24 June 2003

World Health Organization

unicef
Child & Adolescent Health
and Development (CAH)

INTEGRATED MANAGEMENT OF
NEONATAL AND CHILDHOOD ILLNESS

HEALTH WORKER
CHART BOOKLET

Ministry of Health & Family Welfare,

Govt. of India

2003

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 ASSESS & CLASSIFY THE SICK YOUNG INFANT
AGE UPTO 2 MONTHS

ASSESS SIGNS CLASSIFY AS IDENTIFY TREATMENT

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

CHECK FOR POSSIBLE BACTERIAL INFECTION

ASK: LOOK, LISTEN & FEEL: •Convulsions or

•Fast breathing (60 breaths per minute ØGive first dose of
•Has the • Count the breaths or more) or POSSIBLE cotrimoxazole if able to take
infant had in one minute. YOUNG •Severe chest indrawing or SERIOUS orally

}
convulsions? Repeat the count if INFANT •Νasal flaring or BACTERIAL (½ Pediatric tablet for an infant
elevated. MUST •Grunting or INFECTION upto 1 month and 1 tablet for an
BE infant 1-2 months)
• Look for severe CALM •10 or more skin pustules or a big boil
ØAdvise mother to continue
chest indrawing or
breastfeeding
• Look for nasal • If axillary temperature 37.5oC or
ØWarm the young infant by Skin
flaring above (or feels hot to touch) or to Skin contact if feels cold to
• Look and listen for temperature less than 35.5oC(or touch.
grunting feels cold to touch) or Ø Refer URGENTLY to hospital
.• Look at the umbilicus. • Lethargic or unconscious or
Is it red or draining pus? • Less than normal movements
• Look for skin pustules. Are there 10
or more skin pustules or a big boil ?
• Measure axillary temperature (if not
• Umbilicus red or draining LOCAL ØGive oral cotrimoxazole for
possible feel for fever or low body
pus or BACTERIAL 5 days.
temperature).
INFECTION (½ Pediatric tablet twice daily for
•See if the young infant is lethargic or • Skin pustules less than 10. an infant upto 1 month and 1
unconscious. tablet for an infant 1-2 months)
•Look at the young infant’s ØTeach mother to apply 0.5%
movements. Gentian Violet paint twice daily
Are they less than normal? ØFollow-up in 2 days.

THEN ASK: DOES THE YOUNG INFANT HAVE DIARRHOEA?*

IF YES, Two of the following signs:

for SEVERE ØGive first dose of oral
dehy- • Lethargic or unconscious DEHYDRATION cotrimoxazole if able to take
ASK: LOOK & FEEL: dration orally
• Look at the young • Sunken eyes
(½ Pediatric tablet for an infant
• Is there infant’s general • Skin pinch goes back very slowly.
upto 1 month and 1 tablet for an
blood in condition. Is the infant: infant 1-2 months)
the ØRefer URGENTLY to hospital
stool? Lethargic or with mother giving frequent sips
unconscious? Classify Two of the following signs: of ORS on the way.
Diarrhoea ØAdvise mother to continue
Restless and • Restless, irritable. SOME breastfeeding.
irritable? • Sunken eyes. DEHYDRATION ØAdvise to keep the young infant
• Look for sunken • Skin pinch goes back slowly. warm.
eyes. ØGive fluids to treat diarrhea at
• Pinch the skin of the
• Not enough signs to classify as NO home (Plan A).
abdomen.
some or severe dehydration. DEHYDRATION ØAdvise home care.
Does it go back: ØFollow up in 2 days if not
Very slowly (longer improving.
than 2 seconds)?
Slowly?
SEVERE ØGive first dose of oral
• Bbod in the stool DYSENTERY cotrimoxazole if able to
and if take orally
* What is diarrhoea in a young infant? blood in ØRefer URGENTLY to
If the stools have changed from usual stool hospital
pattern and are many and watery (more ØAdvise mother to continue
water than fecal matter). The normally breastfeeding.
frequent or loose stools of a breastfed ØAdvise to keep the young
baby are not diarrhoea. infant warm.

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 ASSESS SIGNS CLASSIFY AS IDENTIFY TREATMENT

CHECK FOR FEEDING PROBLEM

ASK: LOOK & FEEL: • Not able to feed NOT ABLE TO

or FEED - ØWarm the young infant by Skin
• Is there any ASSESS BREASTFEEDING IF THERE • No attachment at all POSSIBLE to Skin contact if feels cold to
or SERIOUS touch.
difficulty feeding? IS NO INDICATION FOR URGENT
• Not suckling at all BACTERIAL Ø Refer URGENTLY to hospital
• Is the infant REFERRAL:
INFECTION
breastfed? If yes, - Ask the mother to put her infant to the
how many times in breast . Observe the breastfeed for
24 hours? 4 minutes. • Not well attached to ØIf not well attached or not
• Does the infant • Is the infant able to attach well? breast or FEEDING suckling effectively, teach
usually receive Not suckling PROBLEM correct positioning and
any other foods or TO CHECK ATTACHMENT, LOOK FOR: effectively attachment.
drinks? - Chin touching breast or
If yes, how often? - Mouth wide open • Less than 8 ØIf breastfeeding less than 8
• What do you use to - Lower lip turned outward
breastfeeds in times in 24 hours , advise to
- More areola visible above than below the
feed the infant? 24 hours
mouth increase frequency of
(All of these signs should be present if the or feeding.
attachment is good)
• Receives other ØIf receiving other foods or
no attachment at all foods or drinks
drinks, counsel mother about
not well attached
good attachment
breastfeeding more, reducing
• Is the infant suckling effectively (that other foods or drinks, and using
a cup and spoon.
is, slow deep sucks, sometimes or
· If not breastfeeding at all,
pausing)?
advise mother about giving
not suckling at all locally appropriate animal milk
not suckling effectively and teach the mother to feed
suckling effectively with a cup and spoon.
Clear a blocked nose if it interferes • Thrush (ulcers or Ø If thrush, teach the mother to
with breastfeeding. white patches in apply 0.25% Gentian Violet
• Look for ulcers or white patches in the mouth).
paint twice daily
mouth (thrush).
• Breast or nipple
ØIf breast or nipple problem,
- If yes, look and feel for: problems
teach the mother to treat breast
• Does the mother • Sore nipples or nipple problems.
have • Engorged breasts or breast abscess
pain while ØAdvise mother to give home
breastfeeding? care
(Breastfeed infant exclusively,
keep infant warm, apply nothing
to cord, ask mother to wash
hands and explain danger signs
in the infant)
ØFollow-up in 2 days.

• Not other signs of ØAdvise to give home care .

inadequate feeding. NO FEEDING
ØPraise the mother for feeding
PROBLEM
the infant well.

THEN CHECK THE YOUNG INFANT’S IMMUNIZATION STATUS

IMMUNIZATION SCHEDULE : AGE VACCINE

Birth BCG OPV-0
6 weeks DPT-1 OPV-1 + Hepatitis B-1*

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

ASSESS OTHER PROBLEMS

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 TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER

Teach The Mother To Give Oral Drugs ØGive Cotrimoxazole

At Home

ØDetermine the appropriate drugs and dosage

for the child’s age or weight. COTRIMOXAZOLE*
(trimethoprim + sulphamethoxazole)
ØTell the mother the reason for giving the Ø Give two times daily for 5 days
drug to the child. Adult Tablet Pediatric Tablet
ØDemonstrate how to measure a dose. AGE or WEIGHT single strength (20 mg trimethoprim
ØWatch the mother practise measuring a dose (80 mg trimethoprim +100 mg
+ sulphamethoxazole)
by herself. 400 mg
ØAsk the mother to give the first dose to her sulphamethoxazole)
child. Birth up to 1 month 1/2*
ØExplain carefully how to give the drug, then (< 3 kg)
label and package the drug. 1 month up to 2 1/4 1
ØIf more than one drug will be given, collect, months (3-4 kg)

count and package each drug separately.

ØExplain that all the oral drug tablets or * Avoid cotrimoxazole in infants less than 1 month of age who are
syrups must be used to finish the course of premature or jaundiced.
treatment, even if the child gets better.
ØCheck the mother’s understanding before
she leaves.

Ø 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 mother’s chest in an upright and extended posture, between her breasts, in Skin to
Skin contact; turn baby’s head to one side to keep airways clear
- Cover the baby with mother’s 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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 COUNSEL THE MOTHER

Ø Teach Correct Positioning and ØAdvise to Give Home Care for the
Attachment for Breastfeeding Young Infant
ØShow the mother how to hold her infant
- with the infant’s head and body straight
- facing her breast, with infant’s nose opposite her Breastfeed frequently, as often and for as long
nipple as the infant wants, day or night, during
- with infant’s body close to her body
- supporting infant’s whole body, not just neck and
sickness and health.Do not give water, other
shoulders. liquids or food.
ØShow 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 her breast, aiming the
infant’s lower lip well below the nipple. In cool weather, cover the infant’s head and
feet and dress the infant with extra clothing.
ØLook for signs of good attachment and effective
suckling. If the attachment or suckling is not good, try
again. Make sure the young infant stays warm at all
times.
ØIf still not suckling effectively, ask the mother to
express breast milk and feed with a cup and spoon in
the clinic.
ØIf able to take with a cup and spoon advise mother to
keep breastfeeding the young infant and at the end Advise mother to wash hands with soap and
of each feed express breast milk and feed with a cup water after defecation and after cleaning the
and spoon . bottom of the baby.
ØIf not able to feed with a cup and spoon, refer to
hospital.

Do not apply anything on the cord and keep

the cord and umbilicus dry.
Ø Teach the mother to treat breast and
nipple problems
• If nipple is sore, apply breast milk for soothing effect and ØAdvise the mother to return immediately if
ensure correct positioning and attachment of the baby. If the young infant has any of these danger
mother continues to have discomfort, feed expressed signs:
breast milk with katori and spoon.
• If breasts are engorged, let the baby continue to suck if • Breastfeeding or drinking poorly
possible. If the baby cannot suckle effectively, help the • Becomes sicker
mother to express milk and then put the young infant
to the breast. Putting a warm compress on the breast • Develops a fever or feels cold to touch
may help. • Fast breathing
• If breast abscess, advise mother to feed from the • Difficult breathing
other breast and refer to a surgeon. If the young infant • Blood in stools
wants more milk, feed undiluted animal milk with
added sugar by cup and spoon.

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 ASSESS AND CLASSIFY THE SICK CHILD
AGE 2 MONTHS UP TO 5 YEARS

CHECK FOR GENERAL DANGER SIGNS

ASK: LOOK: • Not able to drink or

breastfeed
• Is the child able to drink or • See if the child is Or
breastfeed? lethargic or unconscious. • Vomits everything
• Does the child vomit Or
everything? • Convulsions
• Has the child had convulsions? Or
• Lethargic or unconscious

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

ASSESS SIGNS CLASSIFY AS IDENTIFY TREATMENT

THEN ASK ABOUT MAIN SYMPTOMS: • Any general danger SEVERE

DOES THE CHILD HAVE COUGH OR DIFFICULT sign or PNEUMONIA ØGive first dose of cotrimoxazole.
BREATHING? • Chest indrawing. OR VERY
SEVERE DISEASE ØRefer URGENTLY to hospital.
IF YES,
ASK: LOOK :
• For how long? •Count the breaths
CHILD • Fast breathing. ØGive Cotrimoxazole for 5 days.
in one minute.
• Look for chest
indrawing.
} MUST
BE
CALM
PNEUMONIA (2 Pediatric tablet twice daily for a child
2 up to 12 months and 3 tablets twice
daily for a child 12 months up to 5
years.
If the child is: Fast breathing is: ØFollow up in 2 days.
2 months up 50 breaths per
to 12 months minute or more No signs of pneumonia ØAdvise home care for cough or cold.
12 months up 40 breaths per or very severe disease. COUGH OR COLD ØIf coughing for more than 30 days, refer
to 5 years minute or more for assessment.

DOES THE CHILD HAVE DIARRHOEA? Two of the following signs:

ØRefer URGENTLY to hospital
• Lethargic or unconscious
with mother giving frequent
IF YES, LOOK AND FEEL: • Sunken eyes SEVERE sips of ORS on the way.
ASK: for DEHYDRATION
•Look at the child’s general Dehy- • Not able to drink or drinking
condition. dration poorly
• For how
Is the child:
long? • Skin pinch goes back very
Lethargic or unconscious?
Restless and irritable? slowly.
• Is there
blood in
the stool? •Look for sunken eyes. Two of the following signs:
Ø Give fluid and food for some
•Offer the child • Restless, irritable
SOME dehydration (Plan B).
fluid to drink. • Sunken eyes DEHYDRATION Ø Follow-up in 2 days if not
Is the child: Classify
• Drinks eagerly, thirsty improving.
- Not able to drink or Diarrhoea
drinking poorly?
- Drinking eagerly,
• Skin pinch goes back slowly.
thirsty?
Not enough signs to classify as NO Ø Give fluid and food to treat
•Pinch the skin of the abdomen. some or severe dehydration. DEHYDRATION diarrhoea at home (Plan A).
ØFollow-up in 2 days if not
Does it go back: improving
- Very slowly (longer than
2 seconds)?
- Slowly?
and if
diarrhoea .• Diarrhoea for 14 days or SEVERE Ø Refer to hospital.
14 days more. PERSISTENT
or more DIARRHOEA

Ø Give cotrimoxazole for 5 days

and if • Blood in the stool. DYSENTERY (2 Pediatric tablet twice daily
blood for a child 2 up to 12 months
in and 3 tablets twice daily for a
stool child 12 months up to 5 years.
Ø Follow-up in 2 days.
.

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 ASSESS SIGNS CLASSIFY AS IDENTIFY TREATMENT

DOES THE CHILD HAVE FEVER? • Any general danger sign or ØGive first dose of cotrimoxazole.
(BY HISTORY OR FEELS HOT OR
• Stiff neck VERY SEVERE ØGive first dose of antimalarial as per NAMP
TEMPERATURE 37.5°C* OR ABOVE) FEBRILE guidelines after making a smear.
DISEASE ØGive one dose of paracetamol in clinic for
IF YES: high fever.

THEN ASK: LOOK AND FEEL:

• Fever for how • Look or feel for stiff neck. • Fever (by history or feels ØGive antimalarials as per NAMP guidelines
hot or temperature 37.5°C after making a smear.
long?
ØGive one dose of paracetamol in clinic for
• If more than 7 or above).
high fever.
days, has fever MALARIA ØAdvise extra fluids, continue feeding and
been present advise about danger signs.
every day? ØFollow-up in 2 days if fever persists.
ØIf fever is present every day for more than 7
days, refer for assessment.

THEN CHECK FOR MALNUTRITION ØGive Vitamin A.

• Visible severe wasting or SEVERE ØPrevent low blood sugar by breastmilk, other
•Oedema of both feet MALNUTRITION milk /water with sugar ( 4 tsf sugar per cup).Ø
LOOK AND FEEL: Keep the child warm.
ØRefer URGENTLY to hospital
• Look for visible severe wasting.
•Malnutrition grade 2, 3 or 4 VERY Ø Assess and counsel for feeding.
• Look for oedema of both feet. LOW WEIGHT Ø Follow-up in 14 days (If feeding problem,
follow-up in 5 days).
• Determine grade of malnutrition by
plotting weight for age.
• Normal weight for age or NOT VERY Ø If child is less than 2 years old, assess and
Malnutrition grade 1. LOW WEIGHT counsel for feeding.
Ø If feeding problem, follow-up in 5 days.

THEN CHECK FOR ANAEMIA • Severe palmar SEVERE ANAEMIA ØRefer to hospital .
pallor
LOOK AND FEEL:
• Look for palmar pallor. Is it: • Some palmar ANAEMIA ØGive iron folic acid therapy for 14 days.
Severe palmar pallor? Ø Assess and counsel for feeding.
pallor
Some palmar pallor?
• No palmar pallor NO ANAEMIA Ø Give prophylactic iron folic acid if child 6
months or older

THEN CHECK THE CHILD’S IMMUNIZATION, PROPHYLACTIC VITAMIN A & IRON-FOLIC ACID SUPPLEMENTATION STATUS

IMMUNIZATION SCHEDULE
PROPHYLACTIC VITAMIN A PROPHYLACTIC IFA
AGE VACCINE Give one tablet of Pediatric IFA for a
Give a single dose of vitamin A:
Birth BCG + OPV-0 total of 100 days in a year after the child
6 weeks DPT-1+ OPV-1(+ HepB-1)* has recovered from acute illness if :
100,000 IU ( 1 ml) at 9 months with measles
10 weeks DPT-2+ OPV-2(+ HepB-2)*
immunization
14 weeks DPT-3+ OPV-3(+ HepB-3)* ØThe child 6 months of age or older,
200,000 IU ( 2 ml ) at 16-18 months with DPT Booster
9 months Measles + Vitamin A and
200,000 IU ( 2 ml ) at 24 months
16-18 months DPT + OPV + Vitamin A ØHas not recieved Pediatric IFA Tablet
200,000 IU (2 ml ) at 30 months
60 months DT for 100 days in last one year.
200,000 IU (2 ml ) at 36 months
* Hepatitis B if included in the immunization
schedule

ASSESS OTHER PROBLEMS

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 TREAT THE CHILD

Ø Give Cotrimoxazole ØTreat High Fever (> 38.5°C) With Paracetamol

Ø Give a single dose of paracetamol in the clinic
COTRIMOXAZOLE Ø Give 3 additional doses of paracetamol for use at home every 6 hours
(trimethoprim + sulphamethoxazole) until high fever is gone.
Ø Give two times daily for 5 days
ADULT TABLET PEDIATRIC TABLET
80 mg 20 mg PARACETAMOL
AGE or WEIGHT trimethoprim
trimethoprim
+100 mg AGE or WEIGHT TABLET (500 mg)
+ 400 mg sulphamethoxazole
sulphamethoxazole
2 months up to 3 years (4 - <14 kg) 1/4
2 months up to 12
months (4 - <10 kg) 1/2 2
3 years up to 5 years (14 - <19 kg) 1/2
12 months up to 5 years
(10 - 19 kg) 1 3

ØPlan B: Treat Some Dehydration with ORS

Give in clinic recommended amount of ORS over 4-hour period
Ø DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS

AGE* Up to 4 months 4 months up to 12 months up to 2 years up to

12 months 2 years 5 years

WEIGHT < 6 kg 6 - < 10 kg 10 - < 12 kg 12 - 19 kg

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

No Of Cups

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

• If the child wants more ORS than shown, give more.

• For infants under 6 months who are not breastfed, also give 100-200 ml clean water during this period.
Ø 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.
Ø AFTER 4 HOURS:
• Reassess the child and classify the child for dehydration.
• Select the appropriate plan to continue treatment.
• Begin feeding the child .
Ø IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:
• Show her how to prepare ORS solution at home.
• Show her how much ORS to give 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 3 Rules of Home Treatment:
1. GIVE EXTRA FLUID
2. CONTINUE FEEDING
3. WHEN TO RETURN

ØGive Iron Folic Acid therapy ØGive Vitamin A

Ø Give one dose daily for 14 days.
IFA AGE VITAMIN A SYRUP
AGE or WEIGHT PEDIATRIC TABLET 100,000 IU/ml

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

6 months up to 12 months 1 ml
4 months up to 24 months (6 - <12 kg) 1 tablet 12 months up to 5 years 2 ml

2 years up to 5 years (12 - 19 kg) 2 tablets

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 TREAT THE CHILD

ØAdvise 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:
Ø Child becomes sicker
Ø Not able to drink or breastfeed
Ø Fast breathing.
Ø Difficult Breathing
Ø Develops a fever
NOTE: Don’t teach fast breathing, difficult breathing or fever if child already have these signs.

ØPlan 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)

Ø TELL THE MOTHER:
• If the child is exclusively breastfed : Breastfeed frequently and for longer at each
feed. If passing frequent watery stools:
- For less than 6 months age give ORS and clean, preferably boiled, water in
addition 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; ORS
solution, yoghurt drink, milk, lemon drink, rice or pulses-based drink, vegetable soup, green
coconut 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.
Ø TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2 PACKETS OF ORS
TO USE AT HOME.
Ø SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUID
INTAKE:
<2 months 5 spoons after each loose stool.
2 months Up to 2 years 1/4 cup to 1/2 cup after each loose stool.
2 years or more 1/2 cup to 1 cup after each loose stool.
Tell the mother to:
- 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 diarrhoea stops.
2. CONTINUE FEEDING
3. WHEN TO RETURN : ØChild becomes sicker
ØNot able to drink or breastfeed
ØBlood in stool
ØDrinking poorly
ØDevelops a fever
Note: Don’t teach blood in stool or fever, if child already have these signs.

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 COUNSEL THE MOTHER
ØFeeding Recommendations During Sickness and Health
Do you breast feed the child?
ASSESS FEEDING IN ALL How many times in a day?
CHILDREN BELOW 2 YEARS AND Do you breast feed the child at night?
ALSO IN CHILDREN WITH VERY Does the child take any other foods or fluids?
LOW WEIGHT FOR AGE
(Malnutrition grade 2, 3 or 4) OR What foods or fluids?
ANAEMIA. How many times per day?
How large are the servings (katori, teaspoon)?
ASSESS FEEDING: Does the child receive separate serving?
Who feeds the child and how?
Ask if the child’s feeding has changed during this illness?
If yes how?

2 Years and
Up to 6 Months up 12 Months up
Older
6 Months to 12 Months to 2 Years

• Breastfeed as often •Give family

• Breastfeed as often as the child
wants.
• Give one katori serving* at a time
of :
- Mashed roti/ rice /bread/biscuit
mixed in sweetened undiluted milk
OR
- Mashed roti/rice/bread mixed in
•Breastfeed as often as thick dal with added ghee/oil or
the child wants, day
khichri with added oil/ghee. Add
and night, at least cooked vegetables also in the
8 times in 24 hours. servings OR
- Sevian/dalia/halwa/kheer
• Do not give any other prepared in milk or any cereal
foods or fluids not even porridge cooked in milk OR
water - Mashed boiled/fried potatoes or
give one banana/ cheeko/ mango.
__________________________
*3 times per day if breastfed;
5 times per day if not breastfed.
as the child wants. foods at 3
• Offer food from the family pot meals each day.
• Give 11/2 katori serving* at a
time of : • Also, twice daily, give
- Mashed roti/rice/bread mixed in nutritious food between
thick dal with added ghee/oil or meals, such as:
khichri with added oil/ghee. banana/biscuit/ cheeko/
Add cooked vegetables also in mango/ papaya/ egg as
the servings OR snacks
- Mashed roti/ rice /bread/biscuit
mixed in sweetened undiluted
milk OR
- Sevian/dalia/halwa/kheer
prepared in milk or any cereal
porridge cooked in milk OR
- Mashed boiled/fried potatoes
or give at least one banana/
cheeko/ mango.
__________________________
* 5 times per day.

Remember: Remember:
Remember: Remember: • Sit by the side of child and help • Ensure that the child
• Continue breastfeeding • Keep the child in your lap and feed him to finish the serving finishes the serving
if the child is sick with your own hands • Wash your child’s hands with • Teach your child wash
soap and water every time before his hands with soap and
• Wash your own and child’s hands
feeding water every time before
with soap and water every time
feeding
before feeding

* 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.

COUNSEL FOR FEEDING PROBLEMS.

GOOD FEEDING PRACTICES. FEEDING PROBLEMS SOLUTIONS.

(PRAISE THE MOTHER) IDENTIFIED

* * *
* * *
.

9
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 MANAGEMENT OF THE SICK YOUNG INFANT AGE UP TO 2 MONTHS

Name:___________________________ Age: Temperature: °C Date:

ASK: What are the infant’s problems? _______________________________________ Initial visit? _______ Follow-up
Visit?______

CHECK FOR 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):
- 37.5°C or more (or feels hot)?
- Less than 35.5°C ?
▪ See if young infant is lethargic or unconscious
▪ Look at young infant’s movements. Less than normal?

__________________________________________________________________________________________________________________________________
DOES THE YOUNG INFANT HAVE DIARRHOEA? Yes ___ No _
▪ Look at the young infant’s general condition. Is the infant:
• Is there blood in the stool? - Lethargic or unconscious?
- Restless and irritable?
▪ Look for sunken eyes.
▪  Pinch the skin of the abdomen. Does it go back:
- Very slowly (longer than 2 seconds)?
- Slowly
_____________________________________________________________________________________________________________________
THEN CHECK FOR FEEDING PROBLEM
Is 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 INFANT’S 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:

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 TREAT

ØAdvise to Give Home Care for the

Young Infant

Breastfeed frequently, as often and for as long

as the infant wants, day or night, during
sickness and health.Do not give water, other
liquids or food.

In cool weather, cover the infant’s head and

feet and dress the infant with extra clothing.

Make sure the young infant stays warm at all

times.

Advise mother to wash hands with soap and

water after defecation and after cleaning the
bottom of the baby.

Do not apply anything on the cord and keep

the cord and umbilicus dry.

ØAdvise the mother to return immediately if the

young 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

Return for follow up in:

____________________________________________________________

Advise mother when to return immediately.

Give any immunizations needed today: __________________

Counsel the mother about her own health.

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 MANAGEMENT OF THE SICK CHIlD AGE 2 MONTHS UP TO 5 YEARS
Name: __________________________ Age: ___ Weight: _______ kg Temperature: _______ 0C Date:
ASK: What are the child’s problems?_____________________ ________________ Initial visit? ___ Follow-up Visit? ___
ASSESS (Circle all signs present) CLASSIFY
____________________________________________________________________________________________________________________
CHECK FOR GENERAL DANGER SIGNS General danger sign present?
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 child’s general condition. Is the child:
• Is there blood in the stool? Lethargic or unconscious?
Restless and irritable
• Look 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?
________________________________________________________________________________________________________
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 fever
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 ANAEMIA
•Look for palmar pallor.
Severe palmar pallor? Some palmar pallor? No pallor?
______________________________________________________________________________________________________
CHECK THE CHILD’S IMMUNIZATION, PROPHYLACTIC VITAMIN A & IRON-FOLIC ACID STATUS Return for next
Circle immunizations and Vitamin A or IFA supplements needed today. immunization or
_______ ________ _______ ________ ___________ ___ vitamin A or IFA
BCG 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 CHILD’S 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 child’s 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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 14

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