LOOKING for signs of illness

Community Health workers ask caregivers questions to identify the child’s problems. They also look for signs of illness and check for malnutrition.

Three signs are introduced here: Chest indrawing, Fast breathing and unusually sleepy or unconscious.

These signs require skill and practice to learn to identify them and use them to determine what the child needs. You will practice using these. You will practice looking for these in exercises, on videotapes and with children in health facilities and hospital.

Chest indrawing

Children often have cough or colds. A child may have a cough because moisture drips from the nose down the back of the throat. The child with only a cough or cold is not seriously ill.

Sometimes a child with a cough however is very sick. The child might have pneumonia. Pneumonia is an infection of the lungs. In our communities, bacteria are usually the cause of pneumonia

Pneumonia can be severe. You identify SEVERE PNUEMONIA by looking chest indrawing.

When pneumonia is very severe, the lungs become very stiff. Breathing with stiff lungs causes chest indrawing. The chest works hard to pull in the air, and breathing can be very difficult. Children with severe pneumonia cannot be treated well at home. They must be referred to the health facility.

Look for chest indrawing in all sick children. Pay particular attention to children with cough or cold, or children who are having any difficulty breathing.

To look for chest indrawing, the child must be calm. The child must not be breastfeeding. If the child is asleep, try not to awaken the child.

Ask the caregiver to raise the clothing above the chest. Look for the lower chest wall (lower ribs).

Look for chest indrawing when the child breathes IN.

Normally when the child breathes IN, the chest and the stomach move out together. Chest indrawing is not visible when the child breathes out. In a child with chest indrawing, however, the chest blows the ribs pull in instead of filling with air

Fast breathing

Another sign for pneumonia is Fast Breathing.

To look for fast breathing:

• Count the child’s breaths for one full minute (60 seconds). Count all children with cough or cold.
• Always tell the care giver you are going to count her child’s breathing. Ask her to keep the child calm. If the child is sleeping do not wake the child.
• If the child is frightened, crying, angry or moving around, you will not be able to do an accurate count.
• Chose a place on the child’s chest or stomach where you can see the body expands as the child breathes in. to count the breath per minute:

1. Use a (Timer) or (watch with a second hand). Put a watch in a place where you can see the watch and the child’s breathing.
2. Look for breathing movement anywhere on the child’s chest or stomach.
3. Start counting the child ‘s breath when the child is calm. Start when the second hand reaches at an easy point to remember such as 12 or 6 on the watch. (If it is a digital watch start when the second numbers are: 00)
4. When the time reaches exactly 60 seconds, stop counting.
5. Repeat the count if you have difficulty. If the child moves or start crying, wait until the child is calm. Then start again.

After you count the breaths, record the breaths per minute in the space provided in the recording form. Decide if the child has fast breathing.

Fast Breathing depends on the child’s age:

1. In a child aged 2 month up to 12 months, fast breathing is 50 breaths per minute or more.
2. In a child 12 month up to 5 years, fast breathing is 40 breaths per minute or more

A child with fast breathing has PNEUMONIA

Look for signs of illness (continued)

Assess general condition: Unusually Sleepy or unconscious)

• While looking for signs of illness, look for the child’s general condition. Look to see if the child is unusually sleepy or unconscious.
• If the child has been sleeping and you have not seen child awake, ask the caregiver if the child seems unusually sleepy. Gently, try to awake the child by moving the child’s arms or legs. If the child is difficult to awake, see if the child awakes when the caregiver claps.
• An unusually sleepy child is not alert when the child should be. The child is drowsy and does not seem notice what is around him or her.
• An unconscious child cannot awaken. The child does not respond when touched or spoken to. An unusually sleepy or unconscious child will not be fussy or crying.
• In contrast, an alert child pays attention to things and people around him or her. Even though the child is tired, the child awakens.

LOOK for signs of severe malnutrition

Malnutrition is a condition that arises when the body does not get enough food to meet its needs. The word malnutrition means bad nutrition (diet).

Children may get malnutrition due to several reasons such as:

1. Not eating enough food - When the body receives fewer foods, it will not be able to grow, repair itself and replace the parts that are wearing out.
2. Infections and diseases - Infections and diseases such as: diarrhoea, measles and acute respiratory infections (ARI) can prevent a child from getting and using the nutrient that they need. Sickness also reduces a child’s appetite.
3. Poverty- Poverty may keep a family from being able to get enough food and the right kind of foods
4. Mother’s ignorance about proper feeding practice - Mother may not know how and what to feed their younger children.
5. Lack of child spacing - When the mother has had her children too close together, she is not able to breastfeed the older child. She will not be able to give the older child the needed care. This can result in the malnutrition in the older child.

Malnourished children do not grow well. If children are malnourished for a longer time, they are shorter than other children of the same age. They are less active when they play and have less interest in exploring. They have difficult learning new skills such as walking, talking, counting and reading.

The body of malnourished child does have enough energy and nutrients (vitamins and minerals) to meet their needs for growing, being active, learning and staying healthy. By helping children receive better nutrition, you can help children develop stronger bodies and minds. Also, malnourished children are sick. Illness is a special challenge to bodies that is weak with poor nutrition. Malnourished children are more likely to die than well-nourished children. Almost half the children who die from common childhood illness- diarrhea, pneumonia, malaria and measles are poorly nourished. If you identify children with malnutrition, you can help them get proper care. You might prevent these children from dying. When many children in a community are poorly nourished, it is difficult to identify which children are severely malnourished.

Two methods to identify severe acute malnutrition