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

Date: _____________________ Childs name:___________________________________________________Age:________________Sex:________Weight:________kg. Temperature:_________ C ASK:What are the childs problems?__________________________________________________________Initial visit:____________Follow-up visit:_____________ ASSESS (Circle all signs present) CLASSIFY CHECK FOR GENERAL DANGER SIGNS GENERAL DANGER NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN SIGNS PRESENT? VOMITS EVERYTHING YES___ NO___ CONVULSIONS 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. Look and listen for stridor. Look and listen for wheeze. DOES THE CHILD HAVE DIARRHEA? YES___ NO___ For how long? _____days Look at the childs general condition. Is the child: Is there blood in the stool? Abnormally sleepy or difficult to awaken? Restless or irritable? Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drink 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 37.5 C or above) YES___ NO___ Decide malaria risk Does the child live in malaria area? LOOK AND FEEL: Has the child visited/travelled or stayed overnight Look or feel for stiff neck in a malaria area in the past 4 weeks? Look for runny nose If malaria risk, obtain a blood smear (+) (Pf) (Pv) (-) (not done) THEN ASK: Look for signs of MEASLES For how long has the child has fever?_____days Generalized rash and If more than 7 days, has the fever present been every day? One of these:cough, runny nose, or red eyes Has the child had measles within the last 3 months? If the child has measles now or within the last 3 months: Look for mouth ulcers. If yes, are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea. ASSESS DENGUE HEMORRHAGIC FEVER ASK: Has the child had any bleeding from the nose or gums or in the vomitus or stool? Has the child had black vomitus or black stool? Has the child had persistent abdominal pain? Has the child had persistent vomiting?

LOOK AND FEEL: Look for bleeding from nose or gums. Look for skin petechiae. Feel for cold and clammy extremities. Check capillary refill. ____ seconds. Perform tourniquet test if child is 6 months or older AND has no other signs AND has fever for more than 3 days.

DOES THE CHILD HAVE AN EAR PROBLEM? YES___ NO___ Is there ear pain? Look for pus draining from the ear. Is there ear discharge? Feel for tender swelling of the ear. If Yes, for how long? _______ days THEN CHECK FOR MALNUTRITION and ANEMIA Look for visible severe wasting. Look for edema of both feet. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low? CHECK THE CHILDS IMMUNIZATION STATUS (Check the immunization already given; circle immunization needed today.) _____ ______ BCG HEP B1 _____ _____ ______ DPT1 OPV1 HEP B2 _____ _____ ________ DPT2 OPV2 MEASLES _____ _____ ______ DPT3 OPV3 HEP B3 CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older Is the child six months of age or older? Yes _____ No_____ Has the child received Vitamin A in the past 6 months? Yes _____ No_____ CHECK FOR DEWORMING STATUS for children 12 months and older Has the child received Albendazole/Mebendazole for the past 6 months? Yes____ No ____ ASSESS THE CHILDS FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years 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 food or fluids?__________________________________________________________________ How many times per day? _____ times. What do you use to feed the child?___________________________ If very low weight for age: How large are the servings? __________________________________________ Does the child receive his/her own serving? _____ Who feeds the child and how? _____________________ During the illness, has the childs feeding changed? Yes _____ No_____ If yes, how? ___________________________________________________ ASSESS CARE FOR DEVELOPMENT: Ask questions about how the mother cares for her child. Compare the mothers answers to the Recommendations for Care and Development for the childs age. How do you play with your child? How do you communicate with your child? ASSESS OTHER PROBLEMS

Return for next immunization on

(Date)

Vitamin A needed today Yes____ No____ Albendazole/Mebendazole needed today? Yes _____ No _____ Feeding problems:

Care and Development problems:

________________________________ ___________________________________ Student

_________________________________ Clinical Instructor Health Center Staff

TREAT Remember to refer any child who has a danger sign and no other severe classification.

Return for follow-up in:___________________________________________ Advise mother when to return immediately. Give any immunizations needed today: _____________________________ Give Vitamin A if needed today: ___________________________________ Feeding advice:_________________________________________________

DOH

Remember to counsel the mother about her own health. She may treatment or referral for her own health problems.

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