COMMON CHILDHOOD ILLNESSES

FREIDA MICHELLE BONNIT-TAJA, RN, MAN

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 persons 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 Childrens 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

Good communication is important

Good communication techniques and an ability to assess, to observe, to notice and judge the common problems or signs of disease or malnutrition are needed. Using good communication helps the mother or caretaker to be sure that the child will receive good care.

THE STEPS TO GOOD COMMUNICATION

Listen carefully to what the caretaker says. This will show them that you take their concerns, problems seriously. Use words the caretaker understands. Try to use local words and avoid medical terminology. Give the caretaker time to answer questions. S/he may need time to reflect, to think and decide. Ask additional questions when the caretaker is not sure about the answer. A caretaker may not be sure if a symptom is not so obvious. Ask additional, more questions to help her/him give clear answers

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 childs feeding; check the immunization status; and assess the other problems.

General Danger Signs

The child has had convulsions during the present illness Convulsions may be the result of fever. Convulsions are when a persons body shakes rapidly and uncontrollably. All children who have had convulsions during the present illness should be considered seriously ill.
1.

General Danger Signs

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.
2.

General Danger Signs

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 mothers evidence for this, but observe while she tries to breastfeed or to give the child something to drink.
3.

General Danger Signs

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.
4.

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
CHILDS AGE RATE FOR FAST BREATHING

2 months up to 12 months
12 months up to 5 years

50 breaths per minute or more

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 DiarrheaDehydration

Signs of how severe the dehydration is: Childs 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.

Childs 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 childs 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 KoolAid 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 ripe or cooked bananas crackers rice, oatmeal, or other wellcooked Grain potatoes papaya (It helps to add a little sugar or vegetable oil to the cereal foods.) Bodybuilding foods chicken (boiled or roasted) eggs (boiled) meat (well cooked, without much fat or grease) beans or peas (well cooked or mashed) fish (well cooked)

Classification of Dysentery

A child is having dysentery if the mother or caretaker reports blood and mucus in the childs stool. Dysentery is especially severe in infants and in children who are undernourished, who develop a dehydration during their illness, or who are not breastfed. 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 37.5C axillary (38C rectal). If you dont have a thermometer, children are considered to have fever if they feel hot.

A child having fever should be controlled for:

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 childs head forward. It should move freely.
1.

A child having fever should be controlled for:

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.
2.

A child having fever should be controlled for:

Runny nose When malaria risk is low, a child with fever and a runny nose does not need an antimalarial. This childs fever is probably due to a common cold.
3.

A child having fever should be controlled for:

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.
4.

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 appearsfirst 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

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 childs 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 childrens 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 childs 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

Checking Immunization Status

Vaccines give protection against many dangerous diseases.

The Most Important Vaccines

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.
1.

The Most Important Vaccines

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.
2.

The Most Important Vaccines

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.
3.

The Most Important Vaccines

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
4.

The Most Important Vaccines

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.
5.

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 prereferral 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 (38.5C 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 information; show an example; let her practice.

give feedback when s/he practices, praise what was done well and make corrections; allow more practice, if 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 childs 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

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 followup visit; and tell when the next wellchild 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 infants immunization status;

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 37.5C or rectal temperature more than 38C) 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 35.5C (36C 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 breastfeeding technique.

CHECKING FOR MAIN SYMPTOMS

Feeding problems or low weight:

Determine weight for age. 2. Assessment of feeding

1.

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 babys whole body is turned towards the mother the baby is close to the mother the baby is relaxed and happy the babys 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 infants head and body straight facing her breast, with infants nose opposite her nipple with infants body close to her body supporting infants 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.

Writing Effective Incident Reports

Common Problems with Incident Reports

Confusing to someone who wasnt there (report doesnt paint a clear picture) Thoughts not presented in an organized manner Not enough detail (who, what, when, where, why, and how) Not clear and concise Poor grammar, punctuation, and spelling Incorrect word usage Use of terms, abbreviations, and acronyms that readers may not be familiar with Inconsistency in style throughout the department

Characteristics of a Good Report

Accurate and specific Factual Objective Clear Complete Concise Well-organized Grammatically correct Light on abbreviations

Characteristics of a Good Report

A Good Report Is Accurate and Specific - Being accurate also means being specific. Vague reference do not give readers much information. The following is an example: Vague: The patient had a high fever. Specific: The patient had a fever of 103F.

Characteristics of a Good Report

A Good Report Is Factual - An inference is a conclusion based on reasoning. It becomes sound or believable if supported by facts.

Inference: We suspected that he was driving under the influence because we could smell alcohol on his breath and because his speech was slurred. Fact: Blood tests confirmed he had a blood alcohol level that was twice the legal limit. Fact: The driver had a blood alcohol level that was twice the legal limit. Opinion: The patient is an alcoholic.

Characteristics of a Good Report

A Good Report Is Objective - Objective reports are fair and impartial, not influenced by emotion or opinion. Objective: Several witnesses reported hearing the couple arguing about money. Mr. Reilly allegedly hit his wife in the face during the argument. We found Mrs. Reilly with a bloody nose and a swollen cheek. Slanted: Numerous witnesses reported that the couple had been fighting because Mr. Reilly couldnt hold down a job. Mr. Reilly slugged his wife in the face because he was furious that she brought up the subject. We found Mrs. Reilly with severe injuries to the face, including a bloody nose and a badly swollen cheek.

Characteristics of a Good Report

A Good Report Is Complete A well-written report is complete. It covers the who, what, where, when, why, and how.