Essential health services – child health standard 2: Management of newborn and childhood illness
Children have access to priority health services that are designed to address the major causes of newborn and childhood morbidity and mortality.
Key actions (to be read in conjunction with the guidance notes)
Design health education messages to encourage the affected population to seek early care for any illness (fever, cough, diarrhea, etc.) in the newborn. In the design of health education messages, consider children who do not have an adult caring for them (see Health systems standard 1, guidance note 3).
Provide essential newborn care to all newborns according to Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines where possible (see guidance note 1).
Provide healthcare to children at first-level health facilities using national protocol, or the IMCI guidelines where implemented, and hospital care for severely ill children (see Guidance note 2).
Establish a standardised system of emergency assessment and triage at all health facilities providing care to sick children to ensure those with emergency signs receive immediate treatment (see guidance note 3).
Ensure that children attending health services are screened for their nutritional status and referred to nutritional services (see Management of acute malnutrition and micronutrient deficiencies standards 1–3).
Establish an appropriate case management protocol for the treatment of diphtheria and pertussis in situations where the risk of outbreaks of these diseases are high (see guidance note 6).
Make available essential medicines for treatment of common childhood illnesses in the appropriate dosages and formulations.
Key indicators (to be read in conjunction with the guidance notes)
All children under 5 years old presenting with malaria have received effective anti-malarial treatment within 24 hours of onset of their symptoms (see Essential health services – communicable disease standard 2).
All children under 5 years of age presenting with diarrhoea have received both oral rehydration salts (ORS) and zinc supplementation (see guidance note 3).
All children under 5 years of age presenting with pneumonia have received appropriate antibiotics (see guidance note 5).
- Care of the newborn: All newborns should ideally receive skilled care at birth (preferably in a health facility), be kept warm and receive early and exclusive breastfeeding. All newborns should be assessed for any problems, particularly feeding difficulties. All sick newborns should be assessed for possible sepsis and local infections.
- Integrated Management of Childhood Illness (IMCI): IMCI is an integrated approach to child health that focuses on the care of children under 5 at primary-care level. Where IMCI has been developed in a country, and clinical guidelines adapted, these guidelines should preferably be incorporated into the standardised protocols, and health professionals trained appropriately.
- Triage: IMCI and referral care guidelines can be enhanced when used in combination with rapid triage and treatment. Triage is the sorting of patients into priority groups according to their medical need, the resources available and their chances of survival. Clinical staff involved in the care of sick children should be trained using Emergency Triage, Assessment and Treatment (ETAT) guidelines to conduct rapid assessments.
- Management of diarrhoea: Children with diarrhoea must be treated with low osmolality ORS and receive zinc supplementation. Low osmolality ORS shortens the duration of the diarrhoeal episode and reduces the need for intravenous fluid.
- Management of pneumonia: Children with a cough should be assessed for fast and/ or difficult breathing and chest indrawing. Those with fast and/or difficult breathing should receive an appropriate oral antibiotic; those with chest indrawing should be referred to hospital.
- Pertussis or diphtheria outbreaks: Pertussis outbreaks are common in settings of population displacement. A vaccination campaign in response to a pertussis outbreak is usually avoided due to concerns about adverse events among older recipients of whole-cell DPT vaccine. However an outbreak can be used to address routine immunisation gaps. Case management includes antibiotic treatment of cases and early prophylactic treatment of contacts in households where there is an infant or a pregnant woman. Diphtheria outbreaks are less common but always a threat in populations with low diphtheria immunity in crowded settings. Mass vaccination campaigns with three separate doses of vaccine have been conducted in camp settings in response to diphtheria outbreaks. Case management includes the administration of both antitoxin and antibiotics.