Integrated Management of Childhood Illness (IMCI)

SICK CHILD (2 months to 5 years old)

DANGER SIGNS:• Unable to drink or breastfeed• Frequent vomiting• Convulsion during the course of illness• Abnormally sleepy or difficult to awake

if any of these is present- considered SEVERE DISEASE GIVE 1st dose of appropriate antibiotic and refer URGENTLY except for diarrhea if Plan C can resolve the danger sign

THEN ASK ABOUT THE MAIN SYMPTOMS: Does the child have cough or difficulty breathing? Does the child have diarrhea? Does the child have fever? Does the child have an ear problem? Then check for malnutrition and anemia

If with COUGH or DIFFICULTY BREATHING:Ask: How Long?Look, Listen: Count the breaths in one minute

Look for chest indrawingListen for stridor

• Fast breathing if:2 – 12 mos more than 50 bpm12 mos up more than 40 bpm

• Child must be CALM during assessment

SIGNS CLASSIFY AS TREATMENT any danger sign or chest indrawing or stridor

SEVERE PNEUMONIA or VERY SEVERE DISEASE

give 1st dose of an appropriate antibiotic give Vitamin A treat the child to prevent low blood sugar refer URGENTLY to hospital

fast breathing PNEUMONIA give an appropriate antibiotic for 5 days soothe the throat and relieve the cough with

a safe remedy advise mother when to return immediately follow up in 2 days

no signs of pneumonia or very severe disease

NO PNEUMONIACOUGH OR COLD

if coughing for more than 30 days, refer for assessment

soothe the throat and relieve the cough with a safe remedy

advise mother when to return immediately follow up in 2 days

SEVERE PNEUMONIA:Appropriate antibiotic: INTRAMUSCULAR Chloramphenicol

for children who cannot take oral antibiotic give the 1st dose then refer URGENTLY to hospital if REFERRAL is NOT possible:

• repeat the chloramphenicol injection every 12 hours for 5 days• then change to an appropriate oral antibiotic to complete 10 days of treatment

AGE OR WEIGHTCHLORAMPHENICOL

Dose: 40 mg/kgAdd 5 ml sterile water to vial containing 1g

= 5.6 ml at 180mg/ml2 – 4 months (4 - < 6 kg) 1 ml = 180 mg

4 – 9 months (6 - < 8 kg) 1.5 ml = 270 mg

9 – 12 months (8 - < 10 kg) 2 ml = 360 mg

1 – 3 years old (10 - < 14 kg) 2.5 ml = 450 mg

3 – 5 years old (14 – 19 kg) 3.5 ml = 630 mg

VERY SEVERE DISEASE/ PNEUMONIAAppropriate antibiotic: ORAL1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days)2nd line antibiotic: AMOXYCILLIN (TID x 5 days)

Age or weight Tablet Syrup2 – 12 months (4 - < 10 kg) ½ 5 ml1 – 5 years old (10 - < 19 kg) 1 10 ml

GIVE VITAMIN A:

6 - 12 months 100, 000 IU/ cap1 – 5 years old 200, 000 IU/ cap

SOOTHE THE THROAT AND RELIEVE COUGH WITH SAFE REMEDY: Breastmilk for exclusively breastfed infant Tamarind, Calamansi and Ginger

Harm full remedies to discourage: Codeine cough syrup Other cough syrup Oral and nasal decongestant

WHEN TO RETURN IMMEDIATELY:Pneumonia : presence of any danger signCough or Cold : presence of fast breathing or difficult breathing

TREAT THE CHILD TO PREVENT LOW BLOOD SUGAR LEVEL: If the child is able to breastfeed:

Ask the mother to breastfeed the child. If the child is not able to breastfeed but is able to swallow:

Give expressed breastmilk or breastmilk substituteIf neither of these is available, give sugar waterGive 30-50 ml of milk or sugar water before departure

• to make sugar water: Dissolve 4 level teaspoons of sugar (20grams) in a 200-ml cup of clean water.

If the child is not able to swallow:Give 50 ml of milk or sugar water by nasogastric tube

If the child is difficult to awaken or unconscious, start IV infusion:Give 5 ml/kg of 10% of dextrose solution (D10) over a few minutesOr give 1 ml/kg of 50% (D50) by slow push

If with DIRRHEA:ASK: How long?

Is there blood in the stool?LOOK, FEEL: Look at the child’s general condition.

Is the child:- Abnormally sleepy or difficult to awake?- Restless and irritableLook for sunken eyes.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

SIGNS CLASSIFY AS TREATMENTTwo of the following signs:

abnormally sleepy or difficult to awaken

sunken eyes not able to drink or

drinking poorly skin pinch goes back

slowly

SEVERE DEHYDRATION if the child has no other sever classification;

• give fluid for severe dehydration (Plan C) Or;

if the child has another sever classification;• refer URGENTLY to hospital, with

mother giving frequent sips of ORS on the way

• advise the mother to continue breastfeedig

if the child is 2 years or older and there is cholera in the area, give antibiotic for cholera

Two of the following signs: restless, irritable sunken eyes drinks eagerly, thirsty skin pinch goes back

very slowly

SOME DEHYDRATION if the child has no other sever classification; • give fluid for severe dehydration (Plan B)

Or; if the child has another sever classification;• refer URGENTLY to hospital, with mother

giving frequent sips of ORS on the way• advise the mother to continue breastfeedig advise mother when to return immediately follow up in 5 days if not improving

no enough signs to classify as some or severe dehydration

NO DEHYDRATION give fluid and food to treat diarrhea at home

(Plan A) give zinc supplements advise mother when to return immediately follow up in 5 days if not improving

Plan A: Treat Diarrhea at HomeCounsel the mother on the 4 rules of home Treatment:

1. Give Extra Fluid2. Give zinc supplement3. Continue Feeding4. When to return

1. GIVE EXTRA FLUID TELL THE MOTHER:

- Breastfeed frequently and longer at each feeding- if the child is exclusively breastfed, give ORS or clean water in addition to

breast milk.- if the child is not exclusively breastfed, give one or more of the following:

ORS solution, food-based fluids (such as soup, rice water, or “buko juice”), clean water.

It is especially important to give ORS at home when:- The child has been treated with Plan B or Plan C during the visit, or - The child cannot return to a health center if the diarrhea gets worse,

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

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

Up to 2 years 50 to 100 ml after each loose stool2 years or more 100 ml to 200 ml after each loose stool

Tell the mother:- Give frequent small sips from a cup.- If the child vomits, wait 10 minutes, then continue, but more slowly.- Continue giving extra fluid until the diarrhea stops.

2. GIVE ZINC SUPPLEMENTS• 10 mg per day in infants - < 6 mos. For 10-14 days• 20 mg per day in children 6 mos. -5 years old for 10-14 days

3. CONTINUE FEDING4. WHEN TO RETURN

Plan B: Treat Some Dehydration with ORSGive in health center recommended amount of ORS over 4-hour period

DETERMINE AMOUNT OF ORS TO GIV DURING THE FIRST $ HOURS.AGE Up to 4 months 4 months up to12 months up to 2 years up to

12 months 2 years 5 yearsWEIGHT <6 kg 6 to -< 10 kg 10 to -< 12 kg 12 to 19 kgAMOUNT(ml) 200-400 400-700 700-900 900-1400

Use the child’s age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child’s weight (in kg0 times 75.

• If the child wants more ORS than shown, give more.• For infants under 6 months of age who are not breastfed, also give 100-200 ml clean

water during this period.

SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.• Give frequent small sips from a cup.• If the child vomits , wait 10 minutes. Then continue, but more slowly.• Continue breastfeeding whenever the child wants.

IF THE MOTHER MUST LEAVE BEFORE COMLETING TREATMENT:• Show her how to prepare ORS solution at home.• Show her how much ORS to give her child to finish 4-hour treatment at home.• Give her enough ORS packets to complete rehydration. Also give her 2 packets, as

recommended in Plan A.• Explain the 4 rules of home treatment:

DYSENTERYAppropriate antibiotic: ORAL

1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days)2nd line antibiotic: NALIDIXIC ACID (QID x 5 days)

Cotrimoxazole Nalidixic AcidAge or weight Tablet Syrup Syrup

2 – 4 months (4 - < 6 kg) ½ 5 ml 1. 25 ml (1/4 tsp)4 – 12 months (6 - < 10 kg) 2.5 ml (12 tsp)1 – 5 years old (10 - < 19 kg) 1 10 ml 5 m l (1 tsp)

If DIRRHEA for 14 DAYS OR MORE:

SIGNS CLASSIFY AS TREATMENT dehydration present

SEVERE PERSISTENT DIARRHEA

treat dehydration before referral unless the child has another severe classification

give Vitamin A refer to hospital

no dehydration PERSISTENT DIARRHEA

Advise the mother on feeding a child who has PERSISTENT DIARRHEA

give Vitamin A follow up in 5 days advise the mother when to return

immediately

If with BLOOD IN THE STOOL:

SIGNS CLASSIFY AS TREATMENT blood in the stool

DYSENTERY treat for 5 days with an oral antibiotic

recommended for shigella in your area follow up in 2 days advise mother when to return

immediatelly

If with FEVER:

Identify MALARIA risk: Living in malaria area Has visited/ travelled in a malaria area in the past 4 weeks

If with MALARIA RISK:SIGNS CLASSIFY AS TREATMENT

Any general danger sign OR

Stiff neckVERY SEVERE FEBRILE DISEASE/ MALARIA

Give 1st dose of quinine Give 1st dose of appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in the health

center for high fever(T > 38.5˚C) Send a blood smear with the patient Refer URGENTLY to hospital

Blood smear ( + )If blood smear not done:

No runny nose, and No measles, and No other causes of fever

MALARIA Treat the child with oral anti-malarial Give one dose of paracetamol in the health

center for high fever(T > 38.5˚C) Advise the mother when to return

immediately Follow up in 2 days if fever persists If fever is present every day for more than 7

days, refer for assessment Blood smear ( - ) OR Runny nose, OR Measles, OR Other causes of fever

FEVER: MALARIA UNLIKELY

Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)

Advise the mother when to return immediately

Follow up in 2 days if fever persists If fever is present every day for more than 7

days, refer for assessment Treat other causes of fever

If NO Malaria Risk:SIGNS CLASSIFY AS TREATMENT

Any general danger sign Give 1st dose of appropriate antibiotic

OR Stiff neck

VERY SEVERE FEBRILE DISEASE

Treat the child to prevent low blood sugar Give one dose of paracetamol in the health

center for high fever(T > 38.5˚C) Refer URGENTLY to hospital

No signs of very severe febrile disease FEVER: NO MALARIA

Give one dose of paracetamol in the health center for high fever(T > 38.5˚C)

Advise the mother when to return immediately

Follow up in 2 days if fever persists If fever is present every day for more than 7

days, refer for assessment Treat other causes of fever

If with MEASLES now or within 3 months:SIGNS CLASSIFY AS TREATMENT

blood in the stoolDYSENTERY

treat for 5 days with an oral antibiotic recommended for shigella in your area

follow up in 2 days advise mother when to return

immediatelly

If with FEVER:Identify MALARIA risk:

Living in malaria area Has visited/ travelled in a malaria area in the past 4 weeks

If with MALARIA RISK:SIGNS CLASSIFY AS TREATMENT

Clouding of the cornea OR Deep extensive mouth

ulcers Any general danger sign

SEVERE COMPLICATED MEASLES

Give Vitamin A Give 1st dose of appropriate antibiotic If clouding of the cornea or pus draining

from the eyes, apply tetracycline eye ointment

Refer URGENTLY to hospital Pus draining from the eyes,

OR Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS

Give Vitamin A If clouding of the cornea or pus draining

from the eyes, apply tetracycline eye ointment

If mouth ulcers, teach the mother to treat with gentian violet

Follow up in 2 days Advise the mother when to return

immediately Measles now or within the

last 3 months MEASLES Give Vitamin A Advise the mother when to return

immediately

TREAT EYE INFECTION WITH TETRACYCLINE EYE OINTMENT Clean both eyes 3 times daily

• Wash hands• Ask child to close eyes• Use clean cloth and water to gently wipe away pus

Then apply tetracycline eye ointment in both eyes 3 times daily• Ask the child to look up• Squirt a small amount of ointment on the inside of the lower lid• Wash hands again

Treat until redness is gone Do not use other eye ointment or drops, or put anything else in the eyes

TREAT MOUTH ULCERS WITH GENTIAN VIOLET

Treat the mouth ulcers twice daily• Wash hands• Wash child’s mouth clean using soft cloth wrapped around the finger and wet

with salt water• Paint the mouth with half strength gentian violet, using cotton bud• Wash hands again

Assessment for DENGUE HEMORRHAGIC FEVER:SIGNS CLASSIFY AS TREATMENT

Bleeding from nose or gums, OR

Bleeding in stools or vomitus, OR

Black stools or vomius, OR Skin petechiae OR Cold and clammy

extremities OR Capillary refill of > 3 secs Persistent abdominal pain,

OR Persistent Vomiting, OR

Tourniquet test positive

SEVERE DENGUE HEMORRHAGIC

FEVER

If persistent vomiting or persistent abdominal pain or skin petechiae or positive tourniquet test are the only signs, give ORS (Plan B)

If any signs of bleeding is positive, give fluids rapidly, as plan C

Treat the child to prevent low blood sugar Refer all children URGENTLY to hospital DO NOT GIVE ASPIRIN

No signs of severe Dengue Hemorrhagic Fever FEVER: DHF

UNLIKELY

Advise the mother when to return immediately

Follow up in 2 days if fever persists DO NOT GIVE ASPIRIN

VERY SEVERE FEBRILE DISEASE/ MALARIA Appropriate antibiotic: INTRAMUSCULAR QUININE Give the 1st dose of IM quinine and refer URGENTLY to hospital

If Referral is NOT Possible: The child should remain lying down for one hour repeat the quinine injection at 4-8 hours later, and then every 12 hours until the child

is able to take an oral antimalarial. Do not continue quinine injections for more than 1 week

Do not give quinine to a child less than 4 months of ageAGE OR WEIGHT INTRAMUSCULAR QUININE4 up to 12 months (6- <10 kg) 0.3 ml1- 2 years old (10- <12 kg) 0.4 ml2-3 years old (12- <14 kg) 0.5 ml3-5 years old (14- 19 kg) 0.6 ml

Appropriate antibiotic: ORAL ANTIMALARIAL If CHLOROQUINE:

- watched child for 30 minutes, if with vomiting within 30 minutes, repeat dose and return to the center for additional tablets

- itching is a possible, but id not dangerous If SULFADOXINE + PYRIMETHAMINE:

- give a single dose in the health center 2 hours before intake of chloroquine

If PRIMAQUINE:- single doe on DAY 4 for P. falciparum; 14 days for P.vivax

If ARTEMETER+ LUMEFRANTINE:- combination; give for 3 days

If with EAR PROBLEM: SIGNS CLASSIFY AS TREATMENT

Tender swelling behind the ear MASTOIDITIS

Give 1st dose of an appropriate antibiotic Give 1st dose of paracetamol for pain Refer URGENTLY to hospital

Ear pain Pus is seen draining from

the ear, and discharge is reported for less than 14 days

ACUTE EAR INFECTION

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

immediately Pus is seen draining from

the ear, and discharge is reported for more than 14 days

CHRONIC EAR INFECTION

Dry the ear wicking. Follow up in 5 days . Advise mother when to return

immediately. No ear pain, and No pus is seen draining

from the earNO EAR INFECTION

No additional treatment. Advise mother when to return

immediately.

Appropriate antibiotic: ORAL1st line antibiotic: COTRIMOXAZOLE ( BID x 5 days)2nd line antibiotic: AMOXYCILLIN (TID x 5 days)

Age or weight Tablet Syrup2 – 12 months (4 - < 10 kg) ½ 5 ml1 – 5 years old (10 - < 19 kg) 1 10 ml

DRY THE EAR BY WICKING: Dry the ear at least 3 times daily

• Roll clean absorbent cloth or soft, strong tissue paper into a wick• Place the wick in the child’s ear• Remove the wick when wet• Replace the wick with a clean one and repeat these steps until ear is dry

If with MALNUTRITION and ANEMIA: SIGNS CLASSIFY AS TREATMENT

Visible severe wasting or Edema of both feet or Severe palmar pallor

SEVERE MALNUTRITION OR

SEVERE ANEMIA

Give Vitamin A Refer URGENTLY to hospital

Some palmar pallor or Very low weight for age ANEMIA OR VERY

LOW WEIGHT

Assess the child’s feeding and counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart- If feeding problem, follow up in 5

days If some pallor:

- Give iron- Give mebendazole/albendazole if the

child is 12 months or older, and has

AGE Sulfadoxine +pyrethamine Chloroquine

Primaquine

p. falcifarum p. vivax

2- 5 months ¼ ½ ½ ½ ----- ----5- 12 months ½ ½ ½ ½ ----- ----1-3 years old ¾ 1 1 ½ ½ 1/43-5 years old 1 1 ½ 1 ½ 1 ¾ ½

not had a dose in the previous 6 months

- Follow up in 14 days If very low weight for age:

- Give Vitamin A.- Follow up in 30 days.

Advise mother when to return immediately.

Not very low weight for age, and or other signs of malnutrition

NO ANEMIA AND NOT VERY LOW WEIGHT

If the child is less than 2years old, assess the child’s feeding according to the FOOD box on the COUNSEL THE MOTHER chart- If feeding problem, follow up in 5

days Advise mother when to return

immediately

RECOMMENDATIONS FOR FEEDING AND CARE FOR DEVELOPMENT:Birth up to 6 months 6 months to 12 months 12 months to 2 years 2 years and older

FOOD:• Exclusively breastfeed

as often as the child wants, day and night, at least 8 times in 24 hours

• Do not give other foods or fluids

FOOD:• Breastfeed as often as

the child wants• Add any of the

following:• lugaw with added oil,

mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely ground meat, eggyolk, bite-size fruits

• 3 times per day of breastfed

• 5 times if not

FOOD:• Breastfeed as often as

the child wants• Give adequate amount

of family foods, such as: rice, camote, potato, fish, chicken, meat, monggo, steamed tokwa, pulverized roasted dilis, milk and eggs, dark green, leafy and yellow vegetables (malungay, squash) fruits (papaya, banana)

• Add oil or margarine• 5 times per day• feed the baby

nutritious snacks like fruits

FOOD:• Give adequate aunt of

family foods at 3 meals every day

• Give twice daily nutritious foods, between meals such as:Boiled yellow camote, boiled yellow corn, peanuts, boiled saba, banana, taho, fruits, and fruit juices

PLAY:• Provide an area where

the child could move, play and develop his senses of sight, touch, and hearing

• Have large, colorful things for your child to reach for and new things to see

PLAY:• Give your child clean,

safe household things to handle, bang, and drop

PLAY:• Give your child things

to stack up, and to put into containers, and take out

PLAY:• Help your child count,

name, and compare things

• Make simple toys for your child

COMMUNICATE:• Look into your child’s

eyes and smile at him or her

• When you are breastfeeding, it is a good time to talk to your child and get a conversation going with sounds or gestures

COMMUNICATE:• Respond to your

child’s sounds and interests. Tell your child the names of things and people

COMMUNICATE:• Ask your child simple

questions. Respond to your child’s attempts to talk. Play games like “bye”

COMMUNICATE:• Encourage your child

to talk, and answer your child’s questions. Teach your child stories, songs and games.

GIVE MEBENDAZOLE/ALBENDAZOLE: Give 500 mg Medendazole/ 400 mg Albendazole as a single dose in the health

center if the child is 12 months up to 59 months and has not had a dose in the previous 6 months, with the following dose:

AGE OR WEIGHT Albendazole400 mg/tablet

Mebendazole500 mg/tablet

12- 23 months ½ 124-59 months 1 1

WHEN TO RETURN:FOLLOW UP VISIT

If the child has: Return for follow up in:PneumoniaDysenteryMalaria, if the fever persistsFever-Malaria Unlikely, if the fever persistsFever (No Malaria) if the fever persistsMeasles with Eye or Mouth ComplicationsDengue Hemorrhagic Fever Unlikely, if fever persists

2 days

Persistent DiarrheaAcute Ear InfectionChronic Ear InfectionFeeding ProblemsMany other Illnesses, if not improving

5 days

Anemia 14 daysVery Low Weight For Age 30 days

WHEN TO RETURN IMMEDIATELY:Advise the mother to return immediately of the child has any of the these signs:Any Sick Child • Not able to drink or

breastfeed• Becomes sicker• Develops a Fever

If the child has NO PNEUMONIA: COUGH OR COLD, also return if:

• Fast Breathing• Difficult Breathing

If the child has Diarrhea, also return if: • Blood in stool• Drinking Poorly

If the child has FEVER; DENGUE HEMORRHAGIC FEVER UNLIKELY, also return if:

• Any signs of bleeding

• Persistent abdominal pain

• Persistent vomiting• Skin petechiae• Skin rashes

SICK YOUNG INFANT (1 week to 2 months)

SIGNS CLASSIFY AS TREATMENT Convulsions OR Fast breathing (>60 bpm) OR Severe chest indrawing ) OR Nasal Flarring OR Grunting OR Bulging Fontanelle OR Pus draining from the ear OR Umbilical redness extending to

the skin OR Fever (>37.5˚C), hypothermia

(<35.5˚C) OR Many or severe skin pustules OR Abnormally sleepy or difficult to

awaken OR Less than normal movement

POSSIBLE SERIOUS BACTERIAL INFECTION

Give first dose of intramuscular antibiotics

treat the child to prevent low blood sugar

advise mother how to keep the infant warm on the way to the hospital

refer URGENTLY to the hospital.

Red umbilicus or draining pus OR Skin Pustules

LOCAL BACTERIAL INFECTION

Give an appropriate antibiotic treat the local infection in the health

center, and teach the mother to treat local infection at home.

advise mother how to give home care follow up in 2 days

INTRAMUSCULAR ANTIBIOTIC:

• Give 1st dose of BOTH benzylpenicillin and gentamicin intramuscular• Referral is the BEST option for young infant classified as POSSIBLE SERIOUS

BACTERIAL INFECTTION• If referral is NOT possible, give benzylpenicillin every 6 hours plus gentamicin one dose

daily.

WEIGHT GentamicinDose: 5 mg/kg

BenzylpenicillinDose: 50,000 units/kg

1 kg 0.5 ml 0.1 ml2 kg 1.0 ml 0.2 ml3 kg 1.5 ml 0.4 ml4 kg 2.0 ml 0.5 ml5 kg 2.5 ml 0.6 ml

*dilution= gentamicin (6 ml for 80 mg) = benzylpenicillin (2.1 ml for 1 million units)

MAKE SURE THE YOUNG INFANT STAYS WARM AT ALL TIMES:- In cool weather, cover the infant’s head and feet, and dress the infant with

extra clothing

APPROPRIATE ORAL ANTIBIOTIC: (Local Bacterial Infection)1st line: COTRIMOXAZOLE (BID x 5 days)2nd line: AMOXICILLIN (TID x 5 days)

AGE OR WEIGHT Tablet SyrupBirth up to 1 month (<3 kg) -------- 1.25 ml1-2 months (3- 4 kg) 1/4 2.5 ml

TREATMENT FOR LOCAL INFECTION AT HOME:• SKIN PUSTULES

o Wash handso Gently wash off pus and crusts with soap and watero Dry the areao Paint with gentian violeto Wash hands

• UMBILICAL INFECTIONo Wash handso Clean with 70% ethyl alcoholo Paint with gentian violeto Wash hands

• ORAL THRUSH ( ulcers or white patches in the mouth)o Wash handso Wash mouth with clean soft cloth wrapped around the finger and wet with salt

watero Paint the mouth with half-strength gentian violeto Wash hands

HOME CARE FOR YOUNG INFANT:• Breastfeed frequently, as often and for as long as the infant wants, day and night,

during sickness and health• When to return:

Follow up visit:If infant has: Follow up in:

LOCAL BASCTERIAL INFECTIONANY FEEDING PROBLEMTHRUSH

2 days

LOW WEIGTH FOR AGE 14 days

When too return immediately:Advise the mother to return immediately if the young infants has any of these signs:

Breastfeeding or drinking poorlyBecomes sickerDevelops a feverFast breathingDifficult breathingBlood in stool

DIARRHEA: same as for SICK CHILD

FEEDING PROBLEMS OR LOW WEIGHTSIGNS CLASSIFY AS TREATMENT

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

NOT ABLE TO FEED POSSIBLE SERIOUS

BACTERIAL INFECTION

Give the 1st dose of intramuscular antibiotics Treat to prevent low blood sugar level Advise the mother how to keep the young

infant warm on the way to the hospital Refer URGENTLY to hospital

Not well attached to the breast OR Not sucking effectively OR Less than 8 breastfeeds in 24

hours OR Receives other foods or drinks

OR Low weight for age OR Thrush (ulcers or white patches in

the mouth)

FEEDING PROBLEM OR LOW WEIGHT

Advise the mother to breastfeed as often and for as long as the infant wants, day and night• if not well attached or not sucking

effectively, teach correct positioning and attachment

• if breastfeeding less than 8 times in 24 hours, advise to increase frequency of breastfeeding.

If receiving other foods or drinks, counsel mother about breastfeeding more, reducing other foods and drinks, and using a cup.• if not breastfeeding at all;

- refer to breastfeeding counseling and possible relactation

- advise about the correct preparing of breastmilk substitutes, and using a cup

If thrush, teach 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 Not low weight for age, and no

other signs of inadequate feedingNO FEEDING

PROBLEM Advise mother to give home care for the

young infant Praise the mother for feeding the infant well

CORRECT POSITIONING AND ATTACHMENT: Show the mother how to hold her infant.

- with the infant’s head and body straight- facing her breast, with infant’s nose opposite her nipples- with infant’s body close to her body

- supporting infant’s whole body, not just neck and shoulders Show her how to help the infant to attach. She should:

- touch her infant’s lips with her nipple- wait until her infant’s mouth is opening wide- move her infant quickly onto breast, aiming the infant’s lower lip well below the

nipple Look for signs of good attachment and effective sucking. If the attachment or sucking is

good, try again.