IMNCI HW Chart (24 June 03)

8/8/2019 IMNCI HW Chart (24 June 03)

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INTEGRATED MANAGEMENT OFNEONATAL AND CHILDHOOD ILLNESS

HEALTH WORKERCHART BOOKLET

World Health OrganizationChild & Adolescent Healthand Development (CAH)

Ministry of Health & Family Welfare,

Govt. of India

2003

unicef

24 June 2003

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ASSESS & CLASSIFY THE SICK YOUNG INFANTAGE UPTO 2 MONTHS

ASSESS SIGNS CLASSIFY AS IDENTIFY TREATMENT

CHECK FOR POSSIBLE BACTERIAL INFECTION

LOOK, LISTEN & FEEL:

Count the breaths

in one minute.Repeat the count ifelevated.

Look for severe

chest indrawing Look for nasal

flaring Look and listen for

grunting. Look at the umbilicus.

Is it red or draining pus? Look for skin pustules. Are there 10

or more skin pustules or a big boil ? Measure axillary temperature (if not

possible feel for fever or low bodytemperature).

See if the young infant is lethargic or

unconscious.Look at the young infants

movements.Are they less than normal?

Convulsions or

Fast breathing (60 breaths per minute

or more) orSevere chest indrawing or

asal flaring or

Grunting or

10 or more skin pustules or a big boil

or If axillary temperature 37.5oC or

above (or feels hot to touch) ortemperature less than 35.5oC(orfeels cold to touch) or

Lethargic or unconscious or

Less than normal movements

POSSIBLESERIOUS

BACTERIALINFECTION

Give first dose ofcotrimoxazole if able to takeorally( Pediatric tablet for an infantupto 1 month and 1 tablet for aninfant 1-2 months)Advise mother to continue

breastfeedingWarm the young infant by Skin

to Skin contact if feels cold totouch.Refer URGENTLY to hospital

YOUNGINFANTMUST

BECALM

ASK:

Has the

infant hadconvulsions?

THEN ASK: DOES THE YOUNG INFANT HAVE DIARRHOEA?*

LOOK & FEEL: Look at the young

infants generalcondition. Is the infant:

Lethargic orunconscious?

Restless andirritable?

Look for sunken

eyes.

Pinch the skin of theabdomen.Does it go back:Very slowly (longer

than 2 seconds)?Slowly?

Give fluids to treat diarrhea at

home (Plan A).Advise home care.Follow up in 2 days if not

improving.

Give oral cotrimoxazole for5 days.

( Pediatric tablet twice daily f oran infant upto 1 month and 1tablet for an infant 1-2 months)Teach mother to apply 0.5%

Gentian Violet paint twice dailyFollow-up in 2 days.

LOCALBACTERIALINFECTION

Umbilicus red or draining

pus or

Skin pustules less than 10.

Two of the following signs:

Restless, irritable.

Sunken eyes.

Skin pinch goes back slowly.

SOMEDEHYDRATION

SEVEREDEHYDRATION


Lethargic or unconscious

Sunken eyes

Skin pinch goes back very slowly.

Give first dose of oralcotrimoxazole if able to takeorally( Pediatric tablet for an infantupto 1 month and 1 tablet for aninfant 1-2 months)Refer URGENTLY to hospital

with mother giving frequent sipsof ORS on the way.Advise mother to continue

breastfeeding.Advise to keep the young infant

warm.

A child with a pink classification needs URGENT attention, complete the assessmentand pre- referral treatment immediately so referral is not delayed

* What is diarrhoea in a young infant?

If the stools have changed from usualpattern and are many and watery (morewater than fecal matter). The normallyfrequent or loose stools of a breastfedbaby are not diarrhoea.

}

IF YES,

ASK:

Is there

blood inthestool?

ClassifyDiarrhoea

Not enough signs to classify assome or severe dehydration.

NODEHYDRATION

and ifblood in

stool

fordehy-

dration

Give first dose of oralcotrimoxazole if able totake orallyRefer URGENTLY to

hospitalAdvise mother to continue

breastfeeding.Advise to keep the young

infant warm.

SEVEREDYSENTERY Bbod in the stool

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CHECK FOR FEEDING PROBLEM

ASK:

Is there anydifficulty feeding?

Is the infantbreastfed? If yes,how many times in24 hours?

Does the infantusually receiveany other foods ordrinks?If yes, how often?

What do you use tofeed the infant?

Does the motherhavepain whilebreastfeeding?

LOOK & FEEL:

ASSESS BREASTFEEDING IF THEREIS NO INDICATION FOR URGENTREFERRAL:- Ask the mother to put her infant to the

breast . Observe the breastfeed for4 minutes. Is the infant able to attach well?

no attachment at allnot well attached

good a ttachment Is the infant suckling effectively (that

is, slow deep sucks, sometimespausing)?

not suckling at allnot suckling effectivelysuckling effectively

Clear a blocked nose if it interfereswith breastfeeding.

Look for ulcers or white patches in the

mouth (thrush).

- If yes, look and feel for:

Sore nipples Engorged breasts or breast abscess


THEN CHECK THE YOUNG INFANTS IMMUNIZATION STATUS

* Hepatitis B to be given wherever included in the immunization schedule

ASSESS OTHER PROBLEMS

IMMUNIZATION SCHEDULE : AGEBirth6 weeks

VACCINEBCG OPV-0DPT-1 OPV-1 + Hepatitis B-1*

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

(All of these signs should be present if theattachment is good)

2

Not able to feed

or No attachment at all

or Not suckling at all

NOT ABLE TOFEED -

POSSIBLESERIOUS

BACTERIALINFECTION

Warm the young infant by Skinto Skin contact if feels cold totouch.Refer URGENTLY to hospital

Not well attached to

breast orNot sucklingeffectively

or

Less than 8

breastfeeds in24 hours

or

Receives otherfoods or drinks

or

Thrush (ulcers or

white patches inmouth).

Breast or nipple

problems

FEEDINGPROBLEM

If not well attached or notsuckling effectively, teachcorrect positioning andattachment.

If breastfeeding less than 8times in 24 hours , advise toincrease frequency offeeding.

If receiving other foods ordrinks, counsel mother aboutbreastfeeding more, reducingother foods or drinks, and usinga cup and spoon. If not breastfeeding at all,

advise mother about givinglocally appropriate animal milkand teach the mother to feedwith a cup and spoon.

If thrush, teach the mother to

apply 0.25% Gentian Violet

paint twice daily

If breast or nipple problem,

teach the mother to treat breastor nipple problems.

Advise mother to give homecare(Breastfeed infant exclusively,keep infant warm, apply nothingto cord, ask mother to washhands and explain danger signsin the infant)Follow-up in 2 days.

Not other signs ofinadequate feeding. NO FEEDING

PROBLEM

Advise to give home care .

Praise the mother for feedingthe infant well.



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Give Cotrimoxazole

* Avoid cotrimoxazole in infants less than 1 month of age who arepremature or jaundiced.

COTRIMOXAZOLE*(trimethoprim + sulphamethoxazole) Give two times daily for 5 days

AGE or WEIGHTAdult Tablet

single strength(80 mg trimethoprim

+400 mg

sulphamethoxazole)

Pediatric Tablet(20 mg trimethoprim

+100 mgsulphamethoxazole)

Birth up to 1 month(< 3 kg)

1/2*

1 month up to 2months (3-4 kg)

1/4 1

TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER

Teach The Mother To Give Oral DrugsAt Home

Determine the appropriate drugs and dosagefor the childs age or weight.Tell the mother the reason for giving the

drug to the child.Demonstrate how to measure a dose.Watch the mother practise measuring a dose

by herself.Ask the mother to give the first dose to her

child.Explain carefully how to give the drug, then

label and package the drug.If more than one drug will be given, collect,

count and package each drug separately.Explain that all the oral drug tablets or

syrups must be used to finish the course oftreatment, even if the child gets better.Check the mothers understanding before

she leaves.

Teach the mother how to keep the young infant warm: Provide Skin to Skin contact (Kangaroo mother care) as much as possible, day and night.

-Provide privacy to the mother.- Request the mother to sit or recline comfortably.- Undress the baby gently, except for cap, nappy and socks.- Place the baby prone on mothers chest in an upright and extended posture, between her breasts, in Skin to

Skin contact; turn babys head to one side to keep airways clear- Cover the baby with mothers blouse, pallu or gown; wrap the baby-mother duo with an added blanket or

shawl.- Breastfeed the baby frequently.- If possible, warm the room with a heating device.- If mother is not available, Skin to Skin contact may be provided by the father or any other adult.

When Skin to Skin contact not possible:- Keep the room warm with a home heating device

- Clothe the baby in 1-2 layers (Summer)- Clothe the baby in 3-4 layers (Winter) and cover the head, hands and feet with cap, gloves and socks

respectively- Let the baby and mother lie together on a soft, thick bedding- Cover the baby and the mother with additional quilt, blanket or shawl in cold weather

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Teach the mother to treat breast andnipple problems

If nipple is sore, apply breast milk for soothing effect andensure correct positioning and attachment of the baby. Ifmother continues to have discomfort, feed expressedbreast milk with katori and spoon.

If breasts are engorged, let the baby continue to suck ifpossible. If the baby cannot suckle effectively, help themother to express milk and then put the young infantto the breast. Putting a warm compress on the breastmay help.

If breast abscess, advise mother to feed from theother breast and refer to a surgeon. If the young infantwants more milk, feed undiluted animal milk withadded sugar by cup and spoon.

Teach Correct Positioning andAttachment for Breastfeeding

Show the mother how to hold her infant- with the infants head and body straight- facing her breast, with infants nose opposite her

nipple- with infants body close to her body- supporting infants whole body, not just neck and

shoulders.

Show her how to help the infant to attach. She should:- touch her infants lips with her nipple- wait until her infants mouth is opening wide- move her infant quickly onto her breast, aiming the

infants lower lip well below the nipple.

Look for signs of good attachment and effective

suckling. If the attachment or suckling is not good, tryagain.

If still not suckling effectively, ask the mother toexpress breast milk and feed with a cup and spoon inthe clinic.If able to take with a cup and spoon advise mother to

keep breastfeeding the young infant and at the endof each feed express breast milk and feed with a cupand spoon .

If not able to feed with a cup and spoon, refer tohospital.

COUNSEL THE MOTHER

Advise to Give Home Care for the

Young Infant

Breastfeed frequently, as often and for as longas the infant wants, day or night, duringsickness and health.Do not give water, otherliquids or food.

In cool weather, cover the infants head andfeet and dress the infant with extra clothing.

Make sure the young infant stays warm at alltimes.

Advise mother to wash hands with soap andwater after defecation and after cleaning thebottom of the baby.

Do not apply anything on the cord and keepthe cord and umbilicus dry.

Advise the mother to return immediately ifthe young infant has any of these dangersigns:

Breastfeeding or drinking poorly

Becomes sicker

Develops a fever or feels cold to touch

Fast breathing

Difficult breathing Blood in stools

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CHECK FOR GENERAL DANGER SIGNS

A child with any general danger sign needs URGENTattention; complete the assessment andany pre-referral treatment immediately so referral is not delayed.

ASK:

Is the child able to drink orbreastfeed?

Does the child vomiteverything?

Has the child had convulsions?

LOOK:

See if the child is

lethargic or unconscious.

THEN ASK ABOUT MAIN SYMPTOMS:DOES THE CHILD HAVE COUGH OR DIFFICULTBREATHING?

If the child is: Fast breathing is:2 months up 50 breaths perto 12 months minute or more

12 months up 40 breaths perto 5 years minute or more

IF YES,ASK:For how long? CHILD

MUSTBE

CALM

Any general dangersign or

Chest indrawing.

SEVEREPNEUMONIA

OR VERYSEVERE DISEASE

Give first dose of cotrimoxazole.

Refer URGENTLY to hospital.

Fast breathing.PNEUMONIA

Give Cotrimoxazole for 5 days.(2 Pediatric tablet twice daily for a child2 up to 12 months and 3 tablets twicedaily for a child 12 months up to 5years.Follow up in 2 days.

No signs of pneumoniaor very severe disease. COUGH OR COLD

Advise home care for cough or cold.If coughing for more than 30 days, refer

for assessment.

LOOK :Count the breaths

in one minute.Look for chest

indrawing.

}

ASSESS AND CLASSIFY THE SICK CHILDAGE 2 MONTHS UP TO 5 YEARS

5

Not able to drink or

breastfeedOr

Vomits everything

Or Convulsions

Or Lethargic or unconscious


DOES THE CHILD HAVE DIARRHOEA?

LOOK AND FEEL:

Look at the childs generalcondition.Is the child:

Lethargic or unconscious?Restless and irritable?

Look for sunken eyes.

Offer the childfluid to drink.Is the child:

- Not able to drink ordrinking poorly?

- Drinking eagerly,

thirsty?

Pinch the skin of the abdomen.

Does it go back:- Very slowly (longer than

2 seconds)?- Slowly?

IF YES,ASK:

For howlong?

Is thereblood inthe stool?

ClassifyDiarrhoea

forDehy-

dration

and ifdiarrhoea

14 daysor more

and ifblood

instool


Lethargic or unconscious

Sunken eyes

Not able to drink or drinkingpoorly

Skin pinch goes back very

slowly.

SEVEREDEHYDRATION

Refer URGENTLY to hospitalwith mother giving frequentsips of ORS on the way.


Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

Skin pinch goes back slowly.

SOMEDEHYDRATION

Give fluid and food for somedehydration (Plan B).Follow-up in 2 days if not

improving.

Not enough signs to classify assome or severe dehydration.

NODEHYDRATION

Give fluid and food to treatdiarrhoea at home (Plan A).Follow-up in 2 days if not

improving

. Diarrhoea for 14 days or

more.

SEVEREPERSISTENTDIARRHOEA

Refer to hospital.

Blood in the stool. DYSENTERYGive cotrimoxazole for 5 days

(2 Pediatric tablet twice dailyfor a child 2 up to 12 months

and 3 tablets twice daily for achild 12 months up to 5 years.Follow-up in 2 days..



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DOES THE CHILD HAVE FEVER?(BY HISTORY OR FEELS HOT ORTEMPERATURE 37.5C* OR ABOVE)

IF YES:

THEN ASK: Fever for how

long? If more than 7

days, has feverbeen presentevery day?

LOOK AND FEEL: Look or feel for stiff neck.

Give first dose of cotrimoxazole.Give first dose of antimalarial as per NAMP

guidelines after making a smear.Give one dose of paracetamol in clinic f or

high fever.

VERY SEVEREFEBRILEDISEASE

Any general danger sign or

Stiff neck

Fever (by history or feels

hot or temperature 37.5Cor above).

MALARIA

Give antimalarials as per NAMP guidelines

after making a smear.Give one dose of paracetamol in clinic f or

high fever.Advise extra fluids, continue feeding and

advise about danger signs.Follow-up in 2 days if fever persists.If fever is present every day for more than 7

days, refer for assessment.

LOOK AND FEEL:

Look for visible severe wasting.

Look for oedema of both feet.

Determine grade of malnutrition by

plotting weight for age. Normal weight for age or

Malnutrition grade 1.

If child is less than 2 years old, assess andcounsel for feeding.If feeding problem, follow-up in 5 days.

NOT VERYLOW WEIGHT

Visible severe wasting or

Oedema of both feetSEVERE

MALNUTRITION

Give Vitamin A.Prevent low blood sugar by breastmilk, othermilk /water with sugar ( 4 tsf sugar per cup).

Keep the child warm.

Refer URGENTLY to hospital

Malnutrition grade 2, 3 or 4

VERYLOW WEIGHT

Assess and counsel for feeding.Follow-up in 14 days (If feeding problem,

follow-up in 5 days).

LOOK AND FEEL:

Look for palmar pallor. Is it:Severe palmar pallor?Some palmar pallor?

THEN CHECK FOR ANAEMIA Severe palmarpallor

SEVERE ANAEMIA Refer to hospital .

6

THEN CHECK FOR MALNUTRITION

Some palmarpallor

ANAEMIA Give iron folic acid therapy for 14 days.Assess and counsel for feeding.

No palmar pallor NO ANAEMIA Give prophylactic iron folic acid if child 6months or older

THEN CHECK THE CHILDS IMMUNIZATION, PROPHYLACTIC VITAMIN A & IRON-FOLIC ACID SUPPLEMENTATION STATUS

IMMUNIZATION SCHEDULE

* Hepatitis B if included in the immunizationschedule

AGEBirth6 weeks10 weeks14 weeks9 months16-18 months60 months

VACCINEBCG + OPV-0DPT-1+ OPV-1(+ HepB-1)*

DPT-2+ OPV-2(+ HepB-2)*DPT-3+ OPV-3(+ HepB-3)*Measles + Vitamin ADPT + OPV + Vitamin ADT

PROPHYLACTIC VITAMIN A

Give a single dose of vitamin A:

100,000 IU ( 1 ml) at 9 months with measlesimmunization200,000 IU ( 2 ml ) at 16-18 months with DPT Booster200,000 IU ( 2 ml ) at 24 months200,000 IU (2 ml ) at 30 months200,000 IU (2 ml ) at 36 months

PROPHYLACTIC IFA

Give one tablet of Pediatric IFA for atotal of 100 days in a year after the childhas recovered from acute illness if :

The child 6 months of age or older,andHas not recieved Pediatric IFA Tablet

for 100 days in last one year.

ASSESS OTHER PROBLEMS



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Give CotrimoxazoleCOTRIMOXAZOLE

(trimethoprim + sulphamethoxazole) Give two times daily for 5 days

AGE or WEIGHT

ADULT TABLET80 mg

trimethoprim+ 400 mg

sulphamethoxazole

PEDIATRIC TABLET20 mg

trimethoprim+100 mg

sulphamethoxazole

2 months up to 12months (4 - 38.5C) With Paracetamol Give a single dose of paracetamol in the clinic Give 3 additional doses of paracetamol for use at home every 6 hours

until high fever is gone.

PARACETAMOL

AGE or WEIGHT TABLET (500 mg)

2 months up to 3 years (4 -


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Advise Home Care for cough or cold.

TELL THE MOTHER

Feed the child during illness.

Give increased fluids:

Increase breast feeding.Offer the child extra to drink. (See home fluids)

Soothe the Throat, with a Safe Remedy (age 6 months or more)

- Safe remedies to recommend:

Continue Breastfeeding

Honey, tulsi, ginger, herbal teas and other safe local home remedies

- Avoid cough syrups.

If the child's nose is blocked and interferes with feeding, clear the nose.

Watch for the following signs and return quickly if they occur:

Child becomes sicker

Not able to drink or breastfeed

Fast breathing.

Difficult Breathing

Develops a fever

NOTE: Dont teach fast breathing, difficult breathing or fever if child already have these signs.

Plan A: Treat Diarrhoea at Home

Counsel the mother on the 3 Rules of Home Treatment:Give Extra Fluid, Continue Feeding, When to Return

1. GIVE EXTRA FLUID(as much as the child will take) TELL THE MOTHER:

If the child is exclusively breastfed : Breastfeed frequently and for longer at eachfeed. If passing frequent watery stools:- For less than 6 months age give ORS and clean, preferably boiled, water inaddition to breast milk

- If 6 months or older give one or more of the home fluids in addition to breast milk.

If the child is not exclusively breastfed: Give one or more of the following home fluids; ORSsolution, yoghurt drink, milk, lemon drink, rice or pulses-based drink, vegetable soup, greencoconut water or plain clean water.

It is especially important to give ORS at home when:- the child has been treated with Plan B or Plan C during this visit.- the child cannot return to a clinic if the diarrhoea gets worse.

TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2 PACKETS OF ORSTO USE AT HOME.

SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUIDINTAKE:


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Feeding Recommendations During Sickness and Health

Give familyfoods at 3meals each day.

Also, twice daily, givenutritious food betweenmeals, such as:banana/biscuit/ cheeko/mango/ papaya/ egg assnacks

Remember:

Ensure that the childfinishes the serving

Teach your child washhis hands with soap andwater every time beforefeeding

2 Years andOlder

COUNSEL THE MOTHER

Breastfeed as often as the childwants.

Give one katori serving* at a timeof :- Mashed roti/ rice /bread/biscuit

mixed in sweetened undiluted milkOR- Mashed roti/rice/bread mixed in

thick dal with added ghee/oil orkhichri with added oil/ghee. Addcooked vegetables also in theservings OR- Sevian/dalia/halwa/kheer

prepared in milk or any cereal

porridge cooked in milk OR- Mashed boiled/fried potatoes or

give one banana/ cheeko/ mango.__________________________*3 times per day if breastfed;5 times per day if not breastfed.

Remember: Keep the child in your lap and feedwith your own hands Wash your own and childs handswith soap and water every time

before feeding

Breastfeed as often asthe child wants, dayand night, at least8 times in 24 hours.

Do not give any other

foods or fluids not evenwater

Remember: Continue breastfeedingif the child is sick

Up to6 Months

6 Months upto 12 Months

Breastfeed as oftenas the child wants.

Offer food from the family pot

Give 11/2 katori serving* at atime of :- Mashed roti/rice/bread mixed inthick dal with added ghee/oil orkhichri with added oil/ghee.Add cooked vegetables also inthe servings OR- Mashed roti/ rice /bread/biscuitmixed in sweetened undilutedmilk OR- Sevian/dalia/halwa/kheer

prepared in milk or any cerealporridge cooked in milk OR- Mashed boiled/fried potatoes

or give at least one banana/cheeko/ mango.__________________________* 5 times per day.

Remember: Sit by the side of child and helphim to finish the serving Wash your childs hands withsoap and water every time beforefeeding

12 Months upto 2 Years

COUNSEL FOR FEEDING PROBLEMS.

GOOD FEEDING PRACTICES. FEEDING PROBLEMS SOLUTIONS.

(PRAISE THE MOTHER) IDENTIFIED

* * *

* * *.

*A good daily diet should be adequate in quantity and include an energy-rich food (for example, thick cereal porridge with added oil);meat, fish, eggs, or pulses; and fruits and vegetables.Egg is a good snack where culturally acceptable.

ASSESS FEEDING:

Do you breast feed the child?

How many times in a day?

Do you breast feed the child at night?

Does the child take any other foods or fluids?

What foods or fluids?

How many times per day?How large are the servings (katori, teaspoon)?

Does the child receive separate serving?

Who feeds the child and how?

Ask if the childs feeding has changed during this illness?

If yes how?

ASSESS FEEDING IN ALL

CHILDREN BELOW 2 YEARS AND

ALSO IN CHILDREN WITH VERY

LOW WEIGHT FOR AGE

(Malnutrition grade 2, 3 or 4) OR

ANAEMIA.

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11/15

CHECKFOR POSSIBLE BACTERIAL INFECTION Has the infant had convulsions? Count the breaths in one minute. breaths per minute

Repeat if elevated ________ Fast breathing?

Look for severe chest indrawing. Look for nasal flaring.

Look and listen for grunting.

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

Look for skin pustules. Are there 10 or more pustules

or a big boil?

Measure axillary temperature (if not possible, feel for fever

or low body temperature):

- 37.5C or more (or feels hot)?

- Less than 35.5C ?

See if young infant is lethargic or unconscious

Look at young infants movements. Less than normal?

__________________________________________________________________________________________________________________________________

DOES THE YOUNG INFANT HAVE DIARRHOEA? Yes ___ No _ Look at the young infants general condition. Is the infant:

Is there blood in the stool? - Lethargic or unconscious?

- Restless and irritable?


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

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

_____________________________________________________________________________________________________________________THEN CHECK FOR FEEDING PROBLEMIs there any difficulty feeding? Yes __ No ___

Is the infant breastfed? Yes _____ No ___; If Yes, how many times in 24 hours? ____times

Does the infant usually receive any other foods or drinks? Yes ___ No ___; If Yes, how often?________

What do you use to feed the infant?

ASSESS BREASTFEEDING IF THERE IS NO INDICATION FOR URGENT REFERRAL:

Ask the mother to put her infant to the breast. Observe the breastfeed for 4 minutes.

Is the infant able to attach? To check attachment, look for:

- Chin touching breast Yes ___ No ___

- Mouth wide open Yes _____ No ___

- Lower lip turned outward Yes ____ No ___

- More areola above than below the mouth Yes ___ No ___

no attachment at all not well attached good attachment

Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?

not suckling at all not suckling effectively suckling effectively

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

Does the mother have pain while brteastfeeding? If yes, then look for:

- Sore nipples

-Engorged breasts or breast abscess___________________

_____________________________________________________________________________________________________________________CHECK THE YOUNG INFANTS IMMUNIZATION STATUS Circle immunizations needed today. Return for next _______ ______

BCG DPT 1 immunization on:

______ ______OPV 0 OPV 1

_______ HEP-B 1 (Date)

_____________________________________________________________________________________________________________________

ASSESS OTHER PROBLEMS:

MANAGEMENT OF THE SICK YOUNG INFANT AGE UP TO 2 MONTHS

Name:___________________________ Age: Temperature: C Date:

ASK: What are the infants problems? _______________________________________ Initial visit? _______ Follow-upVisit?______

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12/15

Return for follow up in:____________________________________________________________

Advise mother when to return immediately.

Give any immunizations needed today: __________________

Counsel the mother about her own health.

TREAT

Advise to Give Home Care for the

Young Infant

Breastfeed frequently, as often and for as longas the infant wants, day or night, duringsickness and health.Do not give water, otherliquids or food.

In cool weather, cover the infants head andfeet and dress the infant with extra clothing.

Make sure the young infant stays warm at alltimes.

Advise mother to wash hands with soap andwater after defecation and after cleaning thebottom of the baby.

Do not apply anything on the cord and keepthe cord and umbilicus dry.

Advise the mother to return immediately if theyoung infant has any of these danger signs:

Breastfeeding or drinking poorly

Becomes sicker

Develops a fever or feels cold to touch

Fast breathing

Difficult breathing

Blood in stool

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13/15

MANAGEMENT OF THE SICK CHIlD AGE 2 MONTHS UP TO 5 YEARS

Name: __________________________ Age: ___ Weight: _______ kg Temperature: _______ 0C Date:

ASK: What are the childs problems?_____________________ ________________ Initial visit? ___ Follow-up Visit? ___

ASSESS (Circle all signs present) CLASSIFY____________________________________________________________________________________________________________________

CHECK FOR GENERAL DANGER SIGNS General danger signpresent?NOT ABLE TO DRINK OR BREASTFEED LETHARGIC OR UNCONSCIOUS Yes___ No___

VOMITS EVERYTHING Remember to use danger sign

CONVULSIONS when selecting classifications

____________________________________________________________________________________________DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes___ No___

For how long ? ___ Days Count the breaths in one minute

_____ breaths per minute. Fast breathing?

. Look for chest indrawing.

________________________________________________________________________________________________________

DOES THE CHILD HAVE DIARRHOEA ? Yes___ No___

For how long ? _____ Days Look at the childs general condition. Is the child:

Is there blood in the stool? Lethargic or unconscious?

Restless and irritable


Offer the child fluid. Is the child:

Not able to drink or drinking poorly?

Drinking eagerly, thirsty?Pinch the skin of the abdomen. Does it go back:

Very slowly (longer than 2 seconds)?

Slowly?

________________________________________________________________________________________________________

DOES THE CHILD HAVE FEVER?(by history/feels hot/ temperature 37.5OC or above) Yes___ No___

Fever for how long? _ Days Look or feel for stiff neck.

If more than 7 days, has f ever

been present every day?

_____________________________________________________________________________________________

THEN CHECK FOR MALNUTRITION Look for visible severe wasting.

Look for oedema of both feet.

Determine grade of malnutrition Grade 1 2, 3, 4

________________________________________________________________________________________________________

THEN CHECK FOR ANAEMIALook for palmar pallor.

Severe palmar pallor? Some palmar pallor? No pallor?______________________________________________________________________________________________________CHECK THE CHILDS IMMUNIZATION, PROPHYLACTIC VITAMIN A & IRON-FOLIC ACID STATUS Return for nextCircle immunizations and Vitamin A or IFA supplements needed today. immunization or

_______ ________ _______ ________ ___________ ___ vitamin A or IFABCG DPT 1 DPT 2 DPT 3 DPT( Booster) DT supplement on:

_______ ________ _______ ________ ____ _____OPV 0 OPV 1 OPV 2 OPV 3 OPV IFA

________ _______ ________ _________ _________ ____________HEP-B 1 HEP-B 2 HEP-B 3 MEASLES VITAMIN A (Date)

___________________________________________________________________________________________ASSESS CHILDS FEEDING if child has VERY LOW WEIGHT or ANAEMIA or is less than 2 years old

Do you breastfeed your child? Yes___ No ___

If Yes, how many times in 24 hours? ___ times. Do you breastfeed during the night? Yes__ No___

Does the child take any other food or fluids? Yes___ No ___

If Yes, what foods or fluids? _________________________________________________________

_______________________________________________________________________________

How many times per day? ___ times. What do you use to feed the child and how? ______________

How large are the servings? ___________________

Does the child receive his own serving? _______ Who feeds the child and how? _______________

During this illness, has the childs feeding changed? Yes___ No ___

If Yes, how?

______________________________________________________________________________________________

ASSESS OTHER PROBLEMS:

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TREAT

Remember to refer any child who has a general danger

sign and no other severe classification.

Return for follow up in: ____________________

Advise mother when to return immediately.

Give any immunizations, vitamin A or IFA supplements

needed today: _

Counsel the mother about her own health.

Feeding advice: _________________________________



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Documents

IMNCI HW Chart (24 June 03)