002 Assesment for Cough and Difficult Breathing

7/27/2019 002 Assesment for Cough and Difficult Breathing

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“Approach to Sick Child

Under 5 Years Old ” (IMCI)

PRE-CONFERENCE WORKSHOP 1



Assessment and Managementof Children with

Cough and Difficult Breathing





Introduction

• A child with cough or difficult breathing may havepneumonia or another severe respiratoryinfection.

• Both bacteria and viruses can cause pneumonia

• In developing countries, pneumonia is often dueto bacteria.

• The most common are Streptococcus

pneumoniae and Hemophilus influenzae.• Children with bacterial pneumonia may die from

hypoxia or sepsis .

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Introduction..

• There are many children who come to the clinicwith less serious respiratory infections. Mostchildren with cough or difficult breathing have

only a mild infection.• For example, a child who has a cold may cough

because nasal discharge drips down the back of the throat or bronchitis.

• These children are not seriously ill. They do notneed treatment with antibiotics. Their familiescan treat them at home.

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Introduction…

• Health workers need to identify the few, very

sick children with cough or difficult breathing

who need treatment with antibiotics.

• Fortunately, health workers can identify

almost all cases of pneumonia by checking for

these two clinical signs: fast breathing and

chest indrawing.

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Presenting complaint or sign can be

associated with a number of conditions;

Presenting compliant Possible cause/ associated condition

Cough and/or PneumoniaFast breathing Severe anaemia

P. falciparum malaria

Drowsy or Cerebral malariaUnconsciousness Meningitis

Severe dehydrationVery severe pneumonia

Measles rash PneumoniaDiarrhoeaEar infection

‘Very sick’ young infant Pneumonia

MeningitisSepsis04/07/2013 7



IMCI Case Management Process

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THEN ASK ABOUT MAIN SYMPTOMS:

Does the child have cough or difficult breathing?

IF YES, ASK: LOOK, LISTEN, FEEL:

For how long ·

. Count the breaths in one minute

· Look for chest indrawing

· Look and listen for stridor· Look and listen for wheeze

Child

must

becalm}if wheezing and either fast breathing or chest

indrawing:

Give a trial of inhaled Salbutamol for up to

three times 15-20 minutes apart. Count thebreaths and look for chest indrawing again

and then classify


If the child is: fast breathing is:

2 months up to 12 months 50 breaths per minute or more

12 months up to 5 years 40 breaths per minute or more04/07/2013 11



LOOK for chest indrawing

• When the child breathes IN (lower ribs). The

child has chest indrawing if the lower chest

wall goes IN when the child breathes IN .

• Chest indrawing is lower chest wall indrawing.

It does not include "intercostal

indrawing.“(soft tissue between the rib goes

in)

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• For chest indrawing to be present, it must be

clearly visible and present all the time.

• If chest indrawing only present when the child

is crying or feeding, the child does not have

chest indrawing.


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LOOK and LISTEN for stridor

• Is a harsh noise made when the child breathes

IN, happens when there is a swelling of the

larynx, trachea or epiglottis.

• This swelling interferes with air entering the

lungs. It can be life-threatening when the

swelling causes the child's airway to be

blocked.

• A child who has stridor when calm has a

dangerous condition.

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LOOK and LISTEN for wheeze

• Is a musical noise heard when the child breathes

OUT.

• Occurs when the air flow from the lungs is

obstructed due to narrowing of the small airways.• If the child is wheezing and has either fast breathing

or chest indrawing, give a trial of inhaled Salbutamol

for three times; every 15 -20 minutes apart.

• 15 minutes after completing the 3rd dose of inhaled

Salbutamol, count the breaths and look for chest

indrawing again and re-classifying.

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CLASSIFY cough or difficult breathing

• There are four possible classifications for a

child with cough or difficult breathing;

SEVERE PNEUMONIA OR VERY SEVERE

DISEASE or

PNEUMONIA or

WHEEZE or

COUGH OR COLD

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Classification table for cough or

difficult breathingSIGNS CLASSIFY AS TREATMENT

(Urgent pre-referral treatment are in bold print)

Any general danger sign or

Chest indrawing or

Stridor in calm child

SEVERE

PNEUMONIA

OR VERY

SEVERE DISEASE

Give first dose of an appropriate antibiot ic

Refer URGENTLY to ho spital*

Give oxyg en if available

Treat wheeze if present with inh aled Salbutamol

Fast breathing

PNEUMONIA

Give oral antibiot ic for 5 days

Treat wheeze with inhaled Salbutamol and continuewith oral Salbutamol for 5 days

Soothe the throat and relieve cough with safe remedy

If coughing more than 14 days or if having recurrent

wheezing, refer for assessment for TB or Asthma

Advise mother when to return immediately

Follow up in 2 days

Wheeze

WHEEZE

Treat wheeze with inhaled Salbutamol and continue

with oral Salbutamol for 5 days Soothe throat and relieve cough with safe remedy


Follow up in 5 days

No signs of pneumonia

or very severe disease

COUGH OR COLD



Soothe the throat and relieve the cough with

a safe remedy

Advise mother when to return immediately Follow-up in 5 days if not improving

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TREAT THE CHILDGive an Appropriate Oral Antibiotic FOR PNEUMONIA, ACUTE EAR INFECTION, MASTOIDITIS OR VERY SEVERE DISEASE:

FIRST-LINE ANTIBIOTIC: AMOXCYCILLIN (25 mg/kg/dose)

SECOND-LINE ANTIBIOTIC: COTRIMOXAZOLE (4mg/kg/dose)

AMOXYCILLIN

Give TWO times daily for 5 days

COTRIMOXAZOLE

(Trimethoprime +

Sulphamethoxazole)Give TWO times daily for 5 days

AGE or WEIGHT Syrup 125 mg/5 ml Syrup 40 mg Trimethoprim + 200

mg Suphamethoxazole/5 ml

2 months up to 4 months

(4 - <6 kg)

5 ml 2.5 ml


(6- <10 kg)

7.5 ml 5 ml

12 months up to 5 years

(10- <19 kg)

10 – 15 ml 7.5 – 10 ml

FOR SEVERE PNEUMONIA OR VERY SEVERE DISEASE/ MASTOIDITIS: If the child can take orally givedouble the dose of Amoxycillin before urgent referral. Do not use Cotrimoxazole.04/07/2013 20



GIVE THESE TREATMENT IN CLINIC ONLY

• Treat Wheeze in the Child

1. Use of Nebuliser • Dilute 0.5 ml Salbutamol solution (5mg/ml) with 3.5 ml normal saline in a

nebulizer chamber.

• Place the mask to cover the child’s nose and mouth.

• Give the oxygen flow of 6-8 liters/min.

• Nebulise until the liquid is used up or for at least 15 minutes.

2. Use of Spacer or Aerochamber

• Remove the inhaler cap.

• Shake the inhaler well.

• Insert mouthpiece of the inhaler into spacer or Aerochamber.

• Depress the canister down to actuate the spray once.

• Gently place the mask of the spacer to cover the mouth and nose.

• Ask the patient to breathe for at least 10 breaths (infants), 6 breaths (child).

• Give 2 puffs (100mcg/puff), allow at least 30 seconds between each puff.

• Replace inhaler cap.04/07/2013 21




difficult breathing Any general danger sign or

Chest indrawing or


SEVERE

PNEUMONIA

OR VERY

SEVERE DISEASE

Give first dose of an appropriate antibio t ic




Fast breathing

PNEUMONIA



with oral Salbutamol for 5 days Soothe the throat and relieve cough with safe remedy




Follow up in 2 days

Wheeze

WHEEZE


with oral Salbutamol for 5 days

Soothe throat and relieve cough with safe remedy Advise mother when to return immediately

Follow up in 5 days



COUGH OR COLD




a safe remedy


Follow-up in 5 days if not improving04/07/2013 22



TREAT THE CHILDGive an Appropriate Oral Antibiotic FOR PNEUMONIA, ACUTE EAR INFECTION, MASTOIDITIS OR VERY SEVERE DISEASE:

FIRST-LINE ANTIBIOTIC: AMOXCYCILLIN (25 mg/kg/dose)

SECOND-LINE ANTIBIOTIC: COTRIMOXAZOLE (4mg/kg/dose)

AMOXYCILLIN

Give TWO times daily for 5 days

COTRIMOXAZOLE

(Trimethoprime +

Sulphamethoxazole)Give TWO times daily for 5 days

AGE or WEIGHT Syrup 125 mg/5 ml Syrup 40 mg Trimethoprim + 200

mg Suphamethoxazole/5 ml


(4 - <6 kg)

5 ml 2.5 ml


(6- <10 kg)

7.5 ml 5 ml

12 months up to 5 years

(10- <19 kg)

10 – 15 ml 7.5 – 10 ml

FOR SEVERE PNEUMONIA OR VERY SEVERE DISEASE/ MASTOIDITIS: If the child can take orally givedouble the dose of Amoxycillin before urgent referral. Do not use Cotrimoxazole.04/07/2013 23






nebulizer chamber.



• Nebulise until the liquid is used up or for at least 15 minutes.












TREAT THE CHILD

• GIVE ORAL SALBUTAMOL

ORAL SALBUTAMOL

Give three times daily for 5 days

AGE or WEIGHT 2mg/5 ml syrup2 months up to 4 months (4 - <6 kg) 1 ml

4 months up to 12 months (6- <10 kg) 2 ml

12 months up to 3 years (10- <14 kg) 3.5 ml

3 years up to 5 years (14 - <19 kg) 5 ml

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TEACH THE MOTHER TO TREAT LOCAL

INFECTIONS AT HOME

Soothe the Throat, Relieve the Cough with a

Safe Remedy

• Safe remedies to recommend:

- Breastmilk for breastfed infant.

- Warm water if not breastfed.

•

Harmful remedies to discourage:- Cough syrup.

- Nasal decongestants.

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WHEN TO RETURN IMMEDIATELY

Advise mother to return immediately if the child has any of

these signs:

Any sick child • Not able to drink or breastfeed

• Becomes sicker • Develops a fever

If child has COUGH OR COLD, also

return if:

• Fast breathing

• Difficult breathing

If child has Diarrhoea, also return if:•

Blood in stool• Drinking poorly

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Advise the Mother When to Return

to Health Worker FOLLOW-UP VISIT

If the child has: Return for first follow-up visit

in:

•PNEUMONIA

•DYSENTRY

•MALARIA, if fever persists•FEVER-MALARIA UNLIKELY, if fever persists

•MEASLES WITH EYE OR MOUTH COMPLICATIONS

2 days

•WHEEZE

•PERSISTENT DIARRHOEA

•

ACUTE EAR INFECTION•CHRONIC EAR INFECTION

•FEEDING PROBLEM

• ANY OTHER ILLNESS, if not improving

5 days

• ANAEMIA

•VERY LOW WEIGHT FOR AGE

14 days

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Chest indrawing or


SEVERE

PNEUMONIA

OR VERY

SEVERE DISEASE





Fast breathing

PNEUMONIA








Follow up in 2 days

Wheeze

WHEEZE




Follow up in 5 days



COUGH OR COLD




a safe remedy








nebulizer chamber.



•Nebulise until the liquid is used up or for at least 15 minutes.












TREAT THE CHILD

• GIVE ORAL SALBUTAMOL

ORAL SALBUTAMOL

Give three times daily for 5 days

AGE or WEIGHT 2mg/5 ml syrup2 months up to 4 months (4 - <6 kg) 1 ml

4 months up to 12 months (6- <10 kg) 2 ml

12 months up to 3 years (10- <14 kg) 3.5 ml

3 years up to 5 years (14 - <19 kg) 5 ml

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TEACH THE MOTHER TO TREAT LOCAL

INFECTIONS AT HOME

Soothe the Throat, Relieve the Cough with a

Safe Remedy

• Safe remedies to recommend:

- Breastmilk for breastfed infant.

- Warm water if not breastfed.

•

Harmful remedies to discourage:- Cough syrup.

- Nasal decongestants.

04/07/2013 32





Advise the Mother When to Return

to Health Worker FOLLOW-UP VISIT

If the child has: Return for first follow-up visit

in:

•PNEUMONIA

•DYSENTRY

•MALARIA, if fever persists•FEVER-MALARIA UNLIKELY, if fever persists

•MEASLES WITH EYE OR MOUTH COMPLICATIONS

2 days

•WHEEZE

•PERSISTENT DIARRHOEA

•

ACUTE EAR INFECTION•CHRONIC EAR INFECTION

•FEEDING PROBLEM

• ANY OTHER ILLNESS, if not improving

5 days

• ANAEMIA

•VERY LOW WEIGHT FOR AGE

14 days

04/07/2013 34





Chest indrawing or


SEVERE

PNEUMONIA

OR VERY

SEVERE DISEASE





Fast breathing

PNEUMONIA








Follow up in 2 days

Wheeze

WHEEZE




Follow up in 5 days



COUGH OR COLD




a safe remedy





Thank you…

Dr Yusnita Binti YatimPakar Perubatan Keluarga UD54

Klinik Kesihatan Peramu Jaya

002 Assesment for Cough and Difficult Breathing

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