Results for "General Danger Signs" (Age: 2 months - 5 years)
General Danger Signs / Very Severe Disease 2 months - 5 years
Refer URGENTLY
High match
What to tell caregiver
- Explain clearly to the mother/caregiver why referral is urgent and necessary.
- Explain any pre-referral treatments given and why.
- Advise on how to keep the child warm during transport (e.g., blanket, skin-to-skin).
- Advise on continuing breastfeeding during transport if possible.
- If the child also has dehydration, show how to give frequent sips of ORS on the way.
- Write a referral note detailing assessment findings, classification, treatments given, and reason for referral.
Dosage Helper
Enter child weight (kg). Verify against local protocol before prescribing.
- Rectal Diazepam: --
- IM Ampicillin: --
- IM Gentamicin: --
Identification of any life-threatening general danger sign in children aged 2 months to 5 years, indicating a Very Severe Disease requiring immediate urgent attention and pre-referral treatment before transport to a hospital.
Key Features
- The presence of ANY ONE of the listed general danger signs classifies the child as having Very Severe Disease.
- These signs indicate a life-threatening condition requiring immediate action and urgent referral, regardless of the main complaint.
Red Flags (Warning Signs)
- Unable to drink or breastfeed
- Vomits everything
- History of convulsions during this illness
- Convulsing now
- Lethargic or unconscious
Assessment
Ask
- Is the child able to drink or breastfeed?
- Does the child vomit everything?
- Has the child had convulsions during this illness?
Look, listen, feel
- See if the child is lethargic or unconscious.
- Is the child convulsing now?
Classification
- Any general danger sign present (Unable to drink/breastfeed OR Vomits everything OR Had convulsions OR Lethargic/unconscious OR Convulsing now) -> VERY SEVERE DISEASE
Urgency / Refer urgently
Refer URGENTLY
Pre-referral treatment
- If convulsing now: Give Diazepam rectally (10mg/2ml solution). Dose: <6m (<5kg) 0.5ml; 6-<12m (5-<10kg) 1.0ml; 1-<3y (10-<15kg) 1.5ml; 4-<5y (15-19kg) 2.0ml. If convulsions continue after 10 minutes, repeat the dose.
- Treat to prevent low blood sugar: If child can breastfeed, ask mother to do so. If not able to breastfeed but able to swallow: Give expressed breast milk OR breastmilk substitute OR sugar water (Dissolve 4 level teaspoons (20g) sugar in 200ml clean water) - give 30-50ml before departure. If child not able to swallow: Give 50ml of milk or sugar water by nasogastric tube.
- Give relevant pre-referral treatment based on quick assessment findings:
- If signs of Severe Pneumonia/Serious Infection: Give first dose Intramuscular Ampicillin (50 mg/kg) AND Gentamicin (7.5mg/kg). Ampicillin doses (500mg vial diluted to 2.5ml): 4-<6kg: 1ml; 6-<10kg: 2ml; 10-<15kg: 3ml; 15-20kg: 5ml. Gentamicin doses (40mg/ml vial): 4-<6kg: 0.5-1.0ml; 6-<10kg: 1.1-1.8ml; 10-<15kg: 1.9-2.7ml; 15-20kg: 2.8-3.5ml.
- If signs of Very Severe Febrile Disease/Suspected Severe Malaria: Give Rectal Artesunate (10 mg/kg, single dose) OR Intramuscular/IV Artesunate (3 mg/kg if =20kg) OR Intramuscular Quinine (refer to page 11 for detailed dosing based on concentration).
- If signs of Severe Dehydration (Plan C): Start IV fluids immediately if possible OR if child can drink give ORS sips frequently on the way to hospital (refer to page 13).
Management
Non-Pharmacological Management
- Quickly complete the assessment to identify all necessary pre-referral treatments.
- Keep the child warm: Cover the child, ensure no draughts. If possible use skin-to-skin contact.
- Position the child appropriately (e.g., recovery position if unconscious and not convulsing, clear airway).
Pharmacological Treatment
- Specific pharmacological pre-referral treatments depend on associated classifications identified during the rapid assessment (see pre_referral section).
Monitoring & Follow-Up
- To be managed at the referral hospital facility.
Counselling Points
- Explain clearly to the mother/caregiver why referral is urgent and necessary.
- Explain any pre-referral treatments given and why.
- Advise on how to keep the child warm during transport (e.g., blanket, skin-to-skin).
- Advise on continuing breastfeeding during transport if possible.
- If the child also has dehydration, show how to give frequent sips of ORS on the way.
- Write a referral note detailing assessment findings, classification, treatments given, and reason for referral.
Differential Diagnosis
- Severe Pneumonia
- Meningitis
- Cerebral Malaria
- Severe Dehydration with shock
- Severe Sepsis
- Severe Malnutrition with complications
- Poisoning
- Diabetic Ketoacidosis (rare)
Potential Complications
- Shock (Septic, Hypovolemic)
- Respiratory failure
- Severe metabolic acidosis/electrolyte imbalance
- Organ failure
- Brain damage (from hypoxia, hypoglycemia, infection, convulsions)
- Death
Prevention
- Complete routine childhood immunizations.
- Exclusive breastfeeding for the first 6 months, continued breastfeeding with appropriate complementary feeding.
- Use of insecticide-treated nets (ITNs) in malaria-endemic areas.
- Handwashing and safe water/sanitation.
- Prompt recognition of illness and seeking appropriate care.
- Good maternal health and nutrition.
Reference: IMCI Chart Booklet - Page 1, Pages 11-13
Pneumonia 2 months - 5 years
Routine Management / Treat at Clinic (unless HIV+ with chest indrawing, then Refer)
High match
What to tell caregiver
- Explain the diagnosis (pneumonia) and the need for antibiotic.
- Teach the mother how to give the oral Amoxicillin: correct dose, frequency (twice daily), duration (full 5 days), how to measure syrup or disperse tablet.
- If Salbutamol prescribed: Teach how to use the inhaler and spacer correctly (shake inhaler, attach, seal mask/mouthpiece, actuate puff, hold for breaths, repeat for 2nd puff), frequency (3 times daily), duration (5 days).
- Teach how to soothe the throat/relieve cough with safe remedies.
- Advise to continue feeding and offer extra fluids.
- Advise mother WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes fast, child not able to drink or breastfeed, child becomes sicker.
- Advise on follow-up visit in 3 days.
Classification for a child with cough or difficult breathing who has chest indrawing OR fast breathing, but NO general danger signs and NO stridor when calm. Requires treatment with an oral antibiotic.
Key Features
- Presence of Chest Indrawing OR Fast Breathing (age-dependent rate).
- Absence of general danger signs and stridor differentiates from Severe Pneumonia.
- Requires treatment with first-line oral antibiotic (Amoxicillin).
- Wheezing requires addition of an inhaled bronchodilator.
- Chest indrawing in HIV exposed/infected child warrants immediate first dose Amoxicillin and referral.
Red Flags (Warning Signs)
- Chest indrawing in an HIV exposed/infected child (Requires first dose Amoxicillin and REFERRAL).
- Failure to improve after 3 days of appropriate antibiotic treatment.
- Development of any danger sign or stridor.
- Worsening of respiratory distress.
Assessment
Ask
- Does the child have cough or difficult breathing?
- For how long?
- Confirm absence of General Danger Signs (see IMCI_2M5Y_001).
- Confirm absence of Stridor in a calm child.
- Look: Look for chest indrawing (lower chest wall pulls inwards during INspiration). Child must be calm.
- Listen/Feel: Count breaths in one full minute. Check for fast breathing based on age. Child must be calm. Fast Breathing: Age 2-11 months: >= 50 breaths/minute. Age 12 months - 5 years: >= 40 breaths/minute.
- Look/Listen: Look and listen for wheezing (high-pitched whistling sound during OUTspiration).
Classification
- Chest indrawing OR Fast breathing -> PNEUMONIA
Urgency / Refer urgently
Routine Management / Treat at Clinic (unless HIV+ with chest indrawing, then Refer)
Pre-referral treatment
- If chest indrawing is present AND the child is HIV exposed/infected: Give the first dose of oral Amoxicillin (as per dosing above) and REFER the child.
Management
Non-Pharmacological Management
- Soothe the throat and relieve the cough with a safe remedy (e.g., warm fluids; honey if child is >1 year old). Avoid harmful remedies like codeine.
- Continue feeding and encourage fluid intake.
- Ensure child is kept warm.
Pharmacological Treatment
- Give oral Amoxicillin twice daily for 5 days. Dosage: Age 2m-<12m (4-<10kg): 250mg dispersible tablet (1 tab) OR 250mg/5ml syrup (5ml) per dose. Age 12m-5y (10-<19kg): 250mg dispersible tablet (2 tabs) OR 250mg/5ml syrup (10ml) per dose.
- If wheezing is present (or wheezing was present and disappeared after a trial of bronchodilator): Give inhaled rapid-acting bronchodilator (Salbutamol 100mcg/puff) 2 puffs via spacer, 3 times daily for 5 days.
Monitoring & Follow-Up
- Follow-up in 3 days.
- At follow-up (Day 3):
- Assess for general danger signs, check for fever, chest indrawing, count breathing rate, assess feeding. Check HIV status.
- If danger signs/stridor: Give pre-referral 2nd line antibiotic/chloramphenicol, treat hypoglycemia, refer URGENTLY.
- If chest indrawing/fast breathing/fever/eating are same or worse: Change to second-line oral antibiotic recommended locally for treatment failure (treat for 5 days), advise immediate return if worsens, ask to return in 3 days OR Refer (especially if measles within last 3 months or HIV exposed/confirmed).
- If breathing slower, less fever, eating better: Continue and complete the 5-day course of Amoxicillin.
- If coughing for 14 days or more at any visit, assess for TB (see page 9).
Counselling Points
- Explain the diagnosis (pneumonia) and the need for antibiotic.
- Teach the mother how to give the oral Amoxicillin: correct dose, frequency (twice daily), duration (full 5 days), how to measure syrup or disperse tablet.
- If Salbutamol prescribed: Teach how to use the inhaler and spacer correctly (shake inhaler, attach, seal mask/mouthpiece, actuate puff, hold for breaths, repeat for 2nd puff), frequency (3 times daily), duration (5 days).
- Teach how to soothe the throat/relieve cough with safe remedies.
- Advise to continue feeding and offer extra fluids.
- Advise mother WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes fast, child not able to drink or breastfeed, child becomes sicker.
- Advise on follow-up visit in 3 days.
Differential Diagnosis
- Severe Pneumonia / Very Severe Disease
- Asthma/Wheezing (often co-exists or primary issue)
- Bronchiolitis (especially in younger infants)
- Tuberculosis
- Cough or Cold (viral URTI)
- Pertussis
- Heart failure (rare)
Potential Complications
- Progression to severe pneumonia
- Treatment failure/Antibiotic resistance
- Pleural effusion / Empyema (less common with non-severe)
- Dehydration (if poor fluid intake)
Prevention
- Immunization (Hib, PCV, Measles, Pertussis)
- Good nutrition, Vitamin A supplementation.
- Reducing exposure to indoor air pollution (smoke).
- Exclusive breastfeeding for first 6 months.
- Handwashing.
Reference: IMCI Chart Booklet - Page 2, Page 9, Page 14, Page 17, Page 18, Page 22, Page 30
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Cough / Pneumonia
Guidance for assessing cough, difficult breathing, and classifying pneumonia severity.
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