INTEGRATED MANAGEMENT OF CHILD HEALTH (IMCI) 1

SICK CHILD
AGE 2 MONTHS UP TO 5 YEARS

ASSESS AND CLASSIFY THE SICK CHILD TREAT THE CHILD, continued Egyptian
Give Extra Fluid for Diarrhoea
MOHP WHO unicef USAID
Assess, Classify and Identify Treatment
Check for General Danger Signs ..................................... 2 and Continue Feeding
Then Ask About Main Symptoms: SICK YOUNG INFANT
Does the child have cough? ............................................ 2 Plan A: Treat Diarrhoea at Home ............................ 13
Does the child have diarrhoea? ....................................... 3 Plan B: Treat Some Dehydration with ORS ............. 13 AGE UP TO 2 MONTHS
Check for throat problem ....................................................... 4 Plan C: Treat Severe Dehydration Quickly .............. 14 ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT
Does the child have an ear problem? ............................... 4 Assess, Classify and Identify Treatment
Does the child have fever?.............................................. 5 Check for Possible Bacterial Infection .............................................. 24
Classify fever ................................................................. 5 Check for jaundice...........................................................................25
Classify measles ..................................................... 5 Give Follow-up Care Then ask: Does the young infant have diarrhoea? .......................... 26
Then Check for Malnutrition and Anaemia ....................... 6 Pneumonia ............................................................... 15 Then Check for Feeding Problem or Low Weight ............................ 27
Then check for Developmental Status……………………. Cough or Cold - Wheeze ......................................... 15 Then Check the Young Infant’s Immunization Status ...................... 28
Then Check the Child’s Immunization and Dysentery ................................................................. 15 Assess Other Problems ................................................................... 28
Vitamin A supplementation Status ............................ 7 Persistent Diarrhoea ................................................ 16
Assess Other Problems ................................................... 7 Fever - Possible Bacterial Infection and Treat the Young Infant and Counsel the Mother
Fever-Bacterial Infection Unlikely ..................... 16 Intramuscular Antibiotics .................................................................. 29
TREAT THE CHILD Acute Ear Infection .................................................. 16 To Treat Convulsing young infant see TREAT THE CHILD Chart ... 30
Measles with Eye or Mouth Complications .............. 16 To Treat Diarrhoea, See TREAT THE CHILD Chart ........................ 30
Give pre-referral treatment at clinic Measles ................................................................... 17 Immunize Every Sick Young Infant .................................................. 30
Intramuscular antibiotic………………………………….. Feeding Problem ..................................................... 18 Treat Local Infections at Home ........................................................ 30
Treat convulsing child with Sodium valproate …….. Anaemia ................................................................... 17 Correct Positioning and Attachment for Breastfeeding .................... 31
Moderate Malnutrition , ........................................... 17 Home Care for Young Infant ............................................................ 31
Teach the Mother to Give Oral Drugs at Home Stunting ………………………………………………...17 Teach the mother to express breast milk if indicated ………….…....32
Overweight ……………………………………………..18 Teach the mother to feed by cup ……………………………………..32
Oral Antibiotic ............................................................ 8 Teach the mother how to keep low birth weight warm………..…….32
Paracetamol ............................................................... 9 COUNSEL THE MOTHER
Vitamin A ................................................................... 9 Give Follow-up Care for the Sick Young Infant
Iron ............................................................................. 9 Food Jaundice, no jaundice …………………………………………………..33
Multivitamin/ mineral supplement .............................. 9 Assess the Child’s Feeding ..................................... 19 Diarhea……………………………………………………..…………….33
Zinc.............................................................................9 Feeding Recommendations ..................................... 20 Local Bacterial Infection ................................................................... 34
Teach the Mother to Treat Counsel About Feeding Problems ........................... 21 Bacterial Infection Unlikely ............................................................... 34
Local Infections at Home Fluid Feeding Problem .............................................................................. 35
Treat Eye Infection with Tetracycline Eye Ointment 10 Increase Fluid During Illness ................................... 22 Low Weight....................................................................................... 35
Dry the Ear by Wicking ............................................ 10 Thrush or ulcer ................................................................................ 35
Treat Mouth Ulcers and Thrush ............................. 10 When to Return
Child Growth Standards
Soothe the Throat, Relieve the Cough with Advise the Mother When to
Weight - For- age Boys………………………………………..………..36
a Safe Remedy .................................................. 10 Return to Health Worker.................................... 22
Weight - For- age Girls……………………………….………..………..37
Length / height - For- age Boys………………………….……..….…..38
Give These Treatments in Clinic Only Counsel the Mother About
Length / height - For- age Girls………………………….……...….…..39
Her Own Health ............................................................ 23
Treat Wheezing ...................................................... 12 Weight - For– Length Boys( birth– 2 years ) …………………..…….40
Prevent Low Blood Sugar ........................................ 12 Weight - For– height Boys( 2 years – 5 years) … …...………...….41
An antibiotic For Streptococcal Sore Throat ............ 12 Weight - For– Length girls( birth– 2 years ) …………… …….…..42
Weight - For– height girls ( 2 years– 5 years ) ………...……. ….…43
BMI - For- age Boys………………………………………..…...……….44
BMI - For- age Girls………………………………………..…………….45
 2

ASSESS AND CLASSIFY THE SICK CHILD

AGE 2 MONTHS2 UP TO 5 YEARS
ASSESS IDENTIFY
CLASSIFY
ASK THE MOTHER WHAT THE CHILD’S PROBLEMS ARE TREATMENT
 Determine if this is an initial or follow-up visit for this problem.
- if follow-up visit, use the follow-up instructions on TREAT THE CHILD chart.
- if initial visit, assess the child as follows:

CHECK FOR GENERAL DANGER SIGNS SIGNS CLASSIFY AS TREATMENT

(Urgent pre-referral treatments are in bold print.)

ASK: LOOK:  Any general danger VERY Treat convulsions if present now.
 Is the child able to drink or breastfeed?  See if the child is lethargic or unconscious.
sign. SEVERE Complete assessment immediately.
 Does the child vomit everything?  See if the child is convulsing now. DISEASE Give first dose of an appropriate antibiotic.
 Has the child had convulsions in the Treat the child to prevent low blood sugar.
Refer URGENTLY to hospital*.

THEN ASK ABOUT MAIN SYMPTOMS:

Does the child have cough or difficult breathing?
IF YES,ASK: LOOK AND LISTEN:  Any general danger sign OR 
Classify Stridor OR SEVERE Give first dose of an appropriate antibiotic.
 For how long?  Count the breaths in one
COUGH or  Chest indrawing PNEUMONIA Treat wheezing if present.
minute. CHILD DIFFICULT (If chest indrawing and OR VERY Treat the child to prevent low blood sugar.
 Look for chest indrawing. MUST BREATHING wheeze go directly to”Treat
SEVERE Refer URGENTLY to hospital.*
 Look and listen for stridor. BE Wheezing” till 3 times if
CALM needed then reassess after DISEASE
 Look and listen for wheeze

 Fast breathing Give an appropriate antibiotic for 5 days.

Treat wheezing if present.
(If wheeze, go directly to PNEUMONIA If coughing more than 14 days, refer for
“Treat Wheezing” till 3 assessment.
If the child is: Fast breathing is: times if needed then Soothe the throat and relieve the cough with a
2 months up 50 breaths per reassess after treatment). safe remedy.
to 12 months minute or more Advise mother when to return immediately.
12 months up 40 breaths per
No signs of pneumonia or NO PNEUMONIA Treat wheezing if present.
very severe disease. COUGH OR If coughing more than 14 days, refer for
(If wheeze, go directly to COLD assessment.
“Treat Wheezing” ). Soothe the throat and relieve the cough with a
safe remedy.
Advise mother when to return immediately.
Follow up in 2 days if wheezing.
Follow-up in 5 days if not improving

ASSESS AND CLASSIFY

 3
Does the child have diarrhoea? Two of the following signs: If child
 has no other severe classification:
 Lethargic or unconscious. - Give fluid for severe dehydration (Plan C).
IF YES, ASK: LOOK AND FEEL: for OR
 Sunken eyes.
DEHYDRATION SEVERE
 Not able to drink or If child also has another severe classification:**
 For how long?  Look at the child’s general DEHYDRATION - Refer URGENTLY to hospital with mother
drinking poorly.
 Is there blood condition. giving frequent sips of ORS on the way.
Is the child:  Skin pinch goes back very
in the stool? Advise the mother to continue breastfeeding.
Lethargic or unconscious? slowly.
Restless and/or irritable?
Two of the following signs:  Give fluid and food for some dehydration (Plan B).
 Look for sunken eyes.  If child also has a severe classification:
 Restless, irritable. SOME - Refer URGENTLY to hospital with mother
 Offer the child fluid. Is the Classify  Sunken eyes. giving frequent sips of ORS on the way.
DEHYDRATION
child: DIARRHOEA  Drinks eagerly, thirsty. Advise the mother to continue breastfeeding..
Not able to drink or  Skin pinch goes back Give Zinc Syrup for 14 days.
drinking poorly? slowly.  Advise mother when to return immediately.
Drinking eagerly, thirsty?  Follow-up in 5 days if not improving.

 Pinch the skin of the abdomen. Not enough signs to classify NO  Givefluid and food to treat diarrhoea at home (Plan
Does it go back: as some or severe DEHYDRATION A).
Very slowly (longer than 2 dehydration. Give Zinc Syrup for 14 days.

seconds)?  Advise mother when to return immediately.
Slowly?

 Dehydration present. SEVERE  Treatdehydration before referral unless the

and if diarrhoea
PERSISTENT child has another severe classification.
14 days or more
DIARRHOEA Referal to hospital.

 No dehydration.  Advise the mother on feeding a child

PERSISTENT  Give multivitamin, mineral supplement including
DIARRHOEA zinc for 14 days
 Advise mother when to return immediately.
 Follow-up in 5 days.

 Blood in the stool. Treat

 for 5 days with an oral antibiotic
and if blood DYSENTERY recommended for Shigella.
in stool  Advise mother when to return immediately.
Follow-up in 2 days.

3
 4

4
Check for throat problem  fever AND 
Two of the following : Give appropriate antibiotic..
ASK: LOOK AND FEEL: Soothe the throat with a safe remedy.
 Does the child have  Feel for enlarged tender lymph
Classify Red (congested) throat
THROAT White or yellow exudate STREPTOCOCCA Give paracetamol for pain.
fever? node(s) on the front of the neck.
(by history or feels hot or  Look for red (congested) throat
PROBLEM on the throat or tonsils. L SORE THROAT Advise mother when to return immediately.
Follow up in 5 days if not improving.
temperature 37.5 C or  Look for white or yellow exudate Enlarged tender lymph
more) on the throat and tonsils node(s) on the front of the
Does the child have sore  Sore throat OR NON Soothe the throat with a safe remedy.
throat?  Not enough signs to STREPTOCOCCAL Give paracetamol for pain.
calssify as streptococcal SORE THROAT Advise mother when to return immediately.
sore throat Follow up in 5 days if not improving.

 No throat signs or NO Continue assessment of the child.

symptoms THROAT

Does the child have an ear problem?  Tender swelling behind 

Give first dose of an appropriate antibiotic.
the ear. MASTOIDITIS Give first dose of paracetamol for pain.
IF YES, ASK: LOOK AND FEEL: Treat the child to prevent low blood sugar.
Classify
 Refer URGENTLY to hospital.
EAR
Is there agonizing ear Look for pus draining from the PROBLEM
pain? ear.  Agonizing ear pain OR Give an antibiotic for 10 days.

Is there ear Feel for tender swelling behind Pus is seen draining from ACUTE EAR Give paracetamol for pain.
discharge? the ear. the ear and discharge is INFECTION Dry the ear by wicking.
If yes, for how long? reported for less than 14 Advise mother when to return immediately.
 Follow-up in 5 days.
 Pus is seen draining from Dry the ear by wicking.

the ear and discharge is CHRONIC EAR Refer to ENT specialist.
reported for 14 days or INFECTION
more.

 No ear pain AND NO EAR Advise mother to go to ENT specialist for

No pus seen draining from INFECTION assessment.
the ear.
Does the child have fever?
(by history or feels hot or temperature 37.5°C * or above) 5
Any general danger sign  Give first dose of an appropriate antibiotic.
IF YES, ASK: LOOK AND FEEL: Classify OR VERY SEVERE Treat the child to prevent low blood sugar.
FEVER Stiff neck FEBRILE Give one dose of paracetamol in clinic for

Look or feel for stiff neck. DISEASE fever
 For how long? 

An apparent bacterial paracetamol for fever (38°C or above).

 If more than 5 days, has FEVER-

Give
fever cause of fever present Treat apparent causes of fever.
e.g. POSSIBLE Advise mother when to return immediately.
been present every day? BACTERIAL
- Pneumonia  If fever is present every day for more than 5 days,
- Dysentery INFECTION refer for assessment.

- Streptococcal sore  Follow-up in 2 days if fever persists.
 Look for signs of MEASLES
throat
 Has the child had - Acute ear infection
measles within the last 3  Generalized rash and
- Other apparent
months?
 One of these: cough,
No apparent bacterial Give paracetamol for fever (38°C or above).
runny nose, or red eyes. FEVER-
cause of fever Advise mother when to return immediately.
BACTERIAL
 If fever is present every day for more than 5 days,
INFECTION
refer for assessment.
UNLIKELY
 
 Follow-up in 2 days if fever persists.
If the child has measles  Look for mouth ulcers.
now or within the last 3 Are they deep and Any general danger sign 
Give first dose of an appropriate antibiotic.
months: extensive? OR Treat the child to prevent low blood sugar.
Clouding of cornea OR SEVERE If clouding of the cornea or pus draining
Look for pus draining from if MEASLES
Deep or extensive mouth
COMPLICATED from the eye, apply tetracycline eye ointment.
the eye. now or within MEASLES
ulcers OR Give Vitamin A.
last 3 months,
Look for clouding of the Measles now AND Refer URGENTLY to hospital.
cornea. Classify

Pusdraining from the eye Give paracetamol for fever (38°C or above).
OR MEASLES WITH If pus draining from the eye, treat eye infection
Mouth ulcers. EYE OR MOUTH with tetracycline eye ointment.
COMPLICATIONS* Give Vitamin A.
*** If mouth ulcers, treat with gentian violet.
Advise mother when to return immediately.


Measles now or within the Give paracetamol for fever (38°C or above).
last 3 months AND Give Vitamin A.
None of the above signs. MEASLES Advise the mother when to return immediately.
Follow- up in 2 days if not improving.

* These temperatures are based on axillary temperature.

** Other apparent causes of fever include cellulitis, abscess, boil. Or urinary tract infections
*** Other important complications of measles - stridor, diarrhoea, ear infection, and malnutrition - are classified in other 5
 6
 Visible severe wasting
OR
THEN CHECK FOR MALNUTRITION AND ANAEMIA


 Oedema of both feet. OR SEVERE ACUTE  Give Vitamin A.

movements at all  W/L.H or W/A below –3 Z  Treat the child to prevent low blood sugar..
score  Refer URGENTLY to hospital.
OR 6 MALNUTRITION

Classify  W/L. H or W/A between –3 MODERATE  Assess the child`s feeding and counsel the mother
and – 2 Z score ACUTE  Give multivitamin syrup .
LOOK AND FEEL: ACUTE
OR MALNUTRITION  Give Vitamin D since birth up to 30 months.
 Look for visible severe wasting. MALNUTRITIO  MUAC from 115 - 125 mm
 Advise mother when to return immediately.
 Follow-up in 30 days
Look and feel for oedema of both feet
 Determine weight for length/height (W /L..H), W/L.. H or W/A and –2 Z NO ACUTE  Give Vitamin D since birth up to 30 months
score or above MALNUTRITION  Praise caregiver, assess child’s feeding and counsel
 Determine W/A , if not height measurement scale the mother accordingly.
OR
 Determine Length/ height for age (L/HFA) MUAC 125 mm or more
and no other signs of
 Determine body mass index (BMI)
 Measure mid upper arm circumference (MUAC), if
L/H/ A below -3 Z score SEVERE STUNTING Refer for further assessment
no weight or height measurement scale.
L/H/A between –3 and–2 Z score STUNTING  Investigate to exclude other causes, if available.
Classify  Assess the child feeding and counsel the mother
STUNTING  Counsel the mother on sanitation and hygiene
 Give mebendazole biannually.
 Give zinc for 30 days.
 Give multivitamin for 30 days.
 Advise mother when to return immediately.
 Follow up in 30 days .
L/H/A -2 Z score or more NO STUNTING · Praise caregiver, assess child’s feeding and counsel
accordingly

BMI above + 3 Z score OBESITY  Assess the child feeding and counsel the mother
Classify  Assess the child’s life style and counsel the mother
 Refer for further assessment
OBESITY
BMI between +3 and + 2 Z OVERWEIGHT  Assess the child feeding and counsel the mother
score  Assess the child’s life style and counsel the mother
 Follow up in 30 days
BMI + 2 Z score or below NO OBESITY  Praise the mother, assess child feeding and counsel
LOOK :
 Look for palmar pallor and mucous membrane pallor Severe palmar and / or SEVERE  Treat the child to prevent low blood sugar
mucous membrane pallor ANAEMIA
 Refer URGENTLY to hospital
Is it:
Some
palmar and / or ANAEMIA  Give Iron daily for 14 days.
 Severe palmar pallor and / or mucous membrane Classify mucous membrane pallor  if family history of chronic hemolytic anemia don’t
pallor? ANAEMIA give iron & refer for assessment
 Some palmar pallor and / or mucous membrane  Advise mother when to return immediately.
pallor?
 Follow-up in 14 days.
 No palmar or mucous NO ANAEMIA if child is aged 6 - 30 months, give one dose of Iron
membrane
STUNtINGpallor weekly.
if family history of chronic hemolytic anemia don’t
give iron & refer for assessment
Praise caregiver, assess child’s feeding and counsel
 7

Then, Check for Status of Child Development

Child development Milestones
What most children should do at this age:

2 months 4 months 6 months 9 months 12 months

Holds head up when  Holds head steady.  Rolling over in all  Pulls up to stand.
 Holds a toy and direc ons  Sits unsupported.
pushing up on tummy.  Reaches to and trans‐  Explores things in differ‐
 Brings hands to shake it.  Tries to get things ent ways like shaking,
mouth.  Begins to babble. that are in reach. fers objects or food
banging or throwing, and
 Watches things as  Moves both eyes in  Responds to sounds from one hand to the
puts things in a container
all direc ons by making sounds or other or to mouth
they move.  Makes a lot of differ‐ and gets things out.
 Responds to loud  Turns head to vowels.  Points with finger
sounds. sounds  Recognizes familiar ent sounds like
 Says single words like
 Smiles at people  Copies facial expres‐ faces. “mamama”, “bababa”
“mama”or dada”.
sions (smiling, frown‐  Responds to own
ing). name  Plays games like “peek ‐a
‐boo
18 months 24 months 36 months 48 months 59 months
 Stands and Walks Walks steadily. Walks up and down‐ Runs steadily.
· Builds a tower of 4 stairs alterna ng  Hops and Skips.
alone.  Holds a pen and  Uses a fork and a spoon.
 Drinks from a cup . blocks or more. steps. draws a person.
· Uses two‐ word sen‐  Does a puzzle with 3  Tells story of an event  Pronounces properly,
 Says several single tence (like “want wa‐ or 4 pieces. speaks in complete sen‐
new words. that happened (like go‐
 Points to show some‐ ter”).  Carries on conversa‐ ing to the market). tences.
one what he wants. · Names items in a pic‐ on saying two or  Names some colours  Understands concepts
ture‐book (cat, bird, three sentences. such as colors, shapes,
 Points to one body dog).  Dresses and un‐
and some numbers. me.
part. · Knows what to do  Plays with other chil‐  Can count 10 things or
dresses self with help.
 Knows ordinary with common things  Understands the
dren. more.
things at home (brush, phone, spoon). concept of “mine”,  Feeds and dresses self
“his” and “her”.
(telephone, brush). without help.
 8

Check for Child Development Status

If the child did not achieve two DEVELOPMENTAL · Refer to paediatrician for further
or more of developmental mile- DELAY
stones of his/ her age .
assessment and management.
·

ASK AND LOOK FOR

CLASSIFY If the child did not achieve one POSSIBLE DEVELOP- - Encourage the family to do extra play
DEVELOPMENTAL MILESTONES according DEVELOP- developmental milestones MENTAL DELAY and communication activities with the child
to child’s age in the development milestone MENTAL - Follow—up in 7 days
table (Page 7) DELAY -Inform the caregiver about well-child visit,

None of the above NO DEVELOPMENTAL - Praise the mother.

DELAY - Advice caregiver on appropriate play and
communication activities with the child
and praise.
-- Inform the caregiver about next well-

Then, check for hearing and visual impairment Refer the child to a specialist for
One developmental milestone further assessment
HEARING IMPAIRMENT
related to hearing not
achieved
CLASSIFY
ASK AND LOOK FOR VISUAL /
HEARING One developmental milestone Refer the child to a specialist for
DEVELOPMENT MILESTONES (bold under-
IMPARIMENT Related to vision not achieved VISUAL IMPAIRMENT further
lined) according to child’s age in the develop-
ment milestone table (Page 7) assessment.

None of the above Praise the mother

NO HEARING OR VISUAL Counsel on play and communicate
IMPAIRMENT

ASSESS FOR AUTISM, If no developmental delay and NO hearing OR visual impairment.

ASK AND LOOK for RED FLAG SIGNS:
•There are Siblings with autism Any red flag sign AUTISM Refer to a specialist for further as-
CLASSIFY
• The child has regression of any language or sessment
AUTISM None of the Red Flag signs NO AUTISM Counsel on future milestones
social skills at any age.
Counsel the mother on play and
The child makes repetitive movements with ob- communicate
jects, or repetitive body movements , or repeti-
tive sounds
 ASSESS PLAY AND COMMUNICATE, for all children in the absence of urgent referral
Observe , Ask and Look
9
Ask questions about the child’ play and communicate. Compare the mother’s answers to the Play and communicate
Recommendations for the child’s age in the box on next page:

* How do you play with your young infant? ——————-What are the available toys for the young infant?
Not play :————- Why:———-

* How do you communicate with your young infant? How do you make the child smile ? ——————————
Not communicate ————— Why: ———————-

THEN CHECK THE CHILD’S IMMUNIZATION AND VITAMIN A, VITAMIN D, AND IRON
SUPPLEMENTATION STATUS
AGE VACCINE
At birth OPV (zero dose) BCG HBV - zero
IMMUNIZATION 2 months dose VITAMIN A 9 months 1st dose of vitamin A ( 100,000 IU)
SCHEDULE: 4 months OPV-1 PENTA-1 SUPPLEMENTATION 18 months 2nd dose of vitamin A ( 200,000 IU)
6 months OPV-2 PENTA-2 SCHEDULE:
9 months OPV-3 PENTA-3
12 months OPV-4
18 months OPV-5 MMR-1

VITAMIN D SUPPLEMENTATION SCHEDULE: IRON SUPPLEMENTATION SCHEDULE:

Since birth up to 30 months daily dose of 400 IU Since 6 months—30 months: Weekly dose of iron syrup dose according to child’s
weight (sww iron dosage table in Treat section)

ASSESS OTHER PROBLEMS : Assess other complaints and any other problem you identify during examination
 IDENTIFY AND TREAT THE SICK CHILD
10 10
AGE 2 MONTHS UP TO 5 YEARS

GIVE PRE-REFERRAL TREATMENT IN

CLINIC ONLY Treat a Convulsing Child With Sodium
Valproate
Explain to the mother why the drug is given.
 Manage the Airway
Turn the child on his or her side to avoid aspiration

Determine the dose appropriate for the child’s weight (or age).
 Do not insert anything in the mouth.

If the lips and tongue are blue, open the mouth and make sure the airway is clear.

Use a sterile disposable syringe. Measure the dose accurately.
 If necessary, remove secretions from the throat through a catheter inserted through the

nose.
Give the drug as an intramuscular injection.

 Give Sodium Valproate Rectally
Dilute sodium valproate solution (200 mg/ml) 1:7 with tap water.

Give An Intramuscular Antibiotic Draw up the dose of sodium valproate into a small syringe. Then remove the needle.
Attach a piece of nasogastric tubing to the syringe if possible.
FOR CHILDREN BEING REFERRED URGENTLY: Insert 4 to 5 cm of the tube or the tip of the syringe into the rectum and inject the
Give first dose of intramuscular Cefotaxime and refer child urgently to hospital. Dilution of different forms of Sodium Valproate to have a solution of 25 mg/ml concentra-
tion
IF REFERRAL IS NOT POSSIBLE: Concentration 57.6 mg/ml 200 mg/ml 300 mg/ml 200 mg/5 ml
Repeat Cefotaxime injection every 12 hours for 5 days.
Then change to an appropriate oral antibiotic to complete 10 days of treatment. Dilution 1:1 (add 1 ml tap 1:7 (add 7 ml tap 1:11 (add 11 ml (Add 3 ml of tap
water to every water to every tap water to water to evert 5
ml of syrup) ml of syrup) every ml of syr- ml water)
up)

Cefotaxime SODIUM VALPROATE

Dose: 50 mg per kg AGE or WEIGHT GIVEN RECTALLY
AGE or WEIGHT Add 5.0 ml sterile water to vial containing 25 mg/ml Solution
1000 mg = 5.6 ml at 180 mg/ml
Birth up to 4 months 4 ml
2 months up to 4 months (4 - < 6 kg) 1.5 ml = 270 mg
4 months up to 12 months 6 ml
4 months up to 9 months (6 - < 8 kg) 2.0 ml = 360 mg
12 months up to 3 years 10 ml
9 months up to 12 months (8 - < 10 kg) 3.0 ml = 540 mg
3 years up to 5 years 13 ml
12 months up to 3 years (10 - < 14 kg) 4.0 ml = 720 mg
IF High Fever, Lower the Fever
3 years up to 5 years (14 - 19 kg) 5.0 ml = 900 mg Sponge the child with room temperature water sodium valproate solution.
Treat the child to prevent low blood sugar Hold buttocks together for a few

TREAT
 11

Treat Wheezing Treat the Child to Prevent Low Blood Sugar

 Children with wheezing and If the child is able to breastfeed:
GENERAL DANGER SIGN Give one dose of rapid acting
OR STRIDOR bronchodilator and refer immediately Ask the mother to breastfeed the child.

Children with wheezing and If the child is not able to breastfeed but is able to swallow:
NO GENERAL DANGER SIGN Give rapid acting bronchodilator up
Give expressed breastmilk or
to 3 times and AND NO STRIDOR but having if needed and reassess the
a breastmilk substitute.
child 15 to 20 fast breathing and/or chest indrawing minutes
If neither of these is available, give sugar water.
apart , then reassess
Give 30-50 ml of milk or sugar water before departure.

To make sugar water: Dissolve 4 level teaspoons of sugar

IF:
(20 grams) in a 200-ml cup of clean water.
- CHEST INDRAWING Treat for SEVERE PNEUMONIA
(Refer)
If the child is not able to swallow:
PERSISTS
Give 50 ml of milk or sugar water by nasogastric tube.
- FAST BREATHING Treat for PNEUMONIA
if nasogastric tube is not available or you are not trained to use nasogastric tube
ALONE - Give further dose of rapid
give 1 teaspoon of sugar moistened with one or two drops of water sublingually and
acting bronchodilator
repeat the dose every 20 minutes.
- Give inhaled oral salbutamol for 5 days

- NO FAST BREATHING Treat for COUGH OR COLD and give

inhaled or oral salbutamol for 5 days.

CHILDREN WITH WHEEZING Give rapid acting bronchodilator Give An Antibiotic For Streptococcal Sore Throat
RAPID ACTING ORAL SALBUTAMOL
BRONCHODILATOR Three times daily  1st line antibiotic : a single dose of intramuscular benzathine penicillin
for 5 days
 2nd line antibiotic Amoxicillin ( 80mg /kg/day divided in two doses) for 10 days (see
Nebulized 0.5ml Salbutamol AGE or WEIGHT 2 mg / 5 ml syrup dosage table page 12)
Salbutamol plus 2 months up to 4
5 mg/ml 2.0ml normal saline months (4 - <6 kg) 1.0 ml
Metered Dose 4 months up to 12
Inhaler (MDI) with months (6 - <10 kg) 2.0 ml Give Mebendazole for stunting
spacer device 2-3 puffs 12 months up to 3 Give a dose of 500 mg mebendazole in clinic if children 1 years of age or
(100 mcg/dose) years (10 - <14 kg) 2.5 ml older. This dose is to be given annually.
3 years up to 5
years 5 ml
(14 - 19kg)
 TREAT THE CHILD
CARRY OUT THE TREATMENT 12
STEPS IDENTIFIED ON
THE ASSESS AND CLASSIFY CHART

Give an Appropriate Oral Antibiotic



FOR PNEUMONIA (give for 5 days), OR ACUTE EAR INFECTION (give for 10 days):
TEACH THE MOTHER TO GIVE FIRST-LINE ANTIBIOTIC: AMOXYCILLIN

ORAL DRUGS AT HOME SECOND-LINE ANTIBIOTIC: COTRIMOXAZOLE

AMOXYCILLIN COTRIMOXAZOLE*
Follow the instructions below for every oral drug to be given at home. (dose of 80 mg/kg/day) (trimethoprim + sulphamethoxazole)
Also follow the instructions listed with each drug’s dosage table. 
Give two times daily for 5 or 10 Give two times daily for 5 or 10 days
days
 -Determine the appropriate drugs and dosage for the child’s age or SYRUP SYRUP
AGE or WEIGHT 40 mg trimethoprim
weight.
250 mg +200 mg
per 5 ml sulphamethoxazole
- Tell the mother the reason for giving the drug to the child. per 5 ml
2 months up to 4 months (4 - <6
- Demonstrate how to measure a dose. 4 ml per dose 2.5 ml per dose
kg)
4 months up to 12 months
- Watch the mother practise measuring a dose by herself. (6 - <10 kg)
7 ml per dose 5 mlper dose

12 months up to 3 years 10 - 14
- Ask the mother to give the first dose to her child. 10 ml per dose 5 mlper dose
kg)
- Explain carefully how to give the drug, then label the package the 3 years up to 5 years (14-19 kg)
13 ml per dose 7.5 ml per dose
drug.

- Explain that all the oral drug syrups must be used to finish the *don’t give cotrimoxazole for a child with past history or family history of G-6PD deficiency.
course of treatment, even if the child gets better.
= Check the mother’s understanding before she leaves the clinic. FOR DYSENTERY:
COTRIMOXAZOLE SYRUP* CEFOTAXIME (1000g)
(trimethoprim + sulphamethoxazole ) Dose: 25 mg/Kg/dose twice
Give two times daily for 5 days daily
AGE or WEIGHT SYRUP: Add 5ml sterile water to vial
40 mg trimethoprim + 200 mg containing 1000 mg = 5.6 ml at
sulphamethoxazole per 5 ml 180 mg/ml
2 months up to 4 months
(4 - <6 kg) 2.5 ml 0.7 ml
4 months up to 12 months
(6 - <10 kg) 5.0 ml 1 ml
12 months up to 3 years
(10 - <14 kg) 5 ml 1.7 ml
3 years—5 years 7.5 ml
(14 -19 Kg 2.4 ml

12 *Don’t give cotrimoxazole for a child with past history or family history of glucose -6-phosphate dehydrogenase deficiency
 13

13
TEACH THE MOTHER TO GIVE ORAL DRUGS AT HOME

Give Paracetamol for Fever (> 38°C) Give Multivitamin / Mineral Supplement
For persistent diarrhoea, give one dose daily 5 ml of multivitamin mineral mixture
or sore throat or Ear Pain for 2 weeks
each 5 ml includes:
Give paracetamol every 6 hours until fever or pain is gone.
Vitamin A 8000 IU
AGE or WEIGHT PARACETAMOL SYRUP
(120 mg / 5 ml) Folate: 100 micrograms
Magnesium: 150 mg
2 months up to 4 months (4 - <6 kg) 2.5 ml Iron: 20 mg
4 months up to 12 months (6 - <10 kg) 5 ml

12 months up to 3 years (10 - <14 kg) 7.5 ml

Give Oral Salbutamol
3 years up to 5 years (14 - 19 kg) 10 ml Give Salbutamol syrup three times daily for 5 days.
AGE or WEIGHT SALBUTAMOL SYRUP
(Salbutamol syrup = 2 mg / 5 ml )

Give Iron 2 months up to 4 months (4 - <6 kg) 1.0 ml

For treatment of anaemia: give one dose daily for 14 days, then reassess. 4 months up to 12 months (6 - <10 kg) 2.0 ml
For Iron supplementation: give one dose per week. 12 months up to 3 years (10 - <14 kg) 2.5 ml
IRON SYRUP 3 years up to 5 years (14 - 19 kg) 5.0 ml
AGE or WEIGHT Iron syrup 30 mg/ 5 ml

2 months up to 4 months (4 - <6 kg) 2.5 ml

4 months up to 12 months (6 - <10 kg) 5 ml

Give Zinc Syrup
For some or no dehydration and stunting .
12 months up to 3 years (10 - <14 kg) 7.5 ml

Zinc Syrup Zinc Syrup

3 years up to 5 years (14 - 19 kg) 10 ml
10 mg per 5 ml 20 mg per 5 ml
One dose daily One dose daily
for 14 days in diarrhea for 14 days in diarrhea
Give Vitamin A 30 days in stunting 30 days in stunting
Give single dose of vitamin A in the clinic.
2 months up to 6 months 5 ml 2.5 ml
AGE VITAMIN A CAPSULES
200 000 IU 100 000 IU 50 000 IU 6 months up to 5 years 10 ml 5 ml
Up to 6 months 1/2 capsule 1 capsule
6 months up to 12 months 1/2 capsule 1 capsule 2 capsules
12 months up to 5 years 1 capsule 2 capsules 4 capsules

Follow the instructions below for every oral drug to be given at home.
Give Oral Vitamin D (140 IU in a drop) Also follow the instructions listed with each drug’s dosage table
 Give Vitamin D 400 IU daily dose since birth up to 30 months

 14


Dry the Ear by Wicking
TEACH THE MOTHER TO TREAT LOCAL Dry the ear at least 3 times daily.
INFECTIONS AT HOME  Roll clean absorbent cloth or soft, strong tissue paper into a wick.
 Place the wick in the child’s ear.
Explain to the mother what the treatment is and why it should be given.  Remove the wick when wet.
 Replace the wick with a clean one and repeat these steps until the ear is dry.
Describe the treatment steps listed in the appropriate box.

Watch the mother as she does the first treatment in the clinic (except remedy for 
Treat Mouth Ulcers with Gentian Violet
cough or sore throat).

Treat the mouth ulcers twice daily.
Tell her how often to do the treatment at home.  Wash hands.
 Wash the child’s mouth with clean soft cloth wrapped around the finger and
If needed for treatment at home, give mother the tube of tetracycline ointment or wet with salt water.
a small bottle of gentian violet.  Paint the mouth with half-strength gentian violet ( 0.25%) .
 Wash hands again.
Check the mother’s understanding before she leaves the clinic.

Treat Thrush with Nystatin

Treat thrush four times daily for 7 days :
 Wash hands

Treat Eye Infection with Tetracycline 

Wet a clean soft cloth with salt water and used it to wash the child mouth.
Instill nystatin 1ml four times a day
Eye Ointment  Avoid feeding for 20 minutes after medication
 If breastfed check mother's breasts for thrush , if present treat with nystatin.
Clean both eyes 3 times daily.  Advise mother to wash breasts after feeds. If bottle fed advise change to cup and
spoon
 Wash hands.  Give paracetamol if needed for pain
 Ask child to close the eye.
 Use clean cloth and water to gently wipe away pus.
 Soothe the Throat, Relieve the Cough
Then apply tetracycline eye ointment in both eyes 3 times daily.
with a Safe Remedy
 Ask the child to look up.
 Squirt a small amount of ointment on the inside of the lower lid.   Safe remedies to recommend:
 Wash hands again.  - Breastmilk for exclusively breastfed infant.
 - Home made remedies e.g. tea with lemon and honey, anise, tileo, guava leaves
Treat until redness is gone. decoctions, chicken soup.
Do not use other eye ointments or drops, or put anything else in the eye. 
  Harmful remedies to discourage:
 -Cough syrups containing:
codeine, antihistamines, alcohol, atropine and expectorants.
 15

GIVE TREATMENT FOR DIARRHOEA 15

(See FOOD advice on COUNSEL THE MOTHER chart)


Plan A: Treat Diarrhoea at Home 
Plan B: Treat Some Dehydration with ORS
Counsel the mother on the 3 Rules of Home Treatment: Give in clinic recommended amount of ORS over 4-hour period
Give Extra Fluid, Continue Feeding, When to Return
DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS.


1. GIVE EXTRA FLUID (as much as the child will take) AGE* Up to 4 months 4 months up to 12 months up to 2 years up to
12 months 2 years 5 years

 TELL THE MOTHER: WEIGHT < 6 kg 6 - < 10 kg 10 - < 12 kg 12 - 19 kg

- Breastfeed frequently and for longer at each feed.
- If the child is exclusively breastfed, give ORS in addition to breastmilk. ORS In ml 200 - 400 400 - 700 700 - 900 900 - 1400
- If the child is not exclusively breastfed, give one or more of the following: ORS solution,
food-based fluids (such as soup, rice water, yoghurt drink and belila water), or clean
water.
Use the child’s age only when you do not know the weight. The approximate amount of ORS required (in ml)
It is especially important to give ORS at home when: can also be calculated by multiplying the child’s weight (in kg) by 75.
- 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.  If the child wants more ORS than shown, give more.


TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER A BOX OF
  SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.
10 PACKETS OF ORS TO USE AT HOME AND 200 ML CUP.  Give frequent small sips from a cup or cup and spoon (one spoon every 1-2 minutes).
  If the child vomits, wait 10 minutes. Then continue, but more slowly.
  Continue breastfeeding whenever the child wants.
SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL
FLUID INTAKE:  AFTER 4 HOURS:
Up to 2 years 50 to 100 ml after each loose stool  Reassess the child and classify the child for dehydration.
2 years or more 100 to 200 ml after each loose stool  Select the appropriate plan to continue treatment.
Tell the mother to:  Begin feeding the child in clinic.
- Give frequent small sips from a cup.
- If the child vomits, wait 10 minutes. Then continue, but more slowly.  IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:
- Continue giving extra fluid until the diarrhoea stops.  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 a box of 10 packets of ORS

}
as recommended in Plan A.
See COUNSEL THE MOTHER chart  Explain the 3 Rules of Home Treatment:
2. CONTINUE FEEDING

}
3. WHEN TO RETURN 1. GIVE EXTRA FLUID See Plan A for recommended fluids
2. CONTINUE FEEDING and
See COUNSEL THE MOTHER chart
3. WHEN TO RETURN
GIVE TREATMENT FOR DIARRHOEA 16


Plan C: Treat Severe Dehydration Quickly
FOLLOW THE ARROWS. IF ANSWER IS “YES”, GO ACROSS. IF “NO”, GO DOWN.


START HERE · Start IV fluid immediately. If the child can drink, give ORS by mouth while the drip is set
up. Give 100 ml/kg Polyvalent , Pansol, or Ringer’s Lactate Solution (or, if not
Can you give available, normal saline), divided as follows:
intravenous (IV) YES
fluid immediately? AGE First give 30 ml/kg in: Then give 70 ml/kg in:

Infants
(under 12 months) 1 hour* 5 hours
Children
(12 months up to 5 years) 30 minutes* 2 1/2 hours

* Repeat once if radial pulse is still very weak or not detectable.

NO  Reassess the child every 1- 2 hours. If hydration status is not improving, give the IV
drip more rapidly.
 Also give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after
3-4 hours (infants) or 1-2 hours (children).
 Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration. Then
choose the appropriate plan (A, B, or C) to continue treatment.
Is IV treatment
available nearby
(within 30 minutes)? YES  Refer URGENTLY to hospital for IV treatment.
 If the child can drink, provide the mother with ORS solution and show her how to give
frequent sips during the trip.
NO

Are you trained to

use a naso-gastric
 Start rehydration by tube (or mouth) with ORS solution: give 20 ml/kg/hour for 6 hours
(NG) tube for
(total of 120 ml/kg).
rehydration?
 Reassess the child every 1-2 hours:
- If there is repeated vomiting or increasing abdominal distension, give the fluid more
NO YES slowly.
- If hydration status is not improving after 3 hours, send the child for IV therapy.
 After 6 hours, reassess the child. Classify dehydration. Then choose the appropriate
plan (A, B, or C) to continue treatment.
Can the child drink?

NO
NOTE:
 If possible, observe the child at least 6 hours after rehydration to be sure the mother
can maintain hydration giving the child ORS solution by mouth.
Refer URGENTLY to
hospital for IV or NG
treatment

PLAN A, PLAN B
PLAN C 16
 17

GIVE FOLLOW-UP CARE 17

NO pneumonia Cough or Cold - WHEEZE
Care for the child who returns for follow-up using all the boxes that match

After 2 days
the child’s previous classifications.
Check the child for general danger signs. } See ASSESS & CLASSIFY
If the child has any new problem, assess the child as an initial visit
 Assess the child for cough or difficult breathing.
following the ASSESS AND CLASSIFY chart.
Treatment:

 PNEUMONIA  Ifany danger sign or stridor or chest indrawing- Treat as SEVERE PNEUMONIA
OR VERY SEVERE DISEASE, give one dose of pre-referral intramuscular antibiotic.
After 2 days: Give one dose of rapid acting bronchodilator and refer URGENTLY to hospital.

Check the child for general danger signs.

Assess the child for cough or difficult breathing.
} See ASSESS & CLASSIFY chart.  If fast breathing-treat as PNEUMONIA, also give oral salbutamol.

Ask:  If child is wheezing but has no general danger signs, fast breathing or chest
- Is the child breathing slower? indrawing:
- Is there less fever? - If this is the first episode of wheezing or if the child has previous episodes but has
- Is the child eating better? not been
- Is the child still wheezing? referred. continue salbutamol and refer for assessment.

Treatment: - If the child has already been referred for a pervious episode of wheezing advise the
mother
If child has a general danger sign or stridor or chest indrawing or has fast to continue with treatment prescribed by the referral hospital. Advise the mother to
breathing and wheeze, give a dose of pre-referral intramuscular antibiotic. If wheezing return if
also give dose of rapid acting bronchodilator. Then refer URGENTLY to hospital. the child’s breathing becomes more difficult. If this child returns because condition
has
If child is not wheezing but breathing rate, fever and eating are the same. Change worsened, refer URGENTLY to hospital for further treatment.
to the second line antibiotic and advise the mother to return in 2 days or refer.(If this
child had measles in the last three months,refer).
 DYSENTERY
 If breathing slower, less fever, or eating better, complete the 5 days of antibiotic. If
child is wheezing, also treat as below. After 2 days:
Assess the child for diarrhoea. >>> See ASSESS & CLASSIFY chart.
 If child is wheezing but has no general danger signs, fast breathing or chest Ask:
indrawing: - Are there fewer stools? - Is there less blood in the stool?
- Is there less fever? - Is there less abdominal pain?
- If this is the first episode of wheezing or if the child has had previous episodes but - Is the child eating better?
has not Treatment:
been referred, continue salbutamol and refer for assessment. If the child is dehydrated, treat dehydration.
If number of stools, amount of blood in stools, fever, abdominal pain, or eating
- If the child has had at least one episode of wheezing before this and has already is the same or worse:
been referred for assessment, advise mother to continue with treatment prescribed
Change to second-line oral antibiotic recommended for Shigella.
by the referral hospital. Advise the mother to return if the child’s breathing becomes
Give it for 5 days. Advise the mother to return in 2 days. Refer to hospital.
more difficult.If this child returns because condition has worsened, refer for further
Exceptions - if the child: - is less than 12 months old, or
- was dehydrated on the first visit, or
- had measles within the last 3 months

If fewer stools, less blood in the stools, less fever, less abdominal pain, and eating
better, continue giving the same antibiotic until finished.

Follow up
 GIVE FOLLOW-UP CARE 18
 MEASLES WITH EYE OR MOUTH COMPLICATIONS
Care for the child who returns for follow-up using all the boxes that match the

After 2 days:
child’s previous classifications.
If the child has any new problem, assess the child as an initial visit
 Look for red eyes and pus draining from the eyes.
following the ASSESS AND CLASSIFY chart. Look at mouth ulcers.
Smell the mouth.

PERSISTENT DIARRHOEA
 Treatment for Eye Infection:
After 5 days:  If pus is draining from the eye, ask the mother to describe how she has treated the
eye infection. If treatment has been correct, refer to hospital. If treatment has not been
Ask: correct, teach mother correct treatment.
- Has the diarrhoea stopped?
- How many loose stools is the child having per day?  If the pus is gone but redness remains, continue the treatment.

Treatment:  If no pus or redness, stop the treatment.

If the diarrhoea has not stopped (child is still having loose stools), do a full reassessment of the Treatment for Mouth Ulcers:
child. Give any treatment needed. Then refer to hospital.
If the diarrhoea has stopped (child having less loose stools), tell the mother to follow the usual If mouth ulcers are worse, or there is a very foul smell from the mouth, refer to
feeding recommendations for the child’s age. hospital.
Tell the mother to continue giving the child the multivitamin mineral supplement INCLUDING ZINC.
If mouth ulcers are the same or better, continue using half-strength gentian violet for a
total of 5 days.

Treatment for thrush:

ACUTE EAR INFECTION

If thrush is worse check that treatment is being given correctly.
After 5 days: If thrush is the same or better, and the child is feeding well, continue nystatin for a total of
7 days.
Reassess for ear problem. >>> See ASSESS & CLASSIFY chart.
Measure the child’s temperature.

Treatment:

If there is tender swelling behind the ear or ear pain or high fever (38°C or above), refer FEEDING PROBLEM

URGENTLY to hospital.
After 5 days:
Acute ear infection: if ear discharge persists, treat for 5 more days with the same antibiotic.
Continue wicking to dry the ear. Follow-up once again in 5 days. If ear pain or discharge persists
refer. Reassess feeding. >>> See questions at the top of the COUNSEL chart.
Ask about any feeding problems found on the initial visit.
If no ear pain or discharge, praise the mother for her careful treatment. Ask the mother to
continue the same antibiotic for other 5 days.
Counsel the mother about any new or continuing feeding problems. If you
 If discharge, for 14 days or more, refer.
counsel the mother to make significant changes in feeding, ask her to bring the
child back again.
If the child is classified as MODERATE MALNUTRITION ask the mother to return
30 days after the initial visit to measure the child's Wt. /Length /Height, Wt. /age, BMI or

18

FOLLOW-UP
 19

19

GIVE FOLLOW-UP CARE

Care for the child who returns for follow-up using all the boxes that match the child’s
STUNTING
previous classifications.
After 30 days (If investigations proved it is of nutritional origin)
If the child has any new problem, assess the child as an initial visit
 Measure the L/H. A
following the ASSESS AND CLASSIFY chart. Assess child feeding.
Look and ask : Assess for hygiene and sanitation.
MODERATE ACUTE MALNUTRITION - If the practices remain the same, counsel the mother and ask her to
After 30 days: come back in 30 days
 Assess the child using the same measurement (W .L/H , Wt./A , or MUAC) used - If improved praise the mother and ask her to come every 3 months.
on the initial visit: Ask the mother to come every 3 months.
 Check the child for edema of both feet. Each visit measure the L H/A
 Check the child for visible severe wasting Continue until improvement in the linear growth is seen. If after one year,
 Reassess feeding. See questions in the COUNSEL THE MOTHER chart.
Treatment:
‐If the child has developed oedema of both feet, or visible severe was ng or any
of her/his measurement is below – 3 Z score or MUAC less than 115 cm, OVERWEIGHT
After 30 days
Refer the child urgently.
· Assess BMI, feeding , physical activity and sedentary time.
· If the child is s ll classified as MODERATE ACUTE MALNUTRITION, counsel the Treatment:
mother about any feeding problem . Ask the mother to return again monthly -If the situation worsens, refer the child
for 3 months. Assess the situa on every visit: - If not improved, re-counsel and ask the mother to return monthly for 3 months.
In each monthly visit
‐ If the child improves, praise the mother -If the child improves, praise the mother, follow up every 3 months until the child reaches
‐ If the child does not improve a er 3 months, refer the child. the goal set for his age
‐If the child has improved and is classified as NO ACUTE MALNUTRITION, praise the - if the situation is the same, re-counsel and continue the follow up visits
- If the situation worsens, refer the child
mother and provide further counselling
After 3 months if the situation is the same or worsens, refer the child.
Excep on: If you do not think that feeding will improve or if the child has lost · If improved, praise the mother, follow up every 3 months until the child reaches a BMI
weight or his or her measurements have diminished, refer the child.

ANAEMIA

After 14 days:
Reassess for anaemia every 14 days for 2 months

If severe pallor refer URGENTLY to hospital.

If pallor still present or improving, continue giving iron daily for 2 months.
If the child has pallor after 2 months, refer for assessment.
 20

GIVE FOLLOW UP CARE

‫ط‬ Care for the child who returns for follow-up using all boxes that
match The child’s previous classifications.
 If the child has any new problem, assess the child as an initial visit
following ASSESS AND CLASSIFY chart

POSSIBLE DEVELOPMENTAL DELAY

A er 7 days PROBLEM IN PLAY AND COMMUNICATE
Assess developmental milestones After 7 days
Assess play and communicate according to the advices given to the
Assess play and communicate according to the advices given to the
mother mother during the initial visit
If the situa on is worse : refer to a specialist -If the situation is worse : refer to a specialist
If the situa on is the same, iden fy the problem in play and -If the situation is the same, identify the problem in play and com-
communicate and ask the mother to come back in one week. If municate and ask the mother to come back in one week. If the
the situa on is the same or has worsened , refer to a specialist situation is the same or has worsened , refer to a specialist
If there is improvement: praise the mother and encourage her to If there is improvement: praise the mother and encourage her to
con nue. continue, counsel her further if necessary.

IF ANY MORE FOLLOW-UP VISITS ARE NEEDED

BASED ON THE INITIAL VISIT OR THIS VISIT,
ADVISE THE MOTHER OF THE
NEXT FOLLOW-UP VISIT.
 ‫‪21‬‬

‫‪COUNSEL THE MOTHER‬‬

‫قيم تغذية الطفل إذا لم يكن ھناك سبب لإلحالة العاجلة‬

‫ﻻ ____‬ ‫ﻧﻌم ____‬ ‫‪‬ﻫﻝ ﺗرﺿﻌﻳن طﻔﻠك ؟‬

‫ﻻ ___‬ ‫‪ -‬إذا ﻛﺎﻧت اﻹﺟﺎﺑﺔ ﺑﻧﻌم‪ :‬ﻛم ﻣرة ﻓﻰ ‪ ٢٤‬ﺳﺎﻋﺔ __ ﻣرة ﻫﻝ ﺗرﺿﻌﻳن ﺧﻼﻝ اﻟﻠﻳﻝ؟ ﻧﻌم __‬
‫ﻻ ____ﻣﺎﻫو؟_________‬ ‫ﻫﻝ ﻳﺗﻧﺎوﻝ اﻟطﻔﻝ أى ﺷﻳﺊ آﺧر؟ ﻧﻌم __‬
‫‪ -‬إذا ﻛﺎﻧت اﻹﺟﺎﺑﺔ ﺑﻼ‪ ،‬ﻟﻣﺎذا؟_________________‬
‫اذا ﻛﺎن اﻟطﻔﻝ ﻳﺑﻠﻎ ﻣن اﻟﻌﻣر ‪ ٦‬أﺷﻬر أو أﻛﺛر ‪:‬‬
‫ﻻ___إذا ﻛﺎﻧت اﻹﺟﺎﺑﺔ ﺑﻧﻌم‪ :‬ﻣﺎذا ﺗطﻌﻣﻳن طﻔﻠك؟_________‬ ‫ﻫﻝ ﺗطﻌﻣﻳن طﻔﻠك؟ ﻧﻌم ___‬
‫ﻣﺎ ﻫﻰ ﻛﻣﻳﺔ اﻟطﻌﺎم ﻓﻰ اﻟوﺟﺑﺔ؟ ___ ﺳﻠطﺎﻧﻳﺔ‬ ‫ﻛم ﻋدد اﻟوﺟﺑﺎت اﻟرﺋﻳﺳﻳﺔ ﻳوﻣﻳﺎ؟ __ ﻣرة‬
‫ﻣﺎذا ﺗﺳﺗﺧدﻣﻳن ﻹطﻌﺎم طﻔﻠك؟ _____‬ ‫ﻛم ﻋدد اﻟوﺟﺑﺎت اﻟﺧﻔﻳﻔﺔ ﻳوﻣﻳﺎ؟________ ﻣرة‬
‫ﻻ __ ﻣن ﻳﻘوم ﺑﺈطﻌﺎم اﻟطﻔﻝ وﻛﻳف؟ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ ـ‬ ‫ﻫﻝ ﺗﻘدﻣﻳن ﻟﻠطﻔﻝ وﺟﺑﺔ ﺧﺎﺻﺔ ﺑﻪ؟ ﻧﻌم __‬
‫ﻻ _____‬ ‫ﻧﻌم _____‬ ‫ﻫﻝ ﺗﻐﻳرت ﺗﻐذﻳﺔ اﻟطﻔﻝ أﺛﻧﺎء اﻟﻣرض؟‬
‫ﻓﻲ ﺣﺎﻟﺔ ﻧﻌم ‪ :‬ﻛﻳف؟ —————وﻣﺎذا ﻓﻌﻠت ؟————‪-‬‬

‫‪Counsel‬‬
 ‫ﺗوﺻﻳﺎت اﻟﺗﻐذﻳﺔ أﺛﻧﺎء اﻟﻣرض واﻟﺻﺣﺔ‬
‫‪22‬‬

‫*الغذاء الجيد ‪ :‬البد أن يحتوي على كميات كافية ومتضمنة غذاء غني بالمغذيات و الطاقة‪.‬‬ ‫ارﺿﻌﻲ طﻔﻠك رﺿﺎﻋﺔ ﻣطﻠﻘﺔ وﻻﺗﻌطﻳﻪ أي ﺳواﺋﻝ أو أﻏذﻳﺔ‬
‫* تختلف مكونات الطعام بنفس القيمة الغذائية من مجتمع آلخر وكذلك بإختالف القدرة الشرائية لألسرة وأيضا ً بإختالف الفصول‪.‬‬
‫* شجعي الطفل على الطعام والتجبريه على تناوله‬ ‫‪ -‬يجب أن تطعمي الطفل بنفسك ويكون له طبق خاص به‪.‬‬
‫*اليكون قوام الطعام سائال وال سميكا(‪.‬‬
‫ﻣن ‪ ٢٤‬ﺷﻬر ﺣﺗﻰ ‪٥‬‬ ‫ﻣن ‪ ٩‬ﺷﻬور ﺣﺗﻰ ‪ ١٢‬ﺷﻬر ﻣن ‪ ١٢‬ﺷﻬ ارً ﺣﺗﻰ‪ ٢٤‬ﺷﻬر‬ ‫ﻣن ‪ ٦‬أﺷﻬر ﺣﺗﻲ ‪ ٩‬أﺷﻬر‬ ‫ﻣن ﺷﻬرﻳن ﺣﺗﻲ ‪ ٦‬ﺷﻬور‬ ‫ﻣن اﻟوﻻدة ﺣﺗﻰ ﺷﻬرﻳن‬
‫ﺳﻧوات‬

‫‪ -‬أرضعي طفلك كلما أراد‬

‫‪ -‬ابدئي في إعطاء طفلك التغذية ‪ -‬أرضعي طفلك كلما‬
‫أراد ‪.‬‬ ‫التكميلية‪:‬‬ ‫أرضعي طفلك فى أى‬ ‫‪ -‬تبدأ الرضاعة بعد‬
‫أرﺿﻌﻲ طﻔﻠك ﻛﻠﻣﺎ أراد‪.‬‬ ‫وقت يريدة ) عندما‬
‫‪-‬أع ط الطف ل ‪ ٣‬وجب ات‬ ‫الوالدة مباشرة في خالل‬
‫‪-‬‬ ‫‪ -‬يعطى ‪ ٣‬وجبات‬ ‫‪ -‬أعطي طفلك ملعقة واحدة من‬ ‫يبدي عالمات الجوع‬
‫ﻋطﻰ اﻟطﻔﻝ ‪٤ -٣‬‬ ‫الساعة األولى من الوالدة‬
‫من طعام األسرة‬ ‫رئيسية‬ ‫نوع أو نوعين فقط من الطعام‬ ‫)مص االصابع –‬ ‫ليحصل الطفل على اللبأ‬
‫وﺟﺑﺎت رﺋﻳﺳﻳﺔ‬ ‫‪-‬‬ ‫لمدة يومين أو ثالثة حتى يعتاد‬ ‫وتحريك الشفاه( وال‬ ‫)لبن السرسوب( ألنة يقية‬
‫‪ -‬يعط ي الطف ل مق دار‬ ‫عليه ثم تزداد تدريجيا‪ ،‬ثم أدخلي ‪-‬يعطى الطفل مقدار ¾‬ ‫تنتظري بكائة ‪ ,‬ليال‬ ‫من األمراض‬
‫‪-‬ﻳﻌطﻲ اﻟطﻔﻝ ﻣﻘدار‬ ‫نوعا أو نوعين آخرين من الطعام سلطانية )‪ ٢٥٠‬مل( في‬
‫س لطانية س عة ‪٢٥٠‬‬ ‫ونھارا على األقل ‪٨‬‬
‫ﺳﻠطﺎﻧﻳﺔ ﺳﻌﺔ ‪٢٥٠‬‬ ‫كل وجبة ‪.‬‬ ‫وھكذا‪.‬‬ ‫‪ -‬أرضعي طفلك فى أى‬
‫ملليلتر على األقل في كل‬ ‫مرات خالل ‪ ٢٤‬ساعة‪.‬‬
‫وجبة(‬ ‫وقت يريدة ) عندما‬
‫ﻣﻠﻠﻳﻠﺗر ﻋﻠﻰ اﻷﻗﻝ ﻓﻲ‬
‫‪ -‬إذا كان الطفل يرضع يعطى ‪ - ٢‬باإلضافة إلى وجبة‬
‫‪-‬‬ ‫يبدي عالمات الجوع‬
‫‪ ٣ -‬وجبات رئيسية‬
‫أو‪ -‬وجبتين خفيفتين بين ﻛﻝ وﺟﺑﺔ(‬ ‫)مص االصابع –‬
‫‪ -‬باإلضافة إلى وجبتين‬ ‫الوجبات الرئيسية ‪.‬‬
‫بمقدار نصف سلطانية من الطعام‬ ‫‪ -‬التعطي الطفل أي‬ ‫وتحريك الشفاه( وال‬
‫‪ -‬ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ وﺟﺑﺗﻳن‬ ‫)سعة ‪ ٢٥٠‬ملليلتر( في كل وجبة‬ ‫ليال‬ ‫تنتظري بكائة ‪,‬‬
‫خفيفتين بين الوجبات‬ ‫سوائل أو أغذية‬
‫الرئيسية‪.‬‬ ‫ﺧﻔﻳﻔﺗﻳن ﺑﻳن اﻟوﺟﺑﺎت‬ ‫‪ -‬إإذا كان الطفل اليرضع‬
‫ونھارا على األقل ‪٨‬‬
‫أخري‪.‬‬ ‫مرات خالل ‪ ٢٤‬ساعة‪.‬‬
‫اﻟرﺋﻳﺳﻳﺔ‬ ‫يعطى ‪ ٤- ٣‬وجبات رئيسية‬
‫بمقدار نصف سلطانية من الطعام‬ ‫‪ -‬التعطي الطفل أي‬
‫سوائل أو أغذية أخري‪ - .‬ال تستخدمي زجاجات )سعة ‪ ٢٥٠‬ملليلتر( في كل وجبة‬
‫الرضاعة أو الحلمات‪ .‬رئيسية‪.‬‬
‫‪ -‬ال تستخدمي زجاجات‬
‫‪ -‬باإلضافة إلى وجبة ‪ -‬وجبتين‬ ‫الرضاعة أو الحلمات‪.‬‬
‫خفيفتين ‪.‬‬
 23
Feeding Recommendations For a Child Who Has PERSISTENT DIARRHOEA
 If still breastfeeding, give more frequent breastfeeds, day and night.

 If taking other milk:

- replace with increased breastfeeding OR
- Replaced with fermented milk products such as yoghurt if taking fresh cow milk
- replace half the milk with nutrient-rich semisolid food as rice, beans and vegetable soup.
- give milk not more than 50 ml/kg per day.
- give frequent small meals at least 6 times a day.

Counsel the Mother About Feeding Problems

If you identify that the child is not being fed as described in the above recommendations, counsel the mother accordingly. Using good
communication skills.
.

‫ﻗﻳم اﻟﻠﻌب واﻟﺗواﺻﻝ ﻣﻊ اﻟطﻔﻝ ﻣن أﺟﻝ ﺗطور ﺳﻠﻳم ﻟﺟﻣﻳﻊ اﻷطﻔﺎﻝ ﻓﻲ ﺣﺎﻟﺔ ﻋدم وﺟود ﺳﺑب ﻟﻺﺣﺎﻟﺔ اﻟﻌﺎﺟﻠﺔ‬
ّ

‫ ﻻﺣظ ٕواﺳﺄﻝ وأﻧظر‬ 

________ ‫ ﻣﺎﻫﻲ اﻟﻠﻌب ) اﻷﺷﻳﺎء( اﻟﺗﻲ ﺗﻼﻋﺑﻳن اﻟطﻔﻝ ﺑﻬﺎ‬----------- ‫* ﻛﻳف ﺗﻠﻌﺑﻳن ﻣﻊ اﻟطﻔﻝ ؟‬
----------- ‫ﻟﻣﺎذا‬ --- : ‫ﻻ ﺗﻠﻌب ﻣﻊ اﻟطﻔﻝ‬
‫* ﻛﻳف ﺗﺗواﺻﻠﻳن ﻣﻊ طﻔﻠك؟ وﻛﻳف ﺗﺟﻌﻠﻳﻧﺔ ﻳﺑﺗﺳم ؟‬
------------ ‫ﻟﻣﺎذا‬ --- : ‫ا ﻻﺗﺗواﺻﻝ ﻣﻊ اﻟطﻔﻝ‬

FEEDING RECOMMENDATIONS
FEEDING PROBLEMS

23
 ‫اﺻﻝ ﻣن أﺟﻝ ﺗطور ﺳﻠﻳم‬
‫‪24‬‬
‫ﺗوﺻﻳﺎت اﻟﻠﻌب واﻟﺗو‬
‫ﻣن ‪ ٢٤‬ﺷﻬر ﺣﺗﻰ ‪ ٥‬ﺳﻧوات‬ ‫ﻣن ‪ ١٢‬ﺷﻬر ﺣﺗﻰ ‪٢٤‬‬ ‫ﻣن ‪ ٦‬ﺷﻬور ﺣﺗﻰ ‪ ٩‬ﺷﻬور ﻣن ‪ ٩‬ﺷﻬور ﺣﺗﻰ ‪ ١٢‬ﺷﻬر‬ ‫ﻣن ﺷﻬرﻳن ﺣﺗﻰ ‪ ٦‬ﺷﻬور‬ ‫ﻣﻧد اﻟوﻻدة ﺣﺗﻰ ﺷﻬرﻳن‬
‫ﺷﻬر‬
‫دايما العيلة تلعب وتتكلم مع دايما العيلة تلعب وتتكلم مع دايما العيلة تلعب وتتكلم مع دايما العيلة تلعب وتتكلم مع‬ ‫ﻣن ﺷﻬرﻳن ﺣﺗﻰ أﻗﻝ ﻣن ‪ ٤‬ﺷﻬور‪:.‬‬ ‫األسابيع األربعة األولى‬
‫اﻟﻠﻌب‪ :‬ﺣرﻛﻲ أﺷﻳﺎء ﻣﻠوﻧﺔ أﻣﺎم ﻋﻳﻧﻲ‬ ‫اﻟﻠﻌب‪ :‬ﺣرﻛﻲ أﺷﻳﺎء أﻣﺎم ﻋﻳﻧﻲ طﻔﻠك‬
‫الطفل‬ ‫الطفل‬ ‫الطفل‬ ‫الطفل‬
‫طﻔﻠك ﺳﺎﻋدﻳﻪ ﻋﻠﻰ اﻹﻣﺳﺎك ﺑﻬﺎ ﺑﻳدﻳﻪ ‪.‬‬ ‫اﺗرﻛﻲ طﻔﻠك ﻳﺣرك أطراﻓﻪ ﺑﺣرﻳﺔ وﻳﻠﻣﺳك‪.‬‬
‫اللعب‪:‬‬
‫إﻋطﻲ اﻟطﻔﻝ ﺷﺧﺷﻳﺧﺔ أو ﺣﻠﻘﺔ ﺑﺎﻟﺳﻼﺳﻝ‬ ‫ﻗوﻣﻲ ﺑﻔرد أرﺟﻝ طﻔﻠك وﺛﻧﻳﻬﺎ ﺑﻠطف‪.‬‬
‫‪-‬إديله‬
‫ﻟﻳﺣرﻛﻬﺎ وﻳﺳﻣﻊ ﺻوﺗﻬﺎ‪.‬‬ ‫داﻋﺑﻳﻪ وﻫزي طﻔﻠك ورﺑﺗﻲ ﻋﻠﻳﻪ ﺑﻠطف‬
‫حاﺟﺎت‬
‫اﻟﻠﻌب‪ - :‬اﻟﻌﺑﻲ ﻣﻊ اﻟطﻔﻝ ﺑﻌروﺳﺔ‬ ‫التواصل‪ :‬اﻧظري ﻓﻲ ﻋﻳﻧﻲ‬ ‫وﺿﻌﻳﻪ ﻓﻲ وﺿﻌﻳﺔ ﻣﻼﻣﺳﺔ اﻟﺟﻠد ﻟﻠﺟﻠد‬
‫ﻧﺿﻳﻔﺔ وﻣش ﻣؤذﻳﺔ ﻳﻠﻌب ﺑﻳﻬﺎ وﺷﺟﻌﻳﻪ‪،‬‬
‫وﺣﺎﺟﺎت ﻧﺿﻳﻔﺔ وﻣش ﻣؤذﻳﺔ‪.‬‬ ‫طﻔﻠك واﺑﺗﺳﻣﻲ ﻟﻪ وﺗﺣدﺛﻲ‬ ‫)‪skin to skin‬‬
‫زي ﻋﻠﺑﺔ وﻣﻌﻠﻘﺔ وﻛﺑﺎﻳﺔ ﺑﻼﺳﺗﻳك ﻳﺧﺑط‬
‫‪-‬ﺧﺑﻲ ﺣﺎﺟﺔ ﻓﻲ ﻋﻠﺑﺔ وﺷوﻓﻲ اﻟطﻔﻝ‬ ‫ﻋﻠﻳﻬم او ﻳﻠﻌب ﺑطرﻳﻘﺗﻪ‬ ‫أﻟﻳﻪ وﻏﻧﻲ ﻟﻪ وأﻓﺿﻝ وﻗت ﻟذﻟك أﺛﻧﺎء‬ ‫التواصل‪ :‬اﻧظري ﻓﻲ ﻋﻳﻧﻲ‬
‫ﻫﺎﻳﻌرف ﻳطﻠﻌﻬﺎ وﻻ ﻷ‪.‬‬ ‫اﻟرﺿﺎﻋﺔ‪.‬‬ ‫طﻔﻠك واﺑﺗﺳﻣﻲ ﻟﻪ وﺗﺣدﺛﻲ إﻟﻳﻪ وﻏﻧﻲ ﻟﻪ‬
‫اﻟﻠﻌب‪-:‬ﺧﻠﻲ اﻟطﻔﻝ ﻳﻘﻠدك ﻓﻣﺛﻼ اﻟﺑﻧت ﺗﺳرح‬ ‫اﻟﺗواﺻﻝ‪- :‬ردي ﻋﻠﻰ اﻟﺻوت اﻟﻠﻲ ﺑﻳﻌﻣﻠﻪ اﻟﻌﺑﻲ أﻟﻌﺎب زي ﻟﻌﺑﺔ‬ ‫‪-‬ادﻳري ﺣوا ار ﺑﻳﻧك وﺑﻳن طﻔﻠك وذﻟك ﻋن‬
‫اﻟﻠﻌب‪ :‬ﻛﻝ اﻟﻠﻌب ﻻزم ﺗﻛون ﻧﺿﻳﻔﺔ وﻣش‬ ‫وأﻓﺿﻝ وﻗت ﻟذﻟك أﺛﻧﺎء اﻟرﺿﺎﻋﺔ‪.‬‬
‫ﺷﻌرﻫﺎ زﻳك‬ ‫ﺑﺦ ﻳﻌﻧﻲ ﺧﺑﻲ وﺷك وﺑﻌدﻳن ﺑﺻﻲ ﻟﻪ‬ ‫طرﻳق ﺗﻘﻠﻳد أﺻواﺗﻪ ٕواﻳﻣﺎءاﺗﻪ‪.‬‬
‫ﻣؤذﻳﺔ‪.‬‬ ‫واظﻬري اﻫﺗﻣﺎﻣك ﺑﺎﻟﻠﻲ ﺑﻳﻘوﻟﻪ‪.‬‬
‫‪-‬اﻷب ﻳﻠﻌب ﻛﻣﺎن ﻣﻊ اﻟطﻔﻝ ﻟﻌب زي ﻟﻌﺑﺔ‬ ‫األطفال من شھر حتى أقل من شھرين‬
‫‪-‬ﺧﻠﻲ اﻟطﻔﻝ ﻳدﺧﻝ ﻋﻠب ﺟوﻩ ﺑﻌﺿﻬﺎ‬ ‫وﻗوﻟﻲ ﻟﻪ ﺑﺦ‬ ‫‪-‬اﻧدﻫﻲ ﻟﻪ ﺑﺈﺳﻣﻪ وﺷوﻓﻲ رد ﻓﻌﻠﻪ‪ .‬وﻗت‬ ‫اﻟﻠﻌب‪ :‬وﻓري وﺳﺎﺋﻝ ﺗﺳﺎﻋد طﻔﻠك أن ﻳرى‬
‫ﺗرﻛﻳب اﻟﺻور اﻟﻣﻘطﻌﺔ إﻟﻰ أﺟزاء أو ﺗرﻛﻳب‬ ‫ﻣن ‪ ٤‬ﺷﻬور ﺣﺗﻰ أﻗﻝ ﻣن ‪ ٦‬ﺷﻬور‬
‫وﻳطﻠﻌﻬﺎ ﺗﺎﻧﻲ‪ .‬ﻣﻣﻛن ﺗدي ﻟﻪ ﻣﺷﺎﺑك‬ ‫اﻷﻛﻝ دﻩ ﻓرﺻﺔ ﻛوﻳﺳﺔ‬ ‫وﻳﺳﻣﻊ وﻳﺣرك أطراﻓﻪ ﺑﺣرﻳﺔ وﻳﻠﻣﺳك‪.‬‬
‫ﺻور ﺑﺎﻟﻣﻛﻌﺑﺎت‪.‬‬ ‫اﻟﻠﻌب‪ :‬أﻋطﻲ اﻟطﻔﻝ ﻣﻠﻌﻘﺔ ﺧﺷﺑﻳﺔ أو أي‬
‫ﻏﺳﻳﻝ ﺑﻼﺳﺗﻳك وﻳﺣطﻬﺎ ﺟوﻩ ﻋﻠﺑﺔ وﻳطﻠﻌﻬﺎ‬ ‫‪-‬ﺣرﻛﻲ أﺷﻳﺎء ﻣﻠوﻧﺔ أﻣﺎم ﻋﻳﻧﻲ طﻔﻠك‬
‫اﻟﺗواﺻﻝ‪ :‬اﺗﻛﻠﻣﻲ ﻣﻊ اﻟطﻔﻝ واﺣﻛﻲ ﻟﻪ‬ ‫ﺗﺎﻧﻲ‪.‬‬ ‫أﺷﻳﺎء أﺧرى ﻣن اﻷدوات اﻟﻣﻧزﻟﻳﺔ اﻟﻣﺄﻣوﻧﺔ‬
‫ﻟﻳﺗﻌﻠم ﻣﺗﺎﺑﻌﺗﻬﺎ وﻣﺣﺎوﻟﺔ اﻟوﺻوﻝ إﻟﻳﻬﺎ‪.‬‬
‫ﺣﻛﺎﻳﺎت وﻏﻧﻲ ﻟﻪ‪.‬‬ ‫اﻟﺗواﺻﻝ‪- :‬اﻫﺗﻣﻲ ﺑﻣﺣﺎوﻻت اﻟطﻔﻝ ﻟﻣﺎ‬ ‫ﻟﻳﺻﻝ إﻟﻳﻬﺎ وﻳﻣﺳﻛﻬﺎ ﺑﻳدﻳﻪ وﻳﺗﻔﺣﺻﻬﺎ‬
‫اﻟﺗواﺻﻝ‪:‬اﺗﻛﻠﻣﻲ ﻣﻊ طﻔﻠك وﻋﻠﻣﻳﻪ أﺳﺎﻣﻲ‬ ‫‪-‬اﻓردي واﺛﻧﻲ رﺟﻠﻳﻪ وﻳدﻳﻪ ﺑﻠطف ﻣرات‬
‫ﻋﻠﻣﻳﻪ ﻳﺑدأ ﻳﻌد‬ ‫ﻳﺗﻛﻠم ورددي ﻛﻼﻣﻪ وردي ﻋﻠﻳﻪ‬ ‫اﻟﻌﺑﻲ ﻣﻊ طﻔﻠك ﺑﺎﻟﻛرة دﺣرﺟﻳﻬﺎ إﻟﻳﻪ‬
‫اﻟﺣﺎﺟﺎت واﻟﻧﺎس‪.‬‬ ‫‪.‬‬ ‫ﻋدﻳدة‬
‫وﻋﻠﻣﻳﻪ‬ ‫‪-‬ﺷﺎوري ﻋﻠﻰ اﻟﺣﺎﺟﺎت واﺳﺄﻟﻲ اﻟطﻔﻝ‪":‬‬ ‫واﺟﻌﻠﻳﻪ ﻳﻘﻠدك‬
‫ﻋﻠﻣﻳﻪ ﺣرﻛﺎت ﺑﺈﻳدﻩ زي ﻣﻊ اﻟﺳﻼﻣﺔ أو‬ ‫اﻟﺗواﺻﻝ‪ :‬اﻧظري ﻓﻲ ﻋﻳﻧﻲ طﻔﻠك واﺑﺗﺳﻣﻲ‬
‫اﻷﺳﻣﺎء‬ ‫إﻳﻪ دﻩ؟"‬ ‫اﻟﺗواﺻﻝ‪- :‬ﺗﺣدﺛﻲ إﻟﻰ طﻔﻠك ﺑرﻗﺔ‬ ‫ﻟﻪ وأﻓﺿﻝ وﻗت ﻟذﻟك أﺛﻧﺎء اﻟرﺿﺎﻋﺔ‪.‬‬
‫‪-‬ﺷﺟﻌﻳﻪ ﻋﻠﻰ‬ ‫)ﺷﺎوري ﻋﻠﻰ ﻗطﺔ – ﻋﺻﻔورة‪ ،‬راﺳﻪ –‬
‫ﺑﺎي ﺑﺎي‪.‬‬
‫‪-‬أدﻳري ﺣوا ار ﺑﻳﻧك وﺑﻳن طﻔﻠك وذﻟك ﻋن‬ ‫‪-‬اﺟﻌﻠﻲ ﻫﻧﺎك ﺣوا ار ﺑﻳﻧك وﺑﻳن طﻔﻠك وذﻟك‬
‫اﻟﻛﻼم وردي ﻋﻠﻰ أﺳﺋﻠﺗﻪ‪.‬‬ ‫ﻓﻣﻪ ‪(...‬‬
‫طرﻳق ﺗﻘﻠﻳد أﺻواﺗﻪ وﺣرﻛﺎﺗﻪ‬ ‫ﻋن طرﻳق ﺗﻘﻠﻳد أﺻواﺗﻪ ٕواﻳﻣﺎءاﺗﻪ‪.‬‬
‫ورﻳﻪ ﺻور ﻓﻲ ﻛﺗﺎب واﺗﻛﻠﻣﻲ ﻋﻧﻬﺎ‪.‬‬
 25

COUNSEL ON THE THREE RULES OF HOME 25CARE

1. CONTINUE FEEDING
FOLLOW—UP VISITS
 Advise the Mother about feeding During Illness:
Advise mother not to change feeding during illness. Don’t stop breastfeeding or any type of food. Advise the Mother When to Return to Health Worker
Children may loose appetite during illness:
If the child has: Return for
 Divide the recommended amount of food over small frequent feeds so that s/he is given the
total amount of food/ day.. Add a teaspoon of oil to add more energy. PNEUMONIA
 Give the child her/his favourite food NO pneumonia Cough or cold - WHEEZE 2 days
DYSENTERY
 During recovery add an extra nutritious meal for 14 days.
MEASLES WITH EYE OR MOUTH COMPLICATIONS
PERSISTENT DIARRHOEA
ACUTE EAR INFECTION 5 days
2. INCREASE FLUID
POSSIBLE DEVELOPMENTAL DELAY 7 days
PLAY AND COMMUNICATE PROBLEM
 Advise the Mother to Increase Fluid During Illness ANAEMIA 14 days
FOR ANY SICK CHILD:
 Breastfeed more frequently and for longer at each feed. Moderate acute malnutrition - Overweight — Stunting 30 days
 Increase fluid. For example, give soup, rice water, yoghurt
drinks,belila water, home fluids or clean water.
FOR CHILD WITH DIARRHOEA:
 Giving extra fluid can be life saving. Give fluid according to Plan
A or Plan B on TREAT THE CHILD chart.
Counsel the Mother About Her Own Health
3.WHEN TO RETURN IMMEDIATELY · If the mother is sick, provide care for her, or refer her for help.

WHEN TO RETURN IMMEDIATELY · If she has a breast problem (such as engorgement, sore nipples, breast
infection), provide care for her or refer her for help.
Advise the Mother When to Return
· Advise her to eat well to keep up her own strength and health.
Immediately to Health Worker
Advise mother to return immediately if the child has any of these signs: · Check the mother’s immunization status and give her tetanus toxoid if needed.

Any sick child  Not able to drink or breastfeed · Check the mother’s supplementation with iron and vitamin A according to the
 Becomes sicker national policy.
 Develops a fever
· Make sure she has access to:
If child has NO PNEUMONIA:  Fast breathing
COUGH OR COLD, also return if:  Difficult breathing - Family planning
If child has Diarrhoea, also return if:  Blood in stool -Counselling on reproductive health problems.
 Drinking poorly
 26

ASSESS, CLASSIFY AND TREAT THE SICK YOUNG

INFANT AGE UP TO 2 MONTHS
ASSESS CLASSIFY IDENTIFY
ASK THE MOTHER WHAT THE YOUNG INFANT’S PROBLEMS ARE  Determine if this is an initial or follow-up visit for this problem. TREATMENT
- if follow-up visit, use the follow-up instructions on the bottom of this chart.
- if initial visit, assess the young infant as follows:

CHECK FOR POSSIBLE BACTERIAL INFECTION SIGNS CLASSIFY

AS
TREATMENT
(Urgent pre-referral treatments are in bold print)

 Not able to feed OR  Treat current convulsion with

ASK: LOOK, LISTEN, FEEL: Classify Convulsions OR rectal sodium valproate.
 Fast breathing (60 breaths per minute


ALL  Give first dose of intramuscular
Is the young infant  See if the infant is convulsing now. or more) OR
YOUNG
able to feed ?  Count the breaths in one  Severe chest indrawing OR POSSIBLE
antibiotics.
INFANTS
minute.  Nasal flaring OR SERIOUS
 Grunting OR  Treat to prevent low blood
Repeat the count if 60 or YOUNG BACTERIAL
 Has the infant had sugar.
more. INFANT
MUST BE
 Bulging anterior fontanel OR INFECTION
convulsions in the  Look for severe chest CALM  Pus draining from the eyes with
present illness ?  Advise mother how to keep the
indrawing. redness and swelling infant warm on the way to the
 Look and feel for bulging OR hospital.
anterior fontanel Umbilical redness extending to skin OR
 Look for nasal flaring.  Fever (37.5°C* or above or feels hot)  Refer URGENTLY to hospital.**
 Look and listen for grunting. or low body temperature (less than
 Look at the eyes. Is it draining pus? 35.5°C* or feels cold)
Is draining pus associated with redness and OR
swelling?  Many or severe skin pustules OR
 Look at the umbilicus. Is it red or draining pus?  Lethargic or unconscious OR
Does the redness extend to the skin?  Less than normal movements or no
 Measure temperature (or feel for fever or low
body temperature). - Give an appropriate oral
 Look for skin pustules. Are there many or severe  Umbilicus draining pus or Red LOCAL antibiotic for 5 days
pustules? umbilicus OR BACTERIAL
 Skin pustules OR INFECTION - Teach mother to treat local
See if the young infant is lethargic or
unconscious.  Pus draining from the eyes. infections at home.
 Look at the young infant’s movements. - Advise mother to give home care for
Are they less than normal or no movements at the young infant.

 None of the above signs BACTERIAL 

Advise mother to give home care
INFECTION for the young infant.
UNLIKELY Follow-up in 2 days.

Counsel
 27

CHECK FOR JAUNDICE

ASK LOOK AND FEEL  Jaundice started in the first 24 hours Encourage
 breastfeeding to
Classify of life and still present OR SEVERE prevent low blood sugar
 Does the infant has  Look for presence of jaundice (yellow
JAUNDICE Jaundice extending to palms and/or JAUNDICE 
Advise mother how to keep the
jaundice? eyes or skin) soles OR infant warm on the way to the
 When did it start?  Jaundice in Infant 2.5 Kg. or less hospital
 If present, Is it extending to palms and/or
 Is the infant’s age 2 soles? Jaundice ;  Advise the mother to give home
weeks or more ?  Jaundice appearing after 24 hours of care for the young infant
age Or JAUNDICE  If infant aged 2 weeks or more, re-
 Is the infant ‘s birth  Infant aged 14 days or more . fer for assessment.*
weight 2.5 Kg ?  Advise mother to return immediate-
ly if jaundice extends to palms and
· soles

None of the above  Advise the mother to give home

NO care for the young infant.
JAUNDICE

* If infant aged 2 weeks or more and the stool color is pale : refer Urgently to the hos-
pital as there is high possibility of obstructive jaundice .
 28
THEN ASK:
Does the young infant have diarrhoea? Two of the following signs: Treat to prevent low blood sugar.
Advise mother how to keep the infant
IF YES, ASK: LOOK AND FEEL: for  Lethargic or unconscious warm on the way to the hospital.
DEHYDRATION  Sunken eyes Refer URGENTLY to hospital.
 For how long?  Look at the young infant’s general
 Skin pinch goes back very SEVERE
SEVERE
condition. Is the infant:
slowly. DEHYDRATION
 Is there blood in Lethargic or unconscious? DEHYDRATION
the stool? Restless and irritable?

 Look for sunken eyes.  Give fluid and food for some
Two of the following signs:
dehydration (Plan B).
 Pinch the skin of the abdomen.  If infant also has any severe
Does it go back: Classify  Restless, irritable
 Sunken eyes classification :
Very slowly (longer than 2 DIARRHOEA SOME
SOME - Refer URGENTLY to hospital with
seconds)?  Skin pinch goes back slowly. DEHYDRATION
DEHYDRATION mother giving frequent sips of
Slowly? ORS on the way.
Advise mother to continue
breastfeeding
Keep the infant warm .

 Not enough signs to classify as NO Give fluids to treat diarrhoea at home


some or DEHYDRATION (Plan A).
severe dehydration. Follow
 up in 2 days

Diarrhoea lasting 14 days or Treat to prevent low blood sugar.

and if diarrhoea
more. SEVERE Advise mother how to keep the
14 days or more
PERSISTENT infant warm on the way to the
DIARRHOEA hospital.
Refer URGENTLY to hospital.

 Blood in the stool. Treat to prevent low blood sugar.

BLOOD IN Advise mother how to keep the
STOOL infant warm on the way to the
and if blood in
stool hospital.
Refer URGENTLY to hospital.

ASSESS AND CLASSIFY

 29

THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT:

  Advise the mother to breastfeed as often
ASK: LOOK, LISTEN,FEEL: Classify  Poor positioning
29 and for as long as the infant wants, day
Is there any difficulty feeding? OR
 Determine weight for age.
FEEDIN and night.
 Is the infant breastfed? If yes, 
how many times in 24 hours? 
 Not well attached to breast  If low birth weight with breastfeeding
Is the infant breastfed during night?  In newborn: determine birth weight OR problem, refer to hospital
 Does the infant usually receive
any other foods or drinks? If yes,  Look for ulcers or white patches in the  if the infant is breastfed and has a
 Not suckling effectively FEEDING breastfeeding problem, counsel the
how often? mouth (thrush).
OR PROBLEM mother on the breastfeeding problem.
 What do you use to feed the infant?
OR
IF AN INFANT: Has no indications to refer urgently to hospital:  Less than 8 breastfeeds in LOW WEIGHT  If not breastfeeding at all:
24 hours - Refer for breastfeeding counselling
Or and possible relactation.
 Has the infant If the infant has not fed in the previous hour, ask the mother to
· Not breastfeeding during - Advise about correctly preparing
breastfed in the put her infant to the breast. Observe the breastfeed for
night
previous hour? 4 minutes. breastmilk substitutes and using a
(If the infant was fed during the last hour, ask the mother if she
OR cup.
can wait and tell you when the infant is willing to feed again.)
 Receives other foods or
 Is the infant position correct?  If thrush, teach the mother to treat
drinks
OR thrush at home.


TO CHECK POSITIONING , LOOK FOR:  Any other breastfeeding  If mouth ulcers, teach the mother to
 - Infant’s neck is straight or bent slightly back, problems reported by the treat mouth ulcers at home.


- Infant’s body is turned towards the mother, mother  Advise mother to give home care for
- Infants’s body is close to mother’s body, and

 OR
 - Infants’s whole body supported.
(If all of these signs are present, the infant’s positioning is the young

 good)  Low weight for age or low
 birth weight (2500 mg or less) infant.
poor positioning good positioning OR  Follow-up any feeding problem or
 Is the infant able to attach?
TO CHECK ATTACHMENT, LOOK FOR:
 Thrush (white patches in thrush or ulcers in 2 days.
mouth) OR
- Chin touching breast  Ulcers Follow-up low weight for age in 14
- Mouth wide open
- Lower lip turned outward and, days.
- More areola visible above than below the mouth

(If all of these signs are present, the attachment is good.)

not well attached good attachment

 Not low weight for age and NO FEEDING  Advise mother to give home care for the
 Is the infant suckling effectively (that is, slow deep sucks,
no feeding problems. PROBLEM young infant.
sometimes pausing)?
Praise the mother for feeding the infant
not suckling effectively suckling effectively
Clear a blocked nose if it interferes with breastfeeding.
 30

Check developmental status

At this age, milestones are emerging and these require skills for assessment

DEVELOPMENTAL MILE- Ask and look for

STONES:  Abnormal posture, stiff- -Abnormal posture VERY SEVERE DISEASE -Refer urgently to hospital
Makes frequent limb movements ness, floppiness, arching -Absence of eye move-
Brings hands near face of the back, absence of CLASSIFY ments, crossed esyes most
Moves head from side to side eye movement or DEVELOP- of the times
while lying on stomach  crossed eyes most of the MENTAL -Did not achieve one or
times STATUS more of developmental
Responds to loud sounds
-Developmental milestones
None of the above NO DEVELOPMENTAL ·Counsel mother on future milestones
PROBLEM ·Counsel mother on play and communicate
Con

ASSESS PLAY AND COMMUNICATE, in the absence of urgent referral

Observe , Ask and Look
Ask questions about the child’ play and communicate. Compare the mother’s answers to the Play and
communicate Recommendations for the child’s age in the box on next page:

* How do you play with your young infant? ——————-What are the available toys for the young infant?
Not play :————- Why:——————--

* How do you communicate with your young infant? How do you make the child smile ? ——————————
Not communicate ————— Why:——————
 31

THEN CHECK THE YOUNG INFANT’S IMMUNIZATION STATUS AND VITAMIN D

SUPPLEMENTATION
AGE VACCINE
IMMUNIZATION SCHEDULE: At Birth  OPV Zero Dose
 BCG
 HBV-zero Dose (in the first 24 hours)

ORAL VITAMIN D SUPPLEMENTATION

ONE DAILY DOSE OF 400 IU (4 Drops)

ASSESS OTHER PROBLEMS : complete clinical examination

 32
TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER
GIVE PRE-REFERRAL TREATMENT
Give First Dose of Intramuscular Antibiotics
Give first dose of both ampicillin and gentamicin intramuscular.

GENTAMICIN Ampicillin
Dose: 2.5 mg per kg Dose: 50 mg per kg
Undiluted 2 ml vial Add 6 ml sterile To a vial of 500 mg :
water to 2 ml
WEIGHT containing OR vial containing Add 4.5 ml sterile water
20 mg = 2 ml at 80 mg = 8 ml at 10 =
10 mg/ml mg/ml 5.0 ml at 100 mg/ml
1 kg 0.25 ml 0.5 ml
2 kg 0.50 ml 1.0 ml
3 kg 0.75 ml 1.5 ml 

4 kg 1.00 ml 2.0 ml

5 kg 1.25 ml 2.5 ml

GIVE ORAL ANTIBIOTIC TOTREAT LOCAL BACTERIAL INFECTION

 Give an appropriate oral antibiotic

For local bacterial infection
First line antibiotic: Amoxicillin
Second line antibiotic: co-trimoxazole

AGE OR WEIGHT AMOXICILLIN CO-TRIMOXAZOLE

Give 3 times daily for 5 days Trimethoprim+ sulphamethoxazole
Give 2 times daily for 5 days
Syrup Syrup Syrup
125 mg / 5 ml 250 mg/ 5ml (40 mg trimethoprim + 200 mg sulphamethoxa-
zole) in 5 ml
Birth up to 1 month <3 kg 1.25 ml 1.25 ml
1 month up to 2 months 3—4 Kg 2.5 ml 1.25 ml 2.5 ml*

TREAT AND COUNSEL

TREAT THE YOUNG INFANT AND COUNSEL33THE MOTHER

To Treat Convulsing Young Infant, See TREAT THE CHILD Chart.

To Treat Diarrhoea, See TREAT THE CHILD Chart.(exception: Zinc is not given to young infants)

(treat the young infant to prevent low blood sugar) see treat the child chart

Immunize Every Sick Young Infant, as Needed.

 Teach the Mother to Treat Local Infections at Home

 Explain how the treatment is given.
 Watch her as she does the first treatment in the clinic.
 She should return to the clinic if the infection worsens.
27
To Treat Skin Pustules or Umbilical Infection To Treat Thrush (white patches in mouth) and Ulcers To Treat Eye Infection:
Tell her to do the treatment twice daily. Tell her to do the treatment twice daily. Tell her to do the treatment 3 times daily.
The mother should:
The mother should:
Wash hands The mother should
 Wash hands
Wash mouth with clean soft cloth wrapped Wash her hands
 Gently wash off pus and crusts with
around the finger and wet with salt water  Use clean cloth and water to gently remove pus
soap and water
If ulcers, Paint the mouth with half-strength gentian from the eyes
 Dry the area
violet Then apply tetracycline eye ointment in both eyes
 Paint with full strength (1/2%) gentian violet
If thrush, instill 1 ml nystatin 4 times/day. on the inside of the lower lid.
Wash hands
Avoid feeding for 20 minutes after instillation .  Wash her hands
If breastfeed, check mothers breasts for thrush.  Treat until redness is gone.
If present treat with nystatin drops. Advise mothers
to wash breasts after feeds . If bottle fed advise the
use of cup and food.
Wash hands

33
TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER
34

 Teach Correct Positioning and Attachment  Advise Mother to Give Home Care for the Young Infant
for Breastfeeding
1- EXCLUSIVELY BREASTFEED THE YOUNG INFANT
 Give only breastfeeds to the young infant. Breastfeed frequently, as often and for as long as the infant
wants.
Show the mother how to hold her infant
- make sure that the mother is in comfortable position, 2- MAKE SURE THAT THE YOUNG INFANT IS KEPT WARM AT ALL TIMES.
- with the infant’s head and body straight. In cool weather cover the infant's head and feet and dress the infant with extra clothing.
- facing her breast with infant’s nose opposite her nipple 3- WHEN TO RETURN:
- with infant’s body close to her body,
- supporting infant’s whole body, not just neck and shoulders. Follow up Visits
If the infant has: Return for first follow-up in:
Show her how to help the infant to attach. She should:
- touch her infant’s lips with her nipple  JAUNDICE 1day
- wait until her infant’s mouth is opening wide  LOCAL BACTERIAL INFECTION 2 days
- move her infant quickly onto her breast, aiming the infant’s  FEEDING PROBLEM
lower lip well below the nipple.  THRUSH
 DIARRHOEA
Look for signs of good attachment and effective suckling. If the
attachment or suckling is not good, try again.  Play and communicate problem 7 days
 LOW WEIGHT FOR AGE 14 days
 

When to Return Immediately:

Advise the mother to return immediately if the young infant has any of these signs:

Breastfeeding poorly
Becomes sicker
Develops a fever
Feels unusually cold
Fast breathing
Difficult breathing
Blood in stool
Jaundice
If the young infant had jaundice: when Jaundice extends to palms and soles
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Teach The Mother To Express Breast Milk If

Indicated TEACH THE MOTHER HOW TO KEEP THE LOW
 WEIGHT INFANT WARM AT HOME
Ask the mother to:
 Wash her hands thoroughly.
 Keep the young infant in the same bed with the mother.
 Make herself comfortable.
 Hold a wide necked container under her nipple and areola.  keep the room warm (at least 25 ) with home heating device and make sure that
 Place her thumb on top of the breast and the first finger on the under side of the there is no air draught of cold air.
breast so they are opposite each other (at least 4 cm from the tip of the nipple).
 Compress and release the breast tissue between her finger and thumb a few  Avoid bathing the low weight infant. When washing or bathing, do it in a very warm
times. room with warm water, dry immediately and thoroughly after bathing and clothe the
 If the milk does not appear she should re-position her thumb and finger closer to
young infant immediately.
the nipple and compress and release the breast as before.
 Compress and release all the way around the breast, keeping her fingers the  Change clothes (e.g. nappies) whenever they are wet.
same distance from the nipple. Be careful not to squeeze the nipple or to rub the  Provide skin to skin contact as much as possible, day and night.
skin or move her thumb or finger on the skin.
 Express one breast until the milk just drips, then express the other breast until the For skin to skin contact:
milk just drips. - Dress the infant in a warm shirt open at the front, a nappy, hat and socks.
 Alternate between breasts 5 or 6 times, for at least 20 to 30 minutes.
- Place the infant in skin to skin contact on the mother's chest between her
breasts. Keep the infant's head turned to one side.
- Cover the infant with mother's clothes (and an additional warm blanket in cold
weather).
TEACH THE MOTHER HOW TO FEED BY A CUP
 When not in skin to skin contact, keep the young infant clothed or covered as much
 Put a cloth on the infant's front to protect his clothes as some milk can spill. as possible at all times. Dress the young infant with extra clothing including hat and
 Hold the infant semi-upright on the lap. socks, loosely wrap the young infant in a soft dry cloth and cover with a blanket.
 Put a measured amount of milk in the cup.  Check frequently if the hands and feet are warm. If cold, re-warm the baby using

 Hold the cup so that it rests lightly on the infant's lower lip. skin to skin contact.
 Tip the cup so that the milk just reaches the infant's lips.  Breastfeed the infant frequently (or give expressed breast milk by cup).

 Allow the infant to take the milk himself. DO NOT pour the milk into the infant's
mouth.


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GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT

LOCAL BACTERIAL INFECTION
After 2 days:
Reassess the young infant for bacterial infection >>> see “Check for Possible Bacterial Infection” above.
Look at the umbilicus. Is it red or draining pus? Does redness extend to the skin?
Look at the skin pustules. Are there many or severe pustules ?

Treatment :
If signs of possible serious bacterial infection, refer urgently to hospital.
If pus or redness of the umbilicus remains or is worse, refer urgently to hospital.
If pus and redness are improved, tell the mother continue treating the local infection at home.

Look for pus draining from the eye(s). Is it associated with redness and swelling ?
Treatment :
If pus with redness and swelling , refer urgently to hospital.
If pus is still draining from the eye(s), treat with local treatment for 5 days and follow up in 3 days, if pus is still draining refer to hospital.
If improving, tell her to continue local treatment until there is no pus or redness at all. 

BACTERIAL INFECTION UNLIKELY

After 2 days:
Reassess the young infant for bacterial infection >>> see “Check for Possible Bacterial Infection” above.
Treatment:
-If signs of possible serious bacterial infection, refer to hospital.
-If signs of local bacterial infection, treat accordingly.
-If still not improving, continue to give home care.
-If improving , praise the mother for caring the infant well.

FOLLOW-UP
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GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT

JAUNDICE
After 1 day:
 Look for jaundice. Is jaundice extending to palms and soles ?

Treatment:
 If jaundice extending to palms and soles, refer urgently to hospital.
 If jaundice not extending to palms and soles, but jaundice has not decreased, advise the mother home care and ask her to return for
follow up in 1 day.
 If jaundice has started decreasing, reassure the mother and ask her to continue home care. Ask her to return for follow up at 14 days
of age.

DIARRHOEA
After 2 days:
Ask : Has the diarrhoea stopped?
Treatment :
 If the diarrhoea has not stopped, re-assess and treat the young infant for diarrhoea. >SEE "Does the Young Infant Have Diarrhoea?"
 If the diarrhoea has stopped, tell the mother to continue/ encourage exclusive breastfeeding.

THRUSH OR ULCERS
After 2 days:
Look for ulcers or white patches in the mouth (thrush).
Reassess feeding. >>> See “Then Check for Feeding Problem or Low Weight” above.

If thrush or ulcers are worse, or the infant has problems with attachment or suckling, refer to hospital.

If thrush or ulcers are the same or better, and the infant is feeding well, continue half-strength gentian violet for a total of 5 days.
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GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT

FEEDING PROBLEM
After 2 days:
Reassess feeding. >>> See “Then Check for Feeding Problem or Low Weight” above.
Ask about any feeding problems found on the initial visit.

Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding, ask her to bring the young infant back
again (in 2 days).
If the young infant is low weight for age, ask the mother to return 14 days of this follow up visit. Continue follow-up until the infant is gaining weight well.

Exception:
If you do not think that feeding will improve, or if the young infant has lost weight, refer the child.

LOW WEIGHT
After 14 days:
Weigh the young infant and determine if the infant is still low weight for age.
Reassess feeding. >>> See “Then Check for Feeding Problem or Low Weight” above.

If the infant is no longer “low weight for age”, praise the mother and encourage her to continue.

 If the infant is still “low weight for age”, but is feeding well, praise the mother. Ask her to have her infant weighed again within a month or when she returns for
immunization.

If the infant is still “low weight for age” and still has a feeding problem, counsel the mother about the feeding problem. Ask the mother to return again in 14 days (or when
she returns for immunization, if this is within 2 weeks). Continue to see the young infant every week until the infant is feeding well and gaining weight regularly or is no longer
low weight for age.

Exception:
If the infant is not adding weight and has no feeding problem, or if the young infant has lost weight, refer to hospital.

PLAY AND COMMUNICATE PROBLEM

After 7days:
Assess play and communicate for young infant
– If play and communicate problem still exists, re-assess and counsel the mother and ask her to come back in 7 days
- If improves, praise the mother and encourage her to continue, counsel her further if necessary.
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