup, rice water, buko juice or clean water.
Classify Convulsions or
ASK LOOK, LISTEN, FEEL: ALL • Fast breathing (60 breaths per Give first dose of
Count the breaths in one minute. YOUNG minute or more) or intramuscular antibiotics
Has the infant Repeat the count if elevated. YOUNG INFANT INFANTS • Severe chest indrawing or
had Look for severe chest indrawing MUST BE CALM • Nasal flaring or Treat the child to prevent
• Grunting or low blood sugar
Convulsions? Look for nasal flaring.
Look and listen for grunting. • Bulging fontanelle or
• Pus draining from ear or Advise mother how to keep
Look and feel for bulging fontanelle. POSSIBLE
• Umbilical redness extending to the infant warm on the way to
Look for pus draining from the ear. SERIOUS
the skin or the hospital.
Look at the umbilicus. Is it red or draining pus? BACTERIAL
• Fever (37.5о C* or above or feels INFECTION
Does the redness extend to the skin?
hot) or low body temperature Refer URGENTLY to the
• Measure temperature (or feel for fever or low body (less than 35.5о C* or feels cold) hospital.**
temperature) or
• Look for skin pustules. Are there many or severe • Many or severe skin pustules or
pustules? • Abnormally sleepy or difficult to
• See if the young infant is abnormally sleepy or awaken or
difficult to awaken. • Less than normal movement.
• Look at the young infants movements.
Are they less than normal//? Give an appropriate oral
Red umbilicus or draining LOCAL antibiotic
pus or BACTERIAL Treat local infection in the
INFECTION health center and teach the
Skin pustules. mother to treat local infections at
home
Advise mother to give home
care for young infant.
Classify
and if blood
DIARRHEA
in stool
THEN ASK:
Two of the following If infant does not have POSSIBLE SERIOUS
Does the young infant have diarrhea? For DEHYDRATION signs BACTERIAL INFECTION nor DYSENTERY
- Give fluid for severe dehydration (Plan C)
• Abnormally sleepy or OR
If infant also has POSSIBLE SERIOUS
difficult to awaken SEVERE
BACTERIAL INFECTION or DYSENTERY.
IF YES, ASK: LOOK AND FEEL: DEHYDRATION
• Sunken eyes - Refer URGENTLY to hospital with
For how long? Look at the young infant’s mother giving frequent sips of ORS on
general condition. Is the child: • Skin pinch goes back the way.
Is there blood in very slowly - Advise mother to continue breastfeeding.
the stood? - abnormally sleepy or difficult to - Advise mother how to keep the young
awaken? infant warm on the way to the hospital
- Restless and irritable?
Two of the following
Look for sunken eyes. signs: Give fluid for some dehydration (Plan B)
SOME
Pinch the skin of the abdomen. Restless, irritable DEHYDRATION If infant also has POSSIBLE SERIOUS
BACTERIAL INFECTION or DYSENTERY.
Does it go back: - Refer URGENTLY to hospital with mother
Sunken eyes
- Very slowly (longer than 2 giving frequent sips of ORS on the way.
- Advise mother to continue breastfeeding.
seconds)? • Skin pinch goes back
- Slowly? slowly
AGE VACCINE
IMMUNIZATION SCHEDULE Birth BCG Hep B – 1
6 weeks DPT – 1 OPV - 1 Hep B - 2
* Avoid contromoxazole in infants less than 1 month of age who are premature or jaundiced
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 To Treat Umbilical Infection Treat Oral Thrush (ulcers or white patches in
mouth)
WHEN TO RETURN
If the infant has: Return for follow-up in: Advise the mother to return immediately if the
young infant has any of these signs:
LOCAL BACTERIAL
INFECTION ANY 2 days Breastfeeding or drinking poorly
FEEDING PROBLEM Becomes sicker
THRUSH Develops a fever
LOW WEIGHT FOR AGE 14 days Fast breathing
Difficult breathing
MAKE SURE THE YOUNG INFANT STAYS WARM AT ALL TIMES.
Blood in stool
After 2 days
Look at the umbilicus. Is it red or draining pus? Does redness extend to the skin?
Look at the skin pustules. Are there many or severe pustules?
Treatment:
If pus and redness are improved tell the mother to continue giving antibiotic for 5 days and continue
treating the local infection at home.
GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT
FEEDING PROBLEM
After 2 days
Reassess feeding. (See “Then Check for Feeding Problem or Low Weight” chart above)
Ask about any feeding problems found on the initial visit.
Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in
feeding, ask her to bring the young infant back again.
If 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:
If you do not think that feeding will improve, or if the young infant has loss 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” chart above)
If the infant is no longer low weight for age, praise the mother and encourage her to continue.
If 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.
If the young infant is still low weight for age and still has a feeding problem, counsel the mother about the 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 the infant is feeding well and gaining weight regularly or is no longer low weight for age.
Exception:
If 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” chart above)
If thrush is worse, or if the infant has problems with attachment or suckling, refer to hospital.
If thrush is the same or better, and if the infant is feeding well, continue half-strength gentian violet for a total of 5 days.