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2013 EDITION\nGUIDELINES FOR THE MANAGEMENT OF \nCOMMON CHILDHOOD ILLNESSES\nSecond edition\nPOCKET BOOK\n OF\nHospital care\nfor children | 1 | 0 | 0 | WHO-0001 | 1 | who_corpus.pdf | 38 |
ANTIMICROBIAL DRUGS FOR COMMON CONDITIONS
Please fill the blanks with your country’s most recent updated treatment guidelines.(?<=[.!?])\s+(?=[A-Z0-9])Page numbers refer to where generic guidance is found in the Pocket Book.(?<=[.!?])\s+(?=[A-Z0-9])Condition
Drug
Dose
Dysentery (p.(?<=[.!?])\s+(?=[A-Z0-9])144)
HIV tre... | 2 | 1 | 0 | WHO-0001 | 1 | who_corpus.pdf | 371 |
183)
Pneumonia, non-severe (p.(?<=[.!?])\s+(?=[A-Z0-9])86)
Pneumonia, severe (p.(?<=[.!?])\s+(?=[A-Z0-9])82)
drug 2
Sepsis, neonatal (p.(?<=[.!?])\s+(?=[A-Z0-9])55)
drug 2
Sepsis, older child (p.(?<=[.!?])\s+(?=[A-Z0-9])180)
drug 2
Severe acute malnutrition,
uncomplicated (p.(?<=[.!?])\s+(?=[A-Z0-9])207... | 2 | 2 | 1 | WHO-0001 | 1 | who_corpus.pdf | 297 |
POCKET BOOK\n OF\nHospital care\nfor children\nGUIDELINES FOR THE MANAGEMENT OF \nCOMMON CHILDHOOD ILLNESSES\nSecond edition | 3 | 3 | 0 | WHO-0001 | 1 | who_corpus.pdf | 33 |
WHO Library Cataloguing-in-Publication Data :
Pocket book of hospital care for children: guidelines for the management of
common childhood illnesses – 2nd ed.(?<=[.!?])\s+(?=[A-Z0-9])1.Pediatrics.(?<=[.!?])\s+(?=[A-Z0-9])2.Child care.(?<=[.!?])\s+(?=[A-Z0-9])3.Child, Hospitalized.(?<=[.!?])\s+(?=[A-Z0-9])4.Child healt... | 4 | 4 | 0 | WHO-0001 | 1 | who_corpus.pdf | 369 |
Requests for permission to
reproduce or translate WHO publications – whether for sale or for non-commercial
distribution – should be addressed to WHO Press through the WHO web site (www.
who.int/about/licensing/copyright_form/en/index.html).(?<=[.!?])\s+(?=[A-Z0-9])The designations employed and the presentation of th... | 4 | 5 | 1 | WHO-0001 | 1 | who_corpus.pdf | 383 |
However, the published material
is being distributed without warranty of any kind, either expressed or implied.(?<=[.!?])\s+(?=[A-Z0-9])The
responsibility for the interpretation and use of the material lies with the reader.(?<=[.!?])\s+(?=[A-Z0-9])In no
event shall the World Health Organization be liable for damages... | 4 | 6 | 2 | WHO-0001 | 1 | who_corpus.pdf | 138 |
iii
Co ntents
Preface
xv
Acknowledgements
xviii
Abbreviations
xxi
Chart 1: Stages in the management of a sick child admitted
to hospital: key elements
xxii
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE AND EMERGENCY CONDITIONS
1
1.1
Triage
2
1.2 Summary of steps in emergency triage assessment and treatment
3
1.3 Assess... | 5 | 7 | 0 | WHO-0001 | 1 | who_corpus.pdf | 281 |
iv
1.6.3 Principles for inhaled poisons
29
1.6.4 Specifi c poisons
29
Corrosive compounds
29
Petroleum compounds
30
Organophosphorus and carbamate compounds
30
Paracetamol
31
Aspirin and other salicylates
31
Iron
32
Morphine and other opiates
32
Carbon monoxide
33
1.6.5 Pr... | 6 | 8 | 0 | WHO-0001 | 1 | who_corpus.pdf | 317 |
v
3.5 Management of the infant with hypoxic ischaemic encephalopathy
51
3.6 Danger signs in newborns and young infants
52
3.7 Convulsions or fi ts
53
3.8 Serious bacterial infection
54
3.9 Meningitis
55
3.10 Supportive care for sick neonates
56
3.10.1 Thermal environment
56
3.10.2 Fluid management
57
3.10.... | 7 | 9 | 0 | WHO-0001 | 1 | who_corpus.pdf | 355 |
vi
4.3.2 Lung abscess
89
4.3.3 Pneumothorax
90
4.4 Cough or cold
90
4.5 Conditions presenting with wheeze
91
4.5.1 Bronchiolitis
94
4.5.2 Asthma
96
4.5.3 Wheeze with cough or cold
101
4.6 Conditions presenting with stridor
102
4.6.1 Viral croup
102
4.6.2 Diphtheria
105
4.6.3 Epiglottitis
107
... | 8 | 10 | 0 | WHO-0001 | 1 | who_corpus.pdf | 314 |
vii
6.2 Malaria
156
6.2.1 Severe malaria
156
6.2.2 Uncomplicated malaria
163
6.3 Meningitis
167
6.3.1 Bacterial meningitis
167
6.3.2 Meningococcal epidemics
170
6.3.3 Tuberculous meningitis
171
6.3.4 Cryptococcal meningitis
172
6.4 Measles
174
6.4.1 Severe complicated measles
175
6.4.2 Non-sev... | 9 | 11 | 0 | WHO-0001 | 1 | who_corpus.pdf | 281 |
viii
7.4.7
Initial re-feeding
209
7.4.8
Catch-up growth feeding
210
7.4.9
Sensory stimulation
215
7.4.10 Severe acute malnutrition in infants aged < 6 months
216
7.5
Treatment of associated conditions
217
7.5.1
Eye problems
217
7.5.2 Severe anaemia
218
7.5.3 Skin lesions in kwashiorkor
218
... | 10 | 12 | 0 | WHO-0001 | 1 | who_corpus.pdf | 331 |
ix
8.4 Management of HIV-related conditions
243
8.4.1 Tuberculosis
243
8.4.2 Pneumocystis jiroveci pneumonia
244
8.4.3 Lymphoid interstitial pneumonitis
245
8.4.4 Fungal infections
246
8.4.5 Kaposi sarcoma
246
8.5 Prevention of mother-to-child HIV transmission, and infant feeding 247
8.5.1 Prevention ... | 11 | 13 | 0 | WHO-0001 | 1 | who_corpus.pdf | 349 |
x
9.3 Injuries
269
9.3.1 Burns
269
9.3.2 Head injuries
272
9.3.3 Chest injuries
273
9.3.4 Abdominal injuries
275
9.3.5 Fractures
275
9.3.6 Principles of wound care
279
9.4 Abdominal problems
281
9.4.1 Abdominal pain
281
9.4.2 Appendicitis
282
9.4.3 Bowel obstruction after the neonatal period... | 12 | 14 | 0 | WHO-0001 | 1 | who_corpus.pdf | 286 |
xi
10.6.3 Indications for blood transfusion
309
10.6.4 Giving a blood transfusion
309
10.6.5 Transfusion reactions
310
10.7 Oxygen therapy
312
10.8 Toys and play therapy
315
11.(?<=[.!?])\s+(?=[A-Z0-9])MONITORING THE CHILD’S PROGRESS
319
11.1 Monitoring procedures
319
11.2 Monitoring chart
320
11.3 Audit ... | 13 | 15 | 0 | WHO-0001 | 1 | who_corpus.pdf | 346 |
xii
A1.5 Insertion of a chest drain
348
A1.6 Supra-pubic aspiration
350
A1.7 Measuring blood glucose
350
Annex 2.(?<=[.!?])\s+(?=[A-Z0-9])Drug dosages and regimens
353
Annex 3.(?<=[.!?])\s+(?=[A-Z0-9])Equipment sizes
375
Annex 4.(?<=[.!?])\s+(?=[A-Z0-9])Intravenous fl uids
377
A4.1 Choice of intravenous fl ... | 14 | 16 | 0 | WHO-0001 | 1 | who_corpus.pdf | 356 |
How to manage a choking infant or child
7
Chart 4.(?<=[.!?])\s+(?=[A-Z0-9])How to manage the airways in a child with obstructed
breathing (or who has just stopped breathing)
9
Chart 5.(?<=[.!?])\s+(?=[A-Z0-9])How to give oxygen
11
Chart 6.(?<=[.!?])\s+(?=[A-Z0-9])How to position an unconscious child
12
Chart 7.(?<... | 14 | 17 | 1 | WHO-0001 | 1 | who_corpus.pdf | 399 |
Diarrhoea treatment plan C: Treat severe dehydration quickly 130
Chart 14.(?<=[.!?])\s+(?=[A-Z0-9])Diarrhoea treatment plan B: Treat some dehydration with
oral rehydration salts
135
Chart 15.(?<=[.!?])\s+(?=[A-Z0-9])Diarrhoea treatment plan A: Treat diarrhoea at home
138
Chart 16.(?<=[.!?])\s+(?=[A-Z0-9])Feeding rec... | 14 | 18 | 2 | WHO-0001 | 1 | who_corpus.pdf | 129 |
xiii
TABLES
Table 1.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with
an airways or severe breathing problem
21
Table 2.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with shock
22
Table 3.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with letha... | 15 | 19 | 0 | WHO-0001 | 1 | who_corpus.pdf | 377 |
Differential diagnosis in a child presenting with stridor
103
Table 10.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with
chronic cough
110
Table 11.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with diarrhoea 127
Table 12.(?<=[.!?])\s+(?=[A-Z0-9])Classifi cation of the... | 15 | 20 | 1 | WHO-0001 | 1 | who_corpus.pdf | 378 |
Differential diagnosis of fever with rash
153
Table 19.(?<=[.!?])\s+(?=[A-Z0-9])Additional differential diagnosis of fever lasting longer
than 7 days
155
Table 20
WHO criteria for the diagnosis of rheumatic fever
(based on the revised Jones criteria)
194
Table 21.(?<=[.!?])\s+(?=[A-Z0-9])Time frame for the manage... | 15 | 21 | 2 | WHO-0001 | 1 | who_corpus.pdf | 234 |
xiv
Table 25.(?<=[.!?])\s+(?=[A-Z0-9])First-line treatment regimens for children
234
Table 26.(?<=[.!?])\s+(?=[A-Z0-9])Common side-effects of antiretroviral drugs
236
Table 27.(?<=[.!?])\s+(?=[A-Z0-9])Recommended second-line treatment regimens
for children
240
Table 28.(?<=[.!?])\s+(?=[A-Z0-9])Endotracheal tube siz... | 16 | 22 | 0 | WHO-0001 | 1 | who_corpus.pdf | 313 |
Maintenance fl uid requirements
304
Table 33.(?<=[.!?])\s+(?=[A-Z0-9])Primary vaccination schedule for infants recommended
in the Expanded Programme on Immunization
326
Table A2.1
Drug dosage by surface area (m2) of the child
354
Table A5.1.1 Weight-for-age from birth to 5 years: Boys
379
Table A5.1.2 Weight-for-a... | 16 | 23 | 1 | WHO-0001 | 1 | who_corpus.pdf | 181 |
xv
Preface
This is the second edition of the World Health Organization (WHO) Pocket book
of hospital care for children, which was fi rst published in 2005.(?<=[.!?])\s+(?=[A-Z0-9])It is a compila-
tion of the updated WHO guidelines for the management of common childhood
illnesses at the fi rst-referral level in low-res... | 17 | 24 | 0 | WHO-0001 | 1 | who_corpus.pdf | 344 |
It is for use by doctors, senior nurses and other senior health workers
who are responsible for the care of young children at the fi rst referral level in
developing countries.(?<=[.!?])\s+(?=[A-Z0-9])The fi rst edition of the Pocket book was reviewed by a WHO guidelines steering
committee, which identifi ed those chap... | 17 | 25 | 1 | WHO-0001 | 1 | who_corpus.pdf | 367 |
xvi
All the changes were reviewed by external clinical experts and were approved
by the WHO Guidelines Review Committee.(?<=[.!?])\s+(?=[A-Z0-9])A web version of the Pocket book
will be updated regularly as new evidence with clinical implications emerges.(?<=[.!?])\s+(?=[A-Z0-9])Printed editions will be published eve... | 18 | 26 | 0 | WHO-0001 | 1 | who_corpus.pdf | 396 |
Diarrhoea
•
Chapter 9.(?<=[.!?])\s+(?=[A-Z0-9])Common surgical problems
•
Chapter 11.(?<=[.!?])\s+(?=[A-Z0-9])Monitoring the child’s progress
•
Chapter 12.(?<=[.!?])\s+(?=[A-Z0-9])Counselling and discharge from hospital
•
Annexes 1, 3 and 6
Chapters substantially changed from the fi rst edition of the
Pocket book (... | 18 | 27 | 1 | WHO-0001 | 1 | who_corpus.pdf | 355 |
xvii
Additional sections or subsections in this second edition
Several sections of some chapters were added or substantially expanded in
response to demand from users:
•
Chapter 1, section 1.10.(?<=[.!?])\s+(?=[A-Z0-9])Trauma and injuries
•
Chapter 3, section 3.7.(?<=[.!?])\s+(?=[A-Z0-9])Convulsions or fi ts
•
Chapt... | 19 | 28 | 0 | WHO-0001 | 1 | who_corpus.pdf | 374 |
Although some new topics have been added,
standard textbooks of paediatrics should be consulted for rarer conditions not
covered in the Pocket book.(?<=[.!?])\s+(?=[A-Z0-9])These guidelines are applicable in most areas of
the world and may be adapted by countries to suit their specifi c circumstances.(?<=[.!?])\s+(?=... | 19 | 29 | 1 | WHO-0001 | 1 | who_corpus.pdf | 143 |
xviii
Acknowledgements
WHO expresses its gratitude to the following members of the group that up-
dated the guidelines, people who made original contributions, and reviewers,
institutions and consultants for their contributions to updating the Pocket book
of hospital care for children.(?<=[.!?])\s+(?=[A-Z0-9])Guideli... | 20 | 30 | 0 | WHO-0001 | 1 | who_corpus.pdf | 387 |
Special gratitude is owed to Rhona MacDonald, Maternal Child Health Advo-
cacy International, who incorporated the changes and prepared the fi rst draft.(?<=[.!?])\s+(?=[A-Z0-9])Original contributors and external reviewers
WHO coordinated the international contributions for the 2005 edition of the
Pocket book and thank... | 20 | 31 | 1 | WHO-0001 | 1 | who_corpus.pdf | 188 |
xix
Dr Giorgio Tamburlini (Italy), Dr Bridget Wills (Viet Nam) and Fabienne Jäger
(Switzerland).(?<=[.!?])\s+(?=[A-Z0-9])WHO wishes to acknowledge the following for comments and contributions
made at various stages of the Pocket book updating: Sabrina Bakeere-Kitaka,
Makerere Medical School, Uganda; Zulfi qar Bhutta,... | 21 | 32 | 0 | WHO-0001 | 1 | who_corpus.pdf | 355 |
Valuable input was provided by several WHO clusters and the departments of
Family, Women’s and Children’s Health, Health Systems and Services, HIV/AIDS,
Tuberculosis, Neglected Tropical Diseases, Noncommunicable Diseases, and
Mental Health.(?<=[.!?])\s+(?=[A-Z0-9])We particularly acknowledge the WHO staff who partic... | 21 | 33 | 1 | WHO-0001 | 1 | who_corpus.pdf | 319 |
Special thanks to Rami Subhi at the Centre for International Child Health
in Australia, who helped in collating the evidence for recommendations for
updating the Pocket book.(?<=[.!?])\s+(?=[A-Z0-9])The updating of the Pocket book was coordinated by Wilson Were, supported
by Rajiv Bahl, Lulu Muhe, Olivier Fontaine, ... | 21 | 34 | 2 | WHO-0001 | 1 | who_corpus.pdf | 117 |
xx
Institutions
We are grateful to the following institutions for providing input and support
during the review of the Pocket book: Centre for International Child Health,
University of Melbourne, Australia; University of Edinburgh, Scotland; Kenya
Medical Research Institute, Kenya; Asociación Colaboración Cochrane I... | 22 | 35 | 0 | WHO-0001 | 1 | who_corpus.pdf | 197 |
xxi\nAbbreviations\nAIDS \nacquired immunodefi ciency syndrome\nART \nantiretroviral therapy\nAVPU \nalert, responding to voice, responding to pain, unconscious \n(simple consciousness scale) \nBCG \nbacille Calmette-Guérin\nCSF \ncerebrospinal fl uid\nDPT \ndiphtheria, pertussis, tetanus\nEVF \nerythrocyte volume fracti... | 23 | 36 | 0 | WHO-0001 | 1 | who_corpus.pdf | 287 |
xxii
Chart 1.(?<=[.!?])\s+(?=[A-Z0-9])Stages in the management of a sick child
admitted to hospital: key elements
TRIAGE
(present)
• Check for emergency signs
(absent)
• Check for priority signs or conditions
Give emergency
treatment until stable
HISTORY AND EXAMINATION
(including assessment of vaccination statu... | 24 | 37 | 0 | WHO-0001 | 1 | who_corpus.pdf | 400 |
1
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHAPTER 1
T riage and emergency
conditions
1.1
Triage
2
1.2 Summary of steps in emergency triage assessment and treatment
3
1.3 Assessment of emergency and priority signs
4
Triage of all sick children
5
How to manage a choking infant or child
7
How to manage the airway ... | 25 | 38 | 0 | WHO-0001 | 1 | who_corpus.pdf | 320 |
2
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.1
Triage
Triage is the process of rapidly screening sick children soon after their arrival
in hospital, in order to identify:
– those with emergency signs, who require immediate emergency treatment;
– those with priority signs, who should be given priority in the queue so that ... | 26 | 39 | 0 | WHO-0001 | 1 | who_corpus.pdf | 380 |
These children should be assessed without unnecessary delay.(?<=[.!?])\s+(?=[A-Z0-9])If a child has
one or more emergency signs, don’t spend time looking for priority signs.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.7 Drowning
33
1.8 Electrocution
34
1.9 Common causes of envenoming
34
1.9.1
Snake bite
34
1.9.2 Scorpio... | 26 | 40 | 1 | WHO-0001 | 1 | who_corpus.pdf | 158 |
3
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.2
Summary of steps in emergency triage assessment
and treatment
Steps in emergency triage assessment and treatment are summarized in the
charts on pp.(?<=[.!?])\s+(?=[A-Z0-9])5–17.(?<=[.!?])\s+(?=[A-Z0-9])First check for emergency signs in three steps:
•
Step 1.(?<=[.!?])\s+(?... | 27 | 41 | 0 | WHO-0001 | 1 | who_corpus.pdf | 362 |
Quickly determine whether the child is unconscious or convulsing.(?<=[.!?])\s+(?=[A-Z0-9])Give IV glucose for hypoglycaemia and/or an anti-convulsant for convulsing.(?<=[.!?])\s+(?=[A-Z0-9])If emergency signs are found:
•
Call for help from an experienced health professional if available, but do
not delay starting t... | 27 | 42 | 1 | WHO-0001 | 1 | who_corpus.pdf | 374 |
Tables of common differential diagnoses for emergency signs are provided
from p.(?<=[.!?])\s+(?=[A-Z0-9])21 onwards.(?<=[.!?])\s+(?=[A-Z0-9])If no emergency signs are found, check for priority signs:
■Tiny infant: any sick child aged < 2 months
■Temperature: child is very hot
■Trauma or other urgent surgical c... | 27 | 43 | 2 | WHO-0001 | 1 | who_corpus.pdf | 153 |
4
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
■Referral (urgent)
■Malnutrition: visible severe wasting
■Oedema of both feet
■Burns (major)
The above can be remembered from the mnemonic 3TPR MOB.(?<=[.!?])\s+(?=[A-Z0-9])These children need prompt assessment (no waiting in the queue) to determine
what further treatment ... | 28 | 44 | 0 | WHO-0001 | 1 | who_corpus.pdf | 370 |
Stridor indicates obstruction.(?<=[.!?])\s+(?=[A-Z0-9])Is there central cyanosis?(?<=[.!?])\s+(?=[A-Z0-9])Determine whether there is bluish or purplish dis-
coloration of the tongue and the inside of the mouth.(?<=[.!?])\s+(?=[A-Z0-9])Is the child breathing?(?<=[.!?])\s+(?=[A-Z0-9])Look and listen to determine whether ... | 28 | 45 | 1 | WHO-0001 | 1 | who_corpus.pdf | 399 |
If so, determine whether the child is
in shock.(?<=[.!?])\s+(?=[A-Z0-9])Check whether the capillary refi ll time is longer than 3 s.(?<=[.!?])\s+(?=[A-Z0-9])Apply pressure to
whiten the nail of the thumb or the big toe for 5 s.(?<=[.!?])\s+(?=[A-Z0-9])Determine the time from the
moment of release until total recovery... | 28 | 46 | 2 | WHO-0001 | 1 | who_corpus.pdf | 378 |
5
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 2.(?<=[.!?])\s+(?=[A-Z0-9])Triage of all sick children
Emergency signs:
If any sign is positive, call for help, assess and resuscitate, give
treatment(s), draw blood for emergency laboratory investigations
(glucose, malaria smear, Hb)
CHART 2.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE O... | 29 | 47 | 0 | WHO-0001 | 1 | who_corpus.pdf | 398 |
340, 342).(?<=[.!?])\s+(?=[A-Z0-9])If severe malnutrition:
If lethargic or unconscious:
Give IV glucose (Chart 10).
Insert IV line and give fl uids
(Chart 8).(?<=[.!?])\s+(?=[A-Z0-9])If not lethargic or unconscious:
Give glucose orally or by
nasogastric tube.
Proceed immediately to full
assessment and treatme... | 29 | 48 | 1 | WHO-0001 | 1 | who_corpus.pdf | 112 |
6
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHART 2.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE OF ALL SICK CHILDREN
Chart 2.(?<=[.!?])\s+(?=[A-Z0-9])Triage of all sick children
Emergency signs:
If any sign is positive: call for help, assess and resuscitate, give
treatment(s), draw blood for emergency laboratory investigations
(glucose,... | 30 | 49 | 0 | WHO-0001 | 1 | who_corpus.pdf | 397 |
If severe malnutrition:
Do not insert an IV line.
Proceed immediately to full
assessment and treatment (see
section 1.4, p.(?<=[.!?])\s+(?=[A-Z0-9])19).(?<=[.!?])\s+(?=[A-Z0-9])IF COMA OR
CONVULSION
DIARRHOEA
PLUS
two signs
positive
Check for
severe
malnutrition
Severe
dehydration
(only in a child
with diar... | 30 | 50 | 1 | WHO-0001 | 1 | who_corpus.pdf | 269 |
7
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHART 3.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO MANAGE A CHOKING INFANT
Chart 3.(?<=[.!?])\s+(?=[A-Z0-9])How to manage a choking infant
Chest thrusts
Lay the infant on your arm
or thigh in a head-down
position.
Give fi ve blows to the
middle of the infant’s back
with the heel of the ... | 31 | 51 | 0 | WHO-0001 | 1 | who_corpus.pdf | 224 |
8
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHART 3.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO MANAGE A CHOKING CHILD
Chart 3.(?<=[.!?])\s+(?=[A-Z0-9])How to manage a choking child (> 1 year of age)
Heimlich manoeuvre for
a choking older child
Administer back blows to clear airway
obstruction in a choking child.
Give fi ve blows to th... | 32 | 52 | 0 | WHO-0001 | 1 | who_corpus.pdf | 300 |
9
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHART 4.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO MANAGE THE AIRWAY IN A CHILD
Chart 4.(?<=[.!?])\s+(?=[A-Z0-9])How to manage the airway in a child with
obstructed breathing (or who has just stopped
breathing)
A: When no neck trauma is suspected
■ OLDER CHILD
Look, listen and feel for breat... | 33 | 53 | 0 | WHO-0001 | 1 | who_corpus.pdf | 387 |
2.(?<=[.!?])\s+(?=[A-Z0-9])Inspect mouth and
remove foreign body
if present and easily
visible.(?<=[.!?])\s+(?=[A-Z0-9])3.(?<=[.!?])\s+(?=[A-Z0-9])Clear secretions from
the throat.(?<=[.!?])\s+(?=[A-Z0-9])4.(?<=[.!?])\s+(?=[A-Z0-9])Check the airway
by looking for chest
movements, listening
for breath sounds and ... | 33 | 54 | 1 | WHO-0001 | 1 | who_corpus.pdf | 194 |
10
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHART 4.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO MANAGE THE AIRWAY IN A CHILD
Chart 4.(?<=[.!?])\s+(?=[A-Z0-9])How to manage the airway in a child with
obstructed breathing (or who has just stopped
breathing)
B: When neck trauma or cervical spine injury is suspected: jaw thrust
Use jaw th... | 34 | 55 | 0 | WHO-0001 | 1 | who_corpus.pdf | 394 |
Clear secretions from throat under direct vision.(?<=[.!?])\s+(?=[A-Z0-9])4.(?<=[.!?])\s+(?=[A-Z0-9])Check the airway by looking for chest movements, listening for breath
sounds and feeling for breath.(?<=[.!?])\s+(?=[A-Z0-9])If the child is still not breathing
after the above, ventilate with bag
and mask, ideally w... | 34 | 56 | 1 | WHO-0001 | 1 | who_corpus.pdf | 128 |
11
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 5.(?<=[.!?])\s+(?=[A-Z0-9])How to give oxygen
CHART 5.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO GIVE OXYGEN
Give oxygen through nasal
prongs or a nasal catheter.
■ NASAL PRONGS
Place the prongs just inside
the nostrils and secure with
tape.
■ NASAL CATHETER
Use an 8 French gaug... | 35 | 57 | 0 | WHO-0001 | 1 | who_corpus.pdf | 251 |
12
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 6.(?<=[.!?])\s+(?=[A-Z0-9])How to position an unconscious child
CHART 6.(?<=[.!?])\s+(?=[A-Z0-9])HOW TO POSITION AN UNCONSCIOUS CHILD
■ If neck trauma is suspected:
Stabilize the child’s neck and keep the child lying on the back.
Tape the child’s forehead and chin
to the ... | 36 | 58 | 0 | WHO-0001 | 1 | who_corpus.pdf | 237 |
13
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 7.(?<=[.!?])\s+(?=[A-Z0-9])How to give intravenous fl uids to a child in
shock without severe malnutrition
Check that the child is not severely malnourished, as the fl uid volume
and rate are different. (Shock with severe malnutrition, see Chart 8.)
Insert an IV line (and ... | 37 | 59 | 0 | WHO-0001 | 1 | who_corpus.pdf | 337 |
Reassess
after
second
infusion:
• If no improvement with signs of dehydration (as in profuse
diarrhoea or cholera), repeat 20 ml/kg of Ringer’s lactate
or normal saline.
• If no improvement, with suspected septic shock, repeat
20 ml/kg and consider adrenaline or dopamine if available
(see Annex 2, p.(?<=[.!?])\s... | 37 | 60 | 1 | WHO-0001 | 1 | who_corpus.pdf | 365 |
14
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 8.(?<=[.!?])\s+(?=[A-Z0-9])How to give intravenous fl uids to a child in
shock with severe malnutrition
Give this treatment only if the child has signs of shock (usually there will also be a
reduced level of consciousness, i.e. lethargy or loss of consciousness):
Insert an ... | 38 | 61 | 0 | WHO-0001 | 1 | who_corpus.pdf | 346 |
If there are signs of improvement (pulse rate falls, pulse volume increases or
respiratory rate falls) and no evidence of pulmonary oedema
– repeat IV infusion at 15 ml/kg over 1 h; then
– switch to oral or nasogastric rehydration with ReSoMal at 10 ml/kg per h up to
10 h (see p.(?<=[.!?])\s+(?=[A-Z0-9])204);
– ini... | 38 | 62 | 1 | WHO-0001 | 1 | who_corpus.pdf | 313 |
209);
– start IV antibiotic treatment (see p.(?<=[.!?])\s+(?=[A-Z0-9])207).(?<=[.!?])\s+(?=[A-Z0-9])If the child deteriorates during IV rehydration (breathing rate increases by 5/min and
pulse rate increases by 15/min, liver enlarges, fi ne crackles throughout lung fi elds,
jugular venous pressure increases, galloping ... | 38 | 63 | 2 | WHO-0001 | 1 | who_corpus.pdf | 202 |
15
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 9.(?<=[.!?])\s+(?=[A-Z0-9])How to give diazepam rectally
■ Give diazepam rectally:
Draw up the dose from an ampoule of diazepam into a tuberculin (1-ml)
syringe.(?<=[.!?])\s+(?=[A-Z0-9])Base the dose on the weight of the child, when possible.(?<=[.!?])\s+(?=[A-Z0-9])Then
r... | 39 | 64 | 0 | WHO-0001 | 1 | who_corpus.pdf | 186 |
Then
remove the needle.
Insert the syringe 4–5 cm into the rectum, and inject the diazepam
solution.
Hold the buttocks together for a few minutes.(?<=[.!?])\s+(?=[A-Z0-9])Age (weight)
Diazepam given rectally
10 mg/2 ml solution
Dose 0.1 ml/kg
2 weeks to 2 months (< 4 kg)a
0.3 ml
2–< 4 months (4–< 6 kg)
0.5 ml
4–<... | 39 | 65 | 1 | WHO-0001 | 1 | who_corpus.pdf | 383 |
Ensure a very good IV line, as the drug is caustic and will
cause local damage if it extravasates.
■ If high fever:
Undress the child to reduce the fever.
Do not give any oral medication until the convulsion has been controlled
(danger of aspiration).
After convulsions stop and child is able to take orally, giv... | 39 | 66 | 2 | WHO-0001 | 1 | who_corpus.pdf | 183 |
16
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 10.(?<=[.!?])\s+(?=[A-Z0-9])How to give glucose intravenously
Insert an IV line, and draw blood for emergency laboratory
investigations.
Check blood glucose with a glucose monitoring stick.(?<=[.!?])\s+(?=[A-Z0-9])If the level is
< 2.5 mmol/litre (45 mg/dl) in a well-nou... | 40 | 67 | 0 | WHO-0001 | 1 | who_corpus.pdf | 335 |
If it is still low, repeat 5 ml/kg of
10% glucose solution.
Feed the child as soon as he or she is conscious.(?<=[.!?])\s+(?=[A-Z0-9])If the child is unable to feed without danger of aspiration, give:
– milk or sugar solution via a nasogastric tube (to make sugar solution,
dissolve four level teaspoons of sugar (20... | 40 | 68 | 1 | WHO-0001 | 1 | who_corpus.pdf | 371 |
Generally, the strip
must be stored in its box at 2–3 °C, avoiding sunlight or high humidity.(?<=[.!?])\s+(?=[A-Z0-9])A drop of blood
should be placed on the strip (it should cover all the reagent area).(?<=[.!?])\s+(?=[A-Z0-9])After 60 s, the blood
should be washed off gently with drops of cold water and the colour... | 40 | 69 | 2 | WHO-0001 | 1 | who_corpus.pdf | 194 |
17
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Chart 11.(?<=[.!?])\s+(?=[A-Z0-9])How to treat severe dehydration in an
emergency after initial management of shock
For children with severe dehydration but without shock, refer to diarrhoea
treatment plan C, p.(?<=[.!?])\s+(?=[A-Z0-9])131.(?<=[.!?])\s+(?=[A-Z0-9])If the child is ... | 41 | 70 | 0 | WHO-0001 | 1 | who_corpus.pdf | 292 |
Total volume IV fl uid (volume per hour)
Weight
Age < 12 months
Give over 5 h
Age 12 months to 5 years
Give over 2.5 h
< 4 kg
200 ml (40 ml/h)
–
4–6 kg
350 ml (70 ml/h)
–
6–10 kg
550 ml (110 ml/h)
550 ml (220 ml/h)
10–14 kg
850 ml (170 ml/h)
850 ml (340 ml/h)
14–19 kg
–
1200 ml (480 ml/h)
Reassess the child every 1–2 ... | 41 | 71 | 1 | WHO-0001 | 1 | who_corpus.pdf | 374 |
Then choose the appropriate plan A, B or C (pp.(?<=[.!?])\s+(?=[A-Z0-9])138, 135, 131)
to continue treatment.(?<=[.!?])\s+(?=[A-Z0-9])If possible, observe the child for at least 6 h after rehydration to be sure
that the mother can maintain hydration by giving the child ORS solution by
mouth.(?<=[.!?])\s+(?=[A-Z0-9])... | 41 | 72 | 2 | WHO-0001 | 1 | who_corpus.pdf | 166 |
18
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
If the room is very cold, rely on the pulse to determine whether the child is
in shock.(?<=[.!?])\s+(?=[A-Z0-9])Check whether the systolic blood pressure is low for the child’s age (see Table
below).(?<=[.!?])\s+(?=[A-Z0-9])Shock may be present with normal blood pressure, but very... | 42 | 73 | 0 | WHO-0001 | 1 | who_corpus.pdf | 383 |
If the child is not alert but responds to voice, he or she is lethargic.(?<=[.!?])\s+(?=[A-Z0-9])If
there is no response, ask the mother whether the child has been abnormally
sleepy or diffi cult to wake.(?<=[.!?])\s+(?=[A-Z0-9])Determine whether the child responds to pain or
is unresponsive to a painful stimulus.(?<... | 42 | 74 | 1 | WHO-0001 | 1 | who_corpus.pdf | 375 |
Pinch the skin of the
abdomen halfway between the umbilicus and the side for 1 s, then release
and observe.(?<=[.!?])\s+(?=[A-Z0-9])ASSESSMENT OF EMERGENCY AND PRIORITY SIGNS | 42 | 75 | 2 | WHO-0001 | 1 | who_corpus.pdf | 57 |
19
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
■Assess for priority signs
While assessing the child for emergency signs, you will have noted several
possible priority signs:
Is there any respiratory distress (not severe)?(?<=[.!?])\s+(?=[A-Z0-9])Is the child lethargic or continuously irritable or restless?(?<=[.!?])\s+(?=[A... | 43 | 76 | 0 | WHO-0001 | 1 | who_corpus.pdf | 356 |
Those with emergency signs for ‘airway and breathing’ or ‘coma or convulsions’
should receive emergency treatment accordingly (see charts on pp.(?<=[.!?])\s+(?=[A-Z0-9])5–17).
•
Those with signs of severe dehydration but not in shock should not be rehy-
drated with IV fl uids, because severe dehydration is diffi cult ... | 43 | 77 | 1 | WHO-0001 | 1 | who_corpus.pdf | 279 |
204).
•
In severe malnutrition, individual emergency signs of shock may be pre-
sent even when there is no shock.(?<=[.!?])\s+(?=[A-Z0-9])Malnourished children with many signs
of shock: lethargy, reduced level of consciousness, cold skin, prolonged
capillary refi ll and fast weak pulse, should receive additional fl ui... | 43 | 78 | 2 | WHO-0001 | 1 | who_corpus.pdf | 377 |
20
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
infection, severe anaemia and potentially blinding eye problems.(?<=[.!?])\s+(?=[A-Z0-9])It is equally
important to take prompt action to prevent some of these problems, if they were
not present at the time of admission to hospital.(?<=[.!?])\s+(?=[A-Z0-9])1.5
Diagnostic consider... | 44 | 79 | 0 | WHO-0001 | 1 | who_corpus.pdf | 255 |
The following lists and tables are complemented
by the tables in the disease-specifi c chapters.(?<=[.!?])\s+(?=[A-Z0-9])1.5.1
Child presenting with an airway or severe breathing problem
History
•
Onset of symptoms: slow or sudden
•
Previous similar episodes
•
Upper respiratory tract infection
•
Cough and duratio... | 44 | 80 | 1 | WHO-0001 | 1 | who_corpus.pdf | 180 |
21
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Table 1.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with an airway or severe
breathing problem
Diagnosis or underlying cause
In favour
Pneumonia
– Cough with fast breathing and fever
– Grunting or diffi culty in breathing
– Development over days, getting... | 45 | 81 | 0 | WHO-0001 | 1 | who_corpus.pdf | 288 |
22
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
•
Known dengue outbreak
•
Known meningitis outbreak
•
Fever
•
Able to feed
Examination
•
Consciousness level
•
Any bleeding sites
•
Cold or warm extremities
•
Neck veins (elevated jugular venous pressure)
•
Pulse volume and rate
•
Blood pressure
•
Liver size increased
•
... | 46 | 82 | 0 | WHO-0001 | 1 | who_corpus.pdf | 345 |
23
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.5.3
Child presenting with lethargy, unconsciousness
or convulsions
History
•
Fever
•
Head injury
•
Drug overdose or toxin ingestion
•
Convulsions: How long do they last?(?<=[.!?])\s+(?=[A-Z0-9])Have there been previous febrile
convulsions?(?<=[.!?])\s+(?=[A-Z0-9])Epilepsy?(... | 47 | 83 | 0 | WHO-0001 | 1 | who_corpus.pdf | 398 |
In young infants < 1
week old, note the time between birth and the onset of unconsciousness.(?<=[.!?])\s+(?=[A-Z0-9])Other causes of lethargy, unconsciousness or convulsions in some regions of
the world include malaria, Japanese encephalitis, dengue haemorrhagic fever,
measles encephalitis, typhoid and relapsing fev... | 47 | 84 | 1 | WHO-0001 | 1 | who_corpus.pdf | 184 |
24
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHILD PRESENTING WITH LETHARGY, UNCONSCIOUSNESS OR CONVULSIONS
Table 3.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a child presenting with lethargy,
unconsciousness or convulsions
Diagnosis or underlying cause
In favour
Meningitisa,b
– Very irritable
– Stiff neck or bulgi... | 48 | 85 | 0 | WHO-0001 | 1 | who_corpus.pdf | 400 |
25
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
CHILD PRESENTING WITH LETHARGY, UNCONSCIOUSNESS OR CONVULSIONS
Table 3.(?<=[.!?])\s+(?=[A-Z0-9])Continued
Diagnosis or underlying cause
In favour
Acute glomerulonephritis with
encephalopathy
– Raised blood pressure
– Peripheral or facial oedema
– Blood and/or protein in urine
–... | 49 | 86 | 0 | WHO-0001 | 1 | who_corpus.pdf | 339 |
Confi rmation is
given by a low CSF glucose (< 1.5 mmol/litre), high CSF protein (> 0.4 g/litre), organisms
identifi ed by Gram staining or a positive culture.(?<=[.!?])\s+(?=[A-Z0-9])Table 4.(?<=[.!?])\s+(?=[A-Z0-9])Differential diagnosis in a young infant (< 2 months) presenting with
lethargy, unconsciousness or con... | 49 | 87 | 1 | WHO-0001 | 1 | who_corpus.pdf | 240 |
26
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
COMMON POISONING
Table 4.(?<=[.!?])\s+(?=[A-Z0-9])Continued
Diagnosis or underlying cause
In favour
Meningitis
– Lethargy
– Apnoeic episodes
– Convulsions
– High-pitched cry
– Tense or bulging fontanelle
Sepsis
– Fever or hypothermia
– Shock (lethargy, fast breathing, cold
s... | 50 | 88 | 0 | WHO-0001 | 1 | who_corpus.pdf | 359 |
Note that traditional medicines
can be a source of poisoning.(?<=[.!?])\s+(?=[A-Z0-9])Diagnosis
A diagnosis is based on a history from the child or carer, a clinical examination
and the results of investigations, where appropriate.
■Obtain full details of the poisoning agent, the amount ingested and the time
of in... | 50 | 89 | 1 | WHO-0001 | 1 | who_corpus.pdf | 331 |
27
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
PRINCIPLES FOR INGESTED POISONS
oesophageal burns, which may not be immediately apparent, and petroleum
products, if aspirated, can cause pulmonary oedema, which may take some
hours to develop.(?<=[.!?])\s+(?=[A-Z0-9])1.6.1
Principles for ingested poisons
All children who present... | 51 | 90 | 0 | WHO-0001 | 1 | who_corpus.pdf | 362 |
Gastric decontamination does not guarantee that all the
substance has been removed, so the child may still be in danger.(?<=[.!?])\s+(?=[A-Z0-9])Contraindications to gastric decontamination are:
– an unprotected airway in an unconscious child, except when the airway
has been protected by intubation with an infl ated... | 51 | 91 | 1 | WHO-0001 | 1 | who_corpus.pdf | 332 |
Call an anaesthetist to assess the airway.
•
If the child has swallowed other poisons, never use salt as an emetic, as
this can be fatal.
Give activated charcoal, if available, and do not induce vomiting; give by
mouth or nasogastric tube at the doses shown in Table 5.(?<=[.!?])\s+(?=[A-Z0-9])If a nasogastric
t... | 51 | 92 | 2 | WHO-0001 | 1 | who_corpus.pdf | 114 |
28
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Table 5.(?<=[.!?])\s+(?=[A-Z0-9])Poisoning: Amount of activated charcoal per dose
Children ≤ 1 year of age
1 g/kg
Children 1–12 years of age
25–50 g
Adolescents and adults
25–100 g
•
Mix the charcoal in 8–10 volumes of water, e.g.(?<=[.!?])\s+(?=[A-Z0-9])5 g in 40 ml of water. ... | 52 | 93 | 0 | WHO-0001 | 1 | who_corpus.pdf | 391 |
Make sure a suction apparatus is
available in case the child vomits.(?<=[.!?])\s+(?=[A-Z0-9])Place the child in the left lateral head-down
position.(?<=[.!?])\s+(?=[A-Z0-9])Measure the length of tube to be inserted.(?<=[.!?])\s+(?=[A-Z0-9])Pass a 24–28 French gauge
tube through the mouth into the stomach, as a small... | 52 | 94 | 1 | WHO-0001 | 1 | who_corpus.pdf | 304 |
Lavage should
be continued until the recovered lavage solution is clear of particulate matter.(?<=[.!?])\s+(?=[A-Z0-9])Note that tracheal intubation by an anaesthetist may be required to reduce
the risk of aspiration.
Give a specifi c antidote if this is indicated.
Give general care.
Keep the child under ... | 52 | 95 | 2 | WHO-0001 | 1 | who_corpus.pdf | 190 |
29
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.6.2
Principles for poisons in contact with skin or eyes
Skin contamination
Remove all clothing and personal effects, and thoroughly clean all exposed
areas with copious amounts of tepid water.(?<=[.!?])\s+(?=[A-Z0-9])Use soap and water for oily
substances.(?<=[.!?])\s+(?=[... | 53 | 96 | 0 | WHO-0001 | 1 | who_corpus.pdf | 359 |
Evert the eyelids
and ensure that all surfaces are rinsed.(?<=[.!?])\s+(?=[A-Z0-9])When possible, the eye should be
thoroughly examined under fl uorescein staining for signs of corneal damage.(?<=[.!?])\s+(?=[A-Z0-9])If there is signifi cant conjunctival or corneal damage, the child should be
seen urgently by an ophth... | 53 | 97 | 1 | WHO-0001 | 1 | who_corpus.pdf | 379 |
30
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Petroleum compounds
Examples: kerosene, turpentine substitutes, petrol
Do not induce vomiting or give activated charcoal, as inhalation can cause
respiratory distress with hypoxaemia due to pulmonary oedema and lipoid
pneumonia.(?<=[.!?])\s+(?=[A-Z0-9])Ingestion can cause ence... | 54 | 98 | 0 | WHO-0001 | 1 | who_corpus.pdf | 353 |
Treatment
Remove the poison by irrigating eye if in eye or washing skin if on skin.
Give activated charcoal within 4 h of ingestion if ingested.
Do not induce vomiting because most pesticides are in petrol-based solvents.
In a serious case of ingestion, when activated charcoal cannot be given,
conside... | 54 | 99 | 1 | WHO-0001 | 1 | who_corpus.pdf | 389 |
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