Road to health

Danger Signs for Children

• Seek immediate medical attention if you notice any of the following signs in your child:

  • Rapid breathing: More than 50 breaths per minute.

  • Fever in children under 2 months: If the child has a fever and is not feeding well.

  • Persistent vomiting: If the child is unable to keep anything down.

  • Diarrhea: Accompanied by sunken eyes and a sunken fontanelle (soft spot on the head).

  • Convulsions: Child is shaking uncontrollably.

  • Signs of malnutrition: Such as swollen ankles and feet.

  • Lethargy: Child is not moving or unresponsive.

  • Breastfeeding difficulties: Caregiver unable to breastfeed or child does not wake up.

Guidance for Health Workers

• Communicate child growth: Inform mothers whether their baby is growing well or struggling to thrive.

• Growth charts: Explain growth charts to parents and caregivers to address their concerns regarding their baby's development.

• Malnutrition assessment: A child with a MUAC (Mid-Upper Arm Circumference) less than 11.5 cm or with a weight-for-height plot under the -3 line or showing both legs with edema is considered to have SEVERE ACUTE MALNUTRITION and should be referred for further care.

Growth Monitoring and Counseling

• Nutritional status: Growth charts are used to assess nutritional status:

  • Wasting: Measured by either MUAC or weight-for-height (WFH). Both indicators are crucial for detecting undernourishment and need to be checked at every visit.

  • Referral criteria: Hospitalization or therapeutic feeding may be necessary.

  • Short-term growth: Monitor through weight-for-age charts.

  • Long-term growth: Use height-for-age charts to assess stunting.

MUAC Assessment

• MUAC guidelines: Should be measured at all clinic visits for children aged 6 months to 5 years:

  • MUAC < 11.5 cm: Indicates SEVERE ACUTE MALNUTRITION (urgent referral required).

  • MUAC 11.5 - 12.5 cm: Indicates MODERATE ACUTE MALNUTRITION (managed per IMCI guidelines).

  • MUAC ≥ 12.5 cm: Indicates NO ACUTE MALNUTRITION.

Weight-for-Length and Height Charts

• Weight-for-length chart: Indicates how weight relates to length:

  • Obese: Weight-for-length above the +3 line.

  • Overweight: Weight above the +2 line.

  • Wasted: Below the -2 line.

  • Severely wasted: Below -3 line; immediate referral recommended.

Weight-for-Age Interpretation for Girls

• Weight interpretation: Chart indicates weight-for-age relative to the median.

  • Underweight: Below -2 line (orange).

  • Severely underweight: Below -3 line (red).

  • Monitoring significance: shifts away from the median or birth trend line could signal health issues.

Length/Height-for-Age Chart for Girls

• Growth interpretation: Charts measure height in relation to age.

  • Severely stunted: Below -3 line (red).

  • Stunted: Below -2 line (orange).

• Periodic assessments: Should be conducted every six months.

Developmental Milestones

• Early screening: Assess infants for key developmental milestones during regular health visits.

  • 6 weeks: Startles to sounds, follows objects.

  • 6 months: Recognizes familiar faces, sits without support.

  • 12 months: Has meaningful words, stands with support.

  • 18 months: Follows simple commands, communicates in 3 words.

  • 3 years: Forms simple sentences, interacts with peers.

• Collaborative approach: Solicit caregiver feedback and concerns at each visit, and document observations.

Concerns and Referrals

• Eye issues: Abnormalities such as a white spot, lack of tracking, or crossed eyes.

• Hearing deficiencies: Indications include inconsistent responses to sounds or inability to communicate by 18 months.

• Physical development issues: Not walking by 18 months, abnormal head size/shape, or unbalanced limb use.

• Head circumference: Routine checks at 14 weeks and 12 months.

  • Observe ranges for head size deviations, refer as needed.