1.IMNCI Integrated Management of Neonatal and childhood illness strategy

2. The 3 MAIN components Improvement in the case management skills of health staff through use of locally adapted guidelines. Improvements in the overall health systems Improvements in family and community health center practices 3. GUIDELINES Target children less than 5 year old Evidence based syndromic approach (1)health problems the child may have (2)severity of the childs condition (3)action that can be taken to the care of the child. 4. The PRINCIPLES1 All children under 5 year of age must be examine3d for conditions which indicate immediate referral Children must be routinely assessed for major symptoms nutritional ,immunization status , feeding problems and other problems Only a limited number of clinical signs are used for assessment CLASSIFICATION: REFERRAL---PINKTREATMENT IN HEALTHY FACILITYYELLOW MANAGEMENT AT HOME --- GREEN 5. Color code: Referral for PINK Treatment in healthy facility for YELLOW Management at home is GREEN 6. THE PRINCIPLES2 IMNCI addresses most common but not all pediatric problems. IMNCI uses a limited number of essential drugs Care takers are actively involved in the treatment of children. IMNCI includes counseling of care takers about home care including feeding, fluids and when to return to health facility. 7. CASE MANAGEMENT STEP1:Acess the young infant STEP2:classify the illness STEP3:identify treatment STEP4:treat the young infant STEP5:counsel the mother STEP6:follow up care 8. ASSESSMENT History taking and communication with the care taker Checking for general danger sign Checking main symptoms Checking for malnutrition Checking for anemia Assessing child feeding Checking immunization status Assessing other problems 9. General danger signs h/o of convulsion Unconsciousness or lethargy Inability to drink or breast feed Child vomit everything If the child have one or more of theses sign the child is said to be seriously ill. 10. CLASSIFICATION Assessing the sick child age 2 month upto 5 year Assessing the sick child from age 2 month to 5 year 11. OP Management of sick child age 2 month to 5years 12. TREATMENT GUIDELINES1 Tt of local infections: #Local Bacterial Infectioins:oral cotrimoxazole or amoxicillin *5days #Skin pustules:apply gentian violet paint twice daily at home #discharge from ear: try to dry the ear by wicking 13. TREATMENT GUIDELINES2 Some or no dehydration:treat dehydration as per WHO guidelines. Feeding problem: #teach the correct positioning and attatchment for breast feeding #teach the mother to manage the breast feeding and correct the nipple problem. #treat thrush:use gentian violet to clean childs mouth #feeding with cup and spoon. #counsel the mother abt feeding problems 14. Pre referral treatments1 Convulsions: diazepam IV or rectally Severe pneumonia, febrile illness, measles ,mastoiditis :chloramphenicol or ampicillin plus gentamycin or ceftriaxone i.m Severe malaria:first dose of quinine Persistent diarrhea,measles severe malnutrition:vitamin A 15. Pre referral treatments Hypoglycemia prevention:breast feeding and sugar Oral antimalarial as per guidelines. High fever:paracetamol Clouding of cornea:tetracycline eye ointment Diarrhea:ORS2 16. APAC For effective communication and counseling APAC ASK PRAISE ADVICE CHECK 17. COUNSELLING Advice to continue breast feeding Teach how to give oral drugs or to treat local infections Counsel to solve feeding problems Advise when to return 18. WHEN TO RETURN! Mother should bring her child if she notices the below.. Young infant (age 0-2m) #breastfeeding or drinking poorly #becomes sicker #develops fever or cold to touch #fast/difficult breathing Sick child(2month to 5 year) #ANY CHILD *not able to drink or breast feed *becomes sicker *develops faster #CHILD WITH COUGH AND COLD *develops fast/difficult breathing#blood in stool#CHILD WITH DIARRHEA#yellow palms and soles.*has blood in stool *drinking poorly 19. Treatment guideline in OP & at home 1 Pneumonia:1st dose of Antibiotic in clinin and teach mother how to give oral drug cotrimoxazole 1st line, amoxicillin 2nd dose Dysentry:cotrimoxazole 1st line nalidixic acid 2nd line Cholera: single dose of doxycycline Dehydration and persistent diarrhea: teat as per WHO gl 20. Treatment guideline in OP & at home 2 Persistent diarrhea: Zn 20 mg elemental daily for 14 days and a single dose of vitamin A Malaria: as per recommendations Anemia: Fe and Folic acid tabs for 14 days Cough and cold: continue breast feeding, honey , tulsi Local inf:Tt eye with tetracycline 21. ARI ACUTE RESPIRATORY TRACT INFECTIONS CONTROL PROGRAMME 22. Acute respiratory tract infections ARI The common bacteria causing ARI:H.influenza,S.pneumonia and staphylococci. Leading cause of mortality below 5 years Clinical criteria for diagnosis:1.rapid respiration with or without difficulty in respiration. rapid respiration is respiration greater than 60/min in children below 2 mnth of age between 2mnth to 1 year and between 1yr to 5 yr. Difficulty in respiration is lower chest indrawing. 23. ARI In children below 2months of age , presence of any one of the following indicates severe diseases : fever(38 degree or more), convulsions, abnormally sleep or difficulty to wake , stridor in calm child, wheezing, not feeding , tachypnea, chest indrawing, altered sensorium, central cyanosis, grunting apneic spells or distended abdomen. 24. Signs and symptomsclassificationtherapyWhere to treatCough or cold No fast breathing No chest indrawing Or indicators of severe illnessNO pneumoniaHome remediesHomeRR/minute Age 60 or more ; less than 2 months 50 or more;2-12 months 40 or more;12 -60 monthsPneumoniacotrimoxazoleHomeChest indrawingSevere pneumoniaIV/IM pencillinHospitalCyanosis, severe chest indrawing, inability to feedVery severe pneumoniaIV chloramphenicolHospital 25. Less than 2 month- its treatment 26. 2 month to 5 years- its treatment 27. Cotrimoxazole - treatment for pneumonia its dosage 28. STRIDOR 29. STRIDOR It is a musical sound of single pitch that is produced by oscillation of critically narrowed extra thorassic pathways. Initially its inspiratory but when obstruction become more severe it become both inspiratory and expiratory. When stridor is high pitched the child is more distressed. With the resolution of disease sridor becomes low in pitch 30. 2 TYPES OF STRIDOR SUPRAGLOTTIC OBSTRUCTIONTRACHEAL OBSTRUCTIONInspiratory stridor Weak cry/dyspnea Dyspnea is generally mild Less pronounced coughBiphasic or expiratory Normal cry/voice May have severe dyspnea Deepbarking,brassy coughPhysical findings: nasal flaring,suprasternal and intercostal indrawing Radiographs: Cxrays OF LATERAL NECK FILM. barium esophagogram 31. CAUSES for STRIDOR INFECTIONS:CROUP , ACUTE EPIGLOTITTIS , BACTERIAL TRACHEITIS , RETROPHARYNGEAK ABCESS CONGENITAL CAUSES:LARYNGOMALACIA , VOCAL CORD PARALYSIS , CONGENITAL SUBGLOTTIC STENOSIS , VASCULAR RING , SUBGLOTTIC HEMANGIOMA , CONGENITAL SACCULAR CYST, LARYNGEAL WEB , LARYNGEAK ATRESIA IATROGENIC CAUSE: ACQUIRED SUBGLOTTIC STENOSIS, LARYNGEAL GRANULOMA NEOPLASM:RECURRENT RESPIRATORY PAPILLOMA FOREIGN BODY 32. INFECTIONS CROUPAC EPIGLOTITTISBACTERIAL TRACHEITISRETROPHARYN GEAL ABCESS1-5 years Barking type Onset: several days Cxray:steeple sign Resolve in 1-2 days Supplemenal O2 Steroids h.Influenza And staphylococcusAcute onset Sore throat dysphagia fever. Tripod posture Cough is absent Lateral x ray: Thumb like thickening of epiglottisYoung children Brassy cough stridor Life threateningHigh fever Reduced morbidity of neck Toxic appearingS.aureusLateral xray: bulge in post pharyngeal wallCefuroxime iv antibiotics H.influenzaTt:surgical drainage 33. RETROPHARYNGEAL ABCESSCROUPEPIGLOTITTIS 34. Congenital LARYNGO VC MALACIA PARALYSISCONG. SUPRA GLOTTIC STENOSISVASCULAR RINGSUBGLOT TIC HEMANGI OMACONG SACCUL AR CYST,L ARYNG EAL WEB,LA RYNGE AL ATRESI AInspiratory stridor Aggravate d:crying supine Self limited3rd MC Incomplete recanalizati on of laryngotrac heal tube during embryonic developme nt, 1st 6 month.Extrinsic compression of both trachea and esophagusSymptoma tic in 3-6 months Biphasdic stridor barking cough Endoscopy tracheosto my,intra lesion strdrareBL:arnold chiari syndrome,hy drocephalus, hypoxia UL:accidental injury during ligation of PDADysphagia plus stridor esphagogra m 35. LARYNGOMALACIASUBGLOTTIC STENOSISSUBGLOTTIC CYSTVOCAL CORD PARALYSISVASCULAR RINGSUB GLOTTIC HEMANGIOMA 36. Iatrogenic Acquired subglottic stenosisLaryngeal granulomaMC acquired Long term endotracheal tube intubation Tracheostomy Widening of stenosis with cartilage grafts Excision of stenotic graftResult from prolonged intubation Endoscopy:granuloma in vocal cord 37. Neoplasm & foreign body RECURRENT RESPIRATORY PAPILLOMAFOREIGN BODYMC tumor of Larynx HPV type 6 and 11 Cause genital condyloma Infection via passaage through birth canal Tt with CO2 laser ablation/microdebrider excission of papilloma Alpha interferon,intra lesional cedofovirPotential cause Food and coins Young age at great risk Endoscopic visualization and removalForeign body 38. TRACHEOSTOMY INDICATION:ventilator dependance and airway obstruction MC comlication:tube obstructions,accidental decannulation that occur months after injury But Long term tracheostomy in children may affect speech and language development 39. Hoarseness VOCAL NODULES: shouting and screaming children endoscopy BL opposing nodules at junction of ant &middle 1/3rd REFLUX LARYNGITIS: Gastric secretions spilling on to larynx- laryngitis, subglottic stenosis, chr sinusitis otitis media with effussion. HYPOTHYROID MYXODEMA: increased vocal fold edemalook for thyroid function test. LARYNGOTRACHEAL CLEFT :Cong defect in post cricoid cartilage in larynx. child experience recc RTI, feeding difficulty, hoarseness, severe cleft cause aspiration pneumonia 40. Reflux laryngitishypothyroidism 41. Wish you a joyful life. & thank youIMNCI - INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS .ARI-ACUTE RESPIRATORY TRACT INFECTION CONTROL PROGRAME .STRIDOR