Use the problems identified- the results of ASK the caregivers and Look at the child to decide whether to refer the child to the health facility or treat the child at home.

Some problems are danger signs a danger sign indicates that a child id too ill for you and the family to treat in the community. You do not have the medicines this child needs. To help this child survive, you must URGENTLY refer the child to the health facility.

You may see another problem you cannot treat. You may not be able to identify the cause of the problem, or you may not have the correct medicine to treat it. Although the problem is not a danger sign, you will refer the child to the health facility. There; a trained health worker better assesses and treat the child.

Families can treat some sick children at home with your help. If you have the appropriate medicine, they can care for children with diarrhea, fever, (in a malaria area), and tough or difficult breathing.

Any DANGER SIGN: Refer the child

Anyone of the danger sign is a reason to refer the child URGENTLY to the health facility. Using information you have about the child, tick [ ] the danger sign or signs you find if any. The first danger signs are found by asking the caregiver, about the child’s problems.

  • Cough for 14 days or more - A child who has a cough for 14 days or more has a danger sign. The child may have Tuberculosis, asthma, whooping cough or another problem. The child needs more assessment and treatment at health facility. Refer a child with cough for 14 days or more.
  • Diarrhoea for 14 days or more - Diarrhoea usually stops on its own in 3 to 4 days. Diarrhoea for 14 days or more is, however, danger sign. It may be a sign of severe disease. The diarrhea may contribute to malnutrition. Diarrhoea also can cause dehydration, when the body loses more fluid than they are being replaced. If not treated, dehydration results in death. Refer the child diarrhea for 14 days or more.

  • Blood in stool - Diarrhoea with blood in stool, with or without mucus, is dysentery danger sign, if there is blood in stool the child needs medicine that you do not have in your medicine kit. Refer a child with blood in stool.
  • Fever for last seven (7) days or more - Most fevers go within few days. Fever that has lasted for 7 days or more can mean that the child has a severe disease. The fever does not have to occur every day, all the days. Refer the child who has had fever for last 7 days or more for assessment and treatment to the health facility.
  • Convulsions - onvulsion during the child’s current illness is a danger sign. A serious infection or a high fever may be the cause of the convulsions. The health facility may provide appropriate medicines and identify the cause, Refer the child to the health facility.
  •  Not able to drink or eat anything - One of the first indications that the child is very sick is that, the child cannot drink or swallow. Dehydration is a risk. Also, if the child is not able to drink or swallow anything, the child will not be able to swallow oral medicine you have in your medicine kit. Refer. Refer a child who is not able to drink or eat anything.
  • Vomits everything - When a child vomits everything, a child cannot hold down any food or drink at all. The child will not be able to replace the fluid lost during vomiting and is in danger of dehydration. A child who vomits everything also cannot take oral medicines you have in your medicine kit. Refer a child who vomits everything.
  • Has HIV or any other illness - A child who has HIV is likely to get diarrhea, pneumonia, TB and to become malnourished. When this child gets sick, he or she is at risk of developing severe illness and needs special care for the illness. Refer the child who has HIV and other illness.

These danger signs are identified based on the caregivers’ answers to your questions. Other danger signs you identify by looking at the child. The list of danger sign will after an exercise.

Sick but NO danger sign: Treat the child

Look at the far-right column of the recording form-Sick but No danger sign? The column lists signs of illness that can be treated at home if the child has no danger sign. You will tick [ ] the signs listed in the column if the child has any. 

For these problems you treat the child with medicine, advise the family on home care for the sick child and follow up until the child is well. If the child does not improve with home care, then refer the child to the health facility for assessment and treatment.

The list includes three signs of illness that require attention and can be treated at home.

  • Diarrhoea (less than 14 days and no blood in stool) - Diarrhoea for less than 14 days, with no danger sign needs treatment. You will need to give the child Oral Rehydration Salts (ORS) and Zinc. ORS in water prevents and treats dehydration. Zinc helps to reduce the severity of diarrhea and can even prevent diarrhea future months.
  • Fever for less than seven days - Any fever may be a sign of malaria. Therefore, it is important to do a rapid diagnostic test (RDT) for all children with fever. If the RDT is positive you will treat the child with antimalaria. If the RDT is negative, you will decide whether to refer or wait and observe depending on whether the child does not have any other danger sign. The child should return for follow up after 3 days or sooner if the child becomes sicker.
  • Fast breathing - Cough with fast breathing is sign of pneumonia. If there is no chest indrawing and other danger sign, you can treat the child with antibiotics. In addition, a cough for less than 14 days may be simple cough or cold if a child does not have a danger sign AND does not have fast breathing. A cough can be uncomfortable and can irritate the throat. A sore throat may prevent the child from drinking and eating well.
  • For a child who is not exclusively breastfed, sipping a safe remedy – in warm (not hot) water can help relieve the cough and soothe the throat. There is no need for other medicine. Tell the caregiver that, medicines may contain harmful ingredients, and are expensive.
  • At Risk of HIV because - One or both parents have not tested for HIV and child has not tested for HIV / Parents’ current HIV status is unknown.
A sick child who is at risk of HIV needs to be tested for HIV. Advise the caregiver to take the child to the health facility soon for HIV testing. If the child is found to have HIV, the child can start to take ARV and other medicines to stay healthy and grow. The child who is HIV will also receive special care for the current illness. if the child has no HIV, the health worker will know that the child can receive standard (usual) care for the illness.
If the Parents HIV status is not known advise the mother and father to test for HIV also.
  • Living in household with someone on TB treatment - A child who lives in household with someone on TB treatment is exposed to TB. Advise the caregiver to take the child to the health facility soon to be screened for TB. If the child has TB, the child will start TB treatment. If the child does not have TB, the child will be given preventive medicines (Isoniazid preventive treatment, or IPT) for six months to prevent the development of TB.
  • Yellow on MUAC strap (No HIV) - Counsel the care giver on how to feed the child. If there is a community-based feeding programme, refer the child with yellow on the MUAC strap for supplemental feeding. Remember that, a child with yellow on MUAC strap and HIV has a danger sign and should be referred urgently.
    No danger sign; Treat the child at home
      A community Health Worker who has medicines for common childhood illness and received training to use it correctly- can bring treatment to many children. Children receive lifesaving treatment without delay when the treatment is available in the community.

        You will see many children who do not have danger signs or another problem needing referral. Children with diarrhea, malaria and fast breathing may be treated at home. This treatment with good basic care is essential. Without treatment, they become sicker and die.

        This box below summarizes the home treatment for diarrhea, fever, cough or difficulty in breathing.


        For diarrhea, give the child Oral Rehydration Salts and zinc supplement. For fever (less than 7 days), first do a Rapid diagnostic test (RDT) for malaria. If the test is positive give the child an antimalaria ACT. For fast breathing, give the child an oral antibiotic.

        It is common for the child to have two or three of these signs. The child needs treatment for each. If the child need has diarrhea and malaria, for example, give the child: Oral Rehydration Salt (ORS) and Zinc supplement and oral antimalaria for treatment at home. More details for these medicines on how to give them will be discussed later.

        The following box from the recording form states the advice to give a caregiver when a child is at risk of HIV or is leaving in a household with someone on TB treatment. In this situation you will provide treatment at home for the child’s diarrhea, malaria and fast breathing and advise the care giver to take the child to the health facility soon. 


        If at risk of HIV, advise the caregiver to take the child to the health facility to test for HIV soon.

        The box below summarizes the basic home care


        Last modified: Monday, 15 June 2020, 12:54 PM