treat the child

8/8/2019 Treat the Child

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INTEGRATED MANAGEMENT

OF CHILDHOOD ILLNESS

(IMCI)


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Aged 2 Months Up to 5 Years

TREAT THE CHILD


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Objectives

Determining appropriate oral drugs and dosages

Giving oral drugs and teaching how and when to giveoral drugs at home

Treating local infections and teaching how and when togive treatments at home

Checking the mothers understanding

Giving injectable pre-referral drugs

Preventing low blood sugar

Treating different classifications of dehydration andteaching about extra fluids to give at home

Immunizing children


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Select an Appropriate Oral Drug and

Determine the Dose and the Schedule

Give an appropriate antibiotic

The following needs antibiotic General danger signs

Severe pneumonia or very severe disease Pneumonia

Severe dehydration with cholera in the area

Dysentery

Very severe febrile disease/malaria

Severe complicated measles

Mastoiditis

Acute ear infection


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Give first-line oral antibiotic if it is available. Second-

line antibiotic is given only if the first-line is

unavailable, or the illness does not respond to the first-

line antibiotic Sometimes, one antibiotic can be given for several

illnesses. Do not double the dose or prolong the

duration of giving the drug

To determine the correct dose, choose the row for theweight or age. Weight is better used in choosing the

right dose


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For PNEUMONIA, ACUTE EAR INFECTION, VERY

SEVERE DISEASE, MASTOIDITIS

First-line antibiotic: Cotrimoxazole

Second-line antibiotic: Amoxycillin

AGE OR WEIGHT COTRIMOXAZOLE

- Give two times daily for 5 days

AMOXYCILLIN

- Give three times daily for 5 days

ADULT TABLET

80 mg/ 400/mg

SYRUP

40 mg/ 200mg/ 5 mL

TABLET

250 mg

SYRUP

125 mg/ 5 mL

2 months up to 12

months (4-10 kg)

1/2 5 mL 1/2 5 mL

12 months up to 5

years (10-19 kg)

1 10 mL 1 10 mL


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For DYSENTERY: Give antibiotic recommended for

Shigella in your area for 5 days

First-line antibiotic: Cotrimoxazole

Second-line antibiotic: Nalidixic Acid

COTRIMOXAZOLE

- Give two times daily for 5 days

NALIDIXIC ACID

- Give four times daily for 5 days

AGE OR WEIGHT See above dosage SYRUP 250 mg/ 5 mL

2 months up to 4months (4-6 kg) 1.25 mL (1/4 tsp)

4 months up to 12

months (6-10 kg) 2.5 mL (1/2 tsp)

12 months up to 5

years (10-19 kg)5 mL (1 tsp)


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For CHOLERA: Give an antibiotic recommended for

Cholera in your area for 3 days

First-line antibiotic: Tetracycline

Second-line antibiotic: Cotrimoxazole

TETRACYCLINE

- Give four times daily for 3

days

COTRIMOXAZOLE

- Give two times daily for 5

days

AGE OR WEIGHT CAPSULE (250 mg) See above dosage

2 months up to 4 months (4-6

kg)

4 months up to 12 months (6-

10 kg)

1/2

12 months up to 5 years (10-

19 kg)

1


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Give an Oral Antimalarial Treatment with Chloroquine assumes that the child has not

yet been treated with that drug before. Confirm this withthe mother. Use instructions in the GIVE FOLLOW-UP CARE

MALARIA on the TREAT THE CHILD chart if it is a follow-upvisit

Reduce the dose for the three-day treatment of Chloroquine

Explain the possible itching as a side effect of the drug

If (+) for P. Falciparum, a single dose of

Sulfadoxine/Primaquine is given. Then the first dose ofChloroquine is given after two hours to minimize gastricirritation. A single dose of Primaquine will be given on Day4 at the health center


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If (+) P. Vivax, a first dose of Primaquine and

Chloroquine is given in the center, the, one dose each

day for another 13 days

For mixed infections, treat as P. Falciparum and startPrimaquine as in P. Vivax

If no blood smear test done, treat as P. Falciparum

DO NOT give Primaquine to children under 12 months

of age


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Give an oral antimalarial

First-line: Chloroquine, Primaquine, Sulfadoxine and

Pyrimethamine

Second-line: Artemeter-Lumefrantine

If Chloroquine

Explain to watch child carefully for 30 minutes after

giving a dose of Chloroquine. Repeat ifthe child vomitsafter 30 minutes

Itching is a possible side-effect of the drug


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If Sulfadoxine + Pyrimethamine

Give single dose in the health center 2 hours before

intake of Chloroquine

If Primaquine

Give single dose on Day 4 for P. Falciparum

If Artemeter-Lumefrantine

Give for three days


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CHLOROQUINE

- Give for 3 days

PRIMAQUINE

- Give single

dose in health

center for P.

falciparum

PRIMAQUINE

- Give daily

for 14 days

for p. vivax

SULFADOXINE +

PYRIMETHAMINE

- Give single dose in

health center

AGE TABLET(150 mg)

TABLET(15 mg)

TABLET(15 mg)

TABLET(500 mg/ 25 mg)

DAY 1 DAY 2 DAY 3

2 months up

to 5 months

(4-7 kg)

1/2 1/2 1/2 1/4

5 months up

to 12 months

(7-10 kg)

1/2 1/2 1/2 1/2

12 months up

to 3 years

(10-14 kg)

1 1 1/2 1/2 1/4 3/4

3 years up to

5 years (14-

19 kg)

1 1/2 1 1/2 1 3/4 1/2 1


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Give Paracetamol for High Fever (38.5 or higher)

or Ear Pain

Give one dose Paracetamol in the center then give

enough for one day

PARACETAMOL

AGE OR WEIGHT TABLET (500 mg) SYRUP (120 mg/ 5 mL)

2 months up to 3 years (4-

14 kg)

1/4 5 mL (1 tsp)

3 to 5 years (14-19 kg) 1/2 10 mL (2 tsp)


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Give Vitamin A

Vitamin A is given in SEVERE PNEUMONIA or VERY

SEVERE DISEASE, SEVERE PERSISTENT DIARRHEA or

PERSISTENT DIARRHEA, or MEASLES, or SEVEREMALNUTRITION or VERY LOW WEIGHT

For both treatment and supplementation, a single dose

is given in the health center

Should be given only Age six months and older

Children who have not had a dose in the past six months


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AGE VITAMIN A CAPSULES

100,000 IU 200,000 IU

6 months up to 12 months 1 1/2

12 months up to years - 1


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Give Iron

Some palmar pallor

Give syrup to a child under 12 months old. Iron/folate

tablet for children above 12 months

Give mother enough iron for 14 days and tell to give

one dose daily. Teach how to give and what to observe

If receiving antimalarial sulfadozine pyrimethamine

(Fansidar), do not give Iron/Folate tablet yet until a

follow-up visit in two weeks. If the Iron available does

not contain Folate, it may be given


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AGE OR WEIGHT IRON/FOLATE

TABLET

Ferrous sulfate 200

mg + 250 mcg

folate

(60 mg elemental

iron)

IRON SYRUP

Ferrous sulfate 150

mg/ 5mL

(6 mg elemental

iron per mL)

IRON DROPS

Ferrous sulfate 25

mg

(25 mg elemental

iron/ mL)

3 months up to 4

months (4-6 kg)

2.5 mL (1/2 tsp) 0.6 mL

4 months up to 12months (6-10 kg)

4 mL (3/4 tsp) 1 mL

12 months up to 3

years (10-14 kg)

1/2 5 mL 1.5 mL

3 years up to 5

years (14-19 kg)

1 10 mL (1 tsp) 2 mL


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Give Mebendazole

A one-year old child who is anemic and with

hookworms or whipworms needs to be given this drug

Mebendazole 500 mg or Albendazole 400 mg assingle dose is given at the center if the child has not

been given one in the previous six months

AGE OR WEIGHT ALBENDAZOLE 400 mg

Tablet

MEBENDAZOLE 500 mg

Tablet

12 months up to 23 months 1/2 1

24 months up to 59 months 1 1


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Use Good Communication Skills

Success of home treatment depends on how well thehealth care worker communicated. The motherneeds to know how to give the treatment and

understand the importance of the treament Skills in communication include the following

ASK questions and LISTEN to find out what the mother isalready doing for the child

PRAISE for what she has done well ADVISE how to treat at home

CHECK the understanding


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ADVISE THE MOTHER HOW TO TREAT HER CHILD AT

HOME

Three basic steps in teaching

Give information explain how to do the task Show an example show how to do the task

Let her practice ask to do the task while you watch

When teaching

Use words easily understood Use teaching aids that are familiar, such as common containers

Give feedback

Encourage to ask questions


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CHECK THE MOTHERS UNDERSTANDING

Use good checking questions to help make sure that the

mother learns and remembers how to treat her child

Good checking questions require that she describeWHY, HOW, or WHEN

GOOD CHECKING QUESTIONS POOR CHECKING QUESTIONS

How will you prepare the ORS?

How often should you breastfeed your child?On what part of the eye do you apply the

ointment?

How much extra fluid should you give after each

loose stool?Why is it important for you to wash your hands?

Do you remember how to mix the ORS?

Should you breastfeed your child?Have you used ointment on your child

before?

Do you know how to give extra fluids?

Will you remember to wash your

hands?


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Teach the Mother to Give Oral Drugs

at Home

Follow these instructions

Determine the appropriate drugs and dosage for ageand weight

Tell the reason for giving the drug including why andwhat problem it is treating

Demonstrate how to measure a dose

If the drug is in syrup form, show how to measure using

common household teaspoon 1.25 mL tsp

2.5 mL tsp

5 mL 1 tsp


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at Home

Show how to give Vitamin A capsule

Watch the mother practice measuring a dose

Ask the mother to give the first dose. If the child

vomits within 30 minutes, give another dose. If thechild is dehydrated and vomiting, wait until the childis rehydrated before giving the dose again

Explain carefully, then label and package the drug

To write information on a drug label Full name of the drug and the total amount to complete the

treatment


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at Home

Write the correct dose and when to give

Write the daily dose and schedule

Write clearly

Put the drug in its own labelled container, keeping it clean

and dry Ask questions to make sure the mother understands

If more than one drug will be given, package each drugseparately

Explain that all oral drugs must be used to finish the course

of treatment even if the child gets better Advise to store drugs properly

Check mothers understanding before she leaves


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Teach the Mother to Treat Local

Infections at Home

Treat eye infection with Tetracycline eye ointment

If the child will be referred, clean eye gently and squirt

a small amount

If the child will not be referred, teach how to applydrug at home

Treat both eyes until redness is gone from the infected

eye

Do not use any other eye ointments, drops, or

alternative treatments

Bring the child to health center after two days


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at Home

Dry the ear by wicking

Use clean, absorbent cotton cloth or soft strong tissue

paper for making a wick

Done three times daily until wick no longer gets wet

Do not place anything in the ear between wicking

treatments. Do not allow water to get in the ear


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at Home

Treat mouth ulcers with gentian violet

Use half-strength gentian violet

Use clean soft cloth dipped in salt water

Use cotton-tipped stick to paint the gentian violet on the

mouth ulcers. Do not allow child to drink the gentian

violet

Treat mouth ulcers two times per day for five days


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at Home

Soothe the throat and relieve cough with safe

remedy

Should not contain atropine (oral and nasal

decongestants), codeine derivatives or alcohol

Safe remedies to recommend

Breastmilk for exclusively breastfed infants

Tamarind, calamansi, or ginger


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Determine Priority of Advice

When the child has several problems, the

instructions to the mother can be quite complex. In

this case, instructions will have to be limited to what

is most important How much likely can this mother understand and

remember?

Is she likely to come back for follow-up treatment? If so,

some advice can wait until then

What advice is most important


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Determine Priority of Advice

Essential treatments include giving antibiotics or

antimalarial drugs, and giving fluids to a child with

diarrhea

If necessary, OMIT or DELAY

Feeding assessment and couselling

Soothing remedy for cough and cold

Paracetamol Iron treatment

Wicking the ear


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Give These Treatments in Health Center

Only

May need to be given in the health center Intramuscular antibiotic if the child cannot take oral

antibiotic

Quinine for severe malaria

Breastmilk or sugar water to prevent low blood sugar Intramuscular Chloramphenicol may need to be givenbefore leaving for the hospital if Not able to drink or breastfeed

Vomits everything Has convulsions

Abnormally sleepy or difficult to awaken

Cannot take oral antibiotic


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Only

Give an intramuscular antibiotic

First dose is given then refer urgently to hospital

If referral is not possible

Repeat injection every 12 hours for 5 days

Change to appropriate antibiotic to complete 10 days of

treatmentAGE OR WEIGHT CHLORAMPHENICOL

40 mg/ kg

Add 5 mL sterile water to vial containing 1,000 mg

= 5.6 mL at 180 mg/ mL

2 months up to 4 months (4-6 kg) 1 mL = 180 mg

4 months up to 9 months (6-8 kg) 1.5 mL = 270 mg

9 months up to 12 months (8-10 kg) 2 mL = 360 mg

12 months to 3 years (10-14 kg) 2.5 mL = 450 mg

3 to 5 years (14-19 kg) 3.5 mL = 630 mg


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Only

Quinine injection is given to a child with VERYSEVERE FEBRILE DISEASE/ MALARIA if there is goingto be any delay in the child reaching the referral

hospital. It is given intramuscularly ONLY becauseof these possible side effects

Sudden drop in blood pressure

Dizziness

Ringing of the ears Sterile abscess

Should remain lying down for one hour


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Only

Give first dose of intramuscular Quinine then refer

urgently to hospital

If referral is not possible

Repeat Quinine injection at 4 to 8 hours later, then 12

hours until child is able to take oral antimalarial. Do not

continue injections for more than 1 week

DO NOT GIVE QUININE TO A CHILD LESS THAN 4

MONTHSOF AGE


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Only

AGE OR WEIGHT INTRAMUSCULAR QUININE

300 mg/ mL (in ampules)

4 months up to 12 months (6-10 kg) 0.3 mL

12 months up to 2 years (10-12 kg) 0.4 mL

2 years up to 3 years (12-14 kg) 0.5 mL

3 years up to 5 years 914-19 kg) 0.6 mL


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Only

Treat the child to prevent low blood sugar

Low blood sugar occurs in serious infections such as

severe malaria or meningitis, or when the child is not

able to eat for many hoursGiving some breastmilk, breastmilk substitute, or sugar

water is done before the child is referred

Give 30-50 mL of milk or sugar water before

departure To make sugar water: Dissolve 4 level teaspoons of sugar

(20 grams) in 200-mL cup of clean water


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Only

If the child is not able to swallow

Give 50 mL of milk or sugar water by nasogastric tube

If the child is difficult to awaken or unconscious, start IV

infusion Give 5 mL/ kg of 10% of dextrose solution (D10) over a

few minutes

Or give 1 ml/ kg of 50% (D50) by slow push


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Give Extra Fluid for Diarrhea and DHF

and Continue Feeding

Plan A: Treat diarrhea at home

Treatment plan for child with diarrhea with NO

DEHYDRATION

Three rules of home treatment Give extra fluids (as much as the child will take)

Continue feeding

When to return


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GIVE EXTRA FLUIDS Tell the mother

For exclusively breastfed babies, breastfeed frequently andlonger, and give ORS or clean water. For children over six

months, no food-based fluids For children not exclusively breastfed, give one or more of the

following: ORS, food-based fluids, and/or clean water

Teach how to mix and give ORS. Give two packets of ORSto use at home

Show how much fluid to give in addition to the usual fluidintake Up to 2 years 50 to 100 mL after each loose stool

2 years or older 100 to 200 mL after each loose stool


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CONTINUE FEEDING

WHEN TO RETURN

The following signs indicate that the child should be returned

immediately Not able to drink of breastfeed

Becomes weaker

Develops fever

If the child has diarrhea, also tell the mother to return if the

child Has blood in the stool

Drinking poorly


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Plan B: Treat some dehydration with ORS

Initial treatment for four hours in the health center

If the child is for referral, do not try to rehydrate

before leaving. The child will be given frequent sips ofORS on the way

After four hours, reassess and classify

DETERMINE THE AMOUNT OF ORS TO GIVE DURINGTHE FIRST FOUR HOURS The age or weight, degree of dehydration, and number of

stools passed during rehydration will affect the amount ofORS needed


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To determine the amount needed

Multiply childs weight (in kilograms)by 75

Giving ORS should not interfere with breastfeeding. For

infants under six months who are not breastfed, 100-200 mL

clean water should be given during the first four hours in

addition to the ORS

SHOW MOTHER HOW TO GIVE ORS

Food should not be given within the first four hours of

treatment


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AFTER FOUR HOURS Reassess using the ASSESS and CLASSIFY chart

Reassess child BEFORE four hours if child is not taking ORS orseems to be getting worse

If childs eyes are puffy, it is a sign of overhydration. Stop ORSand give clean water or breastmilk. ORS is resumed whenpuffiness is gone

IF THE MOTHER MUST LEAVE BEFORE COMPLETINGTREATMENT Show how to prepare ORS

Show how much to give to complete the 4-hour treatment Give enough packets to complete rehydration plus two more

packets as recommended in Plan A

Explain the three Rules of Home Treatment


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Plan C: Treat severe dehydration quickly

Treatment depends on Type of equipment available

Training of the health worker Whether the child can drink

Treat persistent diarrhea

Requires special feeding

Treat dysenteryOral antibiotic recommended for Shigella is given and

mother is told to return in two days for follow-up


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Immunize Every Sick Child as Needed

If the child is well enough to go home, give thenecessary immunization before he/she leaves the center

Immunization is given even if only one child needs theimmunization

Reconstituted vaccines must be discarded after six hours Opened vials of OPV may be kept if Not yet expired

Stored between 0 to 8 degrees Celsius

Not taken out of the health center OPV vials with vaccine vial monitors that changed in

color indicate expiration


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Immunize Every Sick Child as Needed

Record all immunizations on the childs immunizationcard

If the child has diarrhea and needs OPV, give it but donot record the dose. Tell the mother to return in four

weeks for an extra dose Tell the possible side effects of each vaccine BCG: ulceration

OPV: none

DPT: fever, irritability and soreness Measles: fever and mild rash a week after lasting for oneto

three days

Hepatitis B: none

treat the child

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