Glossary: General and Systemic

Conjunctival pallor 

Moderate: Conjunctivae with neither clearly red nor clearly pale anterior rims or those in which one conjunctiva is pale and the other is normal.

Severe: Conjunctivae with very little or no evidence of red color on the anterior rim, which matches the fleshy color of the posterior aspect of the palpebral conjunctiva.

Palmar pallor

Moderate: If it looks pale compared to the caregiver, then palmar pallor is present. 

Severe: if it is very pale or so pale that it looks white then it is severe palmar pallor. 

Enlarged lymph nodes 

Examine the neck and armpits for palpable lymph nodes. 

Usually in tuberculosis, lymph nodes are large (>2 cm), tender, present on one side of the body, matted, firm to fluctuant and rapidly growing.

Sunken eyes 

Does the child’s eyes appear to sink into their sockets? 

The eyes of a child who is dehydrated may look sunken. Decide if you think the eyes are sunken. Then ask the mother if she thinks her child’s eyes look unusual. Her opinion can help you confirm.

NOTE: In a severely malnourished child who is wasted, the eyes may always look sunken, even if the child is not dehydrated. Still use the sign to classify dehydration. 

Skin pinch 

This test is an important tool for testing for dehydration. When a child is dehydrated, the skin loses elasticity. 

If the skin pinch goes back very slowly (more than 2 seconds), slowly (less than 2 seconds, but not immediately), or immediately. If the skin stays up for even a brief time after you release it, decide that the skin pinch goes back slowly. 

NOTE: The test is not always an accurate sign. In a child with severe malnutrition, the skin may go back slowly even if the child is not dehydrated. If a child is overweight or has oedema, the skin may go back immediately even if the child is dehydrated. However, you should still use it to classify the child’s dehydration. 

Jaundice 

Does the child have yellowed skin or sclera? 

It is important to look for jaundice in natural light. To look for jaundice, press the child’s skin over the forehead with your fingers to blanch. Remove your fingers and look for yellow discoloration. If there is yellow discoloration, the child has jaundice. Also look for yellow eyes, another sign that the child has jaundice. 

Bitôt's spots 

White or yellow, skin-like spots found on the eye. They can be oval, triangular or irregular in shape. Often a sign of Vitamin A deficiency.

Chest indrawing 

Does the child have chest indrawing on inspiration?

Chest indrawing is the abnormal inward movement of subcostal tissue (i.e., the tissue inferior to the costal cartilage of the lower anterior chest wall) during inspiration.

Grunting 

Does the child have a grunt (or short noise at each expiration) on expiration ?

Grunting is characterized as repetitive “eh” sounds, usually short in duration, during early expiration against a partially closed glottis. It represents the child’s attempt to generate additional positive end expiratory pressure and maintain lung volume.

Wheezing 

Wheezing is a high-pitched, whistling sound a child makes when breathing, especially when exhaling. It happens when the airways are tightened, or inflamed, often in the case of reactive airway disease (asthma).

Stridor 

Does the child have a stridor? When the child breathes in, it make a squeaky, high pitched noise from the upper airways.

Barking cough

Cough that sounds like a seal or a dog. Often, the child's voice is also hoarse.

Oedema of both feet 

Oedema is the build-up of fluid in the body’s tissue. Most commonly, the legs or arms are affected.