The case management process is presented on a series of
charts which show the sequence of steps and provide
information for performing them.
The charts describe the following steps:
Assess the child or young infant
Classify the illness
Identify treatment
Treat the child
Counsel the mother
Give follow-up care
I. Assess the child or young infant
“Assess the child” means
taking a history and doing
physical examination.
II. Classify the illness
“Classify the Illness” means taking a decision on
the severity of the illness
Classifications are not specific disease
diagnoses. Instead, they are categories that are
used to determine treatment
For effectively manage childhood illness, a
color-coded system has been utilized which
represents:
green yellowpink
II. Classify the illness
Color Presentation Classification of Disease Level of Management
Green Mild Home Care
Yellow Moderate Management at the RHU
Pink Severe Urgent Referral
ASSESS AND CLASSIFY THE
SICK YOUNG INFANT
AGE UP TO 2 MONTHS
GREET the mother appropriately and
ask about her baby.
LOOK to see if the infant’s weight and temperature
have been recorded
ASK the mother what the infant’sproblems are
DETERMINE if this is an INITIAL visit or FOLLOW
UP visit for this problem
NAME OF THE CHILD
AGE
WEIGHT
TEMPERATURE
CHILD’S PROBLEMS
INITIAL OR FOLLOW UP VISIT
This assessment step is done forevery sick
young infant
The young infant must be calm and may be
asleep while you assess thefirst seven signs ,
ASK:
Has the infant had convulsions?
Is the infant NOT able to feed?
3. LOOK: See if the infant is convulsing now ?
4. LOOK: Count the breaths in one minute.
Repeat the count if elevated .
60 breaths per minute or more is the cutoff used
to identify fast breathing in a young infant.
5. LOOK: For severe chest indrawing .
Mild chest indrawing is normal
Severe chest indrawing is a sign of
pneumonia
6. LOOK: For nasal flaring.
7. LOOK and LISTEN for grunting.
Grunting is the soft, short sounds a young infant
makes when breathing out..
8. LOOK and LISTEN for wheeze.
Wheeze is a soft musical noise when the young infant
breathes out. Wheeze is mainly due to bronchiolitis or
severe pneumonia in a young infant.
. LOOK and FEEL for bulging fontanelle.
The infant must not be crying. Then look at and
feel the fontanelle. If the fontanelle is bulging
rather than flat, this may mean the young infant
has meningitis.
10. LOOK: For pus draining from the ear .
11. LOOK: to the eye, is it red, swollen and
draining pus ?
12. LOOK at the umbilicus - is it red or draining pus?
Does the redness extend to the skin?
If redness extends to the skin of the abdominal wall, it
is a serious infection.
13. FEEL: Measure temperature (or feel for fever or
low body temperature).
Fever may be the only sign of a serious bacterial
infection. Young infants can also respond to infection
by dropping their body temperature to below 35.5C
(36C rectal temperature)..
14. LOOK: For skin pustules. Are there many or severe
pustules?
Many or severe pustules indicate a serious infection
. LOOK: See if the young infant is lethargic or
unconscious.
A lethargic young infant is not awake and alert when he
should be. He may be drowsy and may not stay awake
after a disturbance. Look to see if the child wakens when
the mother talks or gently shakes the child or when you
clap your hands.
An unconscious young infant cannot be wakened at all.
He does not respond when he is touched or spoken to.
16. LOOK: At the young infant's movements. Are
they less than normal?
An awake young infant will normally move his
arms or legs or turn his head several times in a
minute if you watch him closely.
Classify ALL sick young infants for bacterial
infection.
Compare the infant's signs to signs listed
and choose the appropriate classification.
If the infant has any sign in the top row,
select
POSSIBLE SERIOUS BACTERIAL
INFECTION.
If the infant has any sign in the middle row,
LOCAL BACTERIAL INFECTION.
An infant who has none of the signs is classified as having
“BACTERIAL INFECTION UNLIKELY”.
Select only one classification in this table.
An infant who has none of the signs
is classified as having
“BACTERIAL INFECTION UNLIKELY
CHECK
FOR
SIGNIFICANT JAUNDICE
ASK:
Has the jaundice started in
the first 24 hours after
delivery?
LOOK:
For jaundice. Is it extending
to the palms and soles ?
Classify JAUNDICE
Jaundice started in first 24 hours after
delivery and still present,
OR
Jaundice extending from the body to
palms and soles.
SIGNIFICANT JAUNDICE
and the infant should be URGENTLY
referred to the hospital
ASSESS DIARRHEA
ASK: DOES THE YOUNG INFANT HAVE
DIARRHEA
IF YES, assess and classify the young infant’s
diarrhea using the DIARRHEA
Assessment
ASK
Does the child have diarrhea? For 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 awaken?
◦ Restless or 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?
SIGNS CLASSIFY AS TREATMENT
• If the child has no other severe
Two of the following signs: SEVERE DEHYDRATION classification: give fluid for severe
dehydration (OR)
•abnormally sleepy or difficult
• If child also has other severe
to awaken classification, refer urgently to hospital
•sunken eyes with mother giving frequent sips of ORS
on the way. Advise mother to continue
•not able to drink or drinking breastfeeding- If child is 2 years old and
poorly older and there is cholera in your area,
give antibiotic for cholera
•skin pinch goes back very
slowly
• give fluid and food for some
Two of the following signs: SOME DEHYDRATION dehydration
•restless, irritable • if child has also severe classification,
refer urgently to hospital with mother
•sunken eyes giving frequent sips of ORS on the way.
Advise mother to continue breastfeeding
•drinks eagerly, thirsty
• advise mother when to return
•skin pinch goes back slowly immediately
• follow up in 5 days if not improving
•not enough signs to classify as NO DEHYDRATION •give fluid and food to treat diarrhea at
home
some or severe dehydration • advise mother when to return
immediately
• follow up in 5 days if not improving
Severe Dehydration
DIARRHEA
If DIARRHEA for14 days or more
that there is only one possible classification for
persistent diarrhoea are classified as
SEVERE,
PERSISTENT DIARRHEA
And if BLOOD in stool
Young infants with blood in the stool are classified as
severely ill and are referred urgently
CHECK FOR FEEDING PROBLEM
OR LOW WEIGHT
ForALL sick young infants check for signs of
possible bacterial infection, Ask about Diarrhea, then
ASK:
Is there any difficulty in feeding ?
Is the infant breastfed?
If yes
How many times in 24 hours?
Is the infant breastfed during night?
Does the infant receive any other
foods or drinks?
If yes, how often?
4. ASK: What do you use to feed
the infant? a feeding bottle? or
cup?.
5. LOOK: Determine weight for
age.
Use a weight for age chart to
determine if the infant is low
weight for age.
Remember that the age of a young infant is
usually stated in weeks, but the Weight for Age
chart is labeled in months.
In newborn: determine birth weight.
Look for ulcers or white patches in the mouth
(thrush).
CLASSIFY the infant’s nutritional status
using the classification table for “FEEDING
PROBLEM OR LOW WEIGHT”
1. NOT ABLE TO FEED -
POSSIBLE SERIOUS BACTERIAL INFECTION
This infant has a life-threatening problem and requires immediate
attention.
Not able to feed, OR
No attachment at all, OR
No suckling at all.
2. FEEDING PROBLEM OR LOW WEIGHT
This includes infants who are low
weight for age or infants who have
some sign that their feeding needs
improvement
3. NO FEEDING PROBLEM
HOW TO ASSESS BREASTFEEDING
: Has the infant breastfed in the previous hour
Good Positioning :
nfant's neck is straight or bent slightly back,
Infant's body is turned towards the mother,
Infant's body is close to the mother, and
Infant's whole body is supported.
Is the infant able to attach ?
Chin touching breast (or very close)
Mouth wide open
Lower lip turned outward
More areola visible above than below the mouth
Is the infant suckling effectively
3.5-CHECK THE YOUNG INFANT'S
IMMUNIZATION STATUS
3.6-ASSESS OTHER PROBLEMS
