COMMON CHILDHOOD

ILLNESSES
THE HEALTH WORKER
AND CHILDHOOD ILLNESSES
The strategy
preventive and curative health care
to improve and get better practices in
the health system and specially at
homes
THE HEALTH WORKER
AND CHILDHOOD ILLNESSES
The goals are
improvement in family and
community health care practices
to reduce death and the frequency
and severity of illness and disability
to contribute to improved growth and
development in the country
THE HEALTH WORKER
AND CHILDHOOD ILLNESSES
Principles
To get to know what are the general danger
signs.
To assess, check the persons major symptoms.
To classify how severe the person´s condition
is.
Counselling the caretakers about home care,
for example about feeding, fluids and when to
return to a health facility.
The Health Status Of Children Is Important
Children´s Health – Things That Affect Positively
Good mother and childcare
Improvements in breastfeeding
Childhood vaccinations
Oral rehydration therapy; the child can
get enough food and fluid –> reduction
in diarrhoea deaths
Effective antibiotics
CHILDREN AGE
2 MONTHS UP
TO 5 YEARS
Assessment of Sick Children Includes:
communicate with the caretaker – get the history;
who is the child, how old, when did the child get
sick etc.
check the general danger signs;
check the main symptoms;
check the nutritional status;
assess the child’s feeding;
check the immunization status; and
assess the other problems.
General Danger Signs
1. The child has had convulsions during
the present illness
Convulsions may be the result of fever.
Convulsions are when a person’s body
shakes rapidly and uncontrollably. All
children who have had convulsions during
the present illness should be considered
seriously ill.
General Danger Signs
2. The child is unconscious or lethargic
An unconscious child is likely to be
seriously ill. A lethargic child, who is
awake but does not take any notice of his
or her surroundings or does not respond
normally to sounds or movement, may
also be very sick.
General Danger Signs
3.The child is unable to drink or
breastfeed
A child may be unable to drink either
because s/he is too weak or because s/he
cannot swallow. Do not rely completely
on the mother’s evidence for this, but
observe while she tries to breastfeed or to
give the child something to drink.
General Danger Signs
4. The child vomits everything
 The vomiting itself may be a sign of
serious illness, but it is also important to
note because such a child will not be able
to take medication or fluids for
rehydration.
If a child has one or more of these signs,
s/he must be considered seriously ill and
will almost always need to be controlled if
it is:
acute respiratory infection (ARI),
diarrhoea, and fever (especially associated
with malaria and measles).
A checking of nutritional status is also
important, as malnutrition is another main
cause of death.
Checking main symptoms
After checking for general danger signs, the
health care worker must check

for main symptoms.

1) cough or difficult breathing;
2) diarrhoea;
3) fever; and
4) ear problems.
Cough or difficult breathing – Control
Three signs are used to assess a sick child with
cough or difficult breathing:
Respiratory rate, how many times the child
breaths per minute, which distinguishes children
who have pneumonia from those who do not;
Lower chest wall indrawing, which indicates
severe pneumonia; and
Stridor (noisy breathing in children when child
breathes in) which indicates those with severe
pneumonia who require hospital care.
 FAST BREATHING
CHILD’S AGE RATE FOR FAST
BREATHING

2 months up to 12 months 50 breaths per minute or

more

12 months up to 5 years 40 breaths per minute or

more
Lower chest wall indrawing- defined as the
inward movement of the bony structure of
the chest wall with inspiration, is a useful
indicator of severe pneumonia.
Stridor is a harsh noise made when the
child inhales (breathes in). Sometimes a
wheezing noise is heard when the child
exhales (breathes out). This is not stridor. A
wheezing sound is most often associated
with asthma.
Diarrhea
Loose or watery stools
Most common cause: infection and poor
nutrition
Dehydration – death
is a symptom that should be checked in
every child that is not feeling well.
Diarrhea
Assess:
◦ How long the child has diarrhea
◦ Blood in the stool
◦ If 14 days or more with signs of dehydration,
should get to the hospital
How Severe Diarrhea- Dehydration
Signs of how severe the dehydration is:
Child’s general condition.
◦ If the child with diarrhoea is lethargic or
unconscious or look restless/irritable.
Sunken eyes.
◦ The eyes of a dehydrated child may look sunken.
Child’s reaction when offered to drink.
◦ A child is not able to drink if s/he is not able to
take fluid in his/her mouth and swallow it.
Elasticity of the Skin
Use the skin pinch test.
When released, the skin pich goes back
either very slowly (longer than 2
seconds), or slowly (skin stays up even
for a brief instant), or immediately.
How to do Skin Pinch Test
Locate the area on the child’s abdomen
halfway between the umbilicus and the
side of the abdomen; then pinch the skin
using the thumb and first finger.
It is important to firmly pick up all of the
layers of skin and the tissue under them
for one second and then release it.
Recommended drinks for a child with
diarrhea
breastmilk more often than usual
Soups
rice water
fresh fruit juices
weak tea with a little sugar
clean water from a safe source. If there is a
possibility the water is not clean, it should be
purified by boiling or filtering.
oral rehydration salts (ORS) mixed with the
proper amount of clean water.
Drinks should be given from a clean cup. A
feeding bottle should never be used because it
is harder to keep clean and more likely to
cause an infection.
If the child vomits, the caregiver should wait
for 10 minutes and then begin again to give
the drink to the child slowly, small sips at a
time.
Diarrhea usually stops after three or four days.
If it lasts longer than one week, caregivers
should seek help from a trained health worker.
Foods for a person with diarrhea
When the person is
vomiting
or feels too sick to eat,
he should drink
– watery mush or broth of
Rice or
potato
– rice water (with some
mashed rice)
– chicken, meat, egg, or
bean broth
– Kool–Aid or similar
sweetened drinks
– rehydration drink
– breast milk (small babies)
As soon as the child will accept food, give
food he likes and accepts. Following foods or
similar ones:
Energy foods Body–building foods
– ripe or cooked – chicken (boiled or
bananas roasted)
– crackers – eggs (boiled)
– rice, oatmeal, or – meat (well cooked,
other well–cooked without much fat
Grain or grease)
– potatoes – beans or
– papaya peas (well cooked
(It helps to add a or mashed)
little sugar or vegetable – fish (well cooked)
oil to the cereal
foods.)
Classification of Dysentery
A child is having dysentery if the mother or
caretaker reports blood and mucus in the
child’s stool.
Dysentery is especially severe in infants and
in children who are undernourished, who
develop a dehydration during their illness, or
who are not breast–fed.
All children with dysentery (bloody diarrhea)
should be treated promptly with an antibiotic
and that is why they have to visit a doctor.
Fever
It may be caused by minor infections, but
may also be a sign of specific illness,
particularly malaria or other severe
infections, including meningitis, typhoid
fever, or measles.
Important to check
Body temperature should be checked in
all sick children. Children are considered
to have fever if their body temperature is
above 37.5°C axillary (38°C rectal). If
you don’t have a thermometer, children
are considered to have fever if they feel
hot.
A child having fever should be
controlled for:
1. Stiff neck.
A stiff neck may be a sign of meningitis,
cerebral malaria or another very severe
febrile disease. If the child is conscious
and alert, check stuffiness by tickling the
feet, asking the child to bend his/her neck
to look down or by very gently bending
the child’s head forward. It should move
freely.
A child having fever should be
controlled for:
2. Risk of malaria and other infections
Malaria risk can vary by season or places.
The national malaria control program
normally defines areas of malaria risk in a
country.
A child having fever should be
controlled for:
3. Runny nose
When malaria risk is low, a child with
fever and a runny nose does not need an
antimalarial. This child’s fever is probably
due to a common cold.
A child having fever should be
controlled for:
4. Duration of fever
Most fevers go away within a few days. A
fever that has lasted every day for more
than five days can mean that the child has
a more severe disease such as typhoid
fever.
MEASLES
Children with fever should be assessed for
signs of current or previous measles
(within the last three months).
Measles- serious virus infection
Usual signs:
◦ Fever with generalized rash plus on of the
following:
 Red eyes
 Runny nose
 cough
MEASLES
The mother/caregiver
should be asked about if
somebody near the
family/child has had
measles during the last three
months.
The child usually becomes
increasingly ill. The mouth
may become very sore and
he may develop diarrhea.
 MEASLES
After 2 or 3 days a few tiny white spots like
salt grains appear in the mouth.
A day or 2 later the rash appears—first
behind the ears and on the neck, then on the
face and body, and last on the arms and legs.
After the rash appears, the child usually
begins to get better.
 MEASLES
The rash lasts about 5 days. Sometimes
there are scattered black spots caused by
bleeding into the skin (‘black measles’).
This means the attack is very severe. Get
medical help.
 MEASLES (TREATMENT)
The child should stay in bed, drink lots of liquids,
and be given nutritious food. If he cannot swallow
solid food, give her liquids like soup. If a baby
cannot breast feed, give breast milk in a spoon.
If possible, give vitamin A to prevent eye damage.
For fever and discomfort, give acetaminophen (or
ibuprofen).
If earache develops, give an antibiotic.
If signs of pneumonia, meningitis, or severe pain
in the ear or stomach develop, get medical help.
Prevention of Measles
Children with measles should keep far away from
other children.
Protect children who are poorly nourished or who have
tuberculosis or other chronic illnesses.
If children in a family where there is measles have not
yet had measles themselves, they should not go to
school or into stores or other public places for 10 days.
To prevent measles from killing children, make sure all
children are well nourished.
Have your children vaccinated against measles when
they are 12 to 15 months of age.
EAR PROBLEMS
The infection often begins after a few
days with a cold or a stuffy or plugged
nose.
The fever may rise, and the child often
cries or rubs the side of his head.
Sometimes pus can be seen in the ear.
In small children an ear infection
sometimes causes vomiting or diarrhea.
Ear Problems- Clinical signs
Tender swelling behind the ear
◦ The most serious complication of an ear
infection is a deep infection in the mastoid
bone (the bone directly behind the ear). It can
be tender swelling behind one of the child’s
ears. In infants, this tender swelling also may
be above the ear.
Ear Problems- Clinical signs
Ear pain
◦ In the early stages of acute otitis, a child may
have ear pain, which usually causes the child
to become irritable and rub, touch the ear
frequently.
Ear Problems- Clinical signs
Ear discharge or pus
◦ This is another important
sign of an ear infection.
When a mother reports an
ear discharge, the health
care provider should check
for pus drainage from the
ears and find out how long
the discharge has been
present.
Ear Problems- (Treatment)
It is important to treat ear infections early
Carefully clean pus out of the ear with
cotton, but do not put a plug of cotton, a
stick, leaves, or anything else in the ear.
Children with pus coming from an ear
should bathe regularly but should not
swim or dive for at least 2 weeks after
they are well.
Ear Problems- (Prevention)
Teach children to wipe but not to blow
their noses when they have a cold.
Do not bottle feed babies – or if you do,
do not let baby feed lying on his back, as
the milk can go up his nose and lead to an
ear infection.
When children’s noses are plugged up,
use salt drops and suck the mucus out of
the nose.
INFECTION IN THE EAR CANAL
To find out whether the canal or tube
going into the ear is infected, gently pull
the ear.
If this causes pain, the canal is infected.
Put drops of water with vinegar in the ear
3 or 4 times a day. (Mix 1 spoon of
vinegar with 1 spoon of boiled water.)
 If there is fever or pus, get medical help.
THE NUTRITIONAL STATUS –
Malnutrition and Anemia
Poor nutrition can result in the
following health problems:
◦ the child is not growing or gaining weight
normally
◦ slowness in walking, talking, or thinking
◦ big bellies, thin arms and legs
◦ lack of energy, child is sad and does not play
◦ swelling of feet, face, and hands, often with
sores or marks on the skin
Assessing the child’s feeding
All children less than 2 years old and all
children classified as anemia or low (or very
low) weight need to be assessed for feeding.
Often the signs of poor nutrition first appear
when a person has some other sickness. For
example, a child who has had diarrhea for
several days may develop swollen hands and
feet, a swollen face, dark spots, or peeling
sores on his legs. These are signs of severe
malnutrition.
Checking Immunization Status
Vaccinesgive protection against many
dangerous diseases.
The Most Important Vaccines
1. DPT
 for diphtheria, whooping cough
(pertussis), and tetanus. For full
protection, a child needs 4 or 5 injections.
Usually the injections are given at 2
months, 4 months, 6 months, and 18
months old. In some countries one more
injection is given when a child is between
4 and 6 years old.
The Most Important Vaccines
2. Polio (infantile paralysis)
 The child needs drops in the mouth 4 or 5
times. In some countries the first vaccination
is given at birth and the other 3 doses are
given at the same time as the DPT injections.
In other countries, the first 3 doses are given
at the same time as the DPT injections, the
fourth dose is given between 12 and 18
months of age, and a fifth dose is given when
the child is 4 years old.
The Most Important Vaccines
3. Bacille Calmette Guerin (BCG), for
tuberculosis
 A single injection is given under the skin of
the left arm. Children can be vaccinated at
birth or anytime afterwards. If any member
of the household has tuberculosis, it is
important to vaccinate babies in the first
few weeks or months after birth. The
vaccine makes a sore and leaves a scar.
The Most Important Vaccines
4. Measles
 A child needs 1 injection given no younger
than 9 months of age, and often a second
injection at 15 months or older. But in many
countries a ‘3 in 1’ vaccine called MMR is
given, that protects against measles, mumps,
and rubella (German measles). One injection
is given when the child is between 12 and 15
months old, and then a second injection is
given between 4 and 6 years of age.
The Most Important Vaccines
5. HepB (Hepatitis B)
 This vaccine is given in a series of 3
injections at intervals of about 4 weeks
after each other. Generally these
injections are given at the same time as
DPT injections. In some countries the first
HepB is given at birth, the second at 2
months old, and the third when the baby is
6 months old.
The Most Important Vaccines
5. Td or TT (Tetanus toxoid)
 For tetanus (lockjaw) for adults and children
over 12 years old. Throughout the world, tetanus
vaccination is recommended with 1 injection
every 10 years. In some countries a Td injection
is given between 9 and 11 years of age (5 years
after the last DPT vaccination), and then every
10 years. Pregnant women should be vaccinated
during each pregnancy so that their babies will
be protected against tetanus of the newborn.
Urgent pre–referral treatments for
children age 2 months up to 5 years
Appropriate antibiotic
Quinine (for severe malaria)
Vitamin A
Prevention of hypoglycemia with breastmilk or
sugar water
Oral antimalarial
Paracetamol for high fever (38.5°C or above) or
pain
ORS solution so that the mother can give
frequent sips on the way to the hospital
Note:
The first four treatments above are urgent
because they can prevent serious
consequences such as progression of
bacterial meningitis or cerebral malaria,
corneal rupture due to lack of vitamin A, or
brain damage from low blood sugar. The
other listed treatments are also important to
prevent worsening of the illness.
 COUNSELING A MOTHER OR
CARETAKER
give • give feedback when s/he
information; practices, praise what was
show an
done well and make
corrections;
example; • allow more practice, if
let her practice. needed; and
• encourage the mother or
caretaker to ask questions
and then answer all
questions.
Teachings:
Advise to continue feeding and increase
fluids during illness;
Teach how to give oral drugs or to treat
local infection;
Counsel to solve feeding problems (if
any);
Advise when to return.
 Steps in giving Oral Drugs
 what is the right drug and dosage for the child’s age or
weight;
 tell the mother or caretaker what the treatment is and why it
should be given;
 show how to measure a dose;
 watch the mother or caretaker practice measuring a dose;
 ask the mother or caretaker to give the dose to the child;
 explain carefully how, and how often, to do the treatment at
home;
 explain that All oral drug tablets or syrups must be used to
finish the course of treatment, even if the child gets better;
 check the mother’s or caretaker’s understanding.
Every mother or caretaker who is
taking a sick child home needs to be
advised about when to return to a
health facility.
teach signs that mean to return
immediately for further care;
advise when to return for a follow–up
visit; and
tell when the next well–child or
immunization visit shall be done.
Advise a mother or caretaker to return to
a health facility:
Any sick child
Not able to drink or drink or
breastfeed
Becomes sicker
Develops a fever
Advise a mother or caretaker to return to
a health facility:
If child has no pneumonia: cough or
cold, also return if:
◦ Fast breathing
◦ Difficult breathing
If child has diarrhea, also return if:
◦ Blood in stool
◦ Drinking poorly
YOUNG INFANTS
AGE 1 WEEK UP
TO 2 MONTHS
 ASSESSMENT OF SICK YOUNG
INFANTS
Assessment includes the following steps:
Checking for possible bacterial infection;
Assessing if the young infant has diarrhea;
Checking for feeding problems or low
weight;
Checking the young infant’s immunization
status;
Assessing other problems.
 CHECKING FOR MAIN
SYMPTOMS
Bacterial infection:
◦ Convulsions
◦ Fast breathing - >60 breaths per minute
◦ Severe chest indrawing – very deep; sign of
pneumonia or other serious bacterial infection
in young adult
◦ Nasal flaring (when an infant breathes in) and
grunting (when an infant breathes out) are an
indication of troubled breathing and possible
pneumonia.
◦ A bulging fontanel (when an infant is not
crying), skin pustules, umbilical redness or
pus draining from the ear are other signs that
indicate possible bacterial infection.
◦ Lethargy or unconsciousness, or less than
normal movement also indicate a serious
condition.
◦ Temperature (fever or hypothermia)
 may also indicate bacterial infection. Fever (axillary
temperature more than 37.5°C or rectal temperature
more than 38°C) is uncommon in the first two
months of life. Fever in a young infant may indicate
a serious bacterial infection, and may be the only
sign of a serious bacterial infection. Young infants
can also respond to infection by dropping their body
temperature to below 35.5°C (36°C rectal).
 CHECKING FOR MAIN
SYMPTOMS
Diarrhea
Feeding problems or low weight - All
sick young infants seen in health facilities
should be assessed for weight and
adequate feeding, as well as for breast–
feeding technique.
 CHECKING FOR MAIN
SYMPTOMS
Feeding problems or low weight:
1. Determine weight for age.
2. Assessment of feeding
The health worker should ask about:
breastfeeding frequency and night feeds;
what other types foods or fluids the child
has eaten, how often and if the child has
eaten lately; and
how the child has eaten now during this
illness.
Breastfeeding - Signs that the baby is
feeding well
the baby’s whole body is turned towards
the mother
the baby is close to the mother
the baby is relaxed and happy
the baby’s mouth is wide open
the baby takes long, deep sucks
Feeding Problems or Low Weight?
Not able to feed – possible serious bacterial infection
Infants with feeding problems or low weight are those
infants who have feeding problems like not attaching
well to the breast, not sucking effectively, getting
breastmilk fewer than eight times in 24 hours, receiving
other foods or drinks than breastmilk, or those who
have low weight for age or thrush (ulcers/white patches
in mouth).
Infants with no feeding problems are those who are
breastfed exclusively at least eight times in 24 hours
and whose weight is not classified as low weight for
age according to standard measures.
Counseling
Teach how to give oral drugs or to treat local
infection.
Teach correct positioning and attachment for
breastfeeding:
◦ 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
nipple
◦ with infant’s body close to her body
◦ supporting infant’s whole body, not just neck and
shoulders.
Counseling
Look for signs of good attachment and
effective suckling. If the attachment or
suckling is not good, try again.
Advise about food and fluids: advise to
breastfeed frequently, as often as possible
and for as long as the infant wants, day
and night, during sickness and health.
Advice when to return
teach signs that mean to return
immediately for further care;
advise when to return for a follow-up
visit; and
tell when the next well-child or
immunization visit shall be done.