An 11 month old child brought to PHC with respiratory rate 58 per minute and cough, there is no chest indrawing. Next step of management-
Ans. is 'c' i.e., Antibiotic with home care o Only fast breathing with no chest indrawing in 11 month old - Diagnosis is pneumoniao Management is advise mother to give home care and antibiotic to treat fever.o Classification of acute respiratory tract infection (ARTI) is very important because each class has a corresponding treatment plan.o Before going ahead for classification of ARTI, one should know the definition of fast breathing. As the children get older, their breathing rate slows down. Therefore, the cut-off point of fast breathing will depend on the age of the child.o Fast breathing is present when the respiratory rate isi) Child less than 2 months of age - > 60 breaths per minute,ii) Child aged 2 months upto 12 months - > 50 breaths per minute,iii) Child aged 12 months upto 5 years- > 40 breaths per minute.o ARTI is classified differently for, (i) Child aged 2 months upto 5 years, and, (ii) Young infant (< 2 months).Child aged 2 months upto 5 yearso The sick child can be put into one of the four classifications1) No pneumonia: Cough or cold# There is no chest indrawing and no fast breathing.# Treatment is symptomatic with no requirment of antibiotics.2) Pneumonia (not severe)# There is no chest indrawing, but fast breathing is present.# It is managed at home with antibiotic. Cotrimoxazole is the drug of choice.3) Severe pneumonia# There is chest indrawing, grunting, nasal flaring and cyanosis.# First dose of referral antibiotic (ampicillin + gentamycin) is given and the patient is REFERED URGENTLY to hospital. For treatment benzyl penicillin is the drug of choice.4) Very severe disease# Child has any one or more of the following :i) Not able to drinkii) Convulsionsiii) Abnormally sleepy or difficult to wakeiv) Stridor when calmsv) Severe malnutrition# First dose of referral antibiotic (ampicillin + gentamycin) is given and the child is REFERRED URGENTLY to hospital. For treatment, chloramphenical is the drug of choice.Child < 2 months of ageo Child can be put into one of three classifications.1) No pneumonia: Cough and cold# There is no chest indrawing and no fast breathing.# Home care by mother is given, e.g. brest feeding, keeping warm, clear the nose.2) Severe pneumonia# There is severe chest indrawing or fast breathing.# Child is referred urgently to hospital after giving first dose of referral antibiotic.3) Very severe disease :# Child has any one or more of the following :i) Stopped feeding wellii) Convulsionsiii) Abnormally sleepy or difficult to wakeiv) Stridor in a calm childv) Wheezingvi) Fever or low body temperature.# Child is referred urgently to hospital after giving first dose of referral antibiotic.
Reassurance to parent
Urgent referral to hospital
Antibiotic with home care
Nasal saline drop
Communicable Diseases