Date of Visit:________
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
§ Name:
§ Age:
§ Weight: __kg
§ Temperature: __ °C
§ ASK: What are the child’s problems?
Initial visit?
Follow-up vist?
CHECK FOR GENERAL DANGER SIGNS
§ Not able to drink or breastfeed
§ Vomits everything
§ Convulsion during illness
§ Lethargic or unconscious
§ Convulsing now
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
§ For how long? __ Days
§ Count the breaths in on minute. __ breaths per minute. Fast breathing?
§ Look for chest indrawing
§ Look and listen for stridor
§ Look and listen for wheeze
DOES THE CHILD HAVE DIARRHOEA?
§ For how long? __ Days
§ Is there blood in the stools?
§ Look at the child’s general condition.Is the child:
o Lethargic and unconscious
o Restless or irritable
§ Look for sunken eyes.
§ Offer the child fluid. Is the child:
o Not able to drink or drinking poorly?
o Drinking eagerly, thirsty?
§ Skin tugor:Pinch the skin of the abdomen. Does it go back:
o Very slowly (longer than 2 seconds)?
o Slowly?
DOES THE CHILD HAVE FEVER? (by history/temperature 37.5°C or above)
§ For how long? __ Days
§ If more than 7 days, has fever been present every day?
§ Has child had measles within the last three months?
BSMP Positive / Negative / Not done / Falciparum / Vivax
§ Look or feel for stiff neck
§ Look for runny nose
Look for signs of MEASLES:
§ Generalized rash and
§ One of these: cough, runny nose, or red eyes
If the child has measles now or within the last 3 months:
§ Look for mouth ulcers .
§ If yes, are they deep or extensive?
§ Look for pus draining from the eye.
§ Look for clouding of the cornea
DOES THE CHILD HAVE EAR PROBLEM?
§ Is there ear pain?
§ Is there ear discharge?
§ If Yes, for how long? __ Days
§ Pain in ear when touched.
§ Look for pus draining from the ear.
§ Feel for tender swelling behind the ear.
THEN CHECK FOR MALNUTRITION AND ANAEMIA
§ Look for visible severe wasting.
§ Look for palmar pallor
o Severe palmar pallor? Some palmar pallor?
§ Look and feel for oedema of both feet.
§ Determine weight for age.
§ Very Low? Not Very Low?
CHECK THE CHILD’S IMMUNIZATION STATUS
ASSESS CHILD’S FEEDING if child has ANAEMIA OR VERY LOW WEIGHT or is less than 2 years old.
§ Do you breastfeed your child? Yes__ No__
o If Yes, how many times in 24 hours? __ times.
§ Do you breastfeed during the night? Yes__ No__
o If Yes, what food or fluids? _________
§ How many times per day? __ time. What do you use to feed the child? _________
§ If very low weight for age: How large are servings? _________Does the child receive his own serving? __ Who feeds the child and how? _________During the illness, has the child’s feeding changed? Yes__ No__
o If Yes, how?
ASSESS OTHER PROBLEMS:
Sunday, February 04, 2007
Date of Visit:________
MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS
§ Name:
§ Age:
§ Weight: __kg
§ Temperature: __ °C
§ ASK: What are the infant’s problems?
Initial visit?
Follow-up vist?
CHECK FOR POSSIBLE BACTERIAL INFECTION
§ Has the infant had convulsions?
§ Count the breaths in one minute. ___ breaths per minute
o Repeat if elevated. ___ Fast breathing?
§ Look for severe chest indrawing
§ Look for nasal flaring
§ Look and feel for bulging fontanelle
§ Look for pus draining from the ear
§ Look at umbilicus. Is it red or draining pus?
o Does the redness extend to the skin?
§ Fever (temperature 37.5°C or feels hot) or low body temperature (below 35.5°C or feels cold)
§ Look for skin pustules. Are there many or severe pustules?
§ See if young infant is lethargic or unconscious
§ Look at the young infant’s movements. Less than normal?
DOES THE YOUNG INFANT HAVE DIARRHOEA?
§ For how long? ___ Days
§ Is there blood in the stools?
§ Look at the young infant’s general condition. Is the infant:
o Lethargic or unconscious?
o Restless and irritable?
§ Look for sunken eyes
§ Pinch the skin of the abdomen. Does it go back:
o Very slowly (longer than 2 seconds)?
o Slowly?
THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT
§ Is there any difficulty feeding? Yes__ No__
§ Is the infant breastfed? Yes __ No__
§ If Yes, how many times in 24 hours? __ Times
§ Does the infant usually receive any other foods or drinks? Yes__ No__
§ If Yes, how often?
§ What do you use to feed the child?
§ Determine weight for age. Low__ Not Low__
If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or drinks, or is low weight for age AND has no indications to refer urgently to hospital:
ASSESS BREASTFEEDING:
§ Has the infant breastfed in the previous hour?
§ If infant has not fed in the previous hour, ask the mother to put her infant to the breast. Observe breastfeed for 4 minutes.
§ Is the infant able to attach? To check attachment, look for:
o Chin touching breast
o Mouth wide open
o Lower lip turned outward
o More areola above than below the mouth
no attachment at all not well attached good attachment
§ Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?
not suckling at all not suckling effectively suckling effectively
§ Look for ulcers or white patches in the mouth (thrush)
CHECK THE YOUNG INFANT’S IMMUNIZATION STATUS
ASSESS FOR OTHER PROBLEMS:
MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS
§ Name:
§ Age:
§ Weight: __kg
§ Temperature: __ °C
§ ASK: What are the infant’s problems?
Initial visit?
Follow-up vist?
CHECK FOR POSSIBLE BACTERIAL INFECTION
§ Has the infant had convulsions?
§ Count the breaths in one minute. ___ breaths per minute
o Repeat if elevated. ___ Fast breathing?
§ Look for severe chest indrawing
§ Look for nasal flaring
§ Look and feel for bulging fontanelle
§ Look for pus draining from the ear
§ Look at umbilicus. Is it red or draining pus?
o Does the redness extend to the skin?
§ Fever (temperature 37.5°C or feels hot) or low body temperature (below 35.5°C or feels cold)
§ Look for skin pustules. Are there many or severe pustules?
§ See if young infant is lethargic or unconscious
§ Look at the young infant’s movements. Less than normal?
DOES THE YOUNG INFANT HAVE DIARRHOEA?
§ For how long? ___ Days
§ Is there blood in the stools?
§ Look at the young infant’s general condition. Is the infant:
o Lethargic or unconscious?
o Restless and irritable?
§ Look for sunken eyes
§ Pinch the skin of the abdomen. Does it go back:
o Very slowly (longer than 2 seconds)?
o Slowly?
THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT
§ Is there any difficulty feeding? Yes__ No__
§ Is the infant breastfed? Yes __ No__
§ If Yes, how many times in 24 hours? __ Times
§ Does the infant usually receive any other foods or drinks? Yes__ No__
§ If Yes, how often?
§ What do you use to feed the child?
§ Determine weight for age. Low__ Not Low__
If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or drinks, or is low weight for age AND has no indications to refer urgently to hospital:
ASSESS BREASTFEEDING:
§ Has the infant breastfed in the previous hour?
§ If infant has not fed in the previous hour, ask the mother to put her infant to the breast. Observe breastfeed for 4 minutes.
§ Is the infant able to attach? To check attachment, look for:
o Chin touching breast
o Mouth wide open
o Lower lip turned outward
o More areola above than below the mouth
no attachment at all not well attached good attachment
§ Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?
not suckling at all not suckling effectively suckling effectively
§ Look for ulcers or white patches in the mouth (thrush)
CHECK THE YOUNG INFANT’S IMMUNIZATION STATUS
ASSESS FOR OTHER PROBLEMS:
Screening tests for antenatal diagnosis
Maternal blood for....
- blood group + Rh antibodies
- Hep B
- Syphilis
- Rubella
- HIV (after counselling and maternal consent)
- neural tube defects
- Down's syndrome
Ultrasound screening for ....
- gestational age - if performed before 20/52
- multiple pregnancies
- structural abnormalities
- fetal growth monitoring - abdo + head circumference and femur length
- amniotic fluid volume
- oligohydramnios (reduced fetal urine production - dysplastic /absent kidneys or obstructive uropathy, prolonged rupture of membranes -> IUGR) --> Pulmonary hypoplasia and limb + facial deformities from pressure on fetus (Potter's Sx)
- polyhydramnios (assoc. with maternal diabetes & fetal G.I. atresia)
Techniques for antenatal diagnosis
- Detailed Ultrasound - structural malformations
- Amniocentesis - chromosomal analysis, Alphafetoprotein+acetylcholinesterase (NTD), bilirubin estimation (rhesus disease), enzyme analysis (inborn errorof metabolism)
- Transabdominal chorionic villus sample - chromosomal analysis, enzyme analysis (inborn error of metabolism), DNA analysis (thalassaemia, haemophilia A+B, CF, Duchenne's)
- Fetal blood sample - rapid chromosomal anaylsis (fetal malformations or severe IUGR), assessment of severe rhesus & platelet isoimmunisation, congenital infectoin serology
- Fetal tissue sampling - skin biopsy (severe congenital skin disorders)
Pre-Pregnancy Care
Counselling on...
Counselling on...
- smoking - reduced birth wt, increase risk of miscarriage, SIDS
- medication - teratogenic effects
- alcohol xs - fetal damage
- congenital rubella - immunisation b4 pregnancy
- exposure to toxoplasmosis - avoid undercooked meat, wear gloves when handling cat litter
- listeria infection - from unpasteurised dairy products
- liver - best avoided; high[ vitamin A]
- pre-pregnancy folic acid supplements - reduce risk of NTD
Risk of fetal abnormality increases with...
- mother > 35, Down's Sx > 1 in 380
- previous abnormal child
- family history of inherited disorder
- parents = cariers of autosomal recessive disorder e.g. thalassaemia
- parents carry chromosomal rearrangement
Subscribe to:
Posts (Atom)
