Sick Child Age 2 Months to 5 Years

Check for General Danger Signs

Ask

Is the child unable to drink or breastfeed
Is the child vomiting everything
Has the child had convulsions

Look

See if the child lethargic or unconscious
Is the child convulsing now

Classify and Treat as Below

CLINICAL FEATURE

CLASSIFY AS

MANAGEMENT

Any general danger sign

Very Severe Disease

Give diazepam if convulsing (rectal diazepam 0.5 mg/kg)
Quickly complete the assessment
Give any pre referral treatment immediately
Treat to prevent low blood sugar (breastfeed or give expressed breast milk breastmilk substitute or sugar water by cup or NGT)
Keep the child warm
REFER URGENTLY

Check for Cough or Difficult Breathing

Ask

If child has cough and/or difficulty in breathing

If yes, ask

For how long child has had this?

Look Listen and feel

Ensure the child is calm, then

Count the number of breaths/minute
Look for chest indrawing
Look/listen for stridor (stridor is an abnormal harsh, high-pitched sound caused by obstructed airflow, usually more audible while inhaling)
Look and listen for wheezing
If pulse oximeter is available, determine oxygen saturation. Refer if < 90%

If wheezing with either fast breathing or chest indrawing:

Give a trial of rapid acting inhaled bronchodilator (with spacer) for up to 3 times 15-20 min apart. Count the breaths and look for chest indrawing again, and then classify

Fast breathing:

Child 2–12 months: ≥50 breaths per minute
Child 1–5 years: ≥40 breaths per minute

Classify and Treat as Below

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Any general danger sign Or stridor in calm child SpO2 < 90%	Severe Pneumonia or Very Severe Disease	Give 1st dose of appropriate antibiotic : ampicillin 50 mg/ Kg IM and gentamicin 7.5 mg/Kg IM Or Benzylpenicillin 50,000 IU/Kg IM if at HC2 Or Amoxicillin DT 40 mg/kg if parenteral antibiotics not available Refer URGENTLY to HC4/HOSPITAL *If referral not possible* Continue ampicillin 6 hourly and gentamicin once daily for 5 days If strong suspicion of meningitis, dose of ampicillin can be increased 4 times
Chest in drawing Fast breathing Child 12 months: ≥ 50 breaths/minute Children 1-5 years: ≥40 breaths/minute	Pneumonia	Give amoxicillin DT 40 mg/kg for 5 days as first line treatment If wheezing give an inhaled bronchodilator for 5 days (salbutamol inhaler every 3-4 hours as necessary) If coughing for more than 14 days or recurrent wheeze, refer for possible TB or asthma assessment If chest in drawing in HIV exposed/infected child, give first dose of amoxicillin DT 40 mg/kg and refer Soothe throat/relieve cough with safe remedy If coughing for more than 14 days or recurrent wheeze refer for possible TB or asthma assessment . Advise mother when to return immediately (danger signs) FOLLOW UP in 3 days and reassess If better (slower breathing, no indrawing, less fever, eating better), praise the mother and advise to complete treatment If not better or worse, refer urgently to hospital
No signs of severe disease or pneumonia	Cough or Cold (No pneumonia) Most likely viral so no antibiotics needed	If wheezing give an inhaled bronchodilator (salbutamol inhaler every 3-4 hours as necessary) for 5 days Soothe throat/relieve cough with safe remedy If coughing for more than 14 days or recurrent wheezing, refer for possible TB or asthma assessment Advise mother when to return immediately (danger signs) If not improving, FOLLOW UP in 5 days

Note: Use age-appropriate spacers to administer salbutamol inhaler

Child has Diarrhoea

Ask

Does the child have diarrhoea?
If yes, for how long child has had this
Using appropriate local terms, ask if there is blood in the stool

Look and feel

Look at the child’s general condition. Is the child:
- Lethargic or unconscious?
- Restless and irritable?
Look for sunken eyes
Offer the child Is the child:
- Unable to drink or drinks poorly?
- Thirsty, drinks eagerly?
Pinch the skin of the abdomen. Does it go back:
- Very slowly? (>2 seconds)
- Slowly?

Classify and treat as below:

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Any 2 of these signs: Lethargic or unconscious Sunken eyes Unable to drink or drinks poorly Skin pinch returns very slowly (>2 seconds)	Severe Dehydration	If child has no other severe classification, give dehydration Plan C If child also has another severe classification: Give pre-referral treatment and refer urgently with mother giving frequent sips of ORS on the way Advise mother to continue breastfeeding If child is 2 years or older and there is cholera in your area: Give 1st dose of erythromycin 125 mg (if child < 2 years) or 250 mg (child 2-5 years) every 6 hours for 3 days Educate mother on hygiene and sanitation
Any 2 of these signs: Restless, irritable Sunken eyes Thirsty, drinks eagerly Skin pinch returns slowly	Some Dehydration	Give fluid, zinc supplements, and food if possible See Dehydration Plan B If child also has a severe classification: Refer URGENTLY to hospital with mother Giving frequent sips of ORS on the way Advise the mother to continue breastfeeding Advise mother when to return immediately FOLLOW UP in 5 days If better (diarrhoea stopped, less than 3 loose stools per day, praise mother and advise her on feeding) If not better (> 3 loose stools per day), reassess, treat dehydration and refer Educate mother on hygiene and sanitation
Not enough signs to classify as some or severe dehydration	No Dehydration	Give fluid, zinc supplements, and food to treat diarrhoea at home (Plan A) Advise mother when to return immediately FOLLOW UP in 5 days If better (diarrhoea stopped, less than 3 loose stools per day, praise mother and advise her on feeding) If not better (> 3 loose stools per day), reasses, treat dehydration and refer Continue with breast feeding Educate mother on hygiene and sanitation
Blood in stool	Dysentery	Give ciprofloxacin 15 mg/kg for 3 days for Shigella FOLLOW UP in 3 days If better (fewer stools, less blood in stool, less fever, less abdominal pain, better feeding) praise the mother, complete the ciprofloxacin and advise on feeding If not better, refer
If diarrhoea for 14 days or more:
Dehydration present	Severe Persistent Diarrhoea	Give vitamin A Treat dehydration before referral (unless child has another severe classification) Refer to hospital
No dehydration	Persistent Diarrhoea	Advise mother on feeding child with PERSISTENT DIARRHOEA Give vitamin A; multivitamins and minerals (including zinc) for 14 days FOLLOW UP in 5 days If better (diarrhoea stopped, less than 3 loose stools per day, praise mother and advise her on feeding) If not better (> 3 loose stools per day), reassess, treat dehydration and refer If symptoms are the same or worse, start treating dehydration if present and refer to hospital
Note: The current recommendation for treatment of diarrhoea is oral rehydration salts (ORS) and zinc salts (Zn sulphate, Zn gluconate or Zn acetate). Give zinc for 10 days: Child < 6 months: 10 mg per day; Child > 6 months: 20 mg per day

Check for Fever

Ask

If the child has fever
- By history, feels hot, or temperature ≥37.5°C (see note 1 in table below)
If yes, ask for how long child has had this
- If >7 days, ask if fever has been present every day
- Ask if the child has had measles in the last 3 months
DO MALARIA TEST in all fever cases

Look and feel

Look/feel for stiff neck
Look for runny nose
Look for any bacterial cause of fever: local tenderness, oral sores, refusal to use a limb, hot tender swelling, red tender skin or boils, lower abdominal pain or pain on passing urine in older children
Look for signs of measles:
Generalised rash
Cough, runny nose, or red eyes

If child has measles now or had measles in last 3 months

Look for mouth ulcers – are they deep or extensive?
Look for pus draining from the eyes
Look for clouding of the cornea

Classify and Treat as Below

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Any general danger sign Stiff neck	Very Severe Febrile Disease	Give 1st dose of rectal artesunate (10 mg/kg) or IM/IV artesunate (3 mg/kg if < 20 kg, 2.4 mg/kg if > 20 kg) (see Malaria) Give 1st dose of appropriate antibiotic for serious bacterial infection: ampicillin 50 mg/Kg IM and gentamicin 7.5 mg/Kg IM or Benzylpenicillin 50,000 IU/Kg IM if at HC2 Treat child to prevent low blood sugar (breastfeed or give expressed breast milk or breastmilk substitute or sugar water by cup or NGT) Give one dose of paracetamol 10 mg/kg for high fever (38.5°C) Refer urgently
Malaria test positive	Malaria	Give 1st line malaria treatment Give one dose of paracetamol 10 mg/kg for high fever (38.5°C) If a bacterial infection is also identified, give appropriate antibiotic treatment Advise mother when to return immediately, counsel on use of insecticide treated mosquito nets and educate on environmental sanitation FOLLOW UP in 3 days if fever persists: Do a full reassessment and look for other causes of fever Check that the child has completed the full course of antimalarials (without vomiting any dose) Do not repeat RDT if it was positive on the initial visit If no danger sign, no other apparent cause of fever and antimalarial treatment was given correctly, refer for microscopy and/or second line antimalarial If fever every day for >7 days, refer for assessment
Malaria test Negative	Fever No Malaria	Give one dose of paracetamol 10 mg/Kg in child with high fever (38.5°C) If a bacterial infection is identified, give appropriate antibiotic treatment If no bacterial infection identified, reassure, give paracetamol, advise to come back in 3 days or in case of any problem Advise mother when to return immediately and counsel on use of insecticide treated mosquito net and educate on environmental sanitation. FOLLOW UP in 3 days if fever persists Reassess the child for danger signs and other possible causes of fever Repeat the malaria test and treat if positive If no apparent cause of fever, refer If fever every day for >7 days, refer for assessment
If measles now or in last 3 months, classify as:
Any general danger sign Clouding of cornea Deep or extensive mouth ulcers	Severe Complicated Measles	Give vitamin A Give 1st dose of appropriate antibiotic for severe bacterial infection: ampicillin 50 mg/Kg IM and gentamicin 7.5 mg/Kg IM or Benzylpenicillin 50,000 IU/Kg IM if at HC2 If clouding of cornea or pus draining from eye: apply tetracycline eye ointment REFER URGENTLY to hospital
Stridor Difficulty in breathing Diarrhoea Acute malnutrition Ear problem	Complicated Measles	Refer to the relevant IMCI sections
Pus draining from eye Mouth ulcers	Measles + Eye Or Mouth Complications	Give vitamin A If pus draining from eye: Apply tetracycline eye ointment If mouth ulcers, apply gentian violet paint FOLLOW UP in 3 days If eyes still discharging pus and treatment has been given correctly, refer. If eyes only red or better, complete treatment If mouth ulcers/thrush are the same or better, continue treatment. If worse and/or child has problem swallowing, refer
Measles now or in the last three months	Measles	Give Vitamin A
Note: Body temperatures are based on axillary measurement. Rectal readings are approximately 0.5°C higher For doses of Vitamin A, Gentian violet and Tetracycline ointment see section on Medicines for Home Use below.

Check for Ear Problem

Ask

Look and feel

Does the child have an ear problem?
If yes,
Does the child have ear pain?
Is there discharge:
If yes, ask for how long

Look for pus draining from the ear

Feel for tender swelling behind the ear

Classify and treat as below

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Tender swelling behind the ear	Mastoiditis	Give 1st dose of appropriate antibiotic ampicillin 50 mg/ Kg IM and gentamicin 7.5 mg/Kg IM or Benzylpenicillin 50,000 IU/Kg IM Amoxicillin DT 40 mg/kg if parenteral not available Give 1st dose of paracetamol 10 mg/kg for pain REFER URGENTLY
Ear pain Pus seen draining from ear	Acute Ear Infection	Give amoxicillin DT 40 mg/kg every 12 hours for 5 days Give paracetamol 10 mg/kg for pain Dry ear by wicking

Check for Malnutrition and Feeding Problems

Ask

If child ≤ 6 m, ask if the child has breastfeeding problem (how many times a day, etc)
If child ≥ 6 months, ask if child is able to finish his portions (appetite)
- Ask about usual feeding habits
- Which foods are available at home
- What does the child eat
- How many times a day
- Does the child receive his/her own serving

Look and Feel

Look for signs of acute malnutrition like
- Oedema on both feet
- Determine weight for height/length (WFH/L) using WHO growth charts standards (see end of this chapter)
- As an alternative, determine weight for age (WFA) using WHO growth chart standards
- Measure MUAC (Mid Upper Arm Circumference) in children 6 months and above using MUAC tape

If WFH/L is less than -3 z-scores or MUAC < 115 mm, then

Check for any medical complication present
- Any general danger sign
- Any severe classification
- Pneumonia or chest indrawing

If no medical complication presents,

Child ≥ 6 months: assess child appetite
Offer RUTF (Ready to Use Therapeutic Food) and assess if child able to finish the portion or not
- Child ≤ 6 month: assess breastfeeding

Classify and Treat as directed blow:

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Oedema of both feet OR WFH/L less than -3 z scores OR MUAC less than 115 mm or Visible severe wasting AND Any one of the following: Medical complication present OR not able to finish RUTF OR Breastfeeding problem	Complicated Severe Acute Malnutrition	Give first dose appropriate antibiotic (ampicillin 50 mg/Kg IM and gentamicin 7.5 mg/Kg IM or Benzylpenicillin 50,000 IU/Kg IM Treat the child to prevent low blood sugar (breastfeed or give expressed breast milk or sugar water by cup or NGT) Keep the child warm Refer URGENTLY to hospital
WFH/L less than -3 z scores OR MUAC less than 115 mm Or very low weight for age AND Able to finish RUTF	Uncomplicated Severe Acute Malnutrition (SAM)	Give oral antibiotics amoxicillin DT for 5 days (40 mg/kg twice a day) Give ready-to-use therapeutic food (RUTF) for a child aged 6 months or more Counsel the mother on how to feed the child Assess for possible TB infection Advise mother when to return immediately FOLLOW UP in 7 days Reassess child and If no new problem, review again in 7 days. FOLLOW UP in 14 days Reassess and reclassify and continue feeding. Keep checking every 14 days
WFH/L between -3 and -2 z-scores OR MUAC 115 up to 125mm Or low weight for age	Moderate Acute Malnutrition (MAM)	Assess the child’s feeding and counsel the mother on the feeding recommendations If feeding problem, counsel and FOLLOW UP in 7 days Assess for possible TB infection. Advise mother when to return immediately FOLLOW UP in 30 days Reassess and reclassify. If better, praise the mother and counsel on nutrition. If still moderate malnutrition, counsel and - FOLLOW UP in one month If worse, loosing weight, feeding problem: refer
WFH/L - 2 z-scores or more OR MUAC 125 mm or more	No acute Malnutrition	If child is < 2 years old, assess the child’s feeding and counsel the mother on feeding according to the feeding recommendations If feeding problem, FOLLOW UP in 7 days Reassess and counsel If you advise the mother to make significant changes in feeding, ask her to bring the child back again after 30 days to measure the weight
Note: WFH/L is Weight-for-Height or Weight-for-Length determined by using the WHO growth standards charts MUAC is Mid-Upper Arm Circumference measured using MUAC tape in all children ≥ 6 months RUTF is Ready-to-Use Therapeutic Food for conducting the appetite test and feeding children with severe acute malnutrition. RUTF already contains all the necessary vitamins and minerals (folic acid, iron etc) so there is no need of additional supplements

Check for Anaemia

Ask

In appropriate local language, ask if presence of sickle cell anaemia in the family

Look

Look for palmar pallor. Is it

Severe palmar pallor?
Some palmar pallor?

Classify and Treat as below

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Severe palmar pallor	Severe Anaemia	Refer URGENTLY to hospital
Some palmar pallor	Anaemia	Give ferrous sulphate ½ tab/day if 1-5 years, 1 ml of syrup/day if 2-12 months If child has severe acute malnutrition and is receiving RUTF, DO NOT give iron because there is already adequate amount of iron in RUTF) Give folic acid 2.5 mg/daily in child with sickle cell anaemia Give mebendazole if child is 1 year or older and has not had a dose in the previous 6 months Advise mother when to return immediately FOLLOW UP in 14 days: Review and give iron tablets every 2 weeks If child still has palmar pallor after 2 months, refer If better, continue iron treatment for 3 months after Hb has normalized
No palmar pallor	No Anaemia	If child is less than 2 years old, assess the child’s feeding and counsel the mother according to the feeding recommendation If feeding problem, FOLLOW UP in 5 days

Check for HIV Infection

Ask

Is the child already enrolled in HIV care?

If not, ask

Has the mother or child had an HIV test?

If yes: decide HIV status

Mother: POSITIVE or NEGATIVE
Child:
- Virological test POSITIVE or NEGATIVE
- Serological test POSITIVE or NEGATIVE

If no, then test

Mother and child status unknown: TEST mother.
Mother HIV positive and child status unknown: TEST child
- If below 18 months: do virological testing
- If above 18 months, do serological testing

If mother is HIV positive and child is negative or unknown, ASK:

Was the child breastfeeding at the time or 6 weeks before the test?
Is the child breastfeeding now?
If breastfeeding ASK: Is the mother and child on ARV prophylaxis?

Note

For HIV testing algorithm and result interpretation in children, see HIV section

CLINICAL FEATURES	CLASSIFY AS	MANAGEMENT
Positive virological test in child OR Positive serological test in a child 18 months or older	Confirmed HIV Infection (See HIV Diagnosis and Investigation)	Initiate ART treatment and HIV care Give cotrimoxazole prophylaxis Assess the child’s feeding and provide appropriate counselling to the mother. Advise the mother on home care Assess or refer for TB assessment and Isoniazid (INH) preventive therapy (see Tuberculosis) FOLLOW UP regularly as per national guidelines
Mother HIV- positive AND negative virological test in a breastfeeding child or only stopped less than 6 weeks ago OR Mother HIV- positive, child not yet tested OR Positive serological test in a child less than 18 months	HIV Exposed (See HIV Diagnosis and Investigation)	Give cotrimoxazole prophylaxis till infection can be excluded by HIV testing after cessation of breastfeeding for at least 6 weeks Start or continue ARV prophylaxis as recommended Do virological test to confirm HIV status: if negative, repeat 6 weeks after cessation of breastfeeding Assess the child’s feeding and provide appropriate counselling to the mother Advise the mother on home care FOLLOW UP regularly as per national guidelines
Negative HIV test in mother or child	HIV Infection Unlikely	Treat, counsel and FOLLOW UP on existing infections

Check Immunization, Vitamin A, Deworming

Immunization not up to date according to national schedule (see Immunizations)	Child Not Immunized as Per Schedule	Give all missed doses on this visit (Include sick child unless being referred) Give vitamin A if not given in the last 6 months Give mebendazole or albendazole (if age >1 year) if not given in the last 6 months
Immunization up to date as per national schedule	Child Immunized as Per Schedule	Praise the mother Advise the caretaker when to return for the next dose

Summary of Medicines Used

For each medicine

Explain to the mother why the medicine is needed
Calculate the correct dose for the child’s weight or age
Use a sterile needle and syringe for injections
Accurately measure and administer the dose
If referral is not possible, follow the instructions given

Medicines Used Only in Health Centers

DRUG	DOSE	INDICATION	LOC
Ampicillin	50mg/kg	Pre referral IM dose in very severe disease or severe pneumonia	HC3
Gentamicin	7.5mg/kg	Pre referral IM dose in very severe disease or severe pneumonia	HC3
Diazepam rectal (suppository or diluted IV ampoule)	0.5mg/kg	Pre referral treatment of convulsions	HC2
Benzylpenicillin	50,000IU/kg	Pre referral IM dose in very severe disease or severe pneumonia	HC2
Rectal Artesunate	10mg/kg (see Malaria)	Pre referral dose for very severe febrile disease	HC1
Artesunate parenteral	3mg/kg if < 20 kg, 2.4 mg/kg if > 20 kg	Pre referral IM dose for very severe febrile disease	HC3
Salbutamol inhaler	2 puff	For acute wheezing	HC3

Anti-Infective Medicines for Home Use

Teach mother/caretaker how to give oral medicines at home

Determine the correct medicine and dose for the child’s weight or age

For each medicine

Explain the reason for giving the medicine
Show how to measure a dose
Watch the mother practice this
Ask the mother to give the first dose to her child
Explain carefully how to give the medicine
Include dose, frequency, and duration
Stress the need to compete the full course of treatment even if the child gets betterIf child vomits the medicine within one hour from taking it, REPEAT the dose

Collect, measure/count, pack, and label it separately
Check the mother’s understanding before she leaves

Amoxicillin DT 250mg	Every 12 hours for 5 days 2-12 months: 250 mg 1-3 years: 500 mg 3-5 years: 750 mg	Pneumonia Acute ear infection
Artemether/lumefantrine 20/120 mg	Every 12 hours for 3 days 2-12 months: 1 tab 1-3 years: 1 tab 3-5 years: 2 tab	Un-complicated malaria
Erythromicin	Every 6 hours for 3 days Child < 2 years: 125 mg 2-5 years: 250 mg	Cholera
Ciprofloxacin	15 mg/kg every 12 hours for 3 days If tab 500 mg: Child< 6 months: ¼ tab Child 6 months-5 years: ½ tab	Dysentery
Folic acid	2.5 mg/daily	Anaemia in child with sickle cell anaemia
Iron ferrous sulphate (with or without folic acid)	Once daily for 14 days, tab 200 mg 1-5 years:½ tablet Syrup 25 mg/ ml Child < 1 year: 1 ml	Anaemia in non sicklers
Cotrimoxazole 120 mg paediatric tablet	< 6 months: 1 tablet 6 months- 5 years: 2 tab/day (or half adult tablet) Once a day	Prophylaxis in HIV positive and HIV exposed
Mebendazole	Child 1-2 years: 250 mg single dose Child > 2 years: 500 mg single dose	Routine deworming every 6 months
Albendazole	Child 1-2 years: 200 mg single dose Child > 2 years: 400 mg single dose	Routine deworming every 6 months
Paracetamol	Every 6 hours (4 doses/24 hours) month-3 years: 125 mg 3-5 years: 250 mg	Fever > 38.5 ^oC or (ear) pain
Vitamin A	Up to 6 months: 50,000IU 6–12 months: 100,000IU 12 months –5 years: 200,000 IU	Routine every 6 months from age 6 months, 3 doses for persistent diarrhoea, measles at day 0, 1 and 4 weeks
ORS	As per plan A,B,C	Rehydration
Zinc	Daily for 10 days Child 2-6 months: 10mg (1/2 tablet) Child> 6months: 20mg(1 tablet)	Treatment of diarrhoea
Nystatin syrup	1 ml 4 times daily for 7 days	Oral thrush
Tetracycline eye ointment	5 mm of ointment inside lower lid, 4 times daily till pus discharge resolves	Eye infection
Ciprofloxacin ear drops	1-2 drops three times daily	Chronic otitis
Ready To Use Therapeutic Food RUTF)	See chapter 19 of Uganda Clinical Guidelines	Severe malnutrition
ARVs	See HIV Section	HIV prophylaxis and treatment

Treatment of Local Infections at Home

Teach mother/ caretaker how to treat local infections

Explain what the treatment is and why it is needed
Describe the treatment steps as detailed below
Watch the mother do the first treatment in the clinic (except cough/sore throat remedy)
Explain how often to do the treatment and for how long
Provide the required medication for home treatment
Check that she understands completely before leaving the clinic

INFECTION	TREATMENT
Eye infection	Clean both eyes 4 times daily: Wash hands Ask child to close eyes Use clean cloth with clean water to gently remove pus Use a different part of the cloth for each eye Clean each eye from nose-side to ear-side to avoid passing the infection from one eye to the other Apply tetracycline eye ointment 1% to each eye 4 times daily after cleaning the eyes Ask the child to look up Squirt a small amount (5 mm length) on the inside of the lower eyelid Wash hands again Continue application until the redness has disappeared Do not put anything else into the eye
Ear infection	Dry the ear at least 3 times daily Roll clean absorbent cloth or soft gauze into a wick Place this in the ear and remove when wet Replace wick with a clean one Repeat this process until the ear is dry In chronic ear infection: Instill ciprofloxacin ear drops 3 times daily for 3 weeks Do not put anything else into the ear
Mouth Ulcers	Treat these twice daily Wash hands Wash child’s mouth with clean soft cloth moistened with salt water and wrapped around the finger Paint the mouth with gentian violet aqueous paint 0.5% (if necessary, dilute 1% with an equal volume of water and provide this for the mother to use at home) Wash hands again Continue giving gentian violet for 48 hours after ulcers are cured Give paracetamol for pain relief
Oral Thrush	Treat for thrush four times daily for 7 days Wash hands Wash a clean soft cloth with water and use to wash the child’s mouth Instill nystatin 1 ml every six hours Avoid feeding for 20 minutes after medication If breastfed, check mother’s breasts for thrush and if present treat with nystatin Advice mother to wash breast after feeds If baby unable to breastfeed advise mother to feed baby with a cup and spoon. Give paracetamol of needed for pain
Sore throat or cough	Use a safe remedy to soothe the throat and relieve cough: Breastmilk (for exclusively breastfed infant) Warm (lemon) tea with honey Do not use remedies containing codeine or antihistamines (e.g. chlorphenamine, promethazine)

DANGER SIGN	RETURN
Breastfeeding or drinking poorly Becomes more ill Develops fever Fast or difficult breathing Blood in stool	Immediately