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Posting bottle (from 12 months)
Take a large transparent plastic bottle with a
small neck, and place small long objects that
fi t through the neck (not small enough to be
swallowed).(?<=[.!?])\s+(?=[A-Z0-9])TOYS AND PLAY THERAPY | 340 | 700 | 1 | WHO-0001 | 1 | who_corpus.pdf | 70 |
317
10.(?<=[.!?])\s+(?=[A-Z0-9])SUPPORTIVE CARE
TOYS AND PLAY THERAPY
Push-along toy (from 12 months)
Make a hole in the centre of the base
and lid of a cylindrical tin.(?<=[.!?])\s+(?=[A-Z0-9])Thread
a piece of wire (about 60 cm long)
through each hole, and tie the ends
inside the tin.(?<=[.!?])\s+(?=[A-Z0-9])Put ... | 341 | 701 | 0 | WHO-0001 | 1 | who_corpus.pdf | 397 |
Book (from 18 months)
Cut out three rectangular pieces of the same size from a
cardboard box.(?<=[.!?])\s+(?=[A-Z0-9])Glue or draw a picture on both sides of
each piece.(?<=[.!?])\s+(?=[A-Z0-9])Make two holes down one side of each piece
and thread string through to make a book. | 341 | 702 | 1 | WHO-0001 | 1 | who_corpus.pdf | 101 |
318
10.(?<=[.!?])\s+(?=[A-Z0-9])SUPPORTIVE CARE
Notes | 342 | 703 | 0 | WHO-0001 | 1 | who_corpus.pdf | 31 |
319
11.(?<=[.!?])\s+(?=[A-Z0-9])MONITORING
11.1 Monitoring procedures
319
11.2 Monitoring chart
320
11.3 Audit of paediatric care
320
CHAPTER 11
Monitoring the child’s progress
11.1
Monitoring procedures
In order for monitoring to be effective, the health worker must know:
•
the correct administration of the tre... | 343 | 704 | 0 | WHO-0001 | 1 | who_corpus.pdf | 397 |
Children who are seriously ill should be visited by a doctor (or other senior
health professional) soon after admission to hospital.(?<=[.!?])\s+(?=[A-Z0-9])These visits should be
seen as an opportunity to encourage communication between the families of
sick children and hospital staff. | 343 | 705 | 1 | WHO-0001 | 1 | who_corpus.pdf | 70 |
320
11.(?<=[.!?])\s+(?=[A-Z0-9])MONITORING
11.2
Monitoring chart
A monitoring chart should include the following items.
•
patient’s details
•
vital signs (indicated by pulse rate and volume, respiratory rate and presence
of lower chest indrawing, coma score or level of consciousness [AVPU],
temperature and body... | 344 | 706 | 0 | WHO-0001 | 1 | who_corpus.pdf | 395 |
403) for references to examples of monitoring charts and
critical care pathways.(?<=[.!?])\s+(?=[A-Z0-9])11.3
Audit of paediatric care
The quality of care given to sick children in hospital can be improved if there
is a system for reviewing the outcomes of each child admitted to the hospital.(?<=[.!?])\s+(?=[A-Z0-9... | 344 | 707 | 1 | WHO-0001 | 1 | who_corpus.pdf | 384 |
A successful audit calls for full,
constructive participation of all medical and nursing staff.(?<=[.!?])\s+(?=[A-Z0-9])The audit should be
simple and not take up too much of the time required for caring for sick children.(?<=[.!?])\s+(?=[A-Z0-9])One suggestion is to ask medical and nursing staff for their views on i... | 344 | 708 | 2 | WHO-0001 | 1 | who_corpus.pdf | 144 |
321
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
12.1 Timing of discharge from hospital
321
12.2 Counselling
322
12.3 Nutrition counselling
323
12.4 Home treatment
324
12.5 Checking the mother’s health
324
12.6 Checking immunization status
325
12.7 Communicating with the fi rst-level health worker
325
12.8 Providing fol... | 345 | 709 | 0 | WHO-0001 | 1 | who_corpus.pdf | 348 |
322
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
•
the family’s home circumstances and how much support is available to
care for the child
•
the staff’s judgement of the likelihood that the treatment course will be
completed at home
•
the staff’s judgement of the likelihood that the family will return immediately
to hos... | 346 | 710 | 0 | WHO-0001 | 1 | who_corpus.pdf | 389 |
This card will help her to remem-
ber the appropriate foods and fl uids and when to return to the health worker.(?<=[.!?])\s+(?=[A-Z0-9])Appropriate cards should be available as part of national IMCI guidelines.(?<=[.!?])\s+(?=[A-Z0-9])If
they are available, use them; if not, see Annex 6 for a reference to an example.(... | 346 | 711 | 1 | WHO-0001 | 1 | who_corpus.pdf | 393 |
If so, encourage
questions.
•
Ask the mother to tell you in her own words what she should do at home.(?<=[.!?])\s+(?=[A-Z0-9])Encourage her to use the card to help her remember.(?<=[.!?])\s+(?=[A-Z0-9])COUNSELLING | 346 | 712 | 2 | WHO-0001 | 1 | who_corpus.pdf | 86 |
323
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
•
Give her the card to take home.(?<=[.!?])\s+(?=[A-Z0-9])Suggest that she show it to other family
members. (If you do not have a large enough supply of cards to give to every
mother, keep several in the clinic to show to mothers.)
•
Provide an effective interpreter if lang... | 347 | 713 | 0 | WHO-0001 | 1 | who_corpus.pdf | 392 |
Compare the child’s actual feeding with the recommended guidelines for feeding
a child of that age (see section 10.1.2, p.(?<=[.!?])\s+(?=[A-Z0-9])299).(?<=[.!?])\s+(?=[A-Z0-9])Identify any differences, and list
these as feeding problems.(?<=[.!?])\s+(?=[A-Z0-9])In addition, consider:
•
Diffi culty in breastfeeding
... | 347 | 714 | 1 | WHO-0001 | 1 | who_corpus.pdf | 317 |
324
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
•
breastfeeding
•
improved complementary feeding practices with locally available energy-
and nutrient-rich foods
•
giving nutritious snacks to children aged ≥ 2 years.(?<=[.!?])\s+(?=[A-Z0-9])Examples of nutritionally adequate diets (see Chart 15, p.(?<=[.!?])\s+(?=[A-Z0-... | 348 | 715 | 0 | WHO-0001 | 1 | who_corpus.pdf | 364 |
Explain to the mother how to give treatment, e.g. prepar-
ing ORS, giving an oral antibiotic or applying eye ointment.
– Show an example.(?<=[.!?])\s+(?=[A-Z0-9])Demonstrate to the mother how to give the treatment.
– Let her practice.(?<=[.!?])\s+(?=[A-Z0-9])Ask the mother to prepare the medicine or give the treat-
m... | 348 | 716 | 1 | WHO-0001 | 1 | who_corpus.pdf | 356 |
Check the mother’s immunization status,
and, if needed, give her tetanus toxoid.(?<=[.!?])\s+(?=[A-Z0-9])Make sure the mother has access to
family planning and birth spacing and counselling about preventing sexually
transmitted and HIV infections.(?<=[.!?])\s+(?=[A-Z0-9])If the child has TB, the mother and other
me... | 348 | 717 | 2 | WHO-0001 | 1 | who_corpus.pdf | 189 |
325
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
12.6 Checking immunization status
Ask to see the child’s immunization card, and determine whether all the vaccina-
tions recommended for the child’s age have been given.(?<=[.!?])\s+(?=[A-Z0-9])Note any vaccinations
the child still needs, and explain this to the mother.(?<=[.... | 349 | 718 | 0 | WHO-0001 | 1 | who_corpus.pdf | 389 |
A child with diarrhoea who is due to receive oral polio vaccine should be given
a dose, but this dose should not be counted in the schedule.(?<=[.!?])\s+(?=[A-Z0-9])Make a note on
the child’s immunization record that it coincided with diarrhoea, so that the
health worker will give the child an extra dose.(?<=[.!?])\... | 349 | 719 | 1 | WHO-0001 | 1 | who_corpus.pdf | 338 |
326
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
Table 33.(?<=[.!?])\s+(?=[A-Z0-9])Primary vaccination schedule for infants recommended in the
Expanded Programme of Immunization
Vaccine
Age
Birth
6
weeks
10
weeks
14
weeks
9
months
BCG
x
Polio
Oral polio
vaccine
xa
x
x
x
Inactivated
polio vaccine
8
weeks
x
5
months
D... | 350 | 720 | 0 | WHO-0001 | 1 | who_corpus.pdf | 339 |
The scheduled dose should also be given as soon as possible after 9 months
of age.(?<=[.!?])\s+(?=[A-Z0-9])The extra measles dose is also recommended for groups at high risk for death from
measles, such as infants in refugee camps, infants admitted to hospitals, HIV-positive infants
and infants affected by disasters... | 350 | 721 | 1 | WHO-0001 | 1 | who_corpus.pdf | 205 |
327
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
12.8 Providing follow-up care
Advise all mothers who are taking their children home after assessment in the
hospital when to go to a health worker for follow-up care.(?<=[.!?])\s+(?=[A-Z0-9])Mothers may need
to return to hospital:
•
for a follow-up visit within a specifi ed ... | 351 | 722 | 0 | WHO-0001 | 1 | who_corpus.pdf | 389 |
When to return immediately
Advise the mother to return immediately if the child develops any of the fol-
lowing signs:
•
unable to drink or breastfeed
•
becomes sicker
•
develops a fever
•
signs of illness return after successful treatment in hospital
•
a cough or cold: fast or diffi cult breathing
•
diarrhoea: bl... | 351 | 723 | 1 | WHO-0001 | 1 | who_corpus.pdf | 163 |
328
12.(?<=[.!?])\s+(?=[A-Z0-9])DISCHARGE
Notes | 352 | 724 | 0 | WHO-0001 | 1 | who_corpus.pdf | 30 |
329
BIBLIOGRAPHY
B ibliography
This Pocket book was updated on the basis of recommendations and guidelines
derived from published guidelines that are regularly reviewed and updated by
the Guidelines Review Committee.(?<=[.!?])\s+(?=[A-Z0-9])These can be accessed on the WHO website
at http://www.who.int/maternal_chil... | 353 | 725 | 0 | WHO-0001 | 1 | who_corpus.pdf | 364 |
WHO (2012).(?<=[.!?])\s+(?=[A-Z0-9])Guidelines on basic newborn resuscitation.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/maternal_child_adolescent/documents/basic_
newborn_resuscitation/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2012).(?<=[.!?])\s+(?=[A-Z0-9])Technical note: Supplementary foods for the manage... | 353 | 726 | 1 | WHO-0001 | 1 | who_corpus.pdf | 389 |
WHO (2012).(?<=[.!?])\s+(?=[A-Z0-9])Care for child development: improving the care for young
children.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/maternal_child_adolescent/documents/care_child_
development/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2012).(?<=[.!?])\s+(?=[A-Z0-9])HIV and infant feeding 2010: ... | 353 | 727 | 2 | WHO-0001 | 1 | who_corpus.pdf | 226 |
330
BIBLIOGRAPHY
WHO (2012).(?<=[.!?])\s+(?=[A-Z0-9])Integrated Management for Emergency and Essential Surgical
Care (IMEESC) tool kit.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/surgery/publications/imeesc/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2011).(?<=[.!?])\s+(?=[A-Z0-9])Manual on paediatric HIV car... | 354 | 728 | 0 | WHO-0001 | 1 | who_corpus.pdf | 362 |
WHO (2011).(?<=[.!?])\s+(?=[A-Z0-9])Guidelines on optimal feeding of low birth-weight infants in low-
and middle-income countries.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/maternal_child_adolescent/documents/infant_
feeding_low_bw/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2011).(?<=[.!?])\s+(?=[A-Z0-9])Pri... | 354 | 729 | 1 | WHO-0001 | 1 | who_corpus.pdf | 387 |
WHO (2010).(?<=[.!?])\s+(?=[A-Z0-9])Guidelines on HIV and infant feeding 2010.(?<=[.!?])\s+(?=[A-Z0-9])Principles and
recommendations for infant feeding in the context of HIV and a summary of
evidence.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/maternal_child_adolescent/
documents/9789241599535/en/index.html... | 354 | 730 | 2 | WHO-0001 | 1 | who_corpus.pdf | 393 |
Geneva.
http://www.who.int/maternal_child_adolescent/
documents/9789241548083/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2010).(?<=[.!?])\s+(?=[A-Z0-9])Guidelines for the treatment of malaria, 2nd ed.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/malaria/publications/atoz/9789241547925/en/index.
html. | 354 | 731 | 3 | WHO-0001 | 1 | who_corpus.pdf | 157 |
331
BIBLIOGRAPHY
WHO (2010).(?<=[.!?])\s+(?=[A-Z0-9])Rapid advice: treatment of tuberculosis in children.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://whqlibdoc.who.int/publications/2010/9789241500449_eng.pdf.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2010).(?<=[.!?])\s+(?=[A-Z0-9])Guidelines for treatment of tuberculosis, 4th ed.(?<=[.... | 355 | 732 | 0 | WHO-0001 | 1 | who_corpus.pdf | 367 |
WHO (2009).(?<=[.!?])\s+(?=[A-Z0-9])Training course on the management of severe malnutrition,
update 2009.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/nutrition/publications/severemalnutrition/training_
inpatient_MSM/en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2009).(?<=[.!?])\s+(?=[A-Z0-9])WHO child growth st... | 355 | 733 | 1 | WHO-0001 | 1 | who_corpus.pdf | 396 |
WHO, World Food Programme and UNICEF (2007).(?<=[.!?])\s+(?=[A-Z0-9])Community-based
management of severe acute malnutrition.(?<=[.!?])\s+(?=[A-Z0-9])A joint statement by the World
Health Organization, the World Food Programme, the United Nations System
Standing Committee on Nutrition and the United Nations Children... | 355 | 734 | 2 | WHO-0001 | 1 | who_corpus.pdf | 364 |
The treatment of diarrhoea: A manual for physicians and other
senior health workers.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/maternal_child_adolescent/documents/9241593180/
en/index.html.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2003).(?<=[.!?])\s+(?=[A-Z0-9])Managing newborn problems: a guide for doctors, nurses and ... | 355 | 735 | 3 | WHO-0001 | 1 | who_corpus.pdf | 202 |
332
BIBLIOGRAPHY
WHO (2003).(?<=[.!?])\s+(?=[A-Z0-9])Surgical care at the district hospital.(?<=[.!?])\s+(?=[A-Z0-9])Geneva.
http://www.who.int/surgery/publications/en/.(?<=[.!?])\s+(?=[A-Z0-9])WHO (2003).(?<=[.!?])\s+(?=[A-Z0-9])Rheumatic fever and rheumatic heart disease: report of a WHO
expert consultation.(?<=[.!... | 356 | 736 | 0 | WHO-0001 | 1 | who_corpus.pdf | 318 |
333
PRACTICAL PROCEDURES
ANNEX 1
Practical procedures
Practical procedures should fi rst be explained to the parents or to the child
if she or he is old enough; any risks should also be discussed with them and
their consent obtained.(?<=[.!?])\s+(?=[A-Z0-9])Procedures on young infants should be carried out in
warm s... | 357 | 737 | 0 | WHO-0001 | 1 | who_corpus.pdf | 377 |
For ketamine, give 2–4 mg/kg
IM; this takes 5–10 min to act and lasts for about 20 min.(?<=[.!?])\s+(?=[A-Z0-9])A1.1 Giving injections
335
A1.1.1 Intramuscular
336
A1.1.2 Subcutaneous
336
A1.1.3 Intradermal
336
A1.2 Giving parenteral fl uids
338
A1.2.1 Insertion of an indwelling intravenous
cannula in... | 357 | 738 | 1 | WHO-0001 | 1 | who_corpus.pdf | 186 |
334
PRACTICAL PROCEDURES
PRACTICAL PROCEDURES
Wrapping the child to hold him or her securely during a practical procedure
One end of a folded sheet should be pulled through under the arms on both sides
(A and B).(?<=[.!?])\s+(?=[A-Z0-9])The other end is then brought across the front and wrapped around the
child (C an... | 358 | 739 | 0 | WHO-0001 | 1 | who_corpus.pdf | 87 |
335
PRACTICAL PROCEDURES
When giving any sedation or light anaesthesia, manage the child’s airway,
beware of respiratory depression, and monitor oxygen saturation with a pulse
oximeter, when possible.(?<=[.!?])\s+(?=[A-Z0-9])Make sure you have a resuscitation bag available
and, if possible, oxygen.(?<=[.!?])\s+(?=[A... | 359 | 740 | 0 | WHO-0001 | 1 | who_corpus.pdf | 372 |
Discard disposable syringes in a safe container.(?<=[.!?])\s+(?=[A-Z0-9])GIVING INJECTIONS
Restraining the child
for examination of eyes,
ears or mouth | 359 | 741 | 1 | WHO-0001 | 1 | who_corpus.pdf | 49 |
336
PRACTICAL PROCEDURES
A1.1.1 Intramuscular
In children aged > 2 years, give
the injection into the outer thigh
or the upper, outer quadrant
of the buttock, well away from
the sciatic nerve.(?<=[.!?])\s+(?=[A-Z0-9])In younger or
severely malnourished children,
use the outer side of the thigh
midway between the... | 360 | 742 | 0 | WHO-0001 | 1 | who_corpus.pdf | 376 |
Push the needle
(23–25-gauge) under the skin at a 45° angle into the subcutaneous fatty tissue.(?<=[.!?])\s+(?=[A-Z0-9])Do not enter the underlying muscle.(?<=[.!?])\s+(?=[A-Z0-9])Draw back the plunger to make sure there is
no blood (if there is, withdraw slightly and try again).(?<=[.!?])\s+(?=[A-Z0-9])Give the drug... | 360 | 743 | 1 | WHO-0001 | 1 | who_corpus.pdf | 357 |
Considerable resistance is felt when injecting intradermally.(?<=[.!?])\s+(?=[A-Z0-9])A raised,
blanched bleb showing the surface of the hair follicles is a sign that the injection
has been given correctly.(?<=[.!?])\s+(?=[A-Z0-9])Intramuscular injection into the thigh
INTRAMUSCULAR | 360 | 744 | 2 | WHO-0001 | 1 | who_corpus.pdf | 92 |
337\nPRACTICAL PROCEDURES\nINTRAMUSCULAR\nskin\nsubcutaneous tissue\nmuscle or bone\nIntradermal injection (for example in Mantoux test)\nSites for IV access in infants and young children\nVeins on dorsum \nof hand\nScalp veins\nExternal jugular veins\nAntecubital veins\nFemoral veins\nAnkle veins\n➝\n➝\n➝\n➝\n➝\n➝ | 361 | 745 | 0 | WHO-0001 | 1 | who_corpus.pdf | 106 |
338
PRACTICAL PROCEDURES
A1.2 Giving parenteral fl uids
A1.2.1 Insertion of an indwelling intravenous cannula
in a peripheral vein
Select a suitable vein to place the cannula or a gauge 21 or 23 butterfl y needle.(?<=[.!?])\s+(?=[A-Z0-9])Peripheral vein
•
Identify an accessible peripheral vein.(?<=[.!?])\s+(?=[A-Z0-9])... | 362 | 746 | 0 | WHO-0001 | 1 | who_corpus.pdf | 307 |
339
PRACTICAL PROCEDURES
the vein and insert most of its length.(?<=[.!?])\s+(?=[A-Z0-9])Fix the catheter securely with tape.(?<=[.!?])\s+(?=[A-Z0-9])Apply a splint with the limb in an appropriate position (e.g. elbow extended,
wrist slightly fl exed).(?<=[.!?])\s+(?=[A-Z0-9])Scalp vein
These are often used in children... | 363 | 747 | 0 | WHO-0001 | 1 | who_corpus.pdf | 341 |
Introduce the butterfl y needle
as described above.(?<=[.!?])\s+(?=[A-Z0-9])Blood fl owing back slowly through the tubing indicates
that the needle is in the vein.
•
Care should be taken not to cannulate an artery, which is recognized by
palpation.(?<=[.!?])\s+(?=[A-Z0-9])If there is a pulsatile spurting of blood, wi... | 363 | 748 | 1 | WHO-0001 | 1 | who_corpus.pdf | 170 |
340
PRACTICAL PROCEDURES
Care of the cannula
Secure the cannula when introduced.(?<=[.!?])\s+(?=[A-Z0-9])This may require splinting neighbouring
joints to limit the movement of the catheter.(?<=[.!?])\s+(?=[A-Z0-9])Keep the overlying skin clean and
dry.(?<=[.!?])\s+(?=[A-Z0-9])Flush and fi ll the cannula with normal s... | 364 | 749 | 0 | WHO-0001 | 1 | who_corpus.pdf | 388 |
If fever persists for more than 24 h,
antibiotic treatment (effective against Staphylococcus aureus) should be given.(?<=[.!?])\s+(?=[A-Z0-9])Intravenous drug administration through an indwelling cannula
Attach the syringe containing the IV drug to the injection port of the cannula and
introduce the drug.(?<=[.!?])\s... | 364 | 750 | 1 | WHO-0001 | 1 | who_corpus.pdf | 394 |
An alternative
site for needle insertion is the distal femur, 2 cm above the lateral condyle.
•
Prepare the necessary equipment, i.e.:
– bone marrow aspiration or intraosseous needles (15–18 gauge or, if not
available, 21 gauge).(?<=[.!?])\s+(?=[A-Z0-9])If these are not available, bone marrow needles or
large-bor... | 364 | 751 | 2 | WHO-0001 | 1 | who_corpus.pdf | 122 |
341
PRACTICAL PROCEDURES
– a sterile 5-ml syringe fi lled with
normal saline
– a second sterile 5-ml syringe
– IV infusion equipment
– sterile gloves.
•
Place padding under the child’s knee
so that it is bent 30° from the straight
(180°) position, with the heel resting
on the table.
•
Locate the correct positi... | 365 | 752 | 0 | WHO-0001 | 1 | who_corpus.pdf | 390 |
Stabilize the needle
and slowly inject 3 ml while palpating the area for any leakage under the
skin.(?<=[.!?])\s+(?=[A-Z0-9])If no infi ltration is seen, start the infusion.
•
Apply dressings and secure the needle in its place.
•
Note: Failure to aspirate marrow contents does not mean that the needle is
not correct... | 365 | 753 | 1 | WHO-0001 | 1 | who_corpus.pdf | 173 |
342
PRACTICAL PROCEDURES
•
Monitor the infusion by the ease with which the fl uid fl ows and by the clinical
response of the patient.
•
Check that the calf does not swell during the infusion.
•
Stop the intraosseous infusion and remove the needle as soon as venous
access is available.(?<=[.!?])\s+(?=[A-Z0-9])In any ... | 366 | 754 | 0 | WHO-0001 | 1 | who_corpus.pdf | 363 |
External jugular vein
•
Hold the child securely, with the head turned to one side away from the
puncture site and slightly lower than the body (15–30° head-down position).(?<=[.!?])\s+(?=[A-Z0-9])Restrain the child as necessary in this position.
•
After cleaning the skin with an antiseptic solution, identify the ext... | 366 | 755 | 1 | WHO-0001 | 1 | who_corpus.pdf | 389 |
Abduct and externally rotate the
hip joint, and fl ex the knee.(?<=[.!?])\s+(?=[A-Z0-9])An assistant should hold the leg in this position
and keep the other leg out of the way.(?<=[.!?])\s+(?=[A-Z0-9])If the child is conscious, infi ltrate the
area with 1% lignocaine.(?<=[.!?])\s+(?=[A-Z0-9])CENTRAL VEIN CANNULATION | 366 | 756 | 2 | WHO-0001 | 1 | who_corpus.pdf | 131 |
343
PRACTICAL PROCEDURES
•
Clean the skin with an antiseptic solution to ensure that the procedure is
aseptic.(?<=[.!?])\s+(?=[A-Z0-9])Palpate the femoral artery (below the inguinal ligament in the middle
of the femoral triangle).(?<=[.!?])\s+(?=[A-Z0-9])The femoral vein runs medial to the femoral artery.
•
Clean t... | 367 | 757 | 0 | WHO-0001 | 1 | who_corpus.pdf | 339 |
A femoral line can last for up
to 5 days with correct care.
•
Withdraw the cannula after the IV infusion has been given, and apply fi rm
pressure over the site for 2–3 min.(?<=[.!?])\s+(?=[A-Z0-9])A1.2.4 Venous cut-down
This is less appropriate if speed is essential.
•
Immoblize the child’s lower leg, and clean the... | 367 | 758 | 1 | WHO-0001 | 1 | who_corpus.pdf | 378 |
If it does not, check that the cannula is in the vein, or try
withdrawing it slightly to improve the fl ow.(?<=[.!?])\s+(?=[A-Z0-9])VENOUS CUT-DOWN | 367 | 759 | 2 | WHO-0001 | 1 | who_corpus.pdf | 55 |
344
PRACTICAL PROCEDURES
•
Tie the distal ligature around the catheter, and then close the skin incision
with interrupted sutures.(?<=[.!?])\s+(?=[A-Z0-9])Fix the cannula to the skin and cover with a sterile
dressing.(?<=[.!?])\s+(?=[A-Z0-9])A1.2.5 Umbilical vein catheterization
This procedure can be used for resusc... | 368 | 760 | 0 | WHO-0001 | 1 | who_corpus.pdf | 388 |
Note the two
umbilical arteries,
which are thick-
walled and towards
the legs of the infant.(?<=[.!?])\s+(?=[A-Z0-9])C.(?<=[.!?])\s+(?=[A-Z0-9])Fixation of the
inserted catheter,
which prevents
kinking | 368 | 761 | 1 | WHO-0001 | 1 | who_corpus.pdf | 81 |
345
PRACTICAL PROCEDURES
•
Clean the umbilical cord and surrounding skin with an antiseptic solution,
and then tie a suture around the base of the cord.
•
Cut the cord 1–2 cm from the base with a sterile scalpel.(?<=[.!?])\s+(?=[A-Z0-9])Identify the umbili-
cal vein (larger gaping vessel) and umbilical arteries (two... | 369 | 762 | 0 | WHO-0001 | 1 | who_corpus.pdf | 388 |
Mark
the tube at this point.
•
Hold the child fi rmly.(?<=[.!?])\s+(?=[A-Z0-9])Lubricate the tip of the catheter with water, and pass it
directly into one nostril, pushing it slowly in.(?<=[.!?])\s+(?=[A-Z0-9])It should pass easily down into
the stomach without resistance.(?<=[.!?])\s+(?=[A-Z0-9])When the measured d... | 369 | 763 | 1 | WHO-0001 | 1 | who_corpus.pdf | 317 |
346
PRACTICAL PROCEDURES
•
If there is any doubt about the location of the tube, withdraw it and start again.
•
When the tube is in place, fi x a 20-ml syringe (without the plunger) to the
end of the tube, and pour food or fl uid into the syringe, allowing it to fl ow
by gravity.(?<=[.!?])\s+(?=[A-Z0-9])If oxygen ther... | 370 | 764 | 0 | WHO-0001 | 1 | who_corpus.pdf | 373 |
Place the child on the side so that the ver-
tebral column is parallel to this surface, and the transverse axis of the back
is vertical (see fi gure next page).
•
The assistant should fl ex the back of the child, pull the knees up towards
the chest, and hold the child at the upper back between the shoulders and
butto... | 370 | 765 | 1 | WHO-0001 | 1 | who_corpus.pdf | 333 |
347
PRACTICAL PROCEDURES
Prepare the site
•
Use aseptic technique.(?<=[.!?])\s+(?=[A-Z0-9])Scrub the
hands and wear sterile gloves.
•
Prepare the skin around the site
with an antiseptic solution.
•
Sterile towels may be used.
•
In older children who are alert,
give a local anaesthetic (1%
lignocaine) infi ltrate... | 371 | 766 | 0 | WHO-0001 | 1 | who_corpus.pdf | 366 |
In
young infants this decrease in resistance is not always felt, so advance the
needle very carefully.
•
Withdraw the stylet, and drops of CSF will pass out of the needle.(?<=[.!?])\s+(?=[A-Z0-9])If no CSF
is obtained, the stylet can be reinserted and the needle advanced slightly.
•
Obtain a sample of 0.5–1 ml CSF... | 371 | 767 | 1 | WHO-0001 | 1 | who_corpus.pdf | 301 |
348
PRACTICAL PROCEDURES
A1.5 Insertion of a chest drain
Pleural effusions should be drained, except when small.(?<=[.!?])\s+(?=[A-Z0-9])It is sometimes neces-
sary to drain both sides of the chest.(?<=[.!?])\s+(?=[A-Z0-9])You may have to drain the chest two or
three times if the fl uid keeps coming back.(?<=[.!?])\s+(... | 372 | 768 | 0 | WHO-0001 | 1 | who_corpus.pdf | 345 |
Withdraw a sample for microscopy and other
tests, and place in a container.(?<=[.!?])\s+(?=[A-Z0-9])If the fl uid is clear (straw-coloured or brownish), pull out the needle or catheter
after withdrawing enough fl uid to relieve distress, and put a dressing over the
puncture site.(?<=[.!?])\s+(?=[A-Z0-9])Consider a dif... | 372 | 769 | 1 | WHO-0001 | 1 | who_corpus.pdf | 308 |
If the fl uid is thick pus, which cannot pass easily through the needle or catheter,
insert a chest tube (see fi gure).(?<=[.!?])\s+(?=[A-Z0-9])Insertion of a chest tube
Select and prepare the site as described above.
•
Make a 2–3-cm skin incision along the line of the Intercostal space, just
above the rib below (to a... | 372 | 770 | 2 | WHO-0001 | 1 | who_corpus.pdf | 169 |
349
PRACTICAL PROCEDURES
•
Use the forceps to hold the
drainage catheter (16 gauge)
and introduce it into the chest
for several centimetres, point-
ing upwards.(?<=[.!?])\s+(?=[A-Z0-9])Ensure that all
drainage holes of the catheter
are inside the chest.
•
Connect the catheter to a
collection bottle with an un-
... | 373 | 771 | 0 | WHO-0001 | 1 | who_corpus.pdf | 364 |
Insertion of a chest tube: the site is
selected in the mid-axillary line in the 5th
intercostal space (at the level of the nipple)
on the superior aspect of the 6th rib.(?<=[.!?])\s+(?=[A-Z0-9])INSERTION OF A CHEST DRAIN | 373 | 772 | 1 | WHO-0001 | 1 | who_corpus.pdf | 70 |
350
PRACTICAL PROCEDURES
A1.6 Supra-pubic aspiration
Aspirate to a depth of 3 cm in the midline at the proximal transverse crease
above the pubis with a 23-gauge needle under sterile conditions.(?<=[.!?])\s+(?=[A-Z0-9])Do this only in
a child with a full bladder, which can be demonstrated by percussion.(?<=[.!?])\s+(... | 374 | 773 | 0 | WHO-0001 | 1 | who_corpus.pdf | 370 |
A1.7
Measuring blood glucose
Blood glucose can be measured with a rapid diagnostic test (e.g.(?<=[.!?])\s+(?=[A-Z0-9])Dextrostix®)
at the bedside, which provides an estimate of blood glucose within a few min-
utes.(?<=[.!?])\s+(?=[A-Z0-9])There are several brands on the market, which differ slightly in how they
shou... | 374 | 774 | 1 | WHO-0001 | 1 | who_corpus.pdf | 292 |
351
PRACTICAL PROCEDURES
fi eld of the strip is read and compared with a colour scale printed on the box.(?<=[.!?])\s+(?=[A-Z0-9])This allows estimation of the glucose level within a certain range, e.g. between
2 and 5 mmol/l, but does not allow exact determination.(?<=[.!?])\s+(?=[A-Z0-9])Some strips come with an elec... | 375 | 775 | 0 | WHO-0001 | 1 | who_corpus.pdf | 351 |
352\nPRACTICAL PROCEDURES\nNotes | 376 | 776 | 0 | WHO-0001 | 1 | who_corpus.pdf | 9 |
353
DRUGS
ANNEX 2
Drug dosages and regimens
This section gives the doses of the drugs mentioned in these guidelines that
are suitable for infants and children.(?<=[.!?])\s+(?=[A-Z0-9])For ease of use and to avoid having to
make calculations, doses are given according to the body weight of the child.(?<=[.!?])\s+(?=[... | 377 | 777 | 0 | WHO-0001 | 1 | who_corpus.pdf | 366 |
The drugs include those for which the exact dose
is critically important to ensure a therapeutic effect or to avoid toxicity, e.g.
digoxin, chloramphenicol, aminophylline and antiretroviral drugs.(?<=[.!?])\s+(?=[A-Z0-9])For some antiretroviral drugs, the recommended dosages are often given ac-
cording to the surface... | 377 | 778 | 1 | WHO-0001 | 1 | who_corpus.pdf | 263 |
354
DRUGS
Table A2.1 Drug dosage by surface area (m2) of the child
Age or weight of child
Surface area (m2)
Neonate (< 1 month)
0.2–0.25
Young infant (1–< 3 months)
0.25–0.35
Child 5–9 kg
0.3–0.45
Child 10–14 kg
0.45–0.6
Child 15–19 kg
0.6–0.8
Child 20–24 kg
0.8–0.9
Child 25–29 kg
0.9–1.1
Child 30–39 kg
1.1–1.3
Exam... | 378 | 779 | 0 | WHO-0001 | 1 | who_corpus.pdf | 210 |
355
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Abacavir (see separate table for antiretrovirals, p.(?<=[.!?])\s+(?=[A-Z0-9])372)
Adrenaline
For wheeze
0.01 ml/kg (up to a
maximum of 0.3 ml)
of 1:1000 solution
(or 0.1 ml/kg of 1:10
000 solution) given
subc... | 379 | 780 | 0 | WHO-0001 | 1 | who_corpus.pdf | 377 |
356
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Aminophylline
For asthma
(continued)
Maintenance dose:
IV: 5 mg/kg up to
every 6 h
1 ml
1.5 ml
2.5 ml
3.5 ml
5 ml
or by continuous
infusion at 0.9 mg/
kg per h
Calculate exact dose
Give IV loading dose only if t... | 380 | 781 | 0 | WHO-0001 | 1 | who_corpus.pdf | 392 |
If oral ampicillin is required after a course of injectable ampicillin for severe disease, the oral dose
must be two to four times higher than that given here.(?<=[.!?])\s+(?=[A-Z0-9])For dosages and dosage intervals in neonates and premature infants, see p.(?<=[.!?])\s+(?=[A-Z0-9])69.(?<=[.!?])\s+(?=[A-Z0-9])356
AMIN... | 380 | 782 | 1 | WHO-0001 | 1 | who_corpus.pdf | 126 |
357
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Antituberculosis antibiotics (see p.(?<=[.!?])\s+(?=[A-Z0-9])370)
Artemether
For severe malaria
Loading dose:
IM: 3.2 mg/kg
40 mg/1-ml ampoule
80 mg/1-ml ampoule
0.4 ml
0.2 ml
0.8 ml
0.4 ml
1.2 ml
0.6 ml
1.6 ml
0... | 381 | 783 | 0 | WHO-0001 | 1 | who_corpus.pdf | 385 |
Dilute by dissolving 60 mg artesunic acid (which is already dissolved in 0.6 ml of 5% sodium
bicarbonate) in 3.4 ml of 5% glucose.(?<=[.!?])\s+(?=[A-Z0-9])Give a dose at 0, 12 and 24 h and then daily until child is able to take it orally.(?<=[.!?])\s+(?=[A-Z0-9])If the patient is able to swallow,
give the recommended... | 381 | 784 | 1 | WHO-0001 | 1 | who_corpus.pdf | 315 |
358
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Benzathine penicillin – see Penicillin
Cefotaxime
IV: 50 mg/kg every 6 h
Vial of 500 mg mixed
with 2 ml sterile water
or vial of 1 g mixed with
4 ml sterile water or vial
of 2 g mixed with 8 ml
sterile water
... | 382 | 785 | 0 | WHO-0001 | 1 | who_corpus.pdf | 387 |
359
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Chloramphenicol
For meningitis
Calculate exact dose based on body weight.(?<=[.!?])\s+(?=[A-Z0-9])Use the doses below only if this is not possible.(?<=[.!?])\s+(?=[A-Z0-9])IV: 25 mg/kg every 6 h
(max, 1 g per do... | 383 | 786 | 0 | WHO-0001 | 1 | who_corpus.pdf | 316 |
Chloramphenicol,
oily (for treatment
of meningococcal
meningitis during
epidemics)
100 mg/kg single dose;
max, 3 g
IM: vial of 0.5 g in 2 ml
1.2–
2 ml
2.4–
3.6 ml
4–
5.6 ml
6–
7.6 ml
8–
11.6 ml
Chlorphenamine
IM/IV or SC:
10 mg in 1 ml
0.1 ml
0.2 ml
0.3 ml
0.5 ml
0.6 ml
0.25 mg/kg once (can be
repeated up to fo... | 383 | 787 | 1 | WHO-0001 | 1 | who_corpus.pdf | 140 |
360
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Ciprofl oxacin
Oral: 10-20 mg/kg
per dose given twice a
day for 5 days (max,
500 mg per dose)
100 mg tablet
½
1
1½
2
3
250 mg tablet
¼
½
½
1
1½
Cloxacillin or
fl ucloxacillin or
oxacillin
IV: 25–50 mg/kg every ... | 384 | 788 | 0 | WHO-0001 | 1 | who_corpus.pdf | 311 |
70.(?<=[.!?])\s+(?=[A-Z0-9])Co-trimoxazole
(trimethoprim-
sulfamethoxazole)
4 mg/kg trimethoprim
and 20 mg/kg
sulfamethoxazole twice
a day
Oral: adult tablet
(80 mg trimethoprim
+ 400 mg
sulfamethoxazole)
¼
½
1
1
1
Oral: paediatric
tablet (20 mg
trimethoprim + 100 mg
sulfamethoxazole)
1
2
3
3
4
360
CIPROFLOXA... | 384 | 789 | 1 | WHO-0001 | 1 | who_corpus.pdf | 96 |
361
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Co-trimoxazole
(trimethoprim-
sulfamethoxazole
(continued)
Oral: syrup (40 mg
trimethoprim + 200
mg sulfamethoxazole
per 5 ml)
2 ml
3.5 ml
6 ml
8.5 ml
—
Note: For interstitial pneumonia in children with HIV, g... | 385 | 790 | 0 | WHO-0001 | 1 | who_corpus.pdf | 262 |
Deferoxamine
For iron poisoning
15 mg/kg per h IV to max
of 80 mg/kg in 24 h, or
IM: 50 mg/kg every 6 h.(?<=[.!?])\s+(?=[A-Z0-9])Maximum dose, 6 g/day
500-mg ampoule
2
2
2
2
2
Dexamethasone
For severe viral
croup
Oral: 0.6 mg/kg single
dose
0.5-mg tablets
IM: 5 mg/ml
0.5 ml
0.9 ml
1.4 ml
2 ml
3 ml
For meningi... | 385 | 791 | 1 | WHO-0001 | 1 | who_corpus.pdf | 363 |
362
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Digoxin
These doses are for oral digoxin.(?<=[.!?])\s+(?=[A-Z0-9])Give as an initial loading dose followed by twice daily maintenance doses, starting 6 h
after the loading dose:
Loading dose: 15 µg/kg,
once only... | 386 | 792 | 0 | WHO-0001 | 1 | who_corpus.pdf | 383 |
Efavirenz (see separate table for antiretrovirals, p.(?<=[.!?])\s+(?=[A-Z0-9])372)
Erythromycin
(estolate)
Oral: 12.5 mg/kg four
times a day for 3 days
250-mg tablet
¼
½
1
1
1½
Must not be given with theophylline (aminophylline) because of risk of serious adverse reactions.(?<=[.!?])\s+(?=[A-Z0-9])362
DIDANOSINE | 386 | 793 | 1 | WHO-0001 | 1 | who_corpus.pdf | 120 |
363
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Fentanyl
IV injection: 1-4 µg/kg
every 2–4 h
Injection: 50 µg/ml
–
Calculate exact dose based on body weight, and
tailor dose to relieve pain.(?<=[.!?])\s+(?=[A-Z0-9])Infusion: initial IV dose
1–2 µg/kg, then 0... | 387 | 794 | 0 | WHO-0001 | 1 | who_corpus.pdf | 361 |
7.5 mg/kg once a day
IM/IV: vial containing
20 mg (2 ml at 10 mg/
ml) undiluted
2.25–
3.75 ml
4.5–6.75
ml
7.5–10.5
ml
–
–
IM/IV: vial containing
80 mg (2 ml at 40 mg/
ml) mixed with 6 ml
sterile water
2.25–
3.75 ml
4.5–6.75
ml
7.5–10.5
ml
–
–
363
FENTANYL | 387 | 795 | 1 | WHO-0001 | 1 | who_corpus.pdf | 106 |
364
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Gentamicin
(continued)
IM/IV: vial containing
80 mg (2 ml at 40 mg/
ml) undiluted
0.5–
0.9 ml
1.1–
1.7 ml
1.9–
2.6 ml
2.8–
3.5 ml
3.75–
5.4 ml
Risk for adverse effects when given with theophylline.(?<=[.!?])\s+(?... | 388 | 796 | 0 | WHO-0001 | 1 | who_corpus.pdf | 382 |
Ibuprofen
5–10 mg/kg orally every
6–8 h to a max total daily
dose of 40 mg/kg
200-mg tablet
–
¼
¼
½
¾
400-mg tablet
–
–
–
¼
½
Iron
Once a day for 14 days
Iron–folate tablet
(ferrous sulfate 200 mg
+ 250 µg folate = 60 mg
elemental iron
–
–
½
½
1
Iron syrup (ferrous
fumarate, 100 mg per
5 ml = 20 mg/ml
eleme... | 388 | 797 | 1 | WHO-0001 | 1 | who_corpus.pdf | 108 |
365
DRUGS
Drug
Dosage
Form
Dose according to body weight
3–< 6 kg
6–< 10 kg
10–< 15 kg
15–< 20 kg
20–29 kg
Kanamycin
Calculate exact dose based on body weight.(?<=[.!?])\s+(?=[A-Z0-9])Use the doses below only if this is not possible.(?<=[.!?])\s+(?=[A-Z0-9])IM/IV: 20 mg/kg once
a day
250 mg vial (2 ml at
125 mg/ml)
... | 389 | 798 | 0 | WHO-0001 | 1 | who_corpus.pdf | 245 |
Ketamine
For anaesthesia in
major procedures
Calculate exact dose based on body weight.(?<=[.!?])\s+(?=[A-Z0-9])IM: Loading dose: 5–8 mg/kg
20–35
mg
40–60
mg
60–100
mg
80–140
mg
125–200
mg
IM: Further dose: 1–2 mg/kg (if required)
5–10 mg
8–15 mg
12–25 mg
15–35
mg
25–50
mg
IV: Loading dose: 1–2 mg/kg
5–10 mg
8... | 389 | 799 | 1 | WHO-0001 | 1 | who_corpus.pdf | 399 |
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