INTEGRATED

MANAGEMENT
OF
CHILDHOOD ILLNESS
( IMCI )
JANETH ROSE JOSUE ESTAVILLO – TOLEDO RN, MN
SHEANNE AQUE SAPLOT RN
 HOW DO WE TAKE EFFECTIVE
INTERVENTIONS TO THOSE WHO
NEED THEM?
• Effective interventions exist, but one of the main
challenges is how to take them where they are needed.
WHERE ARE THESE INTERVENTIONS
NEEDED MOST?
MAIN COMPONENTS OF IMCI
FACT # 1

Each year more than

10 million children in low-
and middle-income
countries DIE before
they reach their FIFTH
BIRTHDAY.
FACT # 2
• Seven in ten of these deaths
are due to just five preventable
and treatable conditions:
pneumonia, diarrhoea,
malaria, measles, and
malnutrition, and often to a
combination of these
conditions
FACT # 3

• Every day, millions of

parents seek health care
for their sick children,
taking them to hospitals,
health centers,
pharmacists, doctors and
traditional healers
FACT # 4
• Many sick children are
not properly assessed
and treated by these
health care providers,
and that their parents
are poorly advised
 INTRODUCTION

Surveys of the management of sick children

in most developing countries reveal that
• Many children are not properly assessed
and treated and that their parents are
poorly advised.
• Diagnostic supports such as radiology and
laboratory services are minimal or non-
existent. • Drugs and equipment are scarce.
 INTRODUCTION
Projections based on the 1996 analysis The global burden
of disease indicate that common childhood illnesses will
continue to be major contributors to child deaths through
the year 2020 unless greater efforts are made to control
them.
• This assumption makes a strong case for introducing new
strategies to significantly reduce child mortality and
improve child health and development.
• WHO and UNICEF developed a strategy known as
Integrated Management of Childhood Illness (IMCI).
 IMCI

WHO and UNICEF used updated technical

findings to describe management of these
illnesses in a set of integrated guidelines for
each illness.
These guidelines have been adapted to each
country
WHY IS IMCI BETTER THAN SINGLE-CONDITION A
PPROACHES?
• Children brought for medical treatment in
the developing world are often suffering from
more than one condition
• This overlap means that a single diagnosis
may not be possible or appropriate and
treatment may be complicated by the need to
combine therapy for several conditions.
CONT

• An integrated approach to
managing sick children is, therefore,
indicated as is the need for child
health programs to go beyond single
diseases and address the overall
health of a child.
“Looking to The Child as a Whole”.
 BENEFITS OF IMCI
• Addresses major child health problems – The strategy addresses the most
important causes of childhood death and illness
• Promotes prevention as well as cure – In addition to its focus on treatment,
IMCI also provides the opportunity for important preventive interventions such
as immunization and improved infant and child nutrition, including
breastfeeding
• IMCI improves health worker performance and their quality of care.
• IMCI can reduce under-five mortality and improve nutritional status, if
implemented well;
• IMCI is worth the investment, as it costs up to six times less per child
correctly managed than current care
 BENEFITS OF IMCI

• Cost-effective Inappropriate management of

childhood illness wastes scarce resources.

• Improves equity
THE IMCI CASE MANAGEMENT PROCESS
 DISEASES COVERED BY IMCI

1-Diarrheal diseases
2-Acute respiratory infections
3-Malaria
Lead to more than 70% of child
4-Measles mortality and morbidity
5-Malnutrition
 DISEASES NOT COVERED BY IMCI
The IMCI guidelines address the most important but NOT
ALL of the major reasons a sick child or an infant is brought
to the clinic with.

IMCI encourages the health provider to assess problems

not included in IMCI charts. These are considered under
the box :
ASSESS OTHER PROBLEMS IMCI
 WHO ARE THE CHILDREN
COVERED BY THE IMCI
PROTOCOL?

• Sick children birth up to 2 months (Sick

Young Infant)
• Sick children 2 months up to 5 years old
(Sick child)
 WHY NOT USE THE PROCESS FOR CHIL
DREN AGE 5 YEARS OR MORE?
The case management process is designed for children < 5yrs of age,
although much of the advise on treatment of pneumonia, diarrhea,
malaria, measles and malnutrition, is also applicable to older children, the
ASSESSMENT AND CLASSIFICATION of older children would differ. For
example;-
• The cut off rate for determining fast breathing would be different
because normal breathing rates are slower in older children.
• Chest indrawing is not a reliable sign of severe pneumonia as children
get older and the bones of the chest become more firm.
• In addition, certain treatment recommendations or advice to mothers on
feeding would differ for >5yrs old.
IMCI CASE MANAGEMENT
 THE IMCI CODE

PINK - indicates urgent hospital referral or

admission

YELLOW - indicates initiation of specific Outpatient

Treatment

GREEN - indicates supportive home care

SICK YOUNG INFANT AGE UP TO 2 MONTHS
ASSESS
ASK THE MOTHER WHAT THE
YOUNG INFANT'S PROBLEMS
ARE:
Determine if this is an initial or
follow-up visit for this problem:
-if follow-up visit, use the follow-
up instructions.
-if initial visit, assess the child as
follows:
CLASSIF
Y
USE ALL BOXES THAT MATCH THE
INFANT'S SYMPTOMS AND
PROBLEMS TO CLASSIFY THE
ILLNESS.

IDENTIFY
TREATMENT
 CHECK FOR VERY SEVERE
DISEASE AND
LOCAL BACTERIAL
INFECTION
ASK:
-Is the infant having
difficulty in feeding?
-Has the infant had -Measure axillary temperature.
-Look at the umbilicus. (Is it
convulsions (fits)?
red or draining pus?)
-Count the breaths in one -Look for skin pustules.
minute. Repeat the count -Look at the young infant's
if more than 60 breaths movements.
per minute. (If infant is sleeping, ask
-Look for severe chest in the mother to wake
drawing. him/her.)
YOUNG -Does the infant move
INFANT on his/her own?
MUST (If the young infant is not
BE moving, gently stimulate
CALM! him/her.)
-Does the infant not
move at all?
 CE
CHECK FOR JAUNDICE
If jaundice present, ASK: LOOK AND

DI
FEEL:

• When did the jaundice

appear first?
UN
• Look for jaundice (yellow
eyes or skin)
JA

• Look at the young infant's

palms and soles. Are they
yellow?
DIARRHEA
IF YES, LOOK AND FEEL:

?• Look at the young infant's general condition:

• Infant's movements

• Does the infant move on his/her own?

• Does the infant not move even when

stimulated but then stops?

• Does the infant not move at all?

• Is the infant restless and irritable?

• Look for sunken eyes.

• Pinch the skin of the abdomen. Does it go

back:

• Very slowly (longer than 2 seconds)?

or slowly?
INFECTION
ASK
• Has the mother and/or young
infant had an HIV test?
IF YES:

HIV • What is the mother's HIV

status?:
• Serological test POSITIVE or
NEGATIVE
• What is the young infant's HIV
status?:
• Virological test POSITIVE or
NEGATIVE
• Serological test POSITIVE or
NEGATIVE
If mother is HIV positive and
NO positive virological test
in child ASK:
• Is the young infant breastfeeding
now?
• Was the young infant
breastfeeding at the time of test
• or before it?

• Is the mother and young infant

on PMTCT ARV
• prophylaxis?*

IF NO test: Mother and

young infant status
unknown
Perform HIV test for the
mother; if positive,
perform
virological test for the
young infant
Ask: LOOK, LISTEN,
FEEL:
Is the infant breastfed?
If
yes, how many times in
24
hours?

Does the infant usually

receive any other foods
or
drinks? If yes, how
often?
If yes, what do you use
to
feed the infant?
Determine weight for
age.
Look for ulcers or white
patches in the mouth
(thrush)
Check for the Immunization:
DO FOLLOW UP
CARE
 SICK CHILD AGE 2 MONTHS UP TO 5
YEARS
• NAME OF THE CHILD
• AGE
• WEIGHT
• TEMPERATURE
•CHILD’S PROBLEMS
• INITIAL OR FOLLOW UP VISIT
 1. THE GENERAL DANGER SIGNS

1. Is the child able to drink or breastfeed?

 1. THE GENERAL DANGER SIGNS

2-Vomits every thing

3- Has the child had
convulsions?
4- Unconscious,
lethargic 5- Is the child
convulsing now?
MANAGEMENT FOR
DANGER SIGNS
ASSESS THE SICK CHILD, AGE 2 MONTHS UP TO 5
YEARS
Assess major four symptoms:
1-Cough or difficult breathing
2-Diarrhea
3-Fever
4-Ear problems
 CASE STUDY # 1
• Monina is 15 mos old, wt: 8.5 kg, T: 38.5 C. The health
worker asks, “What are the child’s problems? ”The
mother says, “Monina has been coughing for 4 days, &
she is not eating well.” This is Monina’s initial visit. The
health worker checks Monina for danger signs. He asks,
“Is Monina able to drink or breastfeed?” The mother says,
“No, Monina does not want to breastfeed.” The health
worker gives Monina some water to drink. She is too
weak to lift her head. She is not able to drink from cup.
Next, he asks the mother, “Is she vomiting?”. The mother
says, “No”, he then asks, “Has she had convulsions?”.
The mother says, “No”. The health worker checks to see
if Monina is lethargic or unconscious. When the health
worker & the mother are talking, Monina watches them &
looks around the room. Monina is not lethargic or
unconscious.
 2. COUGH OR DIFFICULTY BREATHING
• Pneumonia
• Killer disease
• CA: Streptococcus
pneumoniae, Hemophilus
influenzae
• MOT: droplet
• System affected: Respiratory
system
 2. ASSESS COUGH OR
DIFFICULTY OF BREATHING
• Ask: Does child have difficulty of breathing? (fast, noisy,
interrrupted)
• For how long?
• Count Number of breaths:
• 0-2 mos : 60 & above
• 2-12 mos: 50 & above
• 1-5 years: 40 & above
 DRILL 1- FAST BREATHING
3 mos old 52?
2 year old 38?
6 mos old 48?
12 mos old 38?
12 mos old 42?
3 y/o 37?
8 mos old 54?
18 mos old 45?
 CLASSIFY
COUGH OR DIFFICULTY BREATHING

Severe Pneumonia or
Very Severe Disease

Pneumonia

No Pneumonia: Cough or Colds

 CASE # 2
• Gimo is 6 mos old. Wt: 5.5 kg. T: 38 C. His mother
says that he has had cough for 2 days. The health
worker checks for danger signs. The mother says
Gimo is able to breastfeed. He has not vomited
during the illness. He has not had convulsions.
Gimo is not lethargic or unconscious. The
healthworker says to the mother says to the
mother, “I want to check Gimo’s cough. You said
he has had cough for 2 days now. I am going to
count his breaths per minute. He will need to
remain calm while I do this.” The health worker
counts 58 breaths per minute. He does not see
chest indrawing. He does not hear stridor.
 CASE # 3
• Esmhems - 8 mos old; St: 6 kg., T: 39 C. Her father tells the
health corker “Esmhems has had cough for 3 days. She is
having trouble breathing. She is very weak.” The health
worker says,” You have done the right thing by bringing your
child here today, I will examine her now.” The health worker
checks for danger signs. The mother says, “Esmhems will not
breastfeed. She will not take any drink I offer her.” Esmhems
does not vomit at all, & has not had convulsions. She is
lethargic. She does not look at the health worker or her
parents when they talk. The health worker counts 55 breaths
per minute. He sees chest indrawing. He decides that
 3. ASSESS & CLASSIFY DIARRHEA

• Does the child have diarrhea

• For how long?
• Is there blood in the stool?
 CHECK FOR SIGNS OF DEHYDRATION
LOOK AND FEEL:
[Link] at child’s general condition. Is the child:
• Lethargic or unconscious?
• Restless or Irritable?
[Link] for sunken eyes
[Link] status: Offer the child fluid. Is the child:
• Not able to drink or Drinking poorly?
• Drinking eagerly or thirsty?
[Link] turgor
• Very slowly or slowly ( longer than 2 seconds)?
• Slowly?
CLASSIFY DEHYDRATION

Severe Dehydration

Some dehydration

No dehydration
CLASSIFY PERSISTENT DIARRHEA

Severe Persistent Diarrhea

Persistent Diarrhea
CLASSIFY DYSENTERY

Dysentery
 CASE # 4

• Boghart has had diarrhea for 5 days. There

is no blood in his stool. He is irritable. His
eyes are sunken. His father & mother also
think that Boghart’s eyes are sunken. The
healthworker offers Boghart some water, &
the child drinks eagerly. When the health
worker pinched the skin on the child’s
abdomen, it went back to its original state
slowly.
 CASE # 5
• Jangei has had diarrhea for 3 days. There
is no blood in the stool. The child is not
lethargic or unconscious. She is not
irritable or restless. Her eyes are sunken.
She is able to drink, & is not thirsty. When
her skin was pinched, it went back to its
original state immediately.
 CASE # 6

• Yerin has had diarrhea for 2 days. There is

no blood in the stool. She is restless &
irritable. Her eyes are sunken. She is not
able to drink. When her skin was pinched, it
went back to its original state very slowly.
 4. ASSESS & CLASSIFY FEVER

• Fever
• Malaria
• Measles
• Dengue Hemorrhagic Fever
 MALARIA
Anopheles
Plasmodium Merozoites
falciparum, vivax,
ovale, malariae
Hypnozoites
 MEASLES
• CA: Filterable measles virus
• MOT: secretions from nose &
throat
• System affected: respiratory
tract
• IP: 10-14 days
• Communicable: coryza or
catarrhal symptoms- 9 days- 4
days before & 5 days after
rash appears
• Susceptible: children
 DENGUE
Aedes Aegypti
Chikungunya virus or
Dengue virus Mild
Moderte
Severe

Febrile/invasive stage
Toxic/hemorrhagic
stage
Convalescent stage
 ASSESS FEVER

• Does the child have fever?

• History of fever
• Child feels hot
• Child has an axillary T of 37.5 C or
above
 ASSESS FEVER
• Decide: Malarial Risk? High or Low
Then ask:
• For how long? If more than 7 days, has fever been
present everyday?
• Did child have measles w/in last 3 mos?
• Look or feel for stiff neck.
• Look for runny nose
• Look for any bacterial cause of fever.
 ASSESS FEVER
• Look for signs suggesting measles:
• General rashes, cough, runny nose, red
eyes
 IF THE CHILD HAS MEASLES NOW OR W/IN
THE LAST 3 MONTHS

LOOK FOR:
• Pus draining from eyes

• Mouth ulcers
Are they deep and extensive?

• Clouding of the cornea

 CLASSIFY FEVER- MALARIA
• Malarial Risk:
• Very Severe Disease/ Malaria
• Malaria
• Fever: Malaria Unlikely

• No Malarial Risk
• Very Severe Febrile Disease
• Fever: No Malaria
 CLASSIFY FEVER- MEASLES

Severe Complicated Measles

Measles w/ eye or mouth complications

Measles
 CLASSIFY FEVER- DENGUE

Severe Dengue Hemorrhagic Fever

Fever: DHF unlikely

 CASE # 7
• Angelo is 10 months old. Wt: 8.2. T: 37.5 C. His mother says
he has rashes & cough. The health worker checks Angelo for
general danger signs. Angelo is able to drink, has not been
vomiting, has not had convulsions, & is not lethargic or
unconscious. The health worker then asks about Angelo’s
cough. The mother says Angelo has been coughing for 5
days. He counts 43 breaths per minute. He does not see
chest indrawing. He hoes not hear stridor when Angelo is
calm. Angelo does not have diarrhea. The health worker
then asks about Angelo’s fever. The malaria risk is high. The
mother says Angelo has felt hot for 2 days now. Angelo does
not have a stiff neck. He has had a runny nose, though, with
this illness, his mother says. Angelo has rashes covering his
whole body, & his eyes are red. The health worker checks
the child for complications of measles. There are no mouth
ulcers. There is no pus draining from the eye, & no clouding
of the cornea.
 CASE # 8
• Andrew is 3 y/o. Wt: 9.4 kg. T: 37 C. His mother says
he feels hot. He also has cough, he says. The health
worker checks for general danger signs. Andrew is
able to drink, he has not been vomiting, has not had
convulsions, & is not lethargic or unconscious. The
mother says Andrew has been coughing for 3 days
now. The health worker counts 51 breaths per minute.
He does not see chest indrawing. There is no stridor
when Andrew is calm. Andrew does not have
diarrhea. The health worker also thinks that Andrew
feels hot. He assesses the child for further signs of
fever. The risk of malaria is high. He has felt hot for 5
days now, the mother says. He has not had measles
within the last 3 months. He does not have a stiff
neck, a runny nose, & general rashes.
 5. ASSESS & CLASSIFY EAR INFECTION

Does the child have an ear

problem?
• Is there ear pain?
• Is there ear discharge? If yes,
how long?
Look and feel:
• Look for pus draining from the
ear.
CLASSIFY EAR INFECTION
Mastoiditis

Acute Ear Infection

Chronic Ear Infection

No Ear Infection
 6. CHECK FOR ACUTE MALNUTRITION
LOOK AND FEEL:
• Look for Edema of both feet?
• Determine WFH/L ____z- score
• Measure MUAC ___mm in a child 6 months or older
 7. CHECK FOR ANEMIA
• Look for palmar pallor
• Severe palmar pallor?
• Some palmar pallor?
 CASE # 10
• Laiza - 18 mos old., Wt: 7 kg, T: 38.5 C. Her mother brought
her to the health center today because the child feels has
rashes. The health worker sees that Laiza looks as if she is
made up only of skin & bones. The health worker then checks
for general danger signs. Laiza is able to drink, has not been
vomiting, has not had convulsions, & is not lethargic. She
does not have cough or difficulty in breathing. She does not
have diarrhea. The nurse assesses her fever. Laiza lives in an
area where there is high malaria risk. She has had fever for 5
days now. Her rashes are general & she has red eyes. She
also has measles. She does not have a stiff neck. She does
not have a runny nose either. Laiza does not have mouth
ulcers, no pus draining from her eye, & no corneal clouding,
no ear infection. Laiza has severe wasting. The health worker
then assesses her weight for age.
 CASE # 11
• Allan is 11 months old. Wt: 8 kg. T: 37 C. Allan does
not have any danger sign. Cough has been present
for 21 days now. He counts 41 breaths per minute.
No chest indrawing. There is no stridor when calm,
no diarrhea. He has not had fever during illness. He
does not have visible severe wasting. His palms are
very pale & appear almost white. There is no
edema on both feet. The health worker then
determines if Allan’s weight is appropriate for his
age.
 CASE # 12
• Gelo is 9 mos old. Wt: 5 kg, T: 36.8 C. He is in the clinic today
because mother & father are concerned about his diarrhea. He
does not have any danger sign. He does not have cough or
difficulty breathing. Had diarrhea for 5 days. No blood in stool.
Gelo is not restless or irritable. He is not lethargic or
unconscious. His eyes are not sunken. He is thirsty & eager to
drink the water offered to him. When his skin was pinched, it
went back to its original state slowly. He does not have a fever.
He does not have an ear problem. The child does not have
visible severe wasting. There is no palmar pallor. He does not
have edema on either feet. The health worker determines if
Gelo’s weight is appropriate for his age.
CHECK FOR
HIV
THEN CHECK THE CHILD'S IMMUNIZATION,
VITAMIN A AND DEWORMING STATUS
 APPROPRIATE ANTIBIOTICS
• Pneumonia, Acute Ear Infection, Very
severe disease, mastoiditis
• 1st line – Cotrimoxazole (2x/day- 5 days)
• 2nd line – Amoxicillin (3x/day- 5 days)
• Dysentery
• 1st line – Cotrimoxazole
• 2nd line – Nalidixic Acid (4x/day- 5 days)
 APPROPRIATE ANTIBIOTICS

• Cholera
• 1st line – Tetracycline (4x/day- 3 days)
• 2nd line – Cotrimoxazole (2x/day – 3 days)
 GIVE THESE TREATMENTS IN THE HEALTH
CENTER ONLY!!!
• IM Antibiotics: Chloramphenical
• Children for referral & cannot take oral antibiotic
• Refer
• Referral not possible:
• Repeat injection q 12 hrs for 5 days
• Then change to appropriate oral antibiotics to
complete 10 days.
 GIVE THESE TREATMENTS IN THE HEALTH
CENTER ONLY!!!
• Quinine
• Give 1 dose, then refer
• Referral not possible
• 1st dose of Quinine
• Remain lying for 1 hour
• 4 hrs, 8 hrs, 12 hrs- not more than 1 week
• NO to < 4 months of age
 PREVENT LOW BLOOD SUGAR

• Breastmilk
• 4 tsp of sugar: 200 ml water
• Oral or NGT
 ORAL DRUGS AT HOME
• Oral Antimalarial
• 1st line: Chloroquine (3 days)
Primaquine (Single dose- health
center)
• 2nd line: Sulfadoxine & Pyrimethamine
• Single dose- Health Center
• Paracetamol (38.5 C & above)
• Fever & ear pain
• q 6 hours until fever or pain is gone
 ORAL DRUGS AT HOME

• Vitamin A
• Treatment – give one dose at health center
• Supplementation
• Give 1 dose at health center if 6 mos or older,
& past 6 months.
• Iron
• One dose daily for 14 days
 ORAL DRUGS AT HOME

• Mebendazole/Albendazole
• 500 mg single dose
(hookworm/whipworm)
• 2 y/o or older
• No dose past 6 mos
 TREAT LOCAL INFECTIONS AT HOME

• Eye infection
• Tetracycline eye ointment- 3x/day
• Dry Ear by wicking- 3x/day
• Treat Mouth Ulcers w/ Gentian violet
• Soothe the throat, relieve cough
 FOLLOW UP CARE

• Pneumonia
• Green- complete antibiotics for 5 days
• Yellow- 2nd line of antibiotics
• Red- 2nd line antx, refer
 FOLLOW UP CARE
• Dysentery
• Dehydrated – treat dehydration
• Same stool, blood, fever, abdominal
pain, eating is same or worse- 2nd line,
return 2 days
• Exceptions: <12 mos old, or dehydrated
1st visit, or measles last 6 mos.---REFER
 FOLLOW UP CARE

• Persistent Diarrhea
• Pink: treat, refer
• Green: continue home remedy
• Fever: Malaria unlikely
• Pink- refer
• Malaria likely: blood smear, 1st line, follow up 2
days
• Fever 7 days- refer for assessment
 FOLLOW UP CARE

• Fever (No malaria)

• Pink – treat & refer
• Yellow- see cause & treat
• No cause of fever: refer after 2
days
• 7 days: refer for assessment
 FOLLOW UP CARE
• Measles w/ eye or mouth
complications
• Pus: if treatment correct- refer
• If incorrect treatment- continue
• Mouth ulcers
• Worse w/ foul smell – refer to
hospital
 FOLLOW UP CARE
• Dengue Hemorrhagic Fever
• Fever > 2days – do tourniquet
test, see other causes
• Signs of bleeding – refer asap
• 7 days – refer for assessment
• Return daily
 FOLLOW UP CARE

• Ear infection
• Pink- refer asap!
• Acute ear infection- persists…continue 5
days
• Chronic ear infection- check correct
wicking
• Green- finish antibiotics
 FOLLOW UP CARE

• Feeding problem
• After 5 days
• Counsel on new problems
• Very low wt for age- return after 30
days, reassess weight
 FOLLOW UP CARE

• Anemia
• 5 days
• Return after 14 days
• 2 months
• Still w/ palmar pallor- 2 mos- refer
 FOLLOW UP CARE

• Very low weight

• After 30 days
• Weigh
• Ok na?– praise the mother
• Still there?--- continue to counsel
• Think…walang improvement---refer
na!
COUNSEL THE MOTHER

Assess Child's Appetite

All children aged 6 months or more with SEVERE
ACUTE MALNUTRITION (edema of both feet or
WFH/L less than -3 z-scores or MUAC less than 115
mm) and no medical
complication should be assessed for appetite.
 ASSESS CHILD'S FEEDING

Assess feeding if child is Less Than 2 Does the child take any other food
Years Old, Has MODERATE ACUTE or fluids?
MALNUTRITION, ANAEMIA, • What food or fluids?How many times per
day?
CONFIRMED HIV INFECTION, or is HIV
• What do you use to feed the child?
EXPOSED. Ask questions about the child's
If MODERATE ACUTE MALNUTRITION
usual feeding and feeding during this illness. or if a child with CONFIRMED HIV
Compare the mother's answers to the Feeding INFECTION fails to gain weight or
Recommendations for the child's age. loses weight between monthly
ASK - How are you feeding your measurements, ASK:
• How large are servings?
child?
• Does the child receive his own serving?
If the child is receiving any breast • Who feeds the child and how?
milk, ASK: • What foods are available in the home?
During this illness, has the child's
• How many times during the day?
feeding changed?
• Do you also breastfeed during the night? If yes, how?
 IN ADDITION, FOR HIV EXPOSED CHILD:
If mother and child are on ARV treatment or prophylaxis and child
breastfeeding, ASK:
• Do you take ARV drugs? Do you take all doses, miss doses, do not take
medication?
• Does the child take ARV drugs (If the policy is to take ARV prophylaxis until
1 week after breastfeeding has stopped)?
• Does he or she take all doses, missed doses, does not take medication?

If child not breastfeeding, ASK:

• What milk are you giving?
• How many times during the day and night?
• How much is given at each feed?
• How are you preparing the milk?
• Let the mother demonstrate or explain how a feed is prepared, and how it is
given to the infant.
• Are you giving any breast milk at all?
• Are you able to get new supplies of milk before you run out?
• How is the milk being given? Cup or bottle?
• How are you cleaning the feeding utensils?
 STOPPING BREASTFEEDING
STOPPING BREASTFEEDING means 2. HELP MOTHER MAKE
changing from all breast milk to no breast milk. TRANSITION:

This should happen gradually over one month. • Teach mother to cup feed (See
Plan in advance for a safe transition. chart booklet Counsel part in
Assess, classify and treat the sick
1. HELP MOTHER PREPARE: young infant aged up to 2 months)
• Clean all utensils with soap and
• Mother should discuss and plan in advance
water
with her family, if possible • Start giving only formula or cow’s
• Express milk and give by cup milk once baby takes all feeds by
cup
• Find a regular supply or formula or other milk
(e.g. Full cream cow’s milk) 3. STOP BREASTFEEDING
COMPLETELY:
• Learn how to prepare a store milk safely at Express and discard enough breast
home milk to keep comfortable until
lactation stops
FEEDING RECOMMENDATIONS FOR A CHILD WHO HAS PERSISTENT
DIARRHEA

• If still breastfeeding, give more frequent, longer breastfeeds,

day and night.
• If taking other milk:
• replace with increased breastfeeding OR
• replace with fermented milk products, such as yoghurt OR
• replace half the milk with nutrient-rich semisolid food.
• For other foods, follow feeding recommendations for the child's
age.
 EXTRA FLUIDS AND MOTHER'S HEALTH

Advise the Mother to Increase Fluid During Counsel the Mother about her Own Health
Illness • If the mother is sick, provide care for her, or refer her
for help.
• If she has a breast problem (such as engorgement,
FOR ANY SICK CHILD: sore nipples, breast infection), provide care for her
• Breastfeed more frequently and for longer at each or refer her for help.
feed. If child is taking breast-milk substitutes, • Advise her to eat well to keep up her own strength
increase the amount of milk given. and health.
• Increase other fluids. For example, give soup, rice • Check the mother's immunization status and give
her tetanus toxoid if needed.
water, yoghurt drinks or clean water.
Make sure she has access to:
• Family planning
FOR CHILD WITH DIARRHOEA: • Counselling on STD and AIDS prevention.
• Giving extra fluid can be lifesaving. Give fluid Give additional counselling if the mother is
according to Plan A or Plan B on TREAT THE HIV-positive
CHILD chart. • Reassure her that with regular follow-up,
much can be done to prevent serious
illness and maintain her and the chil’s
health.
• Emphasize good hygiene, and early treatment of
illnesses
THANKS!
Any questions?

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