Communicable Disease Control in Emergencies - A Field Manual (WHO - OMS, 2003, 223 p.): ANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6

Communicable Disease Control in Emergencies - A Field Manual (WHO - OMS, 2003, 223 p.)

		(introduction...)
		ACKNOWLEDGEMENTS
		INTRODUCTION
		CHAPTER 1: RAPID ASSESSMENT
		CHAPTER 2: PREVENTION
		CHAPTER 3: SURVEILLANCE
		CHAPTER 4: OUTBREAK CONTROL
		CHAPTER 5: DISEASE PREVENTION AND CONTROL
		ANNEX 1: WHO REFERENCE VALUES FOR EMERGENCIES
		ANNEX 2: SAMPLE HEALTH SURVEY FORMS
		ANNEX 3: NCHS/WHO NORMALIZED REFERENCE VALUES FOR WEIGHT FOR HEIGHT BY SEX
		ANNEX 4: SAMPLE WEEKLY SURVEILLANCE FORMS
		ANNEX 5: RECOMMENDED CASE DEFINITIONS
		ANNEX 6: OUTBREAK INVESTIGATION FORMS
		ANNEX 7: ORGANIZATION OF AN ISOLATION CENTRE
		ANNEX 8: BASIC LABORATORY SERVICES
		ANNEX 9: LABORATORY INVESTIGATION KIT
		ANNEX 10: TREATMENT GUIDELINES
		ANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6
		ANNEX 12: ASSESSMENT AND TREATMENT OF DIARRHOEA
		ANNEX 13: FLOW CHARTS FOR SYNDROMIC MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
		ANNEX 14: SAMPLE HEALTH CARD
		ANNEX 15: LIST OF WHO GUIDELINES ON COMMUNICABLE DISEASES
		ANNEX 16: LIST OF PUBLISHERS
		ANNEX 17: GENERAL REFERENCES

ANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6

1. ASSESS THE CHILD

Ask

· How old is the child?
· Is the child coughing? For how long?
· Is the child able to drink (for children age 2 months up to 5 years)?
· Has the young infant stopped feeding well (for children less than 2 months)?
· Has the child had fever? For how long?
· Has the child had convulsions?

Look and listen (the child must be calm)

· Count the breaths in a minute.
· Look for chest indrawing.
· Look and listen for stridor.
· Look and listen for wheeze. Is it recurrent?
· See if the child is abnormally sleepy, or difficult to wake.
· Feel for fever, or low body temperature (or measure temperature).
· Look for severe undernutrition.

2. DECIDE HOW TO TREAT THE CHILD

The child aged less than 2 months:		see Table A11.1

The child aged 2 months up to 5 years:
	· who is not wheezing:	see Table A11.2
	· who is wheezing:	refer


Treatment instructions:		see Table A11.3
	1. Give an antibiotic
	2. Advise mother to give home care
	3. Treat fever.

⁶Source: Integrated management of childhood illness. Geneva, World Health Organization, 1997.

Table A11.1. Child under 2 months of age

Signs	No fast breathing (less than 60 per minute) and No severe chest indrawing	Fast breathing (60 per minute or more) or Severe chest indrawing	Not able to drink Convulsions Abnormally sleepy or difficult to wake Stridor in calm child Wheezing or Fever or low body temperature
Classification	No pneumonia - cough or cold	Severe pneumonia	Very severe disease
Treatment	Advise mother to give following home care: keep infant warm breastfeed frequently clear nose if it interferes with feeding Advise mother to return quickly if: illness worsens breathing is difficult breathing becomes fast feeding becomes a problem	Refer urgently to hospital Give first dose of an antibiotic Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely)	Refer urgently to hospital Give first dose of an antibiotic Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely)

Table A11.2. Child 2 months to 5 years of age

Signs	No chest indrawing and No fast breathing (less than 50 per minute if child 2-12 months of age or 40 per minute if child 1-5 years)	No chest indrawing and Fast breathing (50 per minute or more if child 2-12 months of age or 40 per minute if child 1-5 years)	Chest indrawing	Not able to drink Convulsions Abnormally sleepy or difficult to wake Stridor in calm child or Severe undernutrition
Classification	No pneumonia: cough or cold	Pneumonia	Severe pneumonia	Very severe disease
Treatment	If coughing more than 30 days, refer for assessment Assess and treat ear problem or sore throat if present Assess and treat other problems Advise mother to give home care Treat fever if present	Advise mother to give home care Give an antibiotic Treat fever if present Advise mother to return in 2 days for reassessment, or if the child is getting worse	Refer urgently to hospital Give first dose of antibiotics Treat fever if present	Refer urgently to hospital Give first dose of antibiotics Treat fever if present If cerebral malaria is possible, give an antimalarial drug
			(If referral is not possible, treat with an antibiotic and follow closely)

Reassess in 2 days a child who is taking an antibiotic for pneumonia
Signs	Improving · Less fever · Eating better · Breathing slower	The same	Worse · Not able to drink · Has chest indrawing · Has other danger signs
Treatment	Finish 5 days of antibiotics	Change antibiotic or Refer	Refer urgently to hospital

Table A11.3. Treatment instructions

· Give an antibiotic.
· Give first dose of antibiotic in the clinic.
· Instruct mother on how to give the antibiotic for 5 days at home (or to return to clinic for daily procaine penicillin injection).

Age or weight	Co-trimoxazole: trimethoprim (TMP) + sulfamethoxazole (SMX)			Amoxicillin		Procaine penicillin
	Twice daily for 5 days			Three times daily for 5 days		Once daily for 5 days
	Adult tablet single strength (80 mg TMP + 400 mg SMX)	Paediatric tablet (20 mg TMP + 100 mg SMX)	Syrup (40 mg TMP + 200 mg SMX)	Tablet (250 mg)	Syrup (125 mg in 5 ml)	Intramuscular injection
Under 2 months (< 6 kg)^a	¼ ^b	1^b	2.5 ml^b	¼	2.5 ml	200 000 units
2 months to 12 months (6-9 kg)	½	2	5.0 ml	½	5.0 ml	400 000 units
12 months to 5 years (10-19 kg)	1	3	7.5 ml	1	10 ml	800 000 units

^a Give oral antibiotic for f days at home if referral is not feasible.
^b If the child is less than one month old, give ½ paediatric tablet or 1.25 ml syrup twice daily. Avoid co-trimoxazole in infants under one month of age who are premature or jaundiced. Syrups and paediatric tablets are mentioned here for the sake of completeness; they are not available in the kit.

· Advise mother to give home care (for child aged 2 months to 5 years)

· Feed the child

- feed the child during illness
- increase feeding during illness
- clear the nose if it interferes with feeding

· Increase fluids

- offer the child extra to drink
- increase breastfeeding

- soothe the throat and relieve cough with a safe remedy

Most important: for the child classified as having no pneumonia, cough or cold, watch for the following signs and return quickly if they occur:

- breathing becomes difficult
- breathing becomes fast
- child not able to drink

- child becomes sicker

_ This child may have pneumonia

Treat fever

Fever is high (> 39 °C)		Fever is not high (38-39 °C)		In falciparum malarious area: any fever or history of fever		Fever for more than 5 days
Give paracetamol		Advise mother to give more fluids		Give an antimalarial (or treat according to your national malaria programme recommendations)		Refer for assessment
		_
Paracetamol doses every 6 hours					Fever alone is not a reason to give an antibiotic, except in a young infant under 2 months of age. Give first dose of an antibiotic and refer urgently to hospital.
Age or weight	100-mg tablet		500-mg tablet
2 months to 12 months (6-9 kg)	1		¼
12 months to 3 years (10-14 kg)	1		¼
3 years to 5 years (15-19 kg)	1½		½