Sick Young Infant Age up to 2 Months

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  • Ask the mother what the child’s problems are
  • Check if this is an initial or FOLLOW UP visit for this problem
    • If FOLLOW UP visit: Check up on previous treatments
    • If initial visit: Continue as below

Assess, classify and treat for the following:

  • Severe disease and local bacterial infection
  • Jaundice
  • Diarrhoea and dehydration
  • HIV
  • Feeding and weight problems
  • Any other problem
  • Immunization status

Counsel the mother on

  • Nutrition and breastfeeding of the child
  • Her own health needs
  • To return for FOLLOW UP as scheduled
  • To return immediately at the clinic if the danger signs in the table below appear:

DANGER SIGN

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

Immediately

Check for Very Severe Disease and Local Bacterial Infection

Ask

  • Ask if the infant is having difficulty in feeding?
  • Has the infant had any convulsions?

Look, Listen, Feel

  • Count the number of breaths per minute (INFANT MUST BE CALM)
    • Repeat the count if this is > 60 breaths per minute
  • Look for severe chest indrawing and nasal flaring
  • Look and listen for grunting
  • Look and feel for a bulging fontanel
  • Look for pus draining from the ear
  • Look at the Is it red or draining pus?
    • Does the redness extend to the skin?
  • Measure the body temperature (or feel for fever or low body temperature)
  • Look for skin pustules, if present, are they many or severe?
  • See if the young infant is lethargic or unconscious
  • Observe the young infant’s movements
    • Are they less than normal?
    • Observe the young infant for any spasms (differentiate from convulsions)
    • Check if young infant has stiff neck or lock jaw
    • Feel the young infants abdomen for rigidity

Classify and treat possible infection as in the table below:

SIGNS

CLASSIFY AS

TREATMENT

Any of the following:

  • Not feeding well or
  • Convulsions or
  • Fast breathing (>60 breaths/min) or
  • Severe chest in drawing or
  • Fever (>37.5°C or feels hot)
  • Low body temp (<35.5°C or feels cold)
  • Movement when stimulated or no movements at all
  • Blood in stool

Very Severe Disease
  • Give 1st dose of IM antibiotics: ampicillin 50 mg/ kg plus gentamicin 5 mg/kg (if <7 days) or 7.5 mg/kg (if >7 days)
  • Or if HC2, Benzylpenicillin 50,000 IU/Kg IM single pre referral dose
  • Treat to prevent low blood sugar (breastfeed or give expressed breast milk or sugar water by cup or NGT)
  • Advise mother how to keep infant warm on the way to hospital
  • Refer URGENTLY to Hospital

If referral not possible,

  • Continue ampicillin (twice daily if < 7 days, thrice daily if > 7 days)
  • Gentamicin once daily for at least 5 days

Any of the following:

  • Umbilicus red or discharging pus 
  • Skin pustules

Local Bacterial Infection
  • Give appropriate oral antibiotic: amoxicillin 250 mg DT ¼ tab (if below 1 month, 4 kg) or ½ tab (if 1-2 months, 4-6 kg) every 12 hours for 5 days
  • Teach mother to treat local infection at home (apply Gentian Violet paint twice daily for 5 days)
  • Advise mother on home care for the young infant
  • FOLLOW UP in 2 days:
    • If better: praise the mother, advise to complete treatment
    • If same or worse: refer to hospital

None of the signs of very severe disease or local bacterial infection

Severe Disease or Local Infection Unlikely
  • Continue assessment of other problems
  • Advise mother to give home care

Notes:

  • Body temperatures are based on axillary measurement
  • Rectal readings are approximately 0.5°C higher

Check for HIV Infection

Ask

  • Has the mother and/or young infant had an HIV test?

IF YES:

  • What is the mother’s HIV status?
    • Serological test POSITIVE or NEGATIVE
  • What is the young infant’s HIV status?
    • Virological test POSITIVE or NEGATIVE
    • Serological test POSITIVE or NEGATIVE

If mother is HIV positive (or serological test of the child is positive) and NO positive virological test in child ASK:

  • Is the young infant breastfeeding now?
  • Was the young infant breastfeeding at the time of test or before it?
  • Is the mother and young infant on PMTCT ARV prophylaxis?

IF NO test: Mother and young infant status unknown

  • Perform serological HIV test for the mother (or serological test for the child if the mother is not present); if positive, perform virological test for the young infant

Classify and treat HIV (see also HIV section)

CLINICAL FEATURES

CLASSIFY AS

MANAGEMENT
  • Positive virological testing in young infant

Confirmed HIV Infection
  • Give cotrimoxazole prophylaxis from age 6 weeks.
  • Give HIV care and ART
  • Advise the mother on home care
  • FOLLOW UP regularly as per national guidelines
  • Mother HIV positive AND negative virological test in young infant breastfeeding or if only stopped less than 6 weeks ago. OR
  • Mother HIV positive, young infant not yet tested OR
  • Positive serological test in infant

HIV Exposed
  • Give cotrimoxazole prophylaxis from 6 weeks of age
  • Start or continue PMTCT ARV prophylaxis as per national recommendations
  • Do virological test at age 6 weeks or repeat 6 weeks after the child stops breastfeeding
  • Advise the mother on home care
  • FOLLOW UP regularly as per national guidelines
  • Negative HIV test in mother
  • or young infant

HIV Infection Unlikely
  • Treat, counsel and FOLLOW UP existing infections

Check Young Infant’s Immunization Status

Immunization not up to date according to national schedule (see Immunizations) 

Infant Not Immunized as per Schedule

Give all missed doses on this visit (Include sick infants unless being referred)

Immunization up to date as per national schedule

Infant Immunized as Per Schedule

Advise caretaker when to return for the next dose

Summary of IMNCI Medicines Used for Young Infants

DRUG

DOSE

INDICATION

Ampicillin

50 mg/kg

Pre referral IM dose in very severe disease

Gentamicin

Age < 7 days 5 mg/Kg

Pre referral IM dose in very severe disease

Age > 7 days

7.5 mg/kg

Benzyl penicillin

50,000 IU/Kg IM

Pre referral IM dose in very severe disease if ampicillin/ gentamicin not available

Amoxicillin

250 mg dispersible tablets (DT)

Birth-<1 month (< 4 kg):

¼ tab every 12 hours for 5 days

In local bacterial infection

1-2 month (4-6 kg): ½ tab every 12 hours for 5 days

Gentian Violet 0.5%

Apply in the mouth 4 times a day for 7 days

In oral thrush

Apply on skin twice daily for 5 days

Local bacterial infection (skin pustules or umbilical infection)

Cotrimoxazole

Tab 120 mg pediatric tablet

1 tab once daily

Prophylaxis in HIV infected or HIV exposed children till infection can be excluded