IMCI Is simply the umbrella program through which all community health intervention can be delivered to children under

5 years of age

Brief History of IMCI

1992 1ST developed by: UNICEF (United Nations Children s Emergency fund) and WHO AIM: To prevent or early detection and TX of the leading cause of childhood death; reduce childhood mortality and morbidity by improving family and community practices for home management of illness, and improving case management of skills of health workers in the bigger health system 1995 IMCI introduced in the Phil. As a strategy to reduce child death and promote growth and development 19970 - implementation started with a memorandum agreement bet. ADPCN & APSOM Ass. Of Phil,. School of Midwifery in April 2002

GOALS
To reduce the Infant and under-five mortality rate by at least one third in 2010 To reduce the Infant and under-5 mortality rate by at least two thirds in 2015

How does IMCI accomplish This Goals ?

Adopting an integrated approach to child health and development in the national health policy; Adapting standard IMCI clinical guidelines to the country s needs, available drugs, policies and to the local foods and language used by the population; Upgrading care in local clinics by training health workers in the new methods to examine and treat children, and to effectively counsel parents Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available; Strengthening care in hospitals for those children too sick to be treated in outpatient clinic; Developing support mechanism within communities for preventing disease, for helping families to care for sick children, and for getting children to clinic or hospital when needed

Why is IMCI better than Singlecondition Approaches?

Children brought for medical treatment in the health facility are often suffering from more than one condition, thus making a single diagnosis impossible. The IMCI takes into account the combined Tx of the major childhood illnesses. Emphasizing prevention of disease through Immunization and improved nutrition

onditions Overlap (other prob.) elies on history and signs & symptoms quipment & Drugs are scarce
bility of Health workers to practice complicated clinical procedures are few inimal or non-existent Diagnostic nontools

COMPONENTS OF IMCI
upgrading the case management and counseling skills of health care providers

strengthening the health care system for effective management of childhood illnesses improving the family and community
health practices related to childhood and nutrition

Benefits of IMCI and Who Will benefit From it?

C cost-effective of intervention-gainful and profitable interventions for investors H High Impact on health status of children L- low-cost and promotes cost-savingof resources D demands of children answered-IMCI focuses on the major causes of illness and death of children: ARI, malnutrition, measles, malaria, dengue R responsive to major child health problems E equity of access to health care improved N not only curative, but preventive as well

Other Benefits:
Promotes accurate identification of childhood illness in outpatient settings Ensure appropriate combined treatment for all major illness Strengthens the counseling of caretakers and provision of preventive services Speed up referral of severely ill children Promotion of appropriate care-seeking behavior in the home setting, improved nutrition and preventive care, and the correct implementation of prescribed care

Focus of IMCI in the Philippines PD2M3

P - PNEUMONIA D - DENGUE D - DIARRHEA M - MALARIA M - MEASLES M - MALNUTRITION

AGE CATEGORIES OF IMCI

CHILDREN AGE 2 MONTHS UP TO 5 YEARS YOUNG INFANTS AGED 1 WEEK UP TO MONTHS

 ASSESS the child

by checking first the danger signs (or possible bacterial infection in a young infant) asking questions about common conditions examining the child checking nutrition and immunization status Includes checking the child for other problems

CLASSIFY A CHILDS ILLNESS USING COLOR-CODED TRIANGLE SYSTEM

Urgent pre-referral treatment and referral
(PINK)

Specific medical treatment

and advice (YELLOW)

Simple advice on home management (GREEN)

E L E M E N T S O F I M C I

yIDENTIFY specific treatments for the child

y If requires urgent referral, give essential treatment before the patient is transferred y If the child requires treatment at home, develop an integrated plan for the child and give the 1st dose of drugs in the clinic y If a child should be immunized , give immunization

E L E M E N T S O F I M C I

y Provide practical TREATMENT instructions

y Teaching the caretaker on oral drug administration y How to feed and give oral fluids during illness y How to treat local infections at home y Ask the caretaker to return for follow up on a specific date y Teach the caretaker on how to recognize signs that indicate that the child should be return immediately to the health facility

Elements of IMCI
Assess feeding, including breastfeeding practices. COUNSEL to solve any feeding problem found. Then counsel the mother about her own health When a child is brought back to the clinic as requested, GIVE FOLLOW UP CARE and if necessary, reassess the child for new problems

Check for General Danger Signs

Inability to drink or breastfeed Convulsions Lethargy or unconsciousness

Abnormally sleepy or difficult to awaken

Vomiting everything taken.

 ASK: is the child able to drink or breastfeed?

A child has this sign if he/she is too weak to drink and is not able to suck or swallow when offered a drink If you are not sure about the mother s answer, ask her to offer the child a drink. Look to see the child s response Breastfeeding children may have difficulty sucking when their nose is blocked , clear it first

 ASK: Does the

child vomit everything?
A child who is not able to hold on anything down at all has the sign vomits everything

A child with ANY of the Danger Signs has a serious problem and needs URGENT referral to the hospital
y ASK: Has the child had convulsions? y Use the term for convulsions like fits , spasm , or jerky
movements which the mother understands

y LOOK: See if the child is abnormally sleepy or difficult to

awaken
y An abnormally sleepy child is drowsy and does not show interest in what is happening around him/her y He does not look at his mother or watch your face when you talk y He may stare blankly and does not notice what is going on around him y He does not respond when she is touched, shaken or spoken to

I. Cough or Difficulty in breathing

Assess for general danger signs. This child may have
pneumonia or another severe respiratory infection. After checking for danger signs, it is essential to ask the child s caretaker about this main symptom.

Clinical Assessment

Three key clinical signs are used to assess a sick child with cough or difficult breathing:
1. Respiratory rate, which distinguishes children who have

pneumonia from those who do not; pneumonia; and

2. Lower chest wall indrawing, which indicates severe 3. Stridor, which indicates those with severe pneumonia who

require hospital admission.

Cough or Difficulty in breathing

Stridor is a harsh noise made when the child inhales
(breathes in). Children who have stridor when calm have a substantial risk of obstruction and should be referred.

Wheezing is heard when the child exhales (breathes

out). This is not stridor. A wheezing sound is most often associated with asthma. In some cases, especially when a child has wheezing when exhaling, the final decision on presence or absence of fast breathing can be made after a test with a rapid acting bronchodilator (if available).

Cough or Difficulty in breathing

Lower chest wall indrawing: inward movement of the
bony structure of the chest wall with inspiration, is a useful indicator of severe pneumonia. It is more specific than intercostal indrawing, which concerns the soft tissue between the ribs without involvement of the bony structure of the chest wall. Chest indrawing should only be considered present if it is consistently present in a calm child. Agitation, a blocked nose or breastfeeding can all cause temporary chest indrawing.

Cough or Difficulty in breathing

If The Child is :
2 weeks to 2 months 2 to 12 months

Fast Breathing is :
60 or more per minute 50 or more per minute 40 or more per minute

12 months t o 5 years old

THE INTEGRATED CASE MANAGEMENT PROCESS OUT PATIENT HEALTH FACILITY Check for DANGER SIGN
Convulsions Abnormality sleepy or difficult to awaken Unable to drink / breastfeed Vomits everything

Asses MAIN SYMPTOMS

Cough / difficulty breathing ,chestindrawing Diarrhea Fever Ear Problem

Asses NUTRITION,ANEMIA, IMMUNIZATION, and VITAMIN A SUPPLEMENTATION STATUS and POTENTIAL FEEDING PROBLEM Check for OTHER PROBLEMS CLASSIFY CONDITIONS and IDENTIFY TREATMENT ACTION
According to color-coded treatment

Urgent Referral
OUTPATIENT HEALTH FACILITY Pre-referral treatment Advise parents Refer child REFERRAL FACILITY Emergency Triage and Treatment (ETAT) Diagnosis Treatment Monitoring and follow-up

Treatment in outpatient facility

OUTPATIENT HEALTH FACILITY Treat local infection Give oral drugs Advise and teach caretaker Follow-up

Home Management
HOME Caretaker counseled on: Home treatments Feeding and Fluids When to return immediately Follow-up

COUGH OR DIFFICULTY IN BREATHING

SIGN

CLASSIFY

TREATMENT Give the 1st dose of an appropriate antibiotic Give Vitamin A If chest indrawing and wheeze,go directly to treat wheezing Treat child to prevent the lowering of his or her blood sugar level Refer the child URGENTLY to a hospital
Give an appropriate antibiotic for 3 days If wheezing (even if it disappeared after rapid-acting

Any general danger

sign Chest in drawing Stridor in a calm child

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

Fast Breathing

PNEUMONIA

bronchodilator), give an inhaled bronchodilator for 5 days. Soothe the throat and relieve the cough with a safe remedy If coughing for more than 3 weeks or if having recurrent wheezing, refer for assessment for Tb or asthma Advise the mother regarding when the return to the health centre Follow-up in 2 days

If the coughing persist for more 30 days, refer to a

No sign of pneumonia or very severe disease

NO PNEUMONIA COUGH OR COLD

hospital for assessment Soothe the throat and relieve the cough with a safe remedy Advise the mother regarding when to return to the health center Follow-up in 5 days if no improvement is observed

DIARRHEA

SIGN
Two of the following signs : Abnormally sleepy or difficult to awaken Sunken eyes Not able to drink or drinking poorly Pinched skin goes back to its original state very slowly

CLASSIFY

TREATMENT
If the child has no other severe classification : Give fluid for severe dehydration (PLAN C)

SEVERE DEHYDRATION

If the child has another severe classification : Refer the child URGENTLY to a hospital, with the mother giving the child frequent sips of ORS on the way. Advise to the mother to continue breastfeeding the child If the child 2 years old and older, and there is a cholera in your area : Give the child an antibiotic for cholera
Give ORS, zinc supplements and food for some

Two of the following signs : Restless, irritable Sunken eyes Drinks eagerly, thirsty Pinched skin goes back to its original state very slowly

SOME DEHYDRATION

dehydration (PLAN B) If the child has another classification : Refer the child URGENTLY to a hospital, with the mother giving the child frequent sips or ORS on the way. Advise the mother to continue breastfeeding the child Advise the mother regarding when to return to the health center immediately Follow-up in 5 days if no improvement is observed

Give ORS, zinc supplements, and food to treat

No enough sign to classify as some or severe dehydration

NO DEHYDRATION

diarrhea at home (PLAN A) Advise the mother regarding when to return to the health center immediately Follow-up in 5 days if no improvement is observed

Plan A : Treating Diarrhea at Home

1. Give Extra Fluid (as much as the child will take)
a. b. c. d. Breastfeed frequently and for longer time If the child is exclusively breastfeed, give ORS or clean water in addition If the child is not exclusively, give : ORS solution, food-based fluid, clean water Show how much fluid to give her child in addition to the child s usual fluid intake
*Below 2 years old : 50-100 mL after each loose stool evacuation *2 years old or above : 100-200 mL after each loose stool evacuation

e.

If the child vomits, wait for 10 minute

2. Continue Feeding The Child 3. Return To The Health Center 4. Give Zinc Supplementation

1. Determine The amount of ORS to give during the 1st 4 hours 2. Show the mother how to give
ORS SOLUTION REASSESS and CLASSIFY
After 4 Hours

THE CHILD FOR DEHYDRATION

AGE
Below 4 months 4 to 12 months 12 months to 2 years 2 to 5 years old

WEIGHT < 6 kg 6 to < 10 kg 10 to < 12 kg 12 to < 19 kg

AMOUNT (mL) 200-400 400-700 700-900 900-1400

Use the child s age only when You do not know his or her weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child s weight (in kg) by 75

Plan C : Treat Severe Dehydration Quickly

Can you give IV fluid immediately?

Is IV treatment available nearby (within 30 minutes)? Are you trained to use NGT for rehydration? Can the child drink

Y e s Y e s

Give the child IV fluid in your Health Center

Refer the child URGENTLY to a hospital

Refer the child urgently to a hospital for IV / NGT treatment

Give ORS by NGT or by mouth

Persistent Diarrhea
SIGN Dehydration present CLASSIFY SEVERE, PERSISTENT DIARRHEA TREATMENT
Treat the dehydration before referral unless

the child another severe classification. Give vitamin A Refer the child to a hospital

Advise the mother about feeding a child who

No Dehydration

PERSISTENT DIARRHEA

has PERSISTENT DIARRHEA Give Vitamin A Give multivitamins and minerals ( including zinc) for 14 days. Follow-up in 5 days Advise the mother when to return immediately.

Blood in the stool

DYSENTERY

Give ciprofloxacin for 3 days. Follow up in 2 days. Advise the mother when to return

immediately.

Deciding if there is Malaria Risk

1. Category Provinces
A-Provinces with no significant improvement in malaria situation in the last ten years or the situation worsened in the last five years, the average cases is more than 1,000 in the last ten years. (Agusan del sur, Cagayan Davao,Palawan,Quezon,Tawi-tawi etc) B-Provinces where the situation has imporved in the last five years or the average number of cases is 100- 1,000 cases. (Abra,Bataan,Ilocos Norte, Pangasinan,Romblon etc.)

C. Provinces with a significant reduction in cases in the last five years ( Albay, Batanes, Batangas ,Marinduque etc) D. Provinces that are malaria-free, although some are potentially malarious due to vectors ( Aklan, Bohol, Capiz, Cebu etc)

Travelling at least 4 weeks 2. Season --------------Rainy Season

 Any general danger sign

MALARIA RISK
( Including travel to a malaria-risk area)

Stiff neck

VERY SEVERE FEBRILE DISEASE / MALARIA

Blood smear (+)

MALARIA

If the blood smear test is not done : NO runny nose, and NO measles NO other causes fever

CLASSIFY FEVER

Blood smear (-), or Runny nose, or Measles, or Other causes of fever

FEVER : MALARIA UNLIKELY

Any general

danger sign

NO MALARIA RISK

Stiff neck

VERY SEVERE FEBRILE DISEASE / MALARIA

No sign of very severe

febrile disease

FEVER : NO MALARIA

MALARIA RISK

SIGN

CLASSIFY

TREATMENT
Give the 1st dose of quinine (under medical supervisor or

Any general danger

sign Stiff neck

VERY SEVERE FEBRILE DISEASE / MALARIA

if a hospital is not assessable within 4 hours) Give the 1st dose of an appropriate antibiotic Threat the child to prevent the lowering of his/her blood sugar level Give one dose of paracetamol in the health center for high fever (38.5C or above) Send a blood smear with the patient Refer the child URGENTLY to a hospital

Blood smear (+)

If the blood smear test is not done : NO runny nose, and NO measles NO other causes fever

MALARIA

Treat the child with an oral antimalarial Give one dose of paracetamol in the health center for high fever (38.5C or above) Advise the mother regarding when to return to the

health center immediately Follow-up in 2 days if the fever persist If fever has been present everyday for more than 7 days, refer the child to a hospital assessment
Give one dose of paracetamol in the health center for high fever (38.5C or above) Advise the mother regarding when to return to

Blood smear (-), or Runny nose, or Measles, or Other causes of fever

FEVER : MALARIA UNLIKELY

the health center immediately Follow-up in 2 days if the fever persist If fever has been present everyday for more than 7 days, refer the child to a hospital assessment Treat other causes of fever

SIGN

CLASSIFY

TREATMENT

Give the 1st dose of an appropriate

Any general

danger sign Stiff neck

VERY SEVERE FEBRILE DISEASE

antibiotic Threat the child to prevent the lowering of his/her blood sugar level Give one dose of paracetamol in the health center for high fever (38.5C or above) Refer the child URGENTLY to a hospital
Give one dose of paracetamol in the

No sign of a

very severe febrile disease

FEVER NO MALARIA

health center for high fever (38.5C or above) Advise the mother regarding when to return to the health center immediately Follow-up in 2 days if the fever persist If fever has been present everyday for more than 7 days, refer the child to a hospital assessment

Oral Antimalarial
First Line Second Line : CHLOROQUINE and PRIMAQUINE : SULFADOXINE and PYRIMETHAMINE

If CHLOROQUINE and PRIMAQUINE  Explain the mother that she should watch he child carefully for 30 minutes after giving him or her a dose of chloroquine. If the child vomits within 30 minute, she should repeat the dose and return to the health center for additional tablets  Explain that itching is a possible side effect of the drug, and that it is not dangerous IF SULFADOXINE + PYRIMETHAMINE  Give a single dose in the health center

MEASLES

SIGN

CLASSIFY

TREATMENT
Give Vitamin A Give the 1st dose of an appropriate antibiotic If there is clouding of the cornea or pus

Clouding of the

cornea Deep, extensive mouth ulcers Any general danger signs

SEVERE, COMPLICATED MEASLES

draining from the eye, apply tetracycline eye ointment Refer the child URGENTLY to a hospital
Give Vitamin A If there is pus draining from the eye, apply

Pus draining from

the eyes Mouth ulcers

MEASLES WITH tetracycline eye ointment EYE OR If there are mouth ulcers, teach the mother how to treat them with Gentian MOUTH Violet COMPL Follow-up 2 days ICATIONS
Advise the mother when to return

immediately.

Measles now or

Give Vitamin A Advise the mother when to return

within the last 3 months

MEASLES

immediately.

SIGN
Bleeding from the nose

CLASSIFY

TREATMENT

or gums Blood in the stool or vomits Black stool or vomitus Skin petechiae SEVERE, DENGUE Cold and clammy extremities HEMORRHAGIC Slow capillary refill, < 3 FEVER seconds. Persistent abdominal pain Persistent vomiting Tourniquet test positive

If skin petechiae, persistent

abdominal pain, persistent vomiting, or positive tourniquet tests are the only positive signs, give ORS If any other sign or bleeding is positive, give fluids rapidly , as in Plan C Treat the child to prevent the lowering of his or her blood sugar level Refer the child URGENTLY to a hospital DO NOT GIVE ASPIRIN
Advise the mother regarding when to

No sign of severe dengue hemorrhagic fever

FEVER : DENGUE HEMORRHAGIC FEVER UNLIKELY

return to the health center immediately Follow-up in 2 days if the fever persists or if the child shown sign of bleeding DO NOT GIVE ASPIRIN

EAR PROBLEM

SIGN
Tender swelling behind

CLASSIFY
MASTOIDITIS

TREATMENT
Give the 1st dose of an appropriate

the ear

antibiotic Give the 1st dose of paracetamol for pain Refer the child URGENTLY to a hospital

Pus draining from the ear,

and discharge that has been present for less than 14 days, or Ear pain
Pus draining from the

ACUTE EAR INFECTION

Give antibiotic for 5 days Give paracetamol for pain Dry the ear by wicking Follow-up 5 days Advise the mother when to return immediately.

ear, and discharge that has been present for 14 days or more

CHRONIC EAR INFECTION

Dry the ear by wicking Instill quinolone otic drops for 2 weeks. Follow-up in 5 days Advise the mother when to return immediately.

No ear pain and pus

seen draining from the ear

NO EAR INFECTION

No additional treatment Advise the mother when to return

immediately.

Asses Malnutrition :
1. Determine weight for age. 2. Look for edema of both feet. 3. Look for visible severe wasting. 4. For children aged 6 months or more, determine if MUAC* is less than 115 mm.

SIGN
If age up to 6 months and

CLASSIFY
SEVERE MALNUTRITION

TREATMENT
Treat the child to prevent low blood sugar Give Vitamin A Refer the child URGENTLY to a hospital

-visible severe wasting -edema of both feet If age 6 months and above and -MUAC is less than 115 mm -visible severe wasting -edema of both feet

Asses the child s feeding and counsel the

Very low weight for

age

VERY LOW WEIGHT

mother on feeding according to the feeding recommendations and care for development. Give Vitamin A. Advise the mother to return immediately Follow up in 30 days.
If the child is less than 2 years old, assess

Not very low weight for age and no other sign of malnutrition

NOT VERY LOW WEIGHT

the child s feeding and counsel the mother on feeding recommendations and care foe development. If feeding is a problem, follow-up in 5 days Advise the mother regarding when to return to the health center immediately

ANEMIA
SIGN
Severe palmar pallor

CLASSIFY
SEVERE ANEMIA

TREATMENT
Refer the child URGENTLY to a hospital Asses the child s feeding and counsel the mother

Some palmar

pallor

ANEMIA

on feeding according to the feeding recommendations and care for development. Give IRON. Give ALBENDAZOLE/MEBENDAZOLE if child is 1 yr or older and has not had a dose in the previous 6 months. Advise the mother to return immediately Follow up in 14 days.

If the child is less than 2 years old, assess the

No palmar pallor

NO ANEMIA

child s feeding and counsel the mother on feeding recommendations and care foe development. If feeding is a problem, follow-up in 5 days Advise the mother regarding when to return to the health center immediately

Give Iron: Give 1 dose for 14 days daily

AGE OR WEIGHT IRON/FOLATE TABLET
Ferrous sulfate 200 mg + 250 mcg Folate (60 mg Elemental iron)

IRON SYRUP Ferrous Sulfate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml (1/2 Tsp)

IRON DROPS Ferrous Sulfate 25 mg (25 mg elemental iron per ml) 0.6 ml

3 months up to 4 months (4 - <6 kg)

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

4 ml (3/4 tsp)

1.0 ml

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

tablet

5 ml (1 tsp)

1.5 ml

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

1 tablet

10 ml (2 tsp)

2.0 ml

Albendazole
 Albendazole treats hookworm and whipworm infection.  These infections contribute to anemia because of iron loss through intestinal bleeding

Check the young Infant s Immunization and Vitamin A Status

VACCINE VITAMIN A ImmuBCG, Hep B-1 Give 200,000 IU nization to the mother within 4 weeks after delivery Schedule 6 weeks DPT-1,OPV1 HEP-B2 Give all missed doses on this visit Include sick infants unless being referred Advise the caretaker when to return for the dose AGE Birth

An Appropriate Oral Antibiotics

FOR
Pneumonia Acute Ear Infection Very Severe Disease Dysentery Cholera

FIRST LINE
Cotrimoxazole Cotrimoxazole Cotrimoxazole Cifrofloxacin Tetracycline

SECOND LINE
Amoxycillin Amoxycillin Amoxycillin Nalidixic Acid Cotrimoxazole

INTEGRATED CASE MANAGEMENT PROCESS FOR INFANT (2 WEEKS-2 MONTHS

Bacterial Infection The Infant s Feeding

SIGN

CLASSIFY

TREATMENT

Any one of the following signs: Not feeding well or Convulsion or Fast breathing (60 or more breaths/minute) Severe chest in drawing Fever (37.5C , or feels hot) or low body temperature (less than 35.5C, or feels cold) Movement only when stimulated or no movement at all.

Give the young infant the 1st dose of

VERY SEVERE DISEASE

intramuscular antibiotic Treat the young infant to prevent the lowering of his / her blood sugar level Advise the mother regarding hoe to keep the infant warm on the way to the hospital Refer the infant URGENTLY to a hospital

Red umbilicus or draining

pus Skin pustules

LOCAL BACTERIAL INFECTION

Give the young infant an appropriate antibiotic. Treat the local infection in the health center, and teach the mother to treat local infection at home Advise the mother to give home care for the young infant. Asses and counsel the mother on care for development. Follow-up in 2 days

None of the signs of very

severe disease or local bacterial infection

SEVERE DISEASE OR LOCAL INFECTION UNLIKELY

Advise the mother to give home care for the

young infant. Asses and counsel the mother on care for the development.

THE INFANT S FEEDING

SIGN
Not able to breastfeed No attachment at all No sucking at all

CLASSIFY
POSSIBLE SERIOUS BACTERIAL INFECTION

TREATMENT
Give the 1st dose of IM antibiotics Treat the infant to prevent the lowering of his or

her blood sugar level Advise the mother about how to keep the young infant warm on the way to the hospital Refer the infant URGENTLY to the hospital
Advise the mother to breastfeed the infant as often

Not well attached to

the breast Not sucking effectively Less than 8 breastfeeding in 24 FEEDING PROBLEM OR LOW WEIGHT hours FOR AGE Receives other foods or drinks Low weight for age Thrush (ulcers or white patches in the mouth)

as possible and for as long as the infant wants to be breastfeed, day or night If the infant is receiving other foods and drinks, counsel the mother about breastfeeding the infant more and reducing his/her intake the other foods and drinks, and about using a cup for feeding the infant If there is thrush, teach the mother hoe to treat it at home Advise the mother regarding how to give home care to the young infant Follow-up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days

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

Advise the mother regarding how to give

NO FEEDING PROBLEM

home care to the young infant Praise the mother for feeding the infant well

Jaundice
SIGN
Any jaundice if age is

CLASSIFY SEVERE JAUNDICE

TREATMENT
Treat the infant to prevent the lowering of his

less than 24 hours Yellow palms and soles at any age.

or her blood sugar level Advise the mother about how to keep the young infant warm on the way to the hospital Refer the infant URGENTLY to the hospital
Advise the mother to give home care for the

Jaundice appearing

after 24 hours of age Palms and soles are not yellow.

JAUNDICE

infant. Advise the mother to return immediately if palms and soles are yellow. If the young infant is older than 14 days, refer to a hospital for assessment. Assess and counsel the mother on care for development. Follow-up in 1 day.

Assess and counsel the mother on care for

No jaundice

NO JAUNDICE

development. Advise mother to give home care for the young infant.

DEHYDRATION
SIGN
Two of the following

CLASSIFY

TREATMENT
If the infant does not have VERY SEVERE DISEASE.

signs: -movement only when stimulated or no movement at all -Sunken eyes -Skin pinch goes back very slow

SEVERE DEHYDRATION

SEVERE JAUNDICE nor DYSENTERY: - give fluid for severe dehydration ( Plan C ) OR IF INFANT also has a VERY SEVERE DISEASE, SEVERE JAUNDICE or DYSENTERY: -refer URGENTLY to hospital, with mother giving frequent sips of ORS on the way. -advise mother to continue breastfeeding. -advise the mother on how to keep the young warm on the way to the hospital.
Give fluid for some dehydration ( Plan B ).

Two of the following signs: -restless, irritable -sunken eyes. -skin pinch goes back slowly

SOME DEHYDRATION

IF INFANT also has a VERY SEVERE DISEASE, SEVERE JAUNDICE or DYSENTERY: -refer URGENTLY to hospital, with mother giving frequent sips of ORS on the way. -advise mother to continue breastfeeding. -assess and counsel the mother on care for development

Not enough signs to classify as some or severe dehydration

NO DEHYDRATION

Give fluid to treat diarrhea at home. ( Plan A ) assess and counsel the mother on care for

development

Dehydration
SIGN CLASSIFY TREATMENT
If the young infant has dehydration, treat dehydration before referral unless the infant also has VERY SEVERE DISEASE. REFER TO HOSPITAL refer URGENTLY to hospital, with mother giving frequent sips of ORS on the way. -advise mother to continue breastfeeding.

Diarrhea

lasting for 14 days or more

SEVERE , PERSISTENT DIARRHEA

Blood in the stool

DYSENTERY

FEEDING PROBLEM
SIGN
Not well attached

CLASSIFY

TREATMENT
If not able to attach well or not suckling

to breast Not suckling effectively Less than 8 breastfeed in 24 hours Receives other food and drinks Low weight for age Thrush ( ulcers or white patches in the mouth )

FEEDING PROBLEM OR LOW WEIGHT FOR AGE

effectively, teach correct positioning and treatment. -if unable to attach well immediately, teach the mother to express breast milk and feed using a cup. If breastfeeding is done less frequently 8 times every 24 hours, advise to increase frequency of breastfeeding. Advise the mother to breastfeed as often and as long as the infant wants, day and night. If the mother gives her infant other foods or drinks, counsel her about breastfeeding further and instruct her to reduce other foods and drinks, and to use a cup. -if not breastfeeding at all: *refer to breastfeeding counseling and possible relactation. *advise about the correct preparation of breastmilk substitutes and the use of a cup.

SI

LASSIF

T EAT E T

Advise the mother how to feed and

keep the low weight infant warm at home. If thrush, teach the mother to treat thrush at home. Advise the mother to give home care for the young infant Follow up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days. Assess and counsel the mother on care for development.
 Assess and counsel the mother on

care

ot low-weight-

for-age, and no other signs of inadequate feeding

O FEEDI P OBLE

for development  Advise mother to give home care for the young infant.  Praise the mother for feeding the infant well.

CARE FOR DEVELOPMENT

I. What is care for development? II. Assesing the child s care for development. III. Identify Problems in Care for development. Lack of time; communication gap; play; environment IV. Counsel the mother about care for development. V. Counsel the mothe about her own health.

Some Common Feeding Problems

1. Difficulty in breastfeeding 2. Child less than 4 months taking other milk/food 3. Use of breast milk substitute, e.g., cow s milk, evaporated milk 4. Use of feeding bottles 5. Lack of active feeding

6. Not feeding well during illness 7. Complementary food not enough in quantity/quality/variety 8. Child 6 months or older, but not yet given complementary foods 9. Infant not exclusively breastfed 10. Improper handling and use of breast milk substitute

When to Return-Follow up Visit

IF THE CHILD HAS:
PNEUMONIA WHEEZE DYSENTERY MALARIA, if fever persists FEVER:MALARIA UNLIKELY,if fever persists FEVER NO MALARIA, if fever persists MEASLES WITH EYE OR MOUTH COMPLICATIONS RETURN FOR FOLLOWUP

2 DAYS

DENGUE HEMORRHAGIC FEVER UNLIKELY,if fever persists

PERSISTENT DIARRHEA ACUTE EAR INFECTION CHRONIC EAR INFECTION KER FEEDING PROBLEMS ANY OTHER ILLNESS, if not improving

5 DAYS

ANEMIA
VERY LOW WEIGHT FOR AGE

14 DAYS 30 DAYS

WHEN TO RETURN IMMEDIATELY

ADVISE THE MOTHER TO RETURN IMMEDIATELY IF THE CHILD HAS ANY OF THESE SIGNS

ANY SICK CHILD

NOT ABLE TO DRINK OR BREASTFED BECOMES SICKER DEVELOPS A FEVER FAST BREATHING DIFFICULT BREATHING

IF THE CHILD HAS NO PNEUMONIA: COLD,OR COUGH, also return if:

BLOOD IN THE STOOL IF THE CHILD HAS DIARRHEA, DRINKING POORLY also return if:
IF CHILD HAS FEVER :DENGUE HEMORRHAGIC FEVER UNLIKELY,also return if:
ANY SIGN OF BLEEDING PERSISTENT ABDOMINAL PAIN PERSISTENT VOMITING SKIN PETECHIAE SKIN RASH

Case study No. 3

Baby a is a 3 years old