IMCI New

All sick children must be examined for “General Danger Signs”

All sick children must be routinely assessed for Major Symptoms

Assessed for Nutritional Status, Immunization Status, & Vitamin A Status

Only a limited number of carefully selected clinical signs are used.

IMCI management procedures use a limited number of essential drugs & encourage active participation of caretakers.

An essential component of the IMCI guidelines is the counseling of caretakers.

Ask the Mother what the child’s problems are?

IF YES

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

Does the child have Cough or Difficult Breathing?

IF YES:

ASK: How Long?

LOOK & LISTEN: RRChest IndrawingStridor

1. Fast Breathing?

2. No Signs of PNM

3. Danger Signs + Chest Indrawing and Stridor

SIGNS CLASSIFY AS TREATMENT

CUVACSSEVERE PNEUMONIA

OR VERY SEVERE DISEASE

ANTIBIOTIC

VIT. A

TREAT TO PREVENT LOW BLOOD SUGAR

REFER!

Fast Breathing PNEUMONIA

Antibiotic (5 days)

Soothe the throat

When to Return

Follow up in 2 days

No signs of PNM or Very Severe Disease

NO PNEUMONIA:

COUGH OR COLD

Soothe the throat

When to Return

Follow up in 5 days

SIGNS CLASSIFY AS TREATMENT

CUVACSSEVERE PNEUMONIA OR VERY SEVERE DISEASE

1st Dose of Antibiotic

Refer

* Treat Low Blood Sugar at Vit A

Fast Breathing PNEUMONIA

Antibiotic (3 days)

(+) Wheezing = Rapid acting Bronchodilator (5 days)

More than 3 weeks (BAKA TB)

Soothe the throat

When to Return

Follow up in 2 days

No signs of PNM or Very Severe Disease

NO PNEUMONIA:

COUGH OR COLD

(+) Wheezing = Rapid acting Bronchodilator (5 days)

More than 3 weeks (BAKA TB)

Soothe the throat

When to Return

Follow up in 5 days

Does the child have Diarrhea?IF YES:

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

LOOK & LISTEN: General ConditionSunken Eyeball

Not able to drink or eagerly Pinch skin (very slow or slow)

DehydrationIf Diarrhea is for 14 days and moreIf presence of blood in the stool

1. Thirsty

Sunken Eyes

Slow Skin Pinch

2. Abnormally Sleepy

Sunken Eyes

Very Slow Skin Pinch

3. No enough signs and symptoms

Dehydration

2 of the following signs

Sunken eyeball

Skin pinch = very slow

Unable to drink

Abnormally sleepy

SEVERE DEHYDRATION

No other severe classification: Plan C

REFER! (ORS/BF)

2 yrs old + (+) cholera in area = Antibiotic

2 of the following signs

Sunken eyeball

Skin pinch = slow

Drinks eagerly

Restless

SOME DEHYDRATION

Plan B

When to Return

Follow up in 5 days If not improving

Not enough signs to classify as some or severe dehydration NO DEHYDRATION

Plan A

Zinc Supplement

When to Return

Follow up in 5 days

DEHYDRATION

2 of the following signs

Sunken eyeball

Skin pinch = very slow

Unable to drink

Abnormally sleepy

SEVERE DEHYDRATION

No other severe classification: Plan C

REFER! (ORS/BF)

2 yrs old + (+) cholera in area = Antibiotic

2 of the following signs

Sunken eyeball

Skin pinch = slow

Drinks eagerly

Restless

SOME DEHYDRATION

Plan B

Zinc Supplement

When to Return

Follow up in 5 days If not improving

Not enough signs to classify as some or severe dehydration NO DEHYDRATION

Plan A

Zinc Supplement

When to Return

Follow up in 5 days

DEHYDRATION

1. 14 days

Sunken Eyes

Abnormally Sleepy

2. 14 days

Sunken Eyes

Slow Skin Pinch

Restless

3. 14 days

No sunken eyes

Skin pinch goes back fast

Diarrhea of 14 days and more

(+) DehydrationSEVERE

PERSISTENT DIARRHEA

Treat Dehydration

Vit. A

REFER!

(-) DehydrationPERSISTENT

DIARRHEA

Advise on feeding

Vit. A

Follow up in 5 days

When to Return

If Diarrhea is 14 days or more

(+) DehydrationSEVERE

PERSISTENT DIARRHEA

Treat Dehydration

REFER!

* Vitamin A

(-) DehydrationPERSISTENT

DIARRHEA

Advise on feeding

Give multivitamins and minerals + zinc for 14

days

Follow up in 5 days

*When to Return

If Diarrhea is 14 days or more

Blood in the stool DYSENTERY

Antibiotic (5 days)

Follow up in 2 days

When to Return

(+) Blood in the Stool

Blood in the stool DYSENTERY

Ciprofloxacin (3 days)

Follow up in 2 days

*When to Return

(+) Blood in the Stool

Does the child have fever?

ASK: Does the child live in a malaria area?

Has the child visited/travelled in a malaria area in the past 4

weeks?

YES to EITHER: OBTAIN BLOOD SMEAR

IF YES:ASK: How long?

If more than 7 daysFever = everyday?

(+) Measles within the last 3 months

LOOK & LISTEN:

Stiff neck, Runny noseGeneralized Rash, Cough, Runny Nose, Red Eyes

1. Lives in Palawan

(-) Blood Smear

(+) Measles

2. Stayed in Palawan for 1 month

(+) Blood Smear

CUVAS

3. Had a Vacation in Palawan for 2 months

(+) Blood Smear

No danger signs and stiff neck

Malaria Risk

MALARIA RISK

CUVASVERY SEVERE

FEBRILE DISEASE

Quinine

Antibiotic

Low Blood Sugar

Paracetamol

Send the blood smear with client

REFER!

(+) Blood smear

> If BS is not done:

(-) runny nose

(-) measles

(-) other cause of fever

MALARIA

Oral Antimalarial

Paracetamol

When to Return

Follow up in 2 days

(-) Blood smear

(+) runny nose

(+) measles

(+) other cause of fever

FEVER: MALARIA UNLIKELY

Paracetamol

When to Return

Follow up in 2 days

1. Caregiver reported no travelling for the past year

Convulsion

Stiff Neck

2. Caregiver reported of 38 degree celsius temperature of her child with

the use of a rectal thermometer

No Malaria Risk

NO MALARIA RISK

CUVASVERY SEVERE

FEBRILE DISEASE

Antibiotic

Low Blood Sugar

Paracetamol

REFER!

No signs of very severe febrile disease

FEVER:

NO MALARIA

Paracetamol

When to Return

Follow up in 2 days

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

ASK: Measles within last 3 months?

LOOK & LISTEN: Signs of measles (cough, runny nose, red eyes)Mouth UlcersPus draining from eyesClouding of cornea

1. Cough

Coryza

Conjunctivitis

NOW

2. Pus draining from the eye

Mouth Ulcer

3. Danger Signs

Clouding of the Cornea

Deep Mouth Ulcer

Measles

Clouding of cornea

Deep or extensive mouth ulcers

CUVA

SEVERE COMPLICATED

MEASLES

Antibiotic

Vit. A

Tetracycline or Gentian Violet

REFER!

Pus draining from the eye

Mouth ulcers

MEASLES WITH EYE/MOUTH

COMPLICATION

Vit. A

Tetracycline or Gentian Violet

Follow up in 2 days

When to Return

Measles now or within the last

3 monthsMEASLES

Vit. A

When to Return

If DENGUE risk

ASK: Has the child had any bleeding from nose or gumsHas the child had black vomitus? Persistent

vomiting? Black stools?Persistent abdominal pain

LOOK & LISTEN:Bleeding in nose and gumsSkin petechiae Cold & clammy extremities

Tourniquet test

1. (-) Persistent Vomiting

(-) Tourniquet test

38.1 degree Celsius

(-) Melena

2. (+) Black Vomitus

(+) Melena

(+) Abdominal Pain

Epistaxis

3. (+) Tourniquet Test

(+) Vomiting

(+) Abdominal Pain

Dengue Hemorrhagic Fever

BLEEDING

Skin petechiae

+ Tourniquet Test

Cold and Clammy ext.

Persistent abd pain

Persistent vomiting

Bleeding in Stool

SEVERE DENGUE HEMORRHAGIC

FEVER

(+)VAST: Plan B

Signs of Bleeding: Plan C

Low Blood Sugar

NO ASPIRIN!

REFER!

No signs of SDHFFEVER: DENGUE HEMORRHAGIC

FEVER UNLIKELY

NO ASPIRIN!

Follow up in 2 days if fever persist or (+) signs

of Bleeding

When to Return

Does the child have an Ear Problem?IF YES:

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

LOOK & LISTEN:Pus Tender swelling behind ear

1. No Tender Swelling Behind ear

No pus draining

No pain

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

3. 12 days complain of ear pain and pus draining

4. Tender Swelling Behind Ear

Ear Problem

Tender swelling behind the ear

MASTOIDITIS

Antibiotic

Paracetamol

REFER!

Discharge of Less than 14 days

Ear pain

ACUTE EAR INFECTION

Antibiotic (5 days)

Paracetamol

Dry the ear by wicking

Follow up in 5 days

When to Return

Discharge of 14 days or more

CHRONIC EAR INFECTION

Dry the ear by wicking

Follow up in 5 days

When to Return

No ear pain

No dischargeNO EAR INFECTION No additional treatment

Tender swelling behind the ear

MASTOIDITIS

Antibiotic

Paracetamol

REFER!

Discharge of Less than 14 days

Ear pain

ACUTE EAR INFECTION

Antibiotic (5 days)

Paracetamol

Dry the ear by wicking

Follow up in 5 days

When to Return

Discharge of 14 days or more

CHRONIC EAR INFECTION

Dry the ear by wicking

Treat with Topical Quinolone

Follow up in 5 days

When to Return

No ear pain

No dischargeNO EAR INFECTION No additional treatment

LOOK & LISTEN:Visible severe wastingEdema on both feetPalmar pallor: Severe or some?Weight

Classify nutritional status…

VESSEVERE

MALNUTRITION OR SEVERE ANEMIA

Vit. A

REFER!

Some Palmar pallor

Very low weight for ageANEMIA OR VERY LOW

WEIGHT

Paracetamol

Assess child’s feeding: Follow up in 5 days

(FEEDING PROBLEM)

Iron and Mebendazole (12 months + (-) 6

months)

Follow up in 14 days

Vit. A: Follow up in 30 days (LOW WEIGHT)

Not very low weight for age

NO ANEMIA OR Not VERY LOW WEIGHT

Assess child’s feeding: Follow up in 5 days

VESEVERE

MALNUTRITION

Treat to prevent LOW BLOOD SUGAR

REFER!

Very low weight for age VERY LOW WEIGHTAssess child’s feeding: Follow up in 30 days

Not very low weight for age

NOT VERY LOW WEIGHT

Assess child’s feeding: Follow up in 5 days

Severe Palmar Pallor SEVERE ANEMIA REFER!

Some Palmar Pallor ANEMIA

Give Iron

Mebendazole

Anti Malarial (Malaria Risk)

Follow 14 days

No Palmar Pallor NO ANEMIAAssess child’s feeding:

Follow up in 5 days

IMMUNIZATION SCHEDULE

AGE VACCINE

Birth BCG

6 weeks DPT1, OPV1, Hep-B1

10 weeks DPT2, OPV2, Hep-B2

14 weeks DPT3, OPV3, Hep-B3

9 months Measles

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

Give an Appropriate Oral AntibioticFor Pneumonia, Acute Ear Infection, or

Very Severe Disease

First-line antibiotic:Second-line antibiotic:

COTRIMOXAZOLE (2 X daily for 5)

AGE/WEIGHT

ADULT TAB80 mg

Trimethoprim +400 mg

sulphamethoxazole

SYRUP40 mg T

+200 mg S

/5ml

2 mos – 12 mos(4-<10kg)

½ 5

12 mos – 5 years(10-19 kg)

1 10

AMOXYCILLIN (3 x daily for 5)AGE/WEIGHT

TABLET250 mg

SYRUP125 mg/5ml

2 mos – 12 mos(4-<10 kg)

½ 5

12 mos – 5 years(10-19 kg)

1 10

Give an Appropriate Oral AntibioticFor Pneumonia, Acute Ear Infection, or

Very Severe Disease

First-line antibiotic: Amoxicillin/Co - TriSecond-line antibiotic:

Give an Appropriate Oral AntibioticFor Dysentery

First-line antibiotic:Second-line antibiotic:

COTRIMOXAZOLE SAME with above doses

NALIDIXIC ACID (4 x a day for 5)AGE/WEIGHT

SYRUP 250 mg/5ml

2 mos – 4 mos (4-<6 kg) 1.25

4 mos – 12 mos (6-<10kg) 2.5

12 mos – 5 years (10-19 kg) 5

Give an Appropriate Oral AntibioticFor Dysentery

First-line antibiotic: CIPROFLOXACIN (BID x 3)

Second-line antibiotic:

Give an Appropriate Oral AntibioticFor Cholera

First-line antibiotic:Second-line antibiotic:

TETRACYCLINE (4 x a day for 5)AGE/WEIGHT CAPSULE (250 mg)

2 mos – 4 mos (4-<6 kg)

4 mos – 12 mos (6-<10 kg)

12 mos – 5 years (10-19 kg)

COTRIMOXAZOLESame with above doses

Give an Appropriate Oral AntibioticFor Cholera

First-line antibiotic: TetracyclineSecond-line antibiotic: ERYTHROMYCIN (4x

for 3)

Determine appropriate drugs and dosage for child’s age and weight

Tell the reason for giving drugsHow to measureWatch mother perform measuring dose herself1st doseExplain carefully how to give drugs, then labelFinish all course of txCheck the mother’s understanding before she leaves

Give an Oral AntimalarialFirst-line Antimalarial:Second-line Antimalarial: Artemeter

CHLOROQUINERemember!

Watch the child carefully for 30 mins.Itching is a possible side effect but is not

dangerous.

SULFADOXINE & PYRIMETHAMINERemember!

If the child with some palmar pallor is receiving the antimalarial Sulfadoxine-Pyrimethamine (Fansidar), do not give Iron/Folate until a follow up in two weeks.

CHLOROQUINE (3 days)AGE TABLET ( 150 mg base )

DAY 1 DAY 2 DAY 3

2 mos – 5 mos(4-<7 kg)

1/2 1/2 ½

5 mos – 12 mos(7-<10 kg)

1/2 1/2 ½

12 mos – 3 yrs(10-<14 kg)

1 1 ½

3 yrs – 5 yrs(14-<19 kg)

1 1/2 1 1/2 1

PRIMAQUINEAGE/WEIGHT P (Single Dose in

HC for P.Falcifarum)

P (Give Daily for 14 days for P. vivax)

Tablet (15 mg base) Tablet (15 mg base)

2 mos – 5 mos(4-<7 kg)

5 mos – 12 mos(7-<10 kg)

12 mos – 3 yrs(10-<14 kg)

1/2 ¼

3 yrs – 5 yrs(14-<19 kg)

3/4 ½

SULFADOXINE + PYRIMETHAMINE (Single dose)AGE/WEIGHT TABLET (500 mg S + 25 mg

P)

2 mos – 5 mos(4-<7 kg)

¼

5 mos – 12 mos(7-<10 kg)

½

12 mos – 3 yrs(10-<14 kg)

¾

3 yrs – 5 yrs(14-<19 kg)

1

Give an Oral AntimalarialFirst-line Antimalarial: Co Artemeter

LumefantrineSecond-line Antimalarial:

Artemeter is 20 mg while Lumefantrine is 120 mg5 months – 3 years (1 tab): 0h, 8h, 24h, 36h, 48h,

60h3 years – 5 years (2 tabs): 0h, 8h, 24h, 36h, 48h, 60h

Give ParacetamolHigh FeverEar pain

Give paracetamol every 6 hours

Give Vitamin A (100,000; 200,000 IU)6 months to 1 year old:

1 year old to 5 years:

Give Iron

Give one dose daily for 14 days.

Give Mebendazole/AlbendazoleGive 500 mg Mebendazole as a single dose in

health center if:12 mos – 23 mos: A (400 mg): ½

M (500 mg): 124 mos – 59 mos: A (400 mg): 1

M (500 mg): 1

EYE INFECTIONTreat Eye Infection 3 times daily

Tetracycline Eye Oinment

EAR INFECTIONDry the Ear by wicking atleast 3 times daily

MOUTH ULCERSTreat Mouth ulcers with Gentian VioletTreat the mouth ulcers twice daily

COUGHSoothe the Throat, Relieve the Cough with

Safe RemedyBF, Tamarind, Calamansi, Ginger

Do not give:

Codeine cough syrupOther cough syrupsOral and nasal decongestantsAntitussives

Give an Intramuscular AntibioticFor children being referred urgently who

cannot take an oral antibiotic:

GIVE 1st DOSE of IM CHLORAMPHENICOL

Ampicillin 50mg/kgGentamicin 7.5 mg/kg

UPDATE

Give Quinine for Severe MalariaFor children being referred with very severe

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

If Referral is not possible:Give 1st IM QUININERemain lying down for 1 hourRepeat injection 4-8 hours, then 12 hours until

child is able to take oral anti malarial

TREAT HYPOGLYCEMIAIf the child is able to breastfeed:

If unable to breastfeed, but able to swallow:Give EXPRESSED MILK/BREASTMILK SUBSUGAR WATER

Make sugar water:20gms sugar + 200ml water

If unable to swallow:50 ml of milk or sugar water thru NGT

If unconscious & NGT is not possible:Give D10 IVGive D50 slow push

PLAN A: 3 Rules of Home TreatmentGive extra Fluid

BFORSFLUID INTAKE

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

Continue Feeding

When to Return

PLAN B: 4 Hours ORS TreatmentGive ORS during the first 4 hours

Age 0-4mos4mos- 1year

1-2 years 2-5 years

Weight < 6 kg 6-<10 kg 10-<12 kg 12-19 kg

In ml 200-400 400-700 700-900 900-1400

Things to Remember!What if the child vomits?

What will you do after 4 hours?Reassess child – classify DHNSelect app. Plan to continue TXBegin feeding the child in health center

If the Mother must leave before completing treatment:Prepare ORS, Give enough ORS packs, Plan A

Rules

PLAN C: I.V. TreatmentStart IV fluid ImmediatelyGive 100 ml/kg Ringer’s Lactate solution

Age1st give

30 ml/kg in:

Then give

70 ml/kg in:

0-1 year 1 hour 5 hours

1-5 years 30 minutes 2 ½ hours

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

PNEUMONIAAfter 2 days

If (+) chest indrawing or a general danger sign:URGENT REFERRAL

If breathing, fever,& eating are the same:2nd Line Antibiotics

If breathing is slower, less fever or eating better: COMPLETE 5 days Antbiotics

PERSISTENT DIARRHEAAfter 5 days

If the diarrhea has not stopped: REASSESS, TREAT, then REFER

If the diarrhea has stopped: Inform the mother to follow USUAL RECOMMENDATION for child’s age

DYSENTERYAfter 2 days

If the child is dehydrated: 2nd line antibiotics for 5 days, FFUP 2 days

If condition becomes better: Continue giving same antibiotics

MALARIAIf fever persists after 2 days, or returns after 14

days: FULL ASSESSMENT, CLASSIFY

If (+) CUVAS: Treat as VERY SEVERE MALARIA

If (+) other cause of fever other than malaria:Provide Treatment

If Malaria is the only apparent cause of fever:Blood Smear, 2nd line antimalarial

FEVER-MALARIA UNLIKELYIf fever persists after 2 days: ASSESS,

CLASSIFY

If (+) CUVAS: Treat as VERY SEVERE MALARIA

If Malaria is the only apparent cause of fever:Blood smear, 1st line antimalarial

FEVER (NO MALARIA)If fever persists after 2 days: ASSESS,

CLASSIFY

If (+) travel to a malarious area and blood smear(+): Treat accordingly

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

MEASLES WITH EYE OR MOUTH COMPLICATIONAfter 2 days

Eye InfectionIf (+) pus draining from the eye: Correct

tx=refer, wrong tx=teach mother correct tx

If (-) pus but (+) redness : Continue tx

If (-) pus & (-) redness: Stop Tx

Mouth Ulcers

If ulcers are worse: REFER

If ulcers are the same or better: CONTINUE HALF STRENGTH GENTIAN VIOLET

FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

If fever persists after 2 days: ASSESS, CLASSIFY

If the child has any apparent cause of fever:Provide Treatment

If (+) fever for 7 days:Refer for assessment

If no apparent cause of fever:Advise mother to return daily until child

has had no fever for at least 48 hours

EAR INFECTIONAfter 5 days: ASSESS, CLASSIFY

If (+) tender swelling behind the ear or high fever: Treat as MASTOIDITIS

Acute ear infection: If ear pain or discharge persists: CONTINUE WICKING

Chronic Ear infection: CONTINUE EAR WICKING

If no ear pain or discharge: FINISH ANTIBIOTIC, PRAISE HER!!!

FEEDING PROBLEMAfter 5 days

Counsel the mother for any new or continuing feeding problem

If the child is very low weight for age: Ask mother to return in 30 DAYS

ANEMIAAfter 14 days

Give Iron

If the child has any palmar pallor after 2 months: REFER

VERY LOW WEIGHTAfter 30 days: WEIGH

If no longer low weight for age: PRAISE THE MOTHER!!!

If still low weight for age: COUNSEL

Feeding Recommendations0-4mos 4-6mos 6-12mos 12mos-2yrs

2 years & above

•Breastfeed

•Do not give other foods or fluids

•Breastfeed

•Give complementary foods

•Breastfeed

•Give complementary foods

•Breastfeed

•Give complementary foods

•Give adequate amount of food at 3 meals each day

Feeding Recommendation for a Child with Persistent Diarrhea

If still breastfeeding: CONTINUE, DAY and NIGHT

If taking other milk: REPLACE this INCREASED BF

DO NOT USE CONDENSED OR EVAPORATED MILK

FOLLOW-UP VISITS

If the child has: Return for follow-up in:

Pneumonia

Dysentery

Malaria, If fever persists

Fever-Malaria Unlikely, If fever persists

Fever (No Malaria), If fever persists

Measles with eye/mouth complications

Dengue Hemorrhagic Fever Unlikely, If fever persists

2 days

Persistent Diarrhea

Acute & Chronic Ear Infection

Feeding Problem

5 days

Anemia 14 days

Very Low weight for age 30 days

WHEN TO RETURN IMMEDIATELY

Any sick child •Unable to drink or breastfeed•Becomes sicker•Develops a Fever

No Pneumonia: Cough or Cold •Fast breathing•Difficult breathing

Child with Diarrhea •Blood in stool•Drinking poorly

Fever: Dengue Hemorrhagic Fever Unlikely

•Any sign of bleeding•Abdominal pain•Vomiting

CLASSIFICATIONS NEEDING VITAMIN A

Severe Pneumonia or Very Severe DiseasePersistent DiarrheaSevere Persistent Diarrhea Severe Complicated MeaslesMeasles with Eye & Mouth ComplicationsMeaslesSevere Malnutrition & Severe AnemiaVery Low Weight by Age

Ask the Mother what the infant’s problems are?

ASK: Has the infant had CONVULSION?

LOOK & LISTEN:RR, Chest Indrawing, Nasal Flaring, Bulging Fontanelles, Pus in ear,

Draining pus at the umbilicus, Temperature, Skin Pustules, abnormally asleep…

Classify all Young Infants…

CUVA

ALL MAJOR SIGNS (+)

POSSIBLE SERIOUS

BACTERIAL INFECTION

IM Antibiotic

Glucose

Warmth

REFER!

•Red Umbilicus or draining pus•Skin pustules

LOCAL BACTERIAL INFECTION

Antibiotic (5 days)

Treat Local Infection

Follow-up in 2 days

CUVA

ALL MAJOR SIGNS (+)

POSSIBLE SERIOUS

BACTERIAL INFECTION

IM Antibiotic

Glucose

Warmth

REFER!

•Red Umbilicus or draining pus•Skin pustules

LOCAL BACTERIAL INFECTION

Antibiotic (5 days)

Treat Local Infection

Follow-up in 2 days

•No Signs of Very Severe Disease or Local Bacterial Infection

SEVERE DISEASE/ LOCAL BACTERIAL

INFECTION

UNLIKELY

Advise Mother to give home care

Does the young infant have Diarrhea?

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

SAMESEVERE

DEHYDRATIONPlan C or

REFER!

SAMESOME

DEHYDRATIONPlan B or

REFER!

Not enough signs to classify as some or severe dehydration.

NO DEHYDRATION Plan A

DEHYDRATION

Diarrhea lasting 14 days or more

SEVERE PERSISTENT DIARRHEA

Treat dehydration if dehydrated

REFER!

If Diarrhea is 14 days or more

Blood in the stool DYSENTERY REFER!

(+) Blood in the Stool

•Not able to feed•No attachment at all•Not sucking at all

NOT ABLE TO FEED-

POSSIBLE SERIOUS

BACTERIAL INFECTION

IM antibiotic

Glucose

Warmth

REFER!

•Not well attached•Not sucking effectively•< 8 breastfeeds in 24 hours•Low weight for age•Thrush

FEEDING PROBLEM OR LOW WEIGHT

•Advise mother on breastfeeding•Treat Thrush

•Follow-up feeding problem or thrush in 2

days•Follow up low weight for

age in 14 days

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

NO FEEDING PROBLEM

Home care

Praise the mother

UPDATE

No More NOT ABLE TO FEED: POSSIBLE SERIOUS BACTERIAL INFECTION

IMMUNIZATION SCHEDULE

AGE VACCINE

Birth BCG

6 weeks DPT1, OPV1, Hep-B1

Give an Appropriate Oral AntibioticFor Local Bacterial Infection:

First line antibiotic:Second line antibiotic:

COTRIMOXAZOLE (2 x a day for 5)AGE/WEIGHT ADULT TAB SYRUP

Birth – 1 month (<3kg)

1.25 ml

1 – 2 months (3-4 kg) 1/4 2.5

AMOXYCILLIN (3 x a day for 5)AGE/WEIGHT TABLET (250 mg) SYRUP (125 mg/5

ml)

Birth – 1 month (<3kg)

1.25 ml

1 – 2 months (3-4 kg) 1/4 2.5 ml

REMEMBER!!!Avoid cotrimoxazole in infants less than 1

month of age who are premature jaundiced.

Give 1st dose of Intramuscular AntibioticGive 1st dose of both Benzylpenicillin and

Gentamicin IM.

Give 1st dose of Gentamicin and Ampicillin

UPDATE

TREAT LOCAL INFECTION AT HOMETreat Skin Pustules twice daily

GENTIAN VIOLET

TREAT LOCAL INFECTION AT HOMETreat Umbilical Infection twice daily

GENTIAN VIOLET

TREAT LOCAL INFECTION AT HOMETreat Thrush twice daily

WET WITH SALT WATERPAINT with HALF STRENGTH GENTIAN

VIOLET

Correct Positioning & Attachment for Breastfeeding

Infant’s head & body straightFacing her breast, with infant’s nose opposite

her nippleInfant’s body close to her bodySupport infant’s whole bodyTouch infant’s lips with her nipple

Wait until her infant’s mouth is opening wideMove the infant quickly onto the breast

Signs of Good Attachment

Chin touching the breastMouth wide openLower lip turned outwardMore areola visible above than below the

mouth

Give Home CareBreastfeed frequently, as often and as long as

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

FOLLOW-UP VISITS

If the child has: Return for follow-up in:

Local bacterial Infection

Any Feeding Problem

Thrush

2 days

Low weight for age 14 days

WHEN TO RETURN IMMEDIATELY

Breastfeeding or drinking poorly

Becomes sicker

Develops a fever

Fast breathing

Difficult breathing

Blood in stool

Keep the Infant Warm at all times

In cool weather, cover the infant’s head and feet & dress the infant with extra clothing

LOCAL BACTERIAL INFECTIONAfter 2 days

If Pus or redness remains or is worse: REFER

If pus and redness are improved:CONTINUE ANTIBIOTICS FOR 5 DAYS

FEEDING PROBLEMAfter 2 days

Counsel the mother for any new or continuing feeding problem: BRING CHILD BACK

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

LOW WEIGHTAfter 14 days

If no longer low weight for age: PRAISE

If still low weight for age, but is feeding well:COME AGAIN

If still low weight for age & still has a feeding problem: RETURN IN 14 DAYS

THRUSHAfter 2 days

If Thrush is worse or (+) problems with attachment or suckling: REFER

If Thrush is the same or better and is feeding well: CONTINUE HALF STRENGTH GENTIAN VIOLET