1. Integrated Management of Childhood Illness (IMCI)
SICK CHILD (2 months to 5 years old)
DANGER SIGNS:
• Unable to drink or breastfeed
• Frequent vomiting
• Convulsion during the course of illness
• Abnormally sleepy or difficult to awake
 if any of these is present- considered SEVERE DISEASE
 GIVE 1st
dose of appropriate antibiotic and refer URGENTLY
 except for diarrhea if Plan C can resolve the danger sign
THEN ASK ABOUT THE MAIN SYMPTOMS:
 Does the child have cough or difficulty breathing?
 Does the child have diarrhea?
 Does the child have fever?
 Does the child have an ear problem?
 Then check for malnutrition and anemia
If with COUGH or DIFFICULTY BREATHING:
Ask: How Long?
Look, Listen: Count the breaths in one minute
Look for chest indrawing
Listen for stridor
• Fast breathing if:
2 – 12 mos more than 50 bpm
12 mos up more than 40 bpm
• Child must be CALM during assessment
SIGNS CLASSIFY AS TREATMENT
 any danger sign or
 chest indrawing or
 stridor
SEVERE PNEUMONIA or
VERY SEVERE DISEASE
 give 1st
dose of an appropriate antibiotic
 give Vitamin A
 treat the child to prevent low blood sugar
 refer URGENTLY to hospital
 fast breathing PNEUMONIA  give an appropriate antibiotic for 5 days
 soothe the throat and relieve the cough with
a safe remedy
 advise mother when to return immediately
 follow up in 2 days
 no signs of pneumonia or
very severe disease
NO PNEUMONIA
COUGH OR COLD
 if coughing for more than 30 days, refer for
assessment
 soothe the throat and relieve the cough with
a safe remedy
 advise mother when to return immediately
 follow up in 2 days
SEVERE PNEUMONIA:
Appropriate antibiotic: INTRAMUSCULAR Chloramphenicol
 for children who cannot take oral antibiotic
 give the 1st
dose then refer URGENTLY to hospital
 if REFERRAL is NOT possible:
• repeat the chloramphenicol injection every 12 hours for 5 days
• then change to an appropriate oral antibiotic to complete 10 days of treatment

2. AGE OR WEIGHT
CHLORAMPHENICOL
Dose: 40 mg/kg
Add 5 ml sterile water to vial containing 1g
= 5.6 ml at 180mg/ml
2 – 4 months (4 - < 6 kg) 1 ml = 180 mg
4 – 9 months (6 - < 8 kg) 1.5 ml = 270 mg
9 – 12 months (8 - < 10 kg) 2 ml = 360 mg
1 – 3 years old (10 - < 14 kg) 2.5 ml = 450 mg
3 – 5 years old (14 – 19 kg) 3.5 ml = 630 mg
VERY SEVERE DISEASE/ PNEUMONIA
Appropriate antibiotic: ORAL
1st
line antibiotic: COTRIMOXAZOLE ( BID x 5 days)
2nd
line antibiotic: AMOXYCILLIN (TID x 5 days)
Age or weight Tablet Syrup
2 – 12 months (4 - < 10 kg) ½ 5 ml
1 – 5 years old (10 - < 19 kg) 1 10 ml
GIVE VITAMIN A:
6 - 12 months 100, 000 IU/ cap
1 – 5 years old 200, 000 IU/ cap
SOOTHE THE THROAT AND RELIEVE COUGH WITH SAFE REMEDY:
 Breastmilk for exclusively breastfed infant
 Tamarind, Calamansi and Ginger
Harm full remedies to discourage:
 Codeine cough syrup
 Other cough syrup
 Oral and nasal decongestant
WHEN TO RETURN IMMEDIATELY:
Pneumonia : presence of any danger sign
Cough or Cold : presence of fast breathing or difficult breathing
TREAT THE CHILD TO PREVENT LOW BLOOD SUGAR LEVEL:
 If the child is able to breastfeed:
Ask the mother to breastfeed the child.
 If the child is not able to breastfeed but is able to swallow:
Give expressed breastmilk or breastmilk substitute
If neither of these is available, give sugar water
Give 30-50 ml of milk or sugar water before departure
• to make sugar water: Dissolve 4 level teaspoons of sugar (20grams) in a 200-ml
cup of clean water.
 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
If with DIRRHEA:
ASK: How long?
Is there blood in the stool?
LOOK, FEEL: Look at the child’s general condition.

3. Is the child:
- Abnormally sleepy or difficult to awake?
- Restless and irritable
Look for sunken eyes.
Offer the child fluid. Is the child:
- Not able to drink or drinking poorly?
- Drinking eagerly, thirsty?
Pinch the skin of the abdomen.
Does it go back:
- Very slowly (longer than 2 seconds)
- Slowly
SIGNS CLASSIFY AS TREATMENT
Two of the following signs:
 abnormally sleepy or
difficult to awaken
 sunken eyes
 not able to drink or
drinking poorly
 skin pinch goes back
slowly
SEVERE DEHYDRATION
 if the child has no other sever classification;
• give fluid for severe dehydration (Plan
C) Or;
 if the child has another sever classification;
• refer URGENTLY to hospital, with
mother giving frequent sips of ORS on
the way
• advise the mother to continue
breastfeedig
 if the child is 2 years or older and there is
cholera in the area, give antibiotic for
cholera
Two of the following signs:
 restless, irritable
 sunken eyes
 drinks eagerly, thirsty
 skin pinch goes back
very slowly
SOME DEHYDRATION
 if the child has no other sever classification;
• give fluid for severe dehydration (Plan B)
Or;
 if the child has another sever classification;
• refer URGENTLY to hospital, with mother
giving frequent sips of ORS on the way
• advise the mother to continue breastfeedig
 advise mother when to return immediately
 follow up in 5 days if not improving
 no enough signs to
classify as some or severe
dehydration
NO DEHYDRATION
 give fluid and food to treat diarrhea at home
(Plan A)
 give zinc supplements
 advise mother when to return immediately
 follow up in 5 days if not improving
Plan A: Treat Diarrhea at Home
Counsel the mother on the 4 rules of home Treatment:
1. Give Extra Fluid
2. Give zinc supplement
3. Continue Feeding
4. When to return
1. GIVE EXTRA FLUID
 TELL THE MOTHER:
- Breastfeed frequently and longer at each feeding
- if the child is exclusively breastfed, give ORS or clean water in addition to
breast milk.
- if the child is not exclusively breastfed, give one or more of the following:
ORS solution, food-based fluids (such as soup, rice water, or “buko juice”), clean
water.
It is especially important to give ORS at home when:
- The child has been treated with Plan B or Plan C during the visit, or
- The child cannot return to a health center if the diarrhea gets worse,
 TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2
PACKETS OF ORS TO USE AT HOME.

4.  SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE
USUAL FLUID INTAKE:
Up to 2 years 50 to 100 ml after each loose stool
2 years or more 100 ml to 200 ml after each loose stool
Tell the mother:
- Give frequent small sips from a cup.
- If the child vomits, wait 10 minutes, then continue, but more slowly.
- Continue giving extra fluid until the diarrhea stops.
2. GIVE ZINC SUPPLEMENTS
• 10 mg per day in infants - < 6 mos. For 10-14 days
• 20 mg per day in children 6 mos. -5 years old for 10-14 days
3. CONTINUE FEDING
4. WHEN TO RETURN
Plan B: Treat Some Dehydration with ORS
Give in health center recommended amount of ORS over 4-hour period
DETERMINE AMOUNT OF ORS TO GIV DURING THE FIRST $ HOURS.
AGE Up to 4 months 4 months up to12 months up to 2 years up to
12 months 2 years 5 years
WEIGHT <6 kg 6 to -< 10 kg 10 to -< 12 kg 12 to 19 kg
AMOUNT(ml) 200-400 400-700 700-900 900-1400
 Use the child’s age only when you do not know the weight. The approximate amount of
ORS required (in ml) can also be calculated by multiplying the child’s weight (in kg0
times 75.
• If the child wants more ORS than shown, give more.
• For infants under 6 months of age who are not breastfed, also give 100-200 ml clean
water during this period.
 SHOW THE MOTHER HOW TO GIVE ORS SOLUTION.
• Give frequent small sips from a cup.
• If the child vomits , wait 10 minutes. Then continue, but more slowly.
• Continue breastfeeding whenever the child wants.
 IF THE MOTHER MUST LEAVE BEFORE COMLETING TREATMENT:
• Show her how to prepare ORS solution at home.
• Show her how much ORS to give her child to finish 4-hour treatment at home.
• Give her enough ORS packets to complete rehydration. Also give her 2 packets, as
recommended in Plan A.
• Explain the 4 rules of home treatment:
DYSENTERY
Appropriate antibiotic: ORAL
1st
line antibiotic: COTRIMOXAZOLE ( BID x 5 days)
2nd
line antibiotic: NALIDIXIC ACID (QID x 5 days)
Cotrimoxazole Nalidixic Acid
Age or weight Tablet Syrup Syrup
2 – 4 months (4 - < 6 kg) ½ 5 ml 1. 25 ml (1/4 tsp)
4 – 12 months (6 - < 10 kg) 2.5 ml (12 tsp)
1 – 5 years old (10 - < 19 kg) 1 10 ml 5 m l (1 tsp)

5. If DIRRHEA for 14 DAYS OR MORE:
SIGNS CLASSIFY AS TREATMENT
 dehydration present
SEVERE PERSISTENT
DIARRHEA
 treat dehydration before referral unless the
child has another severe classification
 give Vitamin A
 refer to hospital
 no dehydration
PERSISTENT DIARRHEA
 Advise the mother on feeding a child who
has PERSISTENT DIARRHEA
 give Vitamin A
 follow up in 5 days
 advise the mother when to return
immediately
If with BLOOD IN THE STOOL:
SIGNS CLASSIFY AS TREATMENT
 blood in the stool
DYSENTERY
 treat for 5 days with an oral antibiotic
recommended for shigella in your area
 follow up in 2 days
 advise mother when to return
immediatelly
If with FEVER:
Identify MALARIA risk:
 Living in malaria area
 Has visited/ travelled in a malaria area in the past 4 weeks
If with MALARIA RISK:
SIGNS CLASSIFY AS TREATMENT
 Any general danger sign
OR
 Stiff neck
VERY SEVERE
FEBRILE DISEASE/
MALARIA
 Give 1st
dose of quinine
 Give 1st
dose of appropriate antibiotic
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in the health
center for high fever(T > 38.5˚C)
 Send a blood smear with the patient
 Refer URGENTLY to hospital
 Blood smear ( + )
If blood smear not done:
 No runny nose, and
 No measles, and
 No other causes of fever
MALARIA
 Treat the child with oral anti-malarial
 Give one dose of paracetamol in the health
center for high fever(T > 38.5˚C)
 Advise the mother when to return
immediately
 Follow up in 2 days if fever persists
 If fever is present every day for more than 7
days, refer for assessment
 Blood smear ( - ) OR
 Runny nose, OR
 Measles, OR
 Other causes of fever
FEVER: MALARIA
UNLIKELY
 Give one dose of paracetamol in the health
center for high fever(T > 38.5˚C)
 Advise the mother when to return
immediately
 Follow up in 2 days if fever persists
 If fever is present every day for more than 7
days, refer for assessment
 Treat other causes of fever
If NO Malaria Risk:
SIGNS CLASSIFY AS TREATMENT
 Any general danger sign  Give 1st
dose of appropriate antibiotic

6. OR
 Stiff neck
VERY SEVERE
FEBRILE DISEASE
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in the health
center for high fever(T > 38.5˚C)
 Refer URGENTLY to hospital
 No signs of very severe
febrile disease FEVER: NO MALARIA
 Give one dose of paracetamol in the health
center for high fever(T > 38.5˚C)
 Advise the mother when to return
immediately
 Follow up in 2 days if fever persists
 If fever is present every day for more than 7
days, refer for assessment
 Treat other causes of fever
If with MEASLES now or within 3 months:
SIGNS CLASSIFY AS TREATMENT
 blood in the stool
DYSENTERY
 treat for 5 days with an oral antibiotic
recommended for shigella in your area
 follow up in 2 days
 advise mother when to return
immediatelly
If with FEVER:
Identify MALARIA risk:
 Living in malaria area
 Has visited/ travelled in a malaria area in the past 4 weeks
If with MALARIA RISK:
SIGNS CLASSIFY AS TREATMENT
 Clouding of the cornea OR
 Deep extensive mouth
ulcers
 Any general danger sign
SEVERE
COMPLICATED
MEASLES
 Give Vitamin A
 Give 1st
dose of appropriate antibiotic
 If clouding of the cornea or pus draining
from the eyes, apply tetracycline eye
ointment
 Refer URGENTLY to hospital
 Pus draining from the eyes,
OR
 Mouth ulcers
MEASLES WITH EYE OR
MOUTH
COMPLICATIONS
 Give Vitamin A
 If clouding of the cornea or pus draining
from the eyes, apply tetracycline eye
ointment
 If mouth ulcers, teach the mother to treat
with gentian violet
 Follow up in 2 days
 Advise the mother when to return
immediately
 Measles now or within the
last 3 months MEASLES
 Give Vitamin A
 Advise the mother when to return
immediately
TREAT EYE INFECTION WITH TETRACYCLINE EYE OINTMENT
 Clean both eyes 3 times daily
• Wash hands
• Ask child to close eyes
• Use clean cloth and water to gently wipe away pus
 Then apply tetracycline eye ointment in both eyes 3 times daily
• Ask the child to look up
• Squirt a small amount of ointment on the inside of the lower lid
• Wash hands again
 Treat until redness is gone
 Do not use other eye ointment or drops, or put anything else in the eyes
TREAT MOUTH ULCERS WITH GENTIAN VIOLET

7.  Treat the mouth ulcers twice daily
• Wash hands
• Wash child’s mouth clean using soft cloth wrapped around the finger and wet
with salt water
• Paint the mouth with half strength gentian violet, using cotton bud
• Wash hands again
Assessment for DENGUE HEMORRHAGIC FEVER:
SIGNS CLASSIFY AS TREATMENT
 Bleeding from nose or
gums, OR
 Bleeding in stools or
vomitus, OR
 Black stools or vomius, OR
 Skin petechiae OR
 Cold and clammy
extremities OR
 Capillary refill of > 3 secs
 Persistent abdominal pain,
OR
 Persistent Vomiting, OR
Tourniquet test positive
SEVERE DENGUE
HEMORRHAGIC
FEVER
 If persistent vomiting or persistent
abdominal pain or skin petechiae or positive
tourniquet test are the only signs, give ORS
(Plan B)
 If any signs of bleeding is positive, give
fluids rapidly, as plan C
 Treat the child to prevent low blood sugar
 Refer all children URGENTLY to hospital
 DO NOT GIVE ASPIRIN
 No signs of severe Dengue
Hemorrhagic Fever FEVER: DHF
UNLIKELY
 Advise the mother when to return
immediately
 Follow up in 2 days if fever persists
 DO NOT GIVE ASPIRIN
VERY SEVERE FEBRILE DISEASE/ MALARIA
Appropriate antibiotic: INTRAMUSCULAR QUININE
 Give the 1st
dose of IM quinine and refer URGENTLY to hospital
If Referral is NOT Possible:
 The child should remain lying down for one hour
 repeat the quinine injection at 4-8 hours later, and then every 12 hours until the child
is able to take an oral antimalarial. Do not continue quinine injections for more than 1
week
 Do not give quinine to a child less than 4 months of age
AGE OR WEIGHT INTRAMUSCULAR QUININE
4 up to 12 months (6- <10 kg) 0.3 ml
1- 2 years old (10- <12 kg) 0.4 ml
2-3 years old (12- <14 kg) 0.5 ml
3-5 years old (14- 19 kg) 0.6 ml
Appropriate antibiotic: ORAL ANTIMALARIAL
 If CHLOROQUINE:
- watched child for 30 minutes, if with vomiting within 30 minutes,
repeat dose and return to the center for additional tablets
- itching is a possible, but id not dangerous
 If SULFADOXINE + PYRIMETHAMINE:
- give a single dose in the health center 2 hours before intake of
chloroquine
 If PRIMAQUINE:
- single doe on DAY 4 for P. falciparum; 14 days for P.vivax
 If ARTEMETER+ LUMEFRANTINE:
- combination; give for 3 days

8. If with EAR PROBLEM:
SIGNS CLASSIFY AS TREATMENT
 Tender swelling behind the
ear MASTOIDITIS
 Give 1st
dose of an appropriate antibiotic
 Give 1st
dose of paracetamol for pain
 Refer URGENTLY to hospital
 Ear pain
 Pus is seen draining from
the ear, and discharge is
reported for less than 14
days
ACUTE EAR
INFECTION
 Give an antibiotic for 5 days
 Give paracetamol for pain
 Dry the ear by wicking.
 Follow up in 5 days.
 Advise mother when to return
immediately
 Pus is seen draining from
the ear, and discharge is
reported for more than 14
days
CHRONIC EAR
INFECTION
 Dry the ear wicking.
 Follow up in 5 days .
 Advise mother when to return
immediately.
 No ear pain, and
 No pus is seen draining
from the ear
NO EAR INFECTION
 No additional treatment.
 Advise mother when to return
immediately.
Appropriate antibiotic: ORAL
1st
line antibiotic: COTRIMOXAZOLE ( BID x 5 days)
2nd
line antibiotic: AMOXYCILLIN (TID x 5 days)
Age or weight Tablet Syrup
2 – 12 months (4 - < 10 kg) ½ 5 ml
1 – 5 years old (10 - < 19 kg) 1 10 ml
DRY THE EAR BY WICKING:
 Dry the ear at least 3 times daily
• Roll clean absorbent cloth or soft, strong tissue paper into a wick
• Place the wick in the child’s ear
• Remove the wick when wet
• Replace the wick with a clean one and repeat these steps until ear is dry
If with MALNUTRITION and ANEMIA:
SIGNS CLASSIFY AS TREATMENT
 Visible severe wasting or
 Edema of both feet or
 Severe palmar pallor
SEVERE
MALNUTRITION OR
SEVERE ANEMIA
 Give Vitamin A
 Refer URGENTLY to hospital
 Some palmar pallor or
 Very low weight for age ANEMIA OR VERY
LOW WEIGHT
 Assess the child’s feeding and counsel the
mother on feeding according to the FOOD
box on the COUNSEL THE MOTHER
chart
- If feeding problem, follow up in 5
days
 If some pallor:
- Give iron
- Give mebendazole/albendazole if the
child is 12 months or older, and has
AGE Sulfadoxine +
pyrethamine Chloroquine
Primaquine
p. falcifarum p. vivax
2- 5 months ¼ ½ ½ ½ ----- ----
5- 12 months ½ ½ ½ ½ ----- ----
1-3 years old ¾ 1 1 ½ ½ 1/4
3-5 years old 1 1 ½ 1 ½ 1 ¾ ½

9. not had a dose in the previous 6
months
- Follow up in 14 days
 If very low weight for age:
- Give Vitamin A.
- Follow up in 30 days.
 Advise mother when to return
immediately.
 Not very low weight for
age, and or other signs of
malnutrition
NO ANEMIA AND NOT
VERY LOW WEIGHT
 If the child is less than 2years old, assess
the child’s feeding according to the FOOD
box on the COUNSEL THE MOTHER
chart
- If feeding problem, follow up in 5
days
 Advise mother when to return
immediately
RECOMMENDATIONS FOR FEEDING AND CARE FOR DEVELOPMENT:
Birth up to 6 months 6 months to 12 months 12 months to 2 years 2 years and older
FOOD:
• Exclusively breastfeed
as often as the child
wants, day and night,
at least 8 times in 24
hours
• Do not give other
foods or fluids
FOOD:
• Breastfeed as often as
the child wants
• Add any of the
following:
• lugaw with added oil,
mashed vegetables or
beans, steamed tokwa,
flaked fish, pulverized
roasted dilis, finely
ground meat, eggyolk,
bite-size fruits
• 3 times per day of
breastfed
• 5 times if not
FOOD:
• Breastfeed as often as
the child wants
• Give adequate amount
of family foods, such
as: rice, camote,
potato, fish, chicken,
meat, monggo,
steamed tokwa,
pulverized roasted
dilis, milk and eggs,
dark green, leafy and
yellow vegetables
(malungay, squash)
fruits (papaya,
banana)
• Add oil or margarine
• 5 times per day
• feed the baby
nutritious snacks like
fruits
FOOD:
• Give adequate aunt of
family foods at 3
meals every day
• Give twice daily
nutritious foods,
between meals such
as:Boiled yellow
camote, boiled yellow
corn, peanuts, boiled
saba, banana, taho,
fruits, and fruit juices
PLAY:
• Provide an area where
the child could move,
play and develop his
senses of sight, touch,
and hearing
• Have large, colorful
things for your child
to reach for and new
things to see
PLAY:
• Give your child clean,
safe household things
to handle, bang, and
drop
PLAY:
• Give your child things
to stack up, and to put
into containers, and
take out
PLAY:
• Help your child count,
name, and compare
things
• Make simple toys for
your child
COMMUNICATE:
• Look into your child’s
eyes and smile at him
or her
• When you are
breastfeeding, it is a
good time to talk to
your child and get a
conversation going
with sounds or
gestures
COMMUNICATE:
• Respond to your
child’s sounds and
interests. Tell your
child the names of
things and people
COMMUNICATE:
• Ask your child simple
questions. Respond to
your child’s attempts
to talk. Play games
like “bye”
COMMUNICATE:
• Encourage your child
to talk, and answer
your child’s questions.
Teach your child
stories, songs and
games.
GIVE MEBENDAZOLE/ALBENDAZOLE:
 Give 500 mg Medendazole/ 400 mg Albendazole as a single dose in the health
center if the child is 12 months up to 59 months and has not had a dose in the
previous 6 months, with the following dose:

10. AGE OR WEIGHT Albendazole
400 mg/tablet
Mebendazole
500 mg/tablet
12- 23 months ½ 1
24-59 months 1 1
WHEN TO RETURN:
FOLLOW UP VISIT
If the child has: Return for follow up in:
Pneumonia
Dysentery
Malaria, if the fever persists
Fever-Malaria Unlikely, if the fever persists
Fever (No Malaria) if the fever persists
Measles with Eye or Mouth Complications
Dengue Hemorrhagic Fever Unlikely, if fever persists
2 days
Persistent Diarrhea
Acute Ear Infection
Chronic Ear Infection
Feeding Problems
Many other Illnesses, if not improving
5 days
Anemia 14 days
Very Low Weight For Age 30 days
WHEN TO RETURN IMMEDIATELY:
Advise the mother to return immediately of the child has any of the these signs:
Any Sick Child • Not able to drink or
breastfeed
• Becomes sicker
• Develops a Fever
If the child has NO PNEUMONIA: COUGH OR COLD, also
return if:
• Fast Breathing
• Difficult Breathing
If the child has Diarrhea, also return if: • Blood in stool
• Drinking Poorly
If the child has FEVER; DENGUE HEMORRHAGIC FEVER
UNLIKELY, also return if:
• Any signs of
bleeding
• Persistent
abdominal pain
• Persistent vomiting
• Skin petechiae
• Skin rashes
SICK YOUNG INFANT (1 week to 2 months)
SIGNS CLASSIFY AS TREATMENT
 Convulsions OR
 Fast breathing (>60 bpm) OR
 Severe chest indrawing ) OR
 Nasal Flarring OR
 Grunting OR
 Bulging Fontanelle OR
 Pus draining from the ear OR
 Umbilical redness extending to
the skin OR
 Fever (>37.5˚C), hypothermia
(<35.5˚C) OR
 Many or severe skin pustules OR
 Abnormally sleepy or difficult to
awaken OR
 Less than normal movement
POSSIBLE SERIOUS
BACTERIAL INFECTION
 Give first dose of intramuscular
antibiotics
 treat the child to prevent low blood
sugar
 advise mother how to keep the infant
warm on the way to the hospital
 refer URGENTLY to the hospital.
 Red umbilicus or draining pus OR
 Skin Pustules
LOCAL BACTERIAL
INFECTION
 Give an appropriate antibiotic
 treat the local infection in the health
center, and teach the mother to treat
local infection at home.

11.  advise mother how to give home care
 follow up in 2 days
INTRAMUSCULAR ANTIBIOTIC:
• Give 1st
dose of BOTH benzylpenicillin and gentamicin intramuscular
• Referral is the BEST option for young infant classified as POSSIBLE SERIOUS
BACTERIAL INFECTTION
• If referral is NOT possible, give benzylpenicillin every 6 hours plus gentamicin one dose
daily.
WEIGHT Gentamicin
Dose: 5 mg/kg
Benzylpenicillin
Dose: 50,000 units/kg
1 kg 0.5 ml 0.1 ml
2 kg 1.0 ml 0.2 ml
3 kg 1.5 ml 0.4 ml
4 kg 2.0 ml 0.5 ml
5 kg 2.5 ml 0.6 ml
*dilution= gentamicin (6 ml for 80 mg)
= benzylpenicillin (2.1 ml for 1 million units)
MAKE SURE THE YOUNG INFANT STAYS WARM AT ALL TIMES:
- In cool weather, cover the infant’s head and feet, and dress the infant with
extra clothing
APPROPRIATE ORAL ANTIBIOTIC: (Local Bacterial Infection)
1st
line: COTRIMOXAZOLE (BID x 5 days)
2nd
line: AMOXICILLIN (TID x 5 days)
AGE OR WEIGHT Tablet Syrup
Birth up to 1 month (<3 kg) -------- 1.25 ml
1-2 months (3- 4 kg) 1/4 2.5 ml
TREATMENT FOR LOCAL INFECTION AT HOME:
• SKIN PUSTULES
o Wash hands
o Gently wash off pus and crusts with soap and water
o Dry the area
o Paint with gentian violet
o Wash hands
• UMBILICAL INFECTION
o Wash hands
o Clean with 70% ethyl alcohol
o Paint with gentian violet
o Wash hands
• ORAL THRUSH ( ulcers or white patches in the mouth)
o Wash hands
o Wash mouth with clean soft cloth wrapped around the finger and wet with salt
water
o Paint the mouth with half-strength gentian violet
o Wash hands

12. HOME CARE FOR YOUNG INFANT:
• Breastfeed frequently, as often and for as long as the infant wants, day and night,
during sickness and health
• When to return:
Follow up visit:
If infant has: Follow up in:
LOCAL BASCTERIAL INFECTION
ANY FEEDING PROBLEM
THRUSH
2 days
LOW WEIGTH FOR AGE 14 days
When too return immediately:
Advise the mother to return immediately if the young infants has any
of these signs:
Breastfeeding or drinking poorly
Becomes sicker
Develops a fever
Fast breathing
Difficult breathing
Blood in stool
DIARRHEA: same as for SICK CHILD
FEEDING PROBLEMS OR LOW WEIGHT
SIGNS CLASSIFY AS TREATMENT
 Not able to feed OR
 No attachment at all OR
 Not sucking at all
NOT ABLE TO FEED
POSSIBLE SERIOUS
BACTERIAL
INFECTION
 Give the 1st
dose of intramuscular antibiotics
 Treat to prevent low blood sugar level
 Advise the mother how to keep the young
infant warm on the way to the hospital
 Refer URGENTLY to hospital
 Not well attached to the breast OR
 Not sucking effectively OR
 Less than 8 breastfeeds in 24
hours OR
 Receives other foods or drinks
OR
 Low weight for age OR
 Thrush (ulcers or white patches in
the mouth)
FEEDING PROBLEM
OR LOW WEIGHT
 Advise the mother to breastfeed as often and
for as long as the infant wants, day and night
• if not well attached or not sucking
effectively, teach correct positioning
and attachment
• if breastfeeding less than 8 times in 24
hours, advise to increase frequency of
breastfeeding.
 If receiving other foods or drinks, counsel
mother about breastfeeding more, reducing
other foods and drinks, and using a cup.
• if not breastfeeding at all;
- refer to breastfeeding counseling
and possible relactation
- advise about the correct preparing
of breastmilk substitutes, and using
a cup
 If thrush, teach mother to treat thrush at
home
 Advise the mother to give home care for the
young infant
 follow up any feeding problem or thrush in 2
days
 follow up low weight for age in 14 days
 Not low weight for age, and no
other signs of inadequate feeding
NO FEEDING
PROBLEM
 Advise mother to give home care for the
young infant
 Praise the mother for feeding the infant well
CORRECT POSITIONING AND ATTACHMENT:
 Show the mother how to hold her infant.
- with the infant’s head and body straight
- facing her breast, with infant’s nose opposite her nipples
- with infant’s body close to her body

13. - supporting infant’s whole body, not just neck and shoulders
 Show her how to help the infant to attach. She should:
- touch her infant’s lips with her nipple
- wait until her infant’s mouth is opening wide
- move her infant quickly onto breast, aiming the infant’s lower lip well below the
nipple
 Look for signs of good attachment and effective sucking. If the attachment or sucking is
good, try again.