N
T IO
I
ED Chart 12. Neonatal resuscitation: Flow chart
3
2 01 POCKET BOOK Dry the infant immediately with a clean cloth.
Keep warm by skin-to-skin contact and
covered.
OF
Look for ■ Breathing or crying Yes Routine care
■ Good muscle tone or vigorous
Hospital care
(see section 3.1)
movements
No
A
Stimulate by rubbing the back 2 to 3 times. Routine care and
for children
Breathing
Suction only if had meconium stained liquor closely observe
or the mouth or nose is full of secretions. breathing
Not breathing, or gasping
CALL FOR HELP.
Transfer to newborn resuscitation area. Breathing
well Observe closely
Position the head/neck slightly extended. if continues to
Start positive pressure ventilation with mask breathe well
and self-infl ating bag within 1 min of birth. a
Make sure the chest is moving adequately.
B
After 30–60 s If HR
< 60/min
Check the heart rate (HR) with a stethoscope. Chest compres-
If HR ≥ 60/min sions until HR
≥ 100/min (see
figure on p. 48)
■ HR 60–100/min: ■ HR > 100/min: Give higher
Take ventilation Continue to ventilate oxygen
GUIDELINES FOR THE MANAGEMENT OF corrective steps. at 40 breaths per concentration.
Continue to min. ■ If HR remains
COMMON CHILDHOOD ILLNESSES ventilate at Every 1–2 min stop at < 60/min,
40 breaths per to see if breathing consider:
C min. spontaneously. Other ventilatory
Second edition Consider
higher oxygen
Stop ventilating
when respiratory
support.
IV adrenaline.
concentration. rate is > 30 breaths Refer where
Suction, if per min. possible
necessary. Give post ■ If no HR for > 10
Reassess every resuscitation care. min or remains
1–2 min. (see section 3.2.1, < 60/min for 20
p. 50). min, discontinue
If HR (see section
> 100/min 3.2.2, p. 50).
a
Positive pressure ventilation should be initiated with air for infants with gestation > 32
weeks. For very preterm infants, it is preferable to start with 30% oxygen if possible.
A and B are basic resuscitation steps
,Triage of all sick children ANTIMICROBIAL DRUGS FOR COMMON CONDITIONS
EMERGENCY SIGNS: EMERGENCY SIGNS: Please fill the blanks with your country’s most recent updated treatme
Page numbers refer to where generic guidance is found in the Pocket
If any sign is positive, call for help, assess and resuscitate, give If any sign is positive: call for help, assess and resuscitate, give
treatment(s), draw blood for emergency laboratory investigations treatment(s), draw blood for emergency laboratory investigations
(glucose, malaria smear, Hb) (glucose, malaria smear, Hb) Condition Drug Dose
Dysentery (p. 144)
ASSESS TREAT ASSESS TREAT HIV treatment (p. 233)
Do not move neck if a cervical spine Do not move neck if you suspect cervical drug 2
injury is possible, but open the airway. spine injury, but open the airway. drug 3
Malaria, non severe (p. 164–5)
Airway and breathing ANY SIGN If foreign body aspirated Coma/
IF COMA OR
왘 Manage the airway (Chart 4) drug 2
convulsing 왘 If convulsing, give diazepam rectally
■ Obstructed or POSITIVE 왘 Manage airway in choking CONVULSION Malaria, severe (p. 158)
■ Coma (Chart 9)
absent breathing child (Chart 3) 왘 Position the unconscious child (if Mastoiditis (p. 182)
or or
If no foreign body aspirated head or neck trauma is suspected, drug 2
■ Central cyanosis ■ Convulsing
stabilize the neck first) (Chart 6). Meningitis (p. 169)
or 왘 Manage airway (Chart 4) (now)
왘 Give IV glucose (Chart 10). drug 2
■ Severe respiratory 왘 Give oxygen (Chart 5)
왘 Make sure the child is warm Severe Osteomyelitis (p. 187)
distress 왘 Make sure the child is warm.
dehydration DIARRHOEA drug 2
PLUS If no severe malnutrition: Otitis media, acute (p. 183)
(only in a child
Circulation 왘 Insert an IV line and begin giving Pneumonia, non-severe (p. 86)
왘 Stop any bleeding with diarrhoea) two signs
SIGNS fluids rapidly following Chart 11 and
Cold skin with: POSITIVE 왘 Give oxygen (Chart 5) Diarrhoea plus positive
diarrhoea treatment plan C in hospital Pneumonia, severe (p. 82)
■ Capillary refill 왘 Make sure the child is warm. any two of these Check for (Chart 13, p. 131). drug 2
longer than 3 s signs: severe Sepsis, neonatal (p. 55)
Check for If no severe malnutrition If severe malnutrition:
malnutrition
and severe ■ Lethargy 왘 Do not insert an IV line. drug 2
왘 Insert an IV line and begin ■
■ Weak and fast malnutrition Sunken eyes 왘 Proceed immediately to full Sepsis, older child (p. 180)
giving fluids rapidly (Chart 7). ■ Very slow skin pinch assessment and treatment (see
pulse drug 2
If peripheral IV cannot be ■ Unable to drink or drinks section 1.4, p. 19). Severe acute malnutrition,
inserted, insert an intraosseous poorly
uncomplicated (p. 207)
or external jugular line
(see pp. 340–342). PRIORITY SIGNS complicated (p. 207)
These children need prompt assessment and treatment drug 2
If severe malnutrition:
■ Tiny infant (< 2 months) ■ Restless, continuously irritable, or lethargic drug 3
If lethargic or unconscious: ■ Temperature very high ■ Referral (urgent) Tuberculosis (p.116-7)
왘 Give IV glucose (Chart 10). ■ Trauma or other urgent surgical ■ Malnutrition: visible severe wasting
drug 2
왘 Insert IV line and give fluids condition ■ Oedema of both feet or face
■ Pallor (severe) ■ Burns (major) drug 3
(Chart 8).
■ Poisoning (history of) drug 4
If not lethargic or unconscious: ■ Pain (severe) Note: If a child has trauma or other surgical problems, Typhoid fever (p. 181)
왘 Give glucose orally or by ■ Respiratory distress get surgical help or follow surgical guidelines.
drug 2
nasogastric tube.
왘 Proceed immediately to full Urinary tract infection (p. 185)
NON-URGENT drug 2
assessment and treatment.
Proceed with assessment and further treatment according to the child’s priority.
, POCKET BOOK
OF
Hospital care
for children
GUIDELINES FOR THE MANAGEMENT OF
COMMON CHILDHOOD ILLNESSES
Second edition
.indd i 5/06/13 10:00 AM
, WHO Library Cataloguing-in-Publication Data :
Pocket book of hospital care for children: guidelines for the management of
common childhood illnesses – 2nd ed.
1.Pediatrics. 2.Child care. 3.Child, Hospitalized. 4.Child health services.
5.Guideline. I.World Health Organization.
ISBN 978 92 4 154837 3 (NLM classification: WS 29)
© World Health Organization 2013
All rights reserved. Publications of the World Health Organization are available on the
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