Identify problems

Next you will identify child’s health problems and signs of illness. Any problem you will find will help you whether to:

1. Refer the child to a health facility or
2. Treat the child at home and advise the family on home care

To identify the child’s problem, first ASK the care giver and LOOK at the child for the signs of illness.

ASK: What are the child’s problems?

Identify any concern the caregiver has. These are the reasons the caregiver wants you to see child.

A care giver may report: cough, diarrhoea, blood in stool, fever, convulsions, and difficulties in drinking or breast feeding as indicated on the sick child recording form. Sometimes she reports other problems.

The other important question is: “for how long? “Whatever the care giver says you need to write. If it is:

• Cough- write how many days the child had been coughing
• Diarrhoea – (Passing 3 or more loose stool in 24 hours) is diarrhoea
• Blood in stool - If the child has diarrhoea, ask: “is there blood in stool?
• Fever: Find out whether the child had fever sometime in the last 3 days (reported)or the child is having fever now? Fever caused by malaria for example may not be there all the time. The body may be hotter at sometimes than other times. If is now or probably the caregiver does not know; you may feel the child’s stomach or upper arm.
• Convulsions – when you ask about convulsion use local words the caregiver understands to mean convulsions (During convulsions the child’s arms and legs may stiffen. Sometimes the child may stop breathing or lose consciousness and for a short time can be awaken
• Difficulty drinking or breast feeding – Ask: “Is the child not able to drink or breast feed? “A child who is not able to drink or breast feed is too weak to suckle or swallow when offered a drink or breast milk. 
• Vomiting –if the child is vomiting, ask: “Is the child vomiting everything?” A child who is not able to hold anything down has a sign “vomits everything” Such a child will not be able to use oral medicines you have in a kit.
• HIV–Ask if the child has HIV. If the mother says “yes” the child has this sign. If the caregiver says “No” or “I don’t know”; go to the next question.
• At risk of HIV – To determine whether the child is at risk of HIV, ask whether one or both parents have HIV. The question determines whether there is a risk whether child was infected during pregnancy or breastfeeding.
• If the parents or care givers chooses not to answer whether one or both have HIV, you may explain that the answer will remain confidential or private and will not be shared to anyone. Explain that, you will use the information only to assess whether the child’s illness is related to HIV. If the individual still chooses not to answer, consider the parents’ status unknown.
• Also ask if the child has been tested for HIV – This is in situation where one or both parents have HIV or parents’ status (unknown to them or to the CHW) as the risk of HIV cannot be ruled out.
• Lives in household with someone on TB Treatment.
• Ask the caregiver if anyone living in the household with the child is on TB treatment. If so, the child is exposed to TB.
• TB is spread from person to person through the air. If a person has TB of the lungs and they cough, sneeze or spit, the TB germs are propelled in the air. If the child inhales only a few of these germs they will be infected will TB.
• Infants who live in a household with someone who has TB can become ill with TB even if they are vaccinated. Children who have HIV or malnutrition are most at risk of falling ill or dying of TB
• Any other problems – There is a small space on the sick child recording form for you to write other problems that you may refer as you cannot treat them, such as burn or skin infection.