contents...contents aide médicale internationale 21/22-26 maetao road, maesot, tak 63110 tel: (66)...

Contents

Aide Médicale Internationale21/22-26 Maetao Road, Maesot, Tak 63110 Tel: (66) 055 54 32 31 / 08 78 48 60 15 Mail: [email protected]

The procedures, explanations and treatments provided in this publication are based on research and consultation with medical and nursing authorities. They all reflect accepted medical practices. Nevertheless they cannot be considered as absolute and universal recommendations. The authors, the editor and the publisher disclaim responsibility for any adverse effects resulting di-rectly or indirectly from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text.

Part I - Health 4oaE<om;&J@ c&D;vrf; 4Journey of the Foetus 5Health Messenger

umuG,faq;xkd;jcif; 10Immunisation 11Judith Leblanc, Nurse officer (AMI)

uav;rsm; =uD;xGm;zGH@jzdK;r_qkdif&m owfrSwfcsufrsm;ESifh ,if;tay:oufa&mufaom ta=umif;t&mrsm; 16Developmental Milestones and Factors Influencing Childhood Development 17Damarice Ager (ARC)

uav;rsm;ukd ta&;w,l *&kpkdufjcif; 24Caring for your Child 25Damarice Ager (ARC)

Part II - Medical 34arG;uif;puav;i,ftm; csufcsif;jyKpkukor_ay;jcif; 34Immediate Care of the Newborn Infant 35Dr. Claudia Turner & Dr. Verena Carrara (SMRU)

touf 5ESpfatmuf uav;rsm;wGif touf&SKvrf;a=umif;Y vwfwavm ykd;0ifjcif; 46Acute Respiratory Tract Infections (Children < 5 ) 47Dr. Claudia Turner (SMRU)

uav;rsm;wGif jzpfyGm;aom 0rf;av#ma&m*gtrsdK;rsdK;ukd &SmazGazmfxkwfjcif; 60Differential Diagnosis of Diarrhoea Diseases in Children 61Dr. Zaw (World Vision) and HM

uav;oli,f tm[m&csdK@wJha&m*g (yDtD;trf) 68Protein Energy Malnutrition (PEM) 69Andrea Menefee, MPH, RDFood Security Programme Coordinator (TBBC)

uav;rsm;. =uD;xGm;zGH@jzdK;r_ukd apmifh=unfhjcif; 80Child Growth Monitoring 81Erika Garrity Pied, MS, RDNutrition Technical Officer, (TBBC)

uav;rsm;wGif tlvrf;a=umif;wGif; oefxjcif; 90Intestinal Worms in Children 91Dr. Marcus Rijken (SMRU )

Quiz 97

Health Messenger Magazine Issue 38

EditorialThis issue of the health messenger, together

with the previous one “Maternal health”, form a series dedicated to the care of the mother and the child, from conception to the time the child reach-es 5 years old.

Early childhood is a period of vulnerability. 10 million children under the age of five die each year. We would like to contribute to the improve-ment of this situation by giving both the commu-nity and the medical personnel useful information, methods and tools to take care of child health.

In the Health part, we are providing advices to help you accompany your child from before birth to the age of 5 and to ensure him or her a healthy growth and development. We also give you tips about care taking such as immunization, basic care and vision problems.

The medical part is designed to help health workers refresh their knowledge concerning pedi-atric care. Three main aspects are covered:- The immediate care of the newborn,- The growth and nutrition of the child,- The most common diseases.

Enjoy your reading!

You medial editor.

ContributorsProject Manager: Yann Santin Medical Editor: Dr. Min Editorial Committee: Damarice Agger, Thomas Buckley, Dr. Verena Carrara, Annabelle Djeribi, Erika Garrity Pied, Dr. Htwe, Judith Leblanc, Dr. Bertrand Martinez-Aussel, Andrea Menefee, Dr. Jonathan Nield, Dr. Marcus Rijken, Dr. Claudia Turner, Dr. Zaw Distributor: Manit Tipbanjongsuk Graphic Designer: Patrice Leroy Illustrator: Anchalee Areewong Proof reader: Paul Keenan, Dr. Moe, Hannah Mundy Printer: JCC printing Co. Ltd

Health MessengerIssue No 38 | Child Health

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I. First TrimesterA baby is created from a sperm cell and an egg cell. An egg is released every month from the woman’s ovary and moves along her fallopian tube towards her uterus. During sexual inter-course between a man and woman, millions of sperm cells are released from the man’s penis into the woman’s vagina. The sperm swim up the vagina, and through the uterus towards the fallopian tube, where a single sperm cell pen-etrates the egg. The egg is fertilised and con-ception occurs.

The egg divides into two, four, then eight cells. The cells continue to multiply while moving along the mother’s fallopian tube. By the time the egg reaches the mother’s uterus, it has be-come a mass of over 100 cells, and is called an embryo.

The embryo burrows into the uterine wall lin-ing, making roots like a tree to link with the mother’s blood supply.The cells begin to specialise and form the many structures of the future baby.

A tube develops that will become the brain and spinal cord. The heart forms and starts to beat. Blood vessels also develop, connecting the baby and the mother through the umbilical cord.

A human shape starts to emerge. Dimples on the side of the head will become ears and there are thickenings where the eyes will appear. On the body, bumps are forming which will be-come muscles and bones. Small swellings ap-pear where the arms and legs are growing.At seven weeks, the face is slowly forming. The eyes become prominent and coloured, the

Journey of the FoetusHealth Messenger

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Journey of the Foetus

mouth appears. There are the beginnings of hands and feet, with ridges where the fingers and toes will be. The major internal organs like the heart, brain, lungs, kidneys and liver are all developing.

Just 12 weeks after conception, the foetus is fully formed. It has all its organs, muscles, limbs and bones, and its sex organs are devel-oped. From now on it will continue to grow and mature.

Inside the uterus, the baby floats in a bag of fluid called the amniotic sac. The baby is al-ready moving about, but the mother cannot yet feel these movements.

II. Second TrimesterAt 14 weeks, the baby is about 85 mm long from head to bottom. The mother may be just beginning to appear pregnant, but this varies a lot from woman to woman.

The baby is now growing rapidly. The body grows bigger, the face begins to look more hu-man and hair is beginning to grow as well as eyebrows and eyelashes.

From 16 to 22 weeks, the mother can feel her baby move for the first time and at approxi-mately 22 weeks, the baby may respond to touch and sound.

Sometimes the baby gets hiccups. He begins to follow a pattern of waking and sleeping, but this is often different from the mother’s sleep-ing patterns: when she goes to bed at night, the baby may wake up and start kicking.

The baby’s heartbeat can now be heard through a stethoscope, or even by putting an ear on the mother’s abdomen.

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At 24 weeks, the baby is ‘viable’. This means that the baby has a chance of survival if born prematurely. Most babies born before this time cannot survive as their lungs and other vital or-gans are not well enough developed.

III. Third Trimester

At around 26 weeks, the baby’s eyelids open for the first time. At 30 weeks, the baby is about 33cm in length from head to bottom.

By about 32 weeks, the baby is usually laying head downwards and is ready for birth, which usually happens at around 40 weeks.

Foetal Nutrition

Throughout pregnancy, the umbilical cord is the link between baby and mother. Blood cir-

culates through the cord, carrying oxygen and food to the baby and removing waste. Anti-bodies, which give resistance to infection and disease, pass to the baby from the mother in the same way, but so too can alcohol, nicotine and other drugs, so the mother must maintain a healthy lifestyle throughout her pregnancy.

The mother should have a good diet before and during pregnancy to maintain her health at optimum level in preparation for delivery, lactation and also for foetal development. In-fants who are well nourished in the womb have a better chance of entering the world in good health. A nutritious diet enables the mother to produce sufficient milk to nourish her child af-ter birth.

Journey of the Foetus

ukd,f0efumv 16 ywf16 weeks pregnancy

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umuG,faq;xkd;jcif;*sK;'pfvmbvef@cf olemjyKqkdif&m tkyfcsKyfa&;r_; (attrftkdif)

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Immunisation Judith Leblanc, Nurse officer (AMI)

What is immunity?Virus and bacteria are microscopic organisms that cause infections and diseases. When these elements enter the body, our organism defends itself by destroying these invaders. One of the defence mechanisms is the creation of antibod-ies. Antibodies identify and mark the invading

microbes so that they can be destroyed more efficiently by the body’s white blood cells. Antibodies are disease specific: one antibody works against one particular infection but not against others.

The creation of antibodies by our body takes time. The first time our body is infected by a

1

yxrt=udrf ykd;0ifjcif;First infection.

ukd,fcHtm;&SdjyD;ukd,fcE<mrS yÉdypPnf;rsm;odrf;xm;onfThe immunized body keeps antibodies.

2 4

'kwd,r`dykd;0ifjcif;/ uGsEkfyfwkd@ukd,frS vsifjrefpGmwkH@jyefonfSecond infection. Our body reacts quickly.

uGsEkfyfwkd@ukd,fcE<mrS wkef@jyef&efaES;auG;onf?Our body is slow to react.

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tb,fa=umifh uav;rsm;ukd umuG,faq; xkd;&oenf;?b0oufwrf;. yxrvrsm;wGif uav;i,fonf rdcifxHrS yÉdypPnf;rsm;a=umifh a&m*gykd;rsm;pGmukd umuG,fjyD;om;jzpfonf? 4if;wkd@onf rdcifaoG;xJrS

tcsif;ukd jzwfI uav;ukd,fcE<mwGif;okd@ rarG;zGm;rSDwGif a&muf&Sdvm=uonf? rdcifEkd@&nftxl;ojzifh Ekdf@OD;&nf (rdcifxHrS yxrqkH;xGufaomEkd@&nf) xJwGifvnf; yÉd ypPnf;rsm;yg0ifaejyD; 4if;wkd@onf 0rf;av#ma&m*gESifh tjcm;a&m*gykd;rsm;ukd umuG,fay;onf? umuG,faq;xkd;jcif;ukd rdcifxHrS &&Sdaom ukd,fcHpGrf;tm; ukefqkH;jyD; a&m*gtEW&m,fpwifusa&mufEkdifaom tajc taerwkdifrDwGif =udKxkd;xm;oifhonf? b0oufwrf;. yxrqkH;ESpfwGif umuG,faq; trsm;qkH; xkd;ESHavh&Sdonf?

'kuQonf ,m,Daexkdif&mpcef;rsm;wGif umuG,faq;xkd;jcif; qkdonfrSm tb,fenf;?'kuQonf ,m,Daexkdif&mpcef;rsm;wGif umuG,f aq;xkd;jcif;jzifh a&m*gckESpfrsdK;ukd uGsEkfyfwkdf@ wm;qD; umuG,f ay;aeonf? wDbDtqkwfa&mifa&m*g/ 0ufoufa&m*g/ ykdvD,kd ta=umaoa&m*g/ qkHqkd@/ =uufnSm/ ar;ckdifa&m*gESifh tonf;a&miftom;0gbDa&m*gwkd@ jzpf=uonf? umuG,f aq;xkd;&mwGif aq;xkd;&ef taumif;qkH;tcsdefESifh

umuG,faq;xkd;jcif;

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specific virus, the body’s reaction is too slow and we become ill. But once our body has cre-ated antibodies, it will keep them for a certain time. If the same virus enters the body again, the antibodies have no difficulty fighting against it. The body becomes resistant to the disease. This is called immunity.

For example, if someone contracts measles for the first time, he will become ill because his body will take time to react and create antibod-ies. But now that he has developed antibodies against the virus, he has immunity and will not become ill if he comes into contact with the measles virus again.

What is immunisation?Immunisation campaigns are carried out throughout the world in order to control or eradicate certain diseases that can cause dis-ability or death. Immunisation gives people immunity to disease without them getting ill. Children are usually immunised within their first year of life.

What are the advantages of vaccines?A vaccine is a weakened form of the micro-or-ganism which causes the disease. The vaccine causes a child’s body to produce antibodies without the child suffering from the actual dis-ease. The child becomes immune without be-coming ill. However, as a small amount of the disease is injected, the child can have a mild re-action, such as a fever or rash. These symptoms will disappear within a day or so.

Why vaccines are given to children?In the first months of life, a baby is protected against many infections by its mother’s anti-bodies. These come from the mother’s blood, and cross the placenta into the baby’s body be-fore birth. There are also antibodies in breast milk, especially in colostrum (first milk of the mother), which protects a baby against diar-rhoea and other infections.Vaccination should be done before the child starts to lose the immunity he has received from the mother, and therefore starts to be in danger from the disease. This is why vaccina-tions are usually carried out with the first year of life.

What is the immunisation schedule in the refugee camps?We prevent seven diseases by immunisation in the refugee camps: tuberculosis, measles, po-liomyelitis, diphtheria, pertussis, tetanus and hepatitis B. Immunisation follows a precise schedule. Vac-cines are fragile products because they con-tain a weakened form of micro-organism. To maintain their efficacy, the products are stored in cold conditions, generally between 2º and 8ºC. This is why immunisations are organised on set dates: this allows for the best condi-tions of storage and administration. Vaccines are injected or given by mouth. Many vaccines require multiple doses for maximum effective-ness, either to produce sufficient initial im-mune response or to boost response that fades over time.

Immunisation

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tqkdyg a&m*g 7 rsdK;ESifh 4if;wkd@. umuG,faq;rsm;um; tb,fenf;?

ykdvD,dk ta=umaoa&m*gykdvD,kdta=umaoa&m*gonf urBmw0Srf;wGif umuG,f wm;qD;EkdifjyD;aoma&m*gjzpfonf? xkda&m*gonf ta=um aojcif;ukd jzpfyGm;aponf? xkda&m*gumuG,faq;ukd yg;pyfrSwkdufavh&Sdonf? umuG,faq; wkdufauGs;a&;ae@rsm;ukd 'kuQonf ,m,Daexkdif&mpcef;rsm;wGif ESpfpOfusif; yjyKvkyfjcif;jzifh uav;wkdif;onf vkHavmufjynfhpkHaom aq;wkdufauGs;r_ukd &,ljyD;a=umif;aocsmaponf?

0ufoufa&m*g0ufoufa&m*gonf acsmif;qkd;jcif;ESifh ovdyfxGufjcif;rS tvGeful;pufvG,faoma&m*gwpfrsdK;jzpfonf? xkda&m*gukd toufwpfESpfrwkdifrSDwGif umuG,faq;xkd;I vG,fulpGm umuG,fwm;qD;Ekdifrnfjzpfonf?

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ADwmrifatADwmrifatwkdufauGs;jcif;onf umuG,faq;r[kwfyg? rnfokd@yifjzpfap/ xkdaq;ukd 'kuQonf ,m,D aexkdif&mpcef;rsm;wGif ykHrSefumuG,faq;xkd;&mY rsm;aomtm;jzifh wkdufauGs;avh&Sdonf? pifppftm;jzifh tpm;tpmrsm;wGif ADwmrifat ryg0ifjcif;onf uav;rsm;ESifh rsdK;qufyGm;Ekdifaom t&G,fwGif;&Sd trsdK;orD;rsm;ukd tEW&m,f jzpfEkdifajcrsm;aponf? 4if;onf rsufpdukd xdckdufapEkdifjyD; touft&G,f =uD;&ifhvmaomtcg rsufpduG,fjcif;ukd jzpfapEkdifonf? 4if;ukd ykHrSeftcsdefZ,m;twkdif; yg;pyfrS aq;wkdufjcif;jzifh vG,fulpGm umuG,fapEkdifonf?

umuG,faq;xkd;jcif;

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What are the 7 diseases and their vaccines?

Poliomyelitis

Poliomyelitis is an infection which can cause paralysis. This vaccine is usually given orally. Large immunisation campaigns are organised every year in refugee camps and care is taken to ensure that each child receives the correct number of doses of this vaccine.

Measles

Measles is a very contagious disease that is spread through coughing and saliva. This in-fection is easily prevented by a vaccine which is given before a child is one year old.

Diphtheria - Pertussis – Tetanus

Diphtheria is an acute infection of the throat. Pertussis, also called “whooping cough”, is a dis-ease of the respiratory tract. Tetanus is an acute

disease that paralyses the muscles. Contamina-tion generally occurred through a wound.A single vaccination prevents these 3 diseases at the same time. A vaccine prevents the occurrence of tetanus during pregnancy.

Tuberculosis

Tuberculosis is an extremely contagious disease that generally affects the lungs. A single dose vaccine is generally sufficient to give immu-nity. The injection is given just under the skin (intra-dermal) and will usually leave a scar for life.

Hepatitis B

Hepatitis B is a serious disease contracted through exposure with infected blood. Several doses of the vaccine give complete immunity to this disease.

Vitamin A

Vitamin A supplementation is not a vaccine. However, Vitamin A is often given at the time of immunisation in refugee camps. A lack of Vitamin A in the diet puts children and women of repro-ductive age at risk of eye problems and may even cause blindness in cases of extreme de-ficiency. This is easily prevented by an oral dose given on a regu-lar basis.

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uav;rsm; =uD;xGm;zGH@jzdK;r_qkdif&m owfrSwfcsufrsm;ESifh ,if;tay:oufa&mufaom ta=umif;t&mrsm;'g;r&pfpf at*g (tar&duef 'kuQonfrsm; aumfrwD)

‘uav;rsm;. =uD;xGm;zGH@jzdK;r_’onf uav;touf=uD;vm onfESifhtr# aqmif&GufEkdifaom pGrf;&nfrsm;- vlr_a&;/ todOm%fynmESifh um,ykdif;qkdif&mrsm;ukd rnfuJhokd@ vkyfaqmifvmEkdifonfukd &nfn$ef;onf? Tae&mwGif uav;rsm;=uD;xGm;zGH@jzdK;r_onfonf ukd,fcE<m=uD;xGm;r_wpfckwnf;ukd r&nfn$ef;yg?=uD;xGm;zGH@jzdK;r_onf ukd,f&nfukd,faoG; wkd;wufjrifhrm; vmjcif;ukd ac:qkdjyD; ukd,fcE<m=uD;xGm;r_onf t&G,ftpm; =uD;vmjcif;ukd &nfn$ef;onf?

‘uav;rsm;. =uD;xGm;zGH@jzdK;r_qkdif&m owfrSwfcsufrsm;’ onf uav;trsm;pkrS owfrSwfxm;aom t&G,ftykdif; tjcm;wGif aqmif&GufEkdifaom t&nftcsif;tpkHvkdufESifh oD;oef@aqmif&Gufcsufrsm;jzpfonf? uav;wpfa,muf taejzifh =uD;xGm;zGH@jzdK;r_qkdif&m owfrSwfcsufokd@ a&muf&Sdvmaom toufonf uGJjym;jcm;em;avh&SdjyD; wpfa,mufpDonf oD;oef@tcsdefpD&Sd=uonf? rnfokd@yifjzpfap/ tqkdyg azmfjycsufrsm;onf oifhtm; uav;. =uD;xGm;zGH@jzdK;r_ukd vkdufvHapmifh=unfh&efESifh jzpfEkdifajc&Sfdaom jy\emrsm;ukd a&Smif&Sm;&ef tay:,Hoabmukd &Sif;jyxm;onf?

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Developmental Milestones and Factors Influencing Childhood Development

Damarice Ager (ARC)

Child development’ refers to a child’s increase in abilities – social, intellectual and physical - as he gets older. Development is different from growth: development is an increase in skills, while growth is an increase in size.

‘Developmental milestones’ are a defined set of skills or specific tasks that most children can do within a certain age range. The actual age that a child reaches a milestone can vary, as each child is unique. However, these indicators provide a useful overview that can help parents and carers follow the development of a child and identify potential problems.

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uav;rsm;. =uD;xGm;zGH@jzdK;r_qkdif&m owfrSwfcsufrsm;ESifh tusdK;oufa&mufr_rsm;

touf aqmif&GufEkdifoifhonfrSm rdbrsm;ESifh uav;xdef;rsm;tm; t=uHay;jcif;

owdxm;&rnfh tEW&m,f tcsufjy vuQ%mrsm;

arG;uif;p uav;. yg;okd@r[kwf yg;pyf ukd yGwfay;aom vufukd OD;acgif; vSnfh=unfhonf?

yg;pyfokd@ vufESpfzufpvkH; a&$@vsm;Ekdifonf?

uGsrf;w0if&SdaomvloHESifh toHrsm;&Sd&mokd@ vSnfhavh &Sdonf?

rdcifEkd@pkd@jyD; rdcif&ifom; rsm;ukd ukdifwG,fwkd@xdonf?

arG;jyD; wpfem&DtwGif; rdcifESifh ta&jym;csif; xdawG@jyD; Ekd@pkd@ap oifhonf?

uav;ukdrwfrwfxm;pOf OD;acgif;ukd axmufray;yg?

r=umc% ESdyfe,fay;jcif;/ acsmhjrSLjcif;wkd@ aqmif&Gufyg?

yifyef;aepOf okd@r[kwf pdwfr=unfaomtcg uav;ukd nifompGm ukdifwG,fyg?

r=umc%qkdovkd tenf;qkH; 4 em&D wpfcg rdcifEkd@wkdufyg?

uav;ukd pum;ajymjcif;/ pmzwfjyjcif;/ aw;qkdjcif;wkd@ r=umc%jyKvkyfay;yg?

uav;arG;jyD; 6ywfwGif usef;rma&;vkyfom;ESifh jy&ef usef;rma&;Xmeokd@vmyg?

Ekd@aumif;pGm rpkd@Ekdifjcif; okd@r[kwf Ekd@pkd@&ef jiif;qef aejcif;?

ajcvufrsm; v_yf&Sm;r_ vkH;0r&Sdjcif; okd@r[kwf tenf;i,fv_yf&Sm;jcif;?

us,favmifoHrsm; okd@r[kwf tvif;a&mif pl;pl; rsm;ukd wkef@jyefr_r&Sdjcif; okd@r[kwf tenf;i,fom wkef@jyefjcif;?

odomaom ta=umif; &if; wpkHw&mr&SdbJ tcsdef=umjrifhpGm ikdaejcif;?

a&"mwfcef;ajcmufjcif; jzpfapEkdifaom atmh tefjcif; okd@r[kwf 0rf;av#mjcif;?

6 v arSmufvsuf vJaepOfOD;acgif; ESifh &ifbwfukdrxm;Ekdifonf?

,drf;EGJ@aeaom t&mrsm;ukd vufvSrf;onf?

0wWKypPnf;rsm;ukd qkyfukdifI v_yf&rf;onf?

b,fnmESpfzufvkH;vSdrfhonf?

tultyhHjzifh xkdifEkdifonf?

vufESpfzuf/ yg;pyfwkd@ESifht&mrsm;ukd pl;prf;onf?

toHrsm;ESifh jrifzl;aeus rsufESmrsm;ukd twkckd; vkdufvkyfonf?

trnfemrrsm;ESifh jrifaeus rsufESmrsm;ukd wkH@jyefr_&Sdonf?

uav;ukd oef@&Sif;vkHjcKHaom a&jyifnDjyifay:wGifxm;I vGwfvyfpGm v_yf&Sm;apjyD; ypPnf;rsm;ukd vSrf;Ekdifygap?

uav;ukd taetxm;wpfck wGif ukdifxdef;jyD;teD;&Sd tjzpf tysufrsm;ukd =unfhEkdifygap?

ae@a&mnyg uav;Ekd@awmif; wkdif; qufwkdufpkd@apI tjcm; tpmrsm;ukdyg pauGs;yg? (6 -8 v=um; wpfae@ESpf=udrf/ 8-12 v=um;wGif wpfae@ 3 -4 =udrf)

uav;ukd pum;ajymjcif;/ pmzwfjyjcif;/ aw;qkdjcif;wkd@ r=umc%jyKvkyfay;yg?

ajcvufrsm;ukd v_yf&Sm; &mwGif cufcJjcif; okd@r [kwf rmawmifhaejcif;?

OD;acgif; worwfwnf; v_yf&Sm;aejcif; (4if;onf t=um;tm&kH qkH;&SKH;ap Ekdifaom em;twGif; ykd;0ifjcif;ukd n$efjyonf?)

toHrsm;/ jrifzl;aeus rsufESmykdif&Sifrsm; okd@r[kwf rdcif&ifom;wkd@ukd wkef@jyef r_vkH;0r&Sdjcif; okd@r[kwf tenf;i,fom&Sdjcif;?

rdcifEkd@ okd@r[kwf tjcm; tpm; tpmrsm;ukd jiif;qefaejcif;?

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Developmental Milstones and Factors Influencing Development

Age Should be able to: Advice to parents and care takers

Warning signs to watch for

Birth Turn head towards the hand that is stroking the child’s cheek or mouth.

Bring both hands to the mouth.

Turn towards familiar voices or sounds.

Suckle breasts andtouch it with the

fingers.

Make skin to skin contact and breast feed within one hour of birth.

Support the head when holding baby upright.

Massage and cuddle often.

Handle baby gently even when tired or upset.

Breast feed frequently, at least every 4 hours.

Talk, read and sing to baby as often as possible.

Visit health clinic 6 weeks after birth to see health worker.

Poor suckling at breast or refusal to suckle.

Little or no move-ments of arms and legs.

Little or no reac-tion to loud sounds or bright lights.

Crying for long periods for no ap-parent reason.

Vomiting or diar-rhoea which can lead to dehydra-tion.

6 Months

Raise head and chest when lying on stomach.

Reach for dangling ob-jects.

Grasp and shake objects.

Roll both ways.

Sit with support.

Explore objects with both hands and mouth.

Imitate sounds and familiar faces.

Respond to name and familiar faces.

Lay baby on clean, flat, safe surface so that she or he can move more freely and reach objects.

Hold baby in a position so she or he can see what is happening nearby.

Continue to breast feed on demand day and night, start to add other foods (2 meals a day at 6 – 8 months, 3 – 4 meals a day at 8 – 12 months).

Talk, read or sing to the child as often as possible.

Stiffness or dif-ficulty moving limbs.

Constant mov-ing of head (this might indicate an ear infection which could lead to deaf-ness).

Little or no re-sponse to sounds or familiar faces or the breast.

Refusing breast or other foods.

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uav;ukd taetxm;wpfrsdK; wnf;wGif em&Drsm;pGm rxm; ygESifh?

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uav;rS ZGef;/ cGufwkd@jzifh prf;oyfpm;&ef ulnDay;yg?

uav;onf umuG,faq; tjynfhxkd;I jznfhwif;tm[m &rsm;ukd owfrSwffyrm% twkdif; &&Sdygap?

tjcm;olrsm;ukd wkef@jyef&ef uav;rS toHrjyKEkdifjcif;?

a&$@vsm;aeaom t&m 0wWKrsm;ukd uav;rS r=unfhjcif;?

uav;xdef;rsm;ukd uav;rS wkef@jyefr_r&Sdjcif;?

uav;onf tpm;tpm pm;csifpdwf r&Sdjcif; okd@r [kwf tpmukd jiif;qefjcif;?

2 ESpfom; vrf;avsmuf/ twuftqif; ESifh ckefEkdifonf?

trnfajym&HkESifh ypPnf;rsm;/ &kyfykHrsm;ukd n$efjyEkdifonf?

15vom;rSpI pum;vkH; rsm;pGmukd ajymEkdifonf?

&kd;&Sif;aom ckdif;apr_rsm;ukd vkdufemonf?

cJwHokd@r[kwf rSifwHay;vkduf ygu a&;jcpfonf?

ykHjyif&kd;&kd;rsm;ESifh oDcsif;rsm; ukd =udKufESpfoufonf?

tjcm;olrsm;. trlt&mukd wkyonf?

ukd,fhtm;ukd,fukd;I pwif pm;aomufonf?

uav;ESifhtwl pmzwf/oDcsif; qkd/ upm;enf;rsm; upm;yg?

tEW&m,ft&mrsm;ukd a&Smif&ef uav;ukd oifay;yg?

uav;ukd ykHrSefpum;ajymyg? uav;ajym rajymygESifh?

rdcifEkd@ukd qufvuf wkdufauGs; jyD; uav;onf tpm;tpm vkHavmufpGm (yrm%ESifh trsdK;pkH) &&Sd&ef aocsmygap?

uav;ukd tpmpm;&ef tm;ay;yg? zdtm;ray;ygESifh?

&kd;&Sif;aompnf;urf;rsm; csrSwf jyD; usdK;a=umif;qDavsmfaom vkdvm;csufrsm;ukd owfrSwfyg?

uav;aqmif&GufEkdifonfrsm;ukd csD;usK;yg?

tjcm;olrsm;tm; wkef@jyefr_r&Sdjcif;?

vrf;avsmuf&mwGif [efcsuf xdef;Ekdif&ef cufcJjcif;?

xdckduf'%f&m&jcif;ESifh trltusifhrsm;wGif rlrrSefaom trlt&mrsm; awG@&jcif;? (txl;ojzifh uav;ukd tjcm;olrsm;u xdef;ay;aevsif)

pm;aomufcsifpdwfr&Sdjcif;?

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3




12 Months

Sit without support.

Crawl on hands and knees and pull up to stand.

Take steps holding onto support.

Try to imitate words and sounds and respond to

simple requests.

Enjoy clapping and playing.

Repeat sounds and gestures for attention.

Pick up thingswith thumb

and one finger.

Start holding objects such as spoon and cup, attempt self feeding.

Point to objects and name them, talk and play with child frequently.

Use mealtimes to encour-age interaction with all family members.

Do not leave child in one position for many hours.

Continue breast feeding and ensure the child has enough food (quantity and variety).

Help the child experiment with spoon/cup feeding.

Make sure the child is fully immunised and receives all recommended doses of mi-cronutrient supplements.

Child does not make sounds in response to others.

Child does not look at objects that move.

Child does not respond to care taker.

Child has no ap-petite or refuses food.

2 Years Walk, climb and jump.

Point objects or pictures when they are named.

Say several words from about 15 months.

Follow simple in-structions.

Scribble if given pencil or crayon.

Enjoy simple stories and songs

Imitate behavior of others

Begin to eat by self

Read, sing or play games with child.

Teach child to avoid dan-gerous objects.

Talk to child normally, do not use baby talk.

Continue breast feeding and ensure the child has enough food (quantity and variety).

Encourage, but do not force child to eat.

Provide simple rules and set reasonable expectations

Praise child’s achievements

Lack of response to others

Difficulty in keep-ing balance while walking

Injuries and unex-plained changes in behavior (espe-cially if the child has been cared for by others)

Lack of appetite


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3




3 ESpfom; vG,fulpGm vrf;avsmuf/ajy;/ wufqif;ESifh ckefEkdifonf?

jrifzl;aeus t&mrsm;ESifh &kyfykHrsm;ukdjyjcif;jzifh rSwfrdjyD; uGufwdajymEkdifonf?

pum;vkH;ESpfvkH;okH;vkH;yg pma=umif;rsm;ajymEkdifonf?

rdrdtrnfESifh toufukd ajymEkdifonf?

ta&mifrsm; cGJjcm;jyEkdifonf?eHygwfrsm;ukd em;vnfonf?

upm;&mwGif t&mrsm;ukd ,kH=unfr_tm; tokH;jyKonf?

ukd,fhtm;ukd,fukd;I pm;aomufonf?

oHa,mZOfukd jyoonf?

uav;ESifhtwl pmtkyfrsm;ukd zwf&SKI &kyfykHrsm;ta=umif;ajym jyyg?

uav;ukd ykHjyifrsm;ajymjyI um&efESifh oDcsif;rsm; oifay;yg?

uav;ukd pm;aeus xrif; yef;uefokd@r[kwf yef;uefvkH;ukd ay;pm;yg?

uav;pm;aomufcsdefukdvkdtyf oavmuf rsm;rsm;ay;I pm;&ef qufwkduf tm;ay;wkdufwGef;yg?

uav;ukd t0wf ukd,fwkdif 0wfwwf&ef/ vufaq;wwf&ef/ tdrfomwufwwf&ef ulnD oif=um;ay;yg?

upm;&ef pdwfyg0ifpm;r_ r&Sdjcif;?

r=umc%vJusjcif;?

ao;i,faom ypPnf;rsm; ukd ukdifwG,f&mwGif cufcJjcif;?

&kd;&Sif;aom pum;rsm;ukd em;vnfEkdifpGrf;r&Sdjcif;?

pum;vkH;rsm;pGmukd tokH; jyKI pum;rajymEkdifjcif;?

tpm;tpmrsm;ukd vkH;0 pdwfr0ifpm;jcif; okd@r[kwf tenf;tusOf; pdwf0ifpm;jcif;?

5 ESpfom; oifhwifhr#wpGm oGm;vm EkdifjyD; tultnDrygbJ 0wfpm;wwfonf?

pma=umif;rsm;jzifhajymEkdifjyD;rwlnDaom pum;vkHrsm; t okH;jyKonf?

qef@usifbuft&mrsm;ukd em;vnfonf? (Oyrm- 0jcif;ESifh ydefjcif;)

tjcm;uav;rsm;ESifhtwl upm;jyD; vufrsm;ukdaq; onf?

ar;cGef;&kd;&kd;av;rsm;ukd ajzqkd jyD; ypPnf;rsm;ukd 5- 10 xd a&wGufonf?

uav;ajymonfukd em;axmif ay;yg? uav;ESifh r=umc%qufoG,f pum;ajymyg? uav; pum;ryDao;vsif ykdrkdajz;ajz;ajym&ef wkdufwGef;yg?

ykHjyifrsm; zwfI ajymjyyg?

uav;ukd upm;&efESifh avsmuf avhvm&ef tm;ay;yg?

upm;&mwGif uav;. yg0ifr_taetxm;ukd avhvmyg? uav;wGif a=umuf&GH@jcif;/ pdwfqkd;jcif; okd@r[kwf t=urf;zufjcif;wkd@&Sdae ygu ,if;wkd@rSm pdwfykdif;qkdif&m jy\em rsm;/ t=urf;zufcH&jcif; qkdif&mvuQQ%mrsm; jzpfEkdifonf?


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3




3 Years Walk, run, climb and jump easily

Recognize and identify common objects and pictures by pointing

Make sentences of two to three words

Say his/her name and age

Name colors

Understand numbers

Use make believe objectsin play

Feed her/him self

Express affection

Read and look at books with the child and talk about the pictures

Tell the child stories and teach rhymes and songs

Give the child his/her own bowl or plate of food

Continue to encourage the child to eat, giving the child as much time as he/she needs

Help the child to learn to dress, wash her/his hands and use of toilet.

Loss of interest in playing

Frequent falling

Difficulty in ma-nipulating small objects

Failure to un-derstand simple messages

Inability to speak using several words

Little or no inter-est in food

5 Years Move in a coordinated way and dress without help

Speak in sentences and use different words

Understand opposites (e.g. fat and thin)

Play with other children and wash her/his hands

Answer simple ques-tions and count 5 to 10 objects

Listen to the child

Interact frequently with the child

If the child stutters, sug-gest she/he speaks more slowly

Read and tell stories

Encourage child to play and explore

Observe the roles children take in play. If child is fearful, angry or violent, these may be signs of emo-tional problems or abuse


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4


uav;rsm;ukd ta&;w,l *&kpkdufjcif;'g;r&pfpf at*g (tar&duef 'kuQonfrsm; aumfrwD)

oif. uav;=uD;xGm;zGH@jzdK;r_ukd rnfuJhokd@ ulnD&efESifh usef;rma&;jy\emESifh =uKHawG@&ygu rnfuJhokd@ aqmif&GufoifhonfESifh ywfoufI t=uHOm%frsm;. t=uHay;csuftcsdK@ukd wifqufay;vkdufygonf?

1? tpmtm[m&yxr 6 vtwGif; uav;rsm;tm; rdcifEkd@wpfrdsK;wnf;om oD;oef@wkdufauGs;oifhonf? (a&ukdaomfr# rwkdufoifhyg) ajcmufvaemufykdif;wGif &ifaoG;. u,fvkd&DpGrf;tm; vkdtyfr_ukd jynfhrSD&ef rdcifEkd@wpfrsdK;wnf;ESifh rvkHavmufonfhtwGuf e,fzwfxm;aom oifhwifh r#wonfh tpmaysmhaysmhukd pwif auGs;oifhonf? uav;onf tpmrmrsm;ukd pwifpm;EkdifonfESifh yrm% enf;enf;ESifh t=udrfrsm;rsm;auGs;yg? toufESifh vkdufI tpmyrm% wkd;auGs;yg? rdcifEkd@wkdufauGs;jcif;ukdvnf; uav;touf 2ESpfwkdifatmif okd@r[kwf xkd@xufykdI qufwkdufyg?

oifh&ifaoG;i,ftwGuf tpm;tpmESifh ywfoufaom t=uHOm%frsm;ukd aemufpmrsufESmwGif azmfjyxm;onf?

rdcifEkd@wkdufauGs;jcif;ESifh ywfoufonfh t,ltq okH;&yfuav;rsm;onf touf 3ESpft&G,ftxd vpOf =uD;xGm;zGH@jzdK;r_rSwfwrf;wifonfh Xmeukd oGm;a&mufoifhjyD; touf 3 -5 ESpftwGif;wGif usef;rma&;Xmeokd@ wpfESpf 2 =udrfoGm;oifhonf? uav;. ukd,ftav;csdefonf uav;toufESifh vkdufavsmnDaxGpGm wwef;wnf; &Sdaeap&ef ta&;=uD;onf?

pGJrSwf,lqjcif; jzpf&yfrSef

&ifom;ao;i,fjcif; &ifom;t&G,ftpm;ESifh roufqkdifbJ oif. ukd,fcE<mrS oifhuav;twGuf Ekd@vkHavmufpGm xkwfvkyfay;Ekdifygonf? oifom oifh&ifaoG;ukd Ekd@ykHrSefwkduf&ef aocsmygap?

Ekd@rvkHavmufjcif; rdciftm;vkH;wGif Ekfd@&nfvkHavmufpGm ykdifqkdif=uonf? oifh&ifaoG;ukd qmwkdif; awmif;wkdif; wkdufcGifhjyK&efomvkdygonf?

Ekd@Al;wkdufjcif;onf acwfrSDjyD; ykdrkd aumif;rGefjcif;

Ekd@Al;wkdufaom uav;rsm;onf rdcifEkd@pkd@aom uav;rsm;xufpmvsif 0rf;ysuf 0rf;av#ma&m*g jzpfyGm;E_ef; ykdrkdjrifhrm;onf? rdcifEkfd@wkdufjcif;onf rdcifESifh uav;=um; oHa,mZOf=udK;ukd qufay;onf?

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4


Caring for your ChildDamarice Ager (ARC)

Here is some advice on how to support your child’s development, and also some ideas on how to react in the case of a health problem.

1. NutritionDuring the first 6 months of life, babies should be exclusively breast-fed (do not even give wa-ter). After 6 months, as breast milk alone is not sufficient to meet the baby’s calorie needs, in-troduce pureed, light, balanced foods.As the baby starts to eat solid foods, feed more frequently but in small amounts, increasing the amount with age. Continue breast-feeding till 2 years of age or more.

Ideas of meals for your child are given on the next page.

3 myths of breastfeeding

Children from 0 to 3 years should attend growth monitoring every month, and those be-tween 3-5 years, twice a year at the health facil-ity. It is important to ensure the child’s weight is in line with his age.

Myth Reality

Small breasts Your body will produce enough milk for your baby, regardless of the size of your breasts. Make sure you breast-feed regularly.

Not enough milk All mothers have enough breast milk. Just allow your baby to feed on demand

Bottle-feeding is modern and better

Bottle-fed babies have higher incidences of diarrhea-related illness compared to breast-fed babies. Breast-feeding helps the baby form a strong bond with his/her mother.

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uav;rsm;ukd ta&;w,l *&kpkdufjcif;

uav;rsm;. tpm;tpmpDrHudef; 6vrS24vtxd SAMPLE MEAL PLANS FOR CHILDREN 6 – 24 MONTHS OLD

touftkyfpkAge group

eHeufpmMorning meal

tqmajyoGm;a&pmSnack

ae‹vnfpmNoon time meal

tqmajyoGm;a&pmSnack

npmEvening meal

6-8 v a&maxG;aom tpm;tpmqefjyKwf (odk‹) a&maxG;tpm;tpmqDESifh qefjyKwfyspfyspf

ausatmifajcxm;aom iSufaysmoD;yJawmifhrsm;/ qDwkd@jzifh ausatmifacsaom xrif; (odk‹)a&maxG; tpm;tpm qefjyKwf

qefjyKwfESifh [if;oD;[if;&Gufrsm; ausatmifacsjcif; (odk‹) yJawmifhrsm;/ qDwkd@jzifh ausatmif acsaomxrif;

6 - 8 monthsAsiaMix porridge, or Thick rice soup w/ oil & AsiaMix

A half mashed bananaMashed rice & beans with oil, orAsiaMix porridge

Thick rice soup & mashed vegetables, orMashed rice & beans with oil

8-12 va&maxG;aomtpm;tpm/ qefjyKwfESifh [if;oD; [if;&Gufrsm; (odk‹) qDESifh qefjyKwf a&maxG;tpm;tpm

a&maxG;tpm;tpmjzifh zkwfaom udwfrkef‹ (odk‹) *sdK;ausmfjzifh jyKvkyfaom a&maxG; tpm;tpm

yJawmifh/ qDwkd@jzifha&maESmxrif;(odk‹) qD/ [if;oD;[if;&Gufrsm;ESifh xrif;

cGJxm;aom opfoD;pdyfrsm; (iSufaysmoD;/ oabFmoD;/ z&JoD;)

yJawmifhrsm;(odk‹) tom;tcsOf&nfESifh [if;oD; [if;&Gufrsm;ygxrif; (odk‹) rdom;pktpm;tpm (tom;tcsOf&nf/ (odk‹) yJawmifhacs[if;ESifh xrif;)

8 - 12 monthsAsiaMix porridge w/ vegetables, or Rice soup with oil & AsiaMix

Rice & beans with oil, orRice and vegetables w/ oil

Cut-up pieces of fruit (banana, papaya, wa-termelon)

Rice w/ beans or meat sauce & vegetablesorFamily meal (meat sauce or mashed bean curry w/ rice)

12-24 vqD/[if;oD;[if;&Gufrsm;ESifh xrif;(odk‹) *sdK;ausmfjzifh jyKvkyfaom a&maxG; tpm;tpm ESifh opfoD;tcsKd‹

a&maxG;aomtpm;tpmrkef‹0kdif; (odk‹) a&maxG; tpm;tpm iSufaysma=umfrkef‹ (odk‹) [if;oD;[if;&Guf tjyKwf (odk‹)tpdrf;

qD/ yJawmifhrsm;ESifh xrif; (odk‹) qD/ [if;oD;[if;&Gufrsm;ESifh xrif;

opfoD;udk tvHk;vdkuf (=uufarmufoD;/ o&ufoD;/ z&JoD;/ ydEMJoD;)

rdom;pktpm;tpm([if;ESifhxrif;) (odk‹) a&maxG; tpm;tpm [if;oD;[if;&Guf[if; (odk‹) xrif;ESifh ig;/ tom; (odk‹)yJawmifhrsm;ESifh [if;oD;[if;&Gufrsm;

12 - 24 monthsRice with vegetables and oil, orJao Jaw made with AsiaMix and some fruit

AsiaMix donut, orFried AsiaMix banana cake, orSteamed or raw vegetables

Rice & beans with oil, orRice & vegetables w/ oil

Whole piece of fruit (rambutan, mango, watermelon, jackfruit)

Family meal (curry & rice), orSimple vegetable curry with AsiaMix, orRice w/ fish/meat or beans and vegetables

rdcifEdk‹&nfwdkufjcif;ESifhtwl tjrJpwifI yl;wGJauGs;arG;&rnf? Always introduce these meals in addition to breast milk!

tjcm;t}uHOm%frsm;rSm

[if;oD;[if;&GuftjyKwfrsm; (a&ukdqlatmift&ifwnfxm;jyD; [if;oD;[if;&Gufrsm;xnfhyg/ xkd@aemuf tkd;tzkH;tkyf xm;jyD; jyKwfoifhonf- xkd@a=umifhtm[m&qkH;&SkH;jcif;r&Sdyg? a&ESifhcsufjyKwfjcif;a=umifh tm[m&rsm;qkH;&SKH;Ekdifonf? a&tenf;i,fa&mcsuf+yD; [if;oD;[if;&Gufrsm;/ qeftcsKd‹ESifh a&udka&mcsufoifhonf) 6vrS 9vt&G,f&Sd uav;rsm; twGuf [if;oD;[if;&Gufrsm;ukd ausatmifacsoifhonf?

a&maxG;aomtpmjzifhjyKvkyfaom oGm;a&pmtcsKd‹rSm- a&maxG;aomtom;ausmfESifh o=um;/ rkef‹Akdif;awmifh/ wdk&Snf/ rkef‹vHk;ausmf/ pmuav;ausmf/ rkef‹qDausmfrsm;jzpfonf? (Oyrmay;xm;aom rkef@vkyfenf;rsm;ukd &Skyg)

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Other advices:Steamed vegetables should be cooked over the boiling water with a lid covering the pot: this permits to keep the nutrients. Do not cook them in the water as nutrients will be lost. You can also cook them in a small amount of water and mix the water and vegetables with some rice. Vegetables should be mashed for 6-9 month olds.Other snacks made with AsiaMix: Roasted AsiaMix with sugar, Mote Bay Dao, Toh Shay, Mote Lone Kyaw, Sakalay Kyaw, Mote Shee Kyaw.

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•

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Caring for your Child

uav;rsm;. tpm;tpmpDrHudef; 6vrS24vtxd SAMPLE MEAL PLANS FOR CHILDREN 6 – 24 MONTHS OLD

touftkyfpkAge group

eHeufpmMorning meal

tqmajyoGm;a&pmSnack

ae‹vnfpmNoon time meal

tqmajyoGm;a&pmSnack

npmEvening meal

6-8 v a&maxG;aom tpm;tpmqefjyKwf (odk‹) a&maxG;tpm;tpmqDESifh qefjyKwfyspfyspf

ausatmifajcxm;aom iSufaysmoD;yJawmifhrsm;/ qDwkd@jzifh ausatmifacsaom xrif; (odk‹)a&maxG; tpm;tpm qefjyKwf

qefjyKwfESifh [if;oD;[if;&Gufrsm; ausatmifacsjcif; (odk‹) yJawmifhrsm;/ qDwkd@jzifh ausatmif acsaomxrif;

6 - 8 monthsAsiaMix porridge, or Thick rice soup w/ oil & AsiaMix

A half mashed bananaMashed rice & beans with oil, orAsiaMix porridge

Thick rice soup & mashed vegetables, orMashed rice & beans with oil

8-12 va&maxG;aomtpm;tpm/ qefjyKwfESifh [if;oD; [if;&Gufrsm; (odk‹) qDESifh qefjyKwf a&maxG;tpm;tpm

a&maxG;tpm;tpmjzifh zkwfaom udwfrkef‹ (odk‹) *sdK;ausmfjzifh jyKvkyfaom a&maxG; tpm;tpm

yJawmifh/ qDwkd@jzifha&maESmxrif;(odk‹) qD/ [if;oD;[if;&Gufrsm;ESifh xrif;

cGJxm;aom opfoD;pdyfrsm; (iSufaysmoD;/ oabFmoD;/ z&JoD;)

yJawmifhrsm;(odk‹) tom;tcsOf&nfESifh [if;oD; [if;&Gufrsm;ygxrif; (odk‹) rdom;pktpm;tpm (tom;tcsOf&nf/ (odk‹) yJawmifhacs[if;ESifh xrif;)

8 - 12 monthsAsiaMix porridge w/ vegetables, or Rice soup with oil & AsiaMix

Rice & beans with oil, orRice and vegetables w/ oil

Cut-up pieces of fruit (banana, papaya, wa-termelon)

Rice w/ beans or meat sauce & vegetablesorFamily meal (meat sauce or mashed bean curry w/ rice)

12-24 vqD/[if;oD;[if;&Gufrsm;ESifh xrif;(odk‹) *sdK;ausmfjzifh jyKvkyfaom a&maxG; tpm;tpm ESifh opfoD;tcsKd‹

a&maxG;aomtpm;tpmrkef‹0kdif; (odk‹) a&maxG; tpm;tpm iSufaysma=umfrkef‹ (odk‹) [if;oD;[if;&Guf tjyKwf (odk‹)tpdrf;

qD/ yJawmifhrsm;ESifh xrif; (odk‹) qD/ [if;oD;[if;&Gufrsm;ESifh xrif;

opfoD;udk tvHk;vdkuf (=uufarmufoD;/ o&ufoD;/ z&JoD;/ ydEMJoD;)

rdom;pktpm;tpm([if;ESifhxrif;) (odk‹) a&maxG; tpm;tpm [if;oD;[if;&Guf[if; (odk‹) xrif;ESifh ig;/ tom; (odk‹)yJawmifhrsm;ESifh [if;oD;[if;&Gufrsm;

12 - 24 monthsRice with vegetables and oil, orJao Jaw made with AsiaMix and some fruit

AsiaMix donut, orFried AsiaMix banana cake, orSteamed or raw vegetables

Rice & beans with oil, orRice & vegetables w/ oil

Whole piece of fruit (rambutan, mango, watermelon, jackfruit)

Family meal (curry & rice), orSimple vegetable curry with AsiaMix, orRice w/ fish/meat or beans and vegetables

rdcifEdk‹&nfwdkufjcif;ESifhtwl tjrJpwifI yl;wGJauGs;arG;&rnf? Always introduce these meals in addition to breast milk!

tjcm;t}uHOm%frsm;rSm

[if;oD;[if;&GuftjyKwfrsm; (a&ukdqlatmift&ifwnfxm;jyD; [if;oD;[if;&Gufrsm;xnfhyg/ xkd@aemuf tkd;tzkH;tkyf xm;jyD; jyKwfoifhonf- xkd@a=umifhtm[m&qkH;&SkH;jcif;r&Sdyg? a&ESifhcsufjyKwfjcif;a=umifh tm[m&rsm;qkH;&SKH;Ekdifonf? a&tenf;i,fa&mcsuf+yD; [if;oD;[if;&Gufrsm;/ qeftcsKd‹ESifh a&udka&mcsufoifhonf) 6vrS 9vt&G,f&Sd uav;rsm; twGuf [if;oD;[if;&Gufrsm;ukd ausatmifacsoifhonf?

a&maxG;aomtpmjzifhjyKvkyfaom oGm;a&pmtcsKd‹rSm- a&maxG;aomtom;ausmfESifh o=um;/ rkef‹Akdif;awmifh/ wdk&Snf/ rkef‹vHk;ausmf/ pmuav;ausmf/ rkef‹qDausmfrsm;jzpfonf? (Oyrmay;xm;aom rkef@vkyfenf;rsm;ukd &Skyg)

•

•

Other advices:Steamed vegetables should be cooked over the boiling water with a lid covering the pot: this permits to keep the nutrients. Do not cook them in the water as nutrients will be lost. You can also cook them in a small amount of water and mix the water and vegetables with some rice. Vegetables should be mashed for 6-9 month olds.Other snacks made with AsiaMix: Roasted AsiaMix with sugar, Mote Bay Dao, Toh Shay, Mote Lone Kyaw, Sakalay Kyaw, Mote Shee Kyaw.

•

•

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2? wukd,fa&oef@&Sif;a&;uav;i,frsm;ESifh uav;rsm;ukd oef@&Sif;pGmxm;&efvkdtyf onf? uav;tESD;rsm;ESifh ESD;cHt0wfrsm;ukd vJay;jcif;jzifh uav;wkd@. El;nHhaomtom;ta&ukd usef;rmaponf? uav;i,frsm;ESifh uav;rsm;. t0wftpm;ESifh tdyf&mcif; rsm;ukd r=umc% oef@&Sif;ay;jcif;ESifh avovyfcHjcif;wkd@jzifh ta&jym;jy\emrsm;ukd umuG,f&efvkdtyfonf? uav;rsm;onf i,f&G,fvGef;I ukd,fwkdif *&krxm;Ekdifaom vufonf;rsm;/ qHyif/ em;&Gufrsm;ukd txl;*&kjyK =unfh&Skapmifha&Smuf&ef vkdtyfonf?

uav;tpm;tpmrsm;ukd oifhwifpGm ukdifwG,fcsufjyKwfjcif;ESifh odrf;qnf;jcif;wkd@vkdtyfonf? tpm;tpmrsm;ukd oef@&Sif;pGm csufjyKwfjyifqifI tpmauGs;csdefrwkdifrSD tcsdef=umjrifhpGm odrf;qnf;xm;jcif;r&Sdap&ef owd=uD;pGm xm;&rnf? pm;=uGif;pm;usefrsm;ukd v$ifhypfjyD; aemufwpf=udrf xyfpm;&ef odrf;qnf;rxm;ygESifh?

3? upm;apjcif; §v_@Haqmfr_ay;jcif;uav;i,frsm;ESihf tcsdefay;upm;jyD; upm;&ef v_Haqmftm;ay;yg? 4if;onf u¾tm;vkH;- um,/ vlr_a&;ESifh pdwf"mwfykdif;wkd@wGif olwkd@. t&nftaoG;rsm;wkd;wufzGH@jzdK;ap&ef ulnDay;onf? uav;rsm;. =uD;xGm;zGH@jzdK;r_ukd apmifh=unfhjcif;jzifh jy\emwpkHw&mukd azmfxkwfI apmpD;pGmjyifqifuko&ef tajctaeay;vdrfhrnf? aqmif&Gufoifhonfh Oyrm rsm;rSm - pum;ajymjcif;/ twk,lapjcif;/ xkdif/ x/ rwfwwf&yf&ef ulnDay;jcif;/ upm;p&mrsm;ESifh awmufy aomt&m0wWKrsm; tokH;jyKjcif;wkd@yg0ifonf?

4? umuG,faq;xkd;jcif;uav;i,fonf ol.oufwrf;yxrESpftwGif;wGif umuG,faq;xkd;jcif;ukfd jynfhpkHpGm&&SdjyD;a=umif; aocsm ygap? ppfaq;awG@&Sdcsufrsm;ukd uav;jzpfol. usef;rma&;rSwfwrf;pmtkyfwGif a&;rSwfxm;oifhonf?

5? iSufzsm;a&m*gntcgwGif oifh&ifaoG;tm; jcifaxmifcsI odyfyg?

6? usef;rma&;apmifha&Smufr_rsm;zsm;emjcif;. vuQ%mrsm;ukd tav;xm; =unfh&SKI usef;rma&;apmifha&Smufr_ukd tcsdefrSD &,lyg?uav;rsm;wGif tjzpfrsm;aom usef;rma&;jy\emrsm; twGuf trSmpum;tcsdK@ukd atmufwGifazmfjyvkdufonf?

1- tat;rdjcif;acsmif;qkd;jcif;ESifh tat;rdjcif;wkd@onf rsm;aomtm;jzifh ukor_,lp&mrvkdbJ jyefaumif;vmwwfaomfvnf; touf&SkjrefI acsmif;qkd;jcif;ESifh tat;rdjcif;wkd@ukdrl wdusaom aq;ynmqkdif&m*&kwpkdufjyKpkr_ vkdtyfonf? (tqkwfa&mifa&m*g jzpfyGm;Ekdifajc&Sdjcif;)

2- tzsm;&Sdjcif;uav;rsm;wGif tzsm;0ifjcif;onf tEW&m,fusa&muf Ekdifaoma=umifh *&kwpkduf apmifh=uyfukooifhonf?

uav;ukd tdyf&mwGif; tdyfpuftem;,lygap?t&nfrsm;rsm;aomuf&ef ay;yg?ukd,fylcsdef usoGm;ap&ef avvkHaom tcef;wGif; uav;ukd a&aEG;aEG;jzifh a&ywfwkdufay;Ekdifonf? yefumzGifhjcif;/ a&cJ okd@r[kwf a&at;at;jzifh a&ywfwkdufjcif;rjyKbJ uav;ukd csrf;wkefrae ap&yg?yg&mpDwarmwkdufEkfdifonf?

uav;onf rdcifEkd@pkd@aeygu ykHrSeftwkdif;qufwkdufyg?

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2. HygieneBabies and children need to be kept clean. Regular changing of nappies and diapers will keep their delicate skin healthy. Babies’ and children’s clothing and bedding need frequent cleaning and airing to prevent skin problems. Care of nails, hair, ears and eyes need special attention as babies are too young to care for themselves.Babies’ feeds need proper care and handling. Ensure that food is prepared in hygienic condi-tions and not kept for a long period prior to feeding time. Throw away left over food, do not keep it for the next feed.

3. Play/StimulationTake time to play with and stimulate babies and children. This will help them develop their skills in all aspects - physical social, and men-tal. It will also help you follow your child’s de-velopment and detect any problems, enabling early intervention. Some suggested activities are: talking; imitating; helping your baby to sit, walk and stand; playing with toys and brightly coloured objects.

4. ImmunisationMake sure your child receives immunisations during the first year of life. All records should be written in your child’s health record book.

5. MalariaAt night put your baby to sleep under a mos-quito net.

6. Health carePay attention to signs of illness and see a doctor immediately.Here is some advice on common health prob-lems in children:

a - Colds

Coughs and colds often get better with no treatment, but any symptoms of fast breathing need prompt medical attention (this is a pos-sible sign of pneumonia).

b - Fever

Fever in children must be monitored regularly as it can be dangerous.

Put the child to rest in bedGive a lot of fluids to drinkTo help lower the temperature you can give the child a sponge bath in a warm room with warm water. Do not use a fan or ice or cold water, as this will chill the childGive Paracetamol.

If you are breast-feeding your child, continue as normal.

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3- 0rf;ysuf0rf;av#ma&m*g0rf;av#ma&m*gjzpfygu toufaoqkH;apEkdifaom a&"mwf qkH;&SKH;jcif;ukd jzpfyGm;apEkdifaoma=umifh *&kwpkduf apmifh=uyf uko&rnf? omreftqifhwGif ykHrSeftpm;tpmESifh aomufaeus ae@pOf t&nfrsm;ukd qufvufwkdufyg?uav;onf rdcifEkd@pkd@aeygu ykHrSeftwkdif;qufwkdufyg?

usef;rma&;Xmeokd@ uav;ukd ac:aqmifvmyg? tu,fI

0rf;avsm&mwGif aoG;okd@r[kwf tusdtcGsJrsm; ygvmygutvGeftrif; 0rf;ysuf0rf;av#myguoifhuav;onf 0rf;Akdufqkd;&Gm;pGmemusifyguoifhuav;onf ukd,fylcsdef jrifhaeyguumv0rf;a&m*guyf qufvufjzpfyGm;aeygu

4- rD;avmif'%f&mrsm;uav;rsm;wGif tao;pm; rD;avmufr_rsm;jzpfygu ta&jym;ay:wGif rD;avmifcH&aom ae&mukd a&bkHykdifa& atmufwGif rdepf 20cef@tat;cHyg?rnfonfh vdrf;aq;u&ifrf/ tqD okd@r[kwf rD;avmif '%f&mtwGuf tjcm;ukojcif;rsdK;ukdrqkd rvdrf;ygESifh?tu,fI rD;avmif'%f&monf ao;i,fygu (usyfjym; 0kdif;aphyrm%atmufcef@) 4if;ukd

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ykd;owfxm;aom wG,fuyfjcif; r&Sdonfh *Grf;yvmpwmjzifh zkH;tkyfxm;yg?rD;avmif'%f&mrsm;onf vG,fulpGm ykd;0ifEkdifjyD; trm&Gwf qkd;qkd;&Gm;&Gm; usefapEkdifaoma=umifh rD;avmif'%f&m rao;i,fvsif uav;ukd aq;cef;okd@ ac:,ljyoyg?

5- jywf&S'%f&m§ao;i,faom'%f&mrsm;'%f&mrsm;ukd oef@&Sif;aom a&/ qyfjymwkfd@jzifh aq;a=umyg?'%f&may:wGif ykd;owfaq; (bDwm'if;)ukd vdrf;ay;yg?'%f&mukd ywfwD;pnf;I umuG,fay;yg?

usef;rma&;jyKpkapmifha&Smufr_&,lyg? tu,fI '%f&monf oef@&Sif;r_ r&Sdygujywf&Sjcif;onf =uD;rm;ygu (wpfpifwDrDwmxufykd&Snfygu)aoG;,kdpdrfhjcif;onf vsifjrefpGm r&yfwef@ygujywf&S'%f&monf jrifraumif;aom trm&Gwf usef&pfEkdifygu (Oyrm- rsufESmay:wGif / txl;ojzifh rsufvkH;ywf0ef;usifwGif)

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Bring the child to the health center if:The fever stays for several hoursThe temperature risesThe child develops new symptoms such as seizures, abnormal movements of the face, arms, or legs, or has difficulty breathingThe child has a marked change in be-havior, level of consciousness, or level of activity.

c - Diarrhoea

Diarrhoea should be carefully monitored as it may cause dehydration, which can lead to death.In mild cases, continue with a normal diet and the usual daily drinks.If you are breast-feeding your child, continue as normal.

Bring the child to the health center if:there is blood or mucus in the diarrhoeain cases of severe loose motions

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your child has severe abdominal pain your child has a high temperaturethere is a cholera outbreak going on.

d - Burns

For small burns in children, hold the burnt area of skin under a cold running tap water for 20 minutesDo not put any creams, grease or other treatments on the burnsIf the burn is small (under the size of a large coin) it can be covered with a ster-ile, non-stick dressingBurns can become infected easily and they can leave bad scarring, so unless the burn is very small, take the child to a clinic.

e - Cuts/ Small wounds

Clean the wound with clean water and soapApply disinfectant (Betadin) to the woundProtect the wound with a bandage.

Seek health care if:the wound is not cleanthe wound is large (more than a centime-tre long)bleeding does not stop quicklythe cut might leave an unsightly scar (e.g on the face, especially around the eye).

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31

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uav;rsm;. tjriftm&kHjy\emrsm;ukd ajc&mcHjcif;

32

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How to Detect Vision Problems in Children

Whilst vision problems are common, diagnosis in children can be difficult as they may not recognise that they have a problem and therefore will not complain about it. It is important that parents and teachers pay attention to the vision of the children in order to detect problems as soon as possible. Even if nobody in the family has a history of vision problems, you should still be on the lookout for signs.Here are some signs that may help you to detect potential problems:

Abnormal appearance of the eye- Unusual redness of eyes and eyelids- Crusted eyelids- Other strange signs (excessive tearing, one eye turns in or out with fatigue)

Disturbance/ irritation- Eyes blinking frequently- Excessive rubbing of eyes- Complaints about the eye or vision

In everyday life- Bumps into things, knocks things over- Does not recognise familiar people in the distance- Avoids bright light

When reading- Holds a book very close while reading- Positions head strangely when reading- Covers or closes one eye when reading- Complains of headaches as a result of reading or writing

At school- Difficulty copying from the blackboard- Difficulty concentrating and focusing on his work- Difficulty writing in a straight line

If you notice one of these symptoms or other possible signs, take action.There are eye clinics in the hospital, so do not hesitate to ask for advice. It is important to detect and correct vision prob-lems early to prevent them from worsening.

How to detect vision problems in children

33


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2? tEW&m,fusa&mufEkdifajc jrifhrm;aom uav;rsm;ukd &SmazGazmfxkwfjcif;wkd@jzpfonf?

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1? vraph uav; (37 ywfatmuf)

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1? toufu,fjcif;ukor_ vkdtyfaom rnfonfhuav;rqkd

2? arG;&myg csdK@,Gif;csuf&Sdaomuav; (tu,fI uav;wGif csdK@,Gif;csuf wpfck&Sdygu tjcm;wpfck xyf&SdvG,f onf)2? aygifrjynfh uav; (2³ 5

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4? rdcifwGif tzsm;=uD;jcif;okd@ r[kwf azmfxkwfEkdifaom ul;pufa&m*g&Sdjcif;

- a&m*gykd;0ifEkdifajcjrifhrm;jcif;

34


An estimated 4 million neonates (infants less than 4 weeks of age) die every year.The majority of these are in the first week of life with the highest risk of death being on the first day of life.Care of a newborn infant begins before the baby is born with1. The care of the mother in labour2. The identification of the “at risk” infant

Identification of the “at risk” infant:

The following groups of infants have specific risks which should be planned for during la-bour.

Immediate Care of the Newborn Infant

Dr. Claudia Turner & Dr. Verena Carrara (SMRU) �

“At risk” infants identified before or during labour At risk” infants identi-fied after delivery

1. Preterm infant < 37 weeks

a. Need for resuscitationb. Increased risk of infectionc. Inability to maintain body temperatured. Problems with feedinge. Low blood glucose

1. Any infant who has needed resuscitation

2. An infant with a con-genital abnormality(If one abnormality is identified the infant is more likely to have another).

2. Low birth weight babies < 2.5 kg

a. Increased risk of infectionb. Inability to maintain body temperaturec. Problems with feedingd. Low blood glucose

3. Prolonged rupture of membranes

a. Increased risk of infection

4. Maternal py-rexia or known infection

a. Increased risk of infection

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rdcifEkd@&ifaoG;tm; rdcifEkd@wkdufauGs;apjcif;onf rD;zGm;jyD;jyKpk apmifha&Smufjcif;. t"du &nf&G,fcsufrsm;wGif wpfck tygt0ifjzpfonf? rD;zGm;jyD;wpfem&DtwGif; arG;uif;p uav;tm; rdcifxH v$Jay;oifhjyD; uav;Ekd@pkd@vkda=umif; vuQ%mjyygu Ekd@pkd@apoifhonf? om;zGm;q&mr (okd@) ukd,f0efaqmifapmifha&Smufolonf xkdta&;=uD;tcsdefwGif ulnDjyKpkr_ESifh vrf;n$efr_ukd teD;uyfay;oifhonf? rdcifEkd@wkduf&ef ysufuGufjcif;onf ywf0ef;usifqkdif&m ta=umif; w&m;rsm;a=umifhjzpfjyD; trSefwu,f Ekd@rxGufjcif;rSm tvGef&Sm;yg;vSonf?

rdcifxHrS yxrqkH;xGufaomEkd@ukd Ekd@OD;&nf[kac:jyD; tkdif*sDatac: yÉdypPnf;rsm;jzifh jynfh0aewwfonf? 4if;wkd@onf tlvrf;a=umif;uJhokd@aom rsufESmjyifrsm;ay:wGif AufwD;&D;,m;rsm; wG,fuyfjcif;ukd &yfwef@apjyD; uav;ukd a&m*gykd;0ifjcif;rS umuG,fay;onf? rdcifEkd@onf &ifhusufvmonfESifhtr# trkdifEkdtufqpfESifh =udK;quftqDtufqpfuJhokd@aom r&Sdrjzpf tm[m&rsm; yg0ifvmonf?

tpmtdrfwGif; ESmacgif;ykdufjzifh tpmauGs;jcif;ukd,f0efaqmifumv 34 ywfwGif Ekd@pkd@jcif;wkH@jyefr_jzpfpOf pwifonf? ukd,f0efaqmifumv 34 ywfatmufarG;aom

arG;uif;puav;i,ftm; csufjcif; jyKpkukor_ay;jcif;

arG;uif;puav;tm; jyKpkukor_ay;&mwGif tokH;0ifaom ulnDr_ay;onfh rSmwrf;rSm-

toufu,fjyKpkapmifha&Smufjcif; ukd,fcE<mykdif;qkdif&m prf;oyfppfaq;jcif; MACHO

M - Milk: uav;ukd rnfokd@ Ekd@csdKwkdufauGs;rnfenf;? vaph/ raph?A - Antibiotics: uav;tm; yÉdZD0aq;0g;rsm; pwifwkdufauGs;oifhygovm;?C - Cord: uav;arG;jyD;jyD;csif; csuf=udK;jzwfonfrS csufa=uGonftxd jyKpkukor_?H - Heat: arG;uif;puav;onf ukd,ftylcsdefukd xdef;odrf;xm;Ekdifygovm;?O - Oxygen: atmufqD*sif- arG;uif;puav;wGif touf&SKvrf;a=umif;zdpD;r_ &Sdygovm;? atmufqD*sif

vkdtyfygovm;?

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Resuscitation

There is no room here for a full description of neonatal resuscitation. Any unit that delivers infants should have a standardised protocol for resuscitation of the newborn infant. This protocol or drill should be practiced with all team members on a regular basis (best with a mannequin). Formal resuscitation training im-proves both the 1 minute and 5 minute Apgars of infants.

Examination

Straight after birth:Determine the sexInspect (and measure) vital signs and pres-ence of major anomalies.Estimate the gestational age and the weight as this helps to estimate the level of risk facing the baby.

A more detailed examination should be per-formed by trained personnel when the infant is stable.

Milk

Establishment of breast feeding should be one of the major goals of postpartum care. The in-fant should be handed to the mother within one hour of birth and be allowed to suck when he shows signs of wanting to. The midwife or birth attendant should be on hand to give ad-vice and support at this crucial time. Failure of breast feeding can usually be explained by environmental factors, true failure of lactation is very rare.

The first milk produced by the mother is called colustrum: it is rich in antibodies (IgA) which help to protect the infant from infection, by stopping bacteria sticking to surfaces such as the intestine. As the breast milk matures, it will contain essential nutrients such as amino acids and long chain fatty acids.

NGT feeding

The suck reflex develops at around 34 weeks gestation. Babies < 34 weeks old will need help with their feeding. Use a nasogastric tube (NGT). Once the NGT has been placed, the


A useful aide memoire for the care of the newborn is:

• Resuscitation• Examination• MACHO

M - Milk: how is the baby going to feed? Term or Preterm?A - Antibiotics: should the baby be started on antibiotics?C - Cord: cord care starts at delivery and continues until detachment.H - Heat: is the infant able to maintain body temperature?O - Oxygen: does the infant have any respiratory distress, should they receive oxygen?

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uav;rsm;onf tpmjznfh&ef tultnDvkdonf? ESmacgif;rS tpmtdrfoGif;ykdufukd tokH;jyKyg? ESmacgif;rS tpmtdrfoGif;ykdufukd ae&mcsxm;jyD;onfESifh ae&mrSef a&muf&Sdaea=umif; twnfjyKyg?avyrm%tenf;i,fukd xdk;oGif;jyD; tpmtdrfay:rS em;axmif=unfhvsif ae&mrSefwGif&Sdygu av0ifoGm;oHukd =um;&Ekdifonf? uav;. tav;csdefukd tokH;jyKI 24em&DtwGif; ay;&rnfh rSefuefaomrdcifEkd@yrm%ukd wGufcsufyg? om;OD;uav;rsm;onf Ekd@yrm% avsmhenf;vkdtyfavh&SdjyD; xkdyrm%onf &uftenf;i,ftwGif; jrifhwufvmonf? tb,fa=umifhqkdaomf rdcifEkd@onf yrm%tjynfhokd@ a&muf&Sd&ef &uftenf;i,f tcsdef,laoma=umifh oifwkduf auGs;aom yrm%ukd &uftenf;i,ftwGif; wkd;jrSifh oifhonf? tu,fI uav;onf ukd,ftav;csdef 2³ 5 uDvkd*&rftxuf&Sdygu 150 rDvDvDwm§uDvkd*&rfay;yg? uav;onf ukd,ftav;csdef 2³ 5 uDvkd*&rfatmuf&Sdygu 200 rDvDvDwm§uDvkd*&rfay;yg?

24 em&DtwGif; wkduf&rnfh Ekd@yrm%

2³ 5 uDvkd*&rftxuf 2³ 5 uDvkd*&rfatmuf

&uf 1 60 rDvD§uDvkd &uf 2 80 rDvD§uDvkd &uf 3 100 rDvD§uDvkd &uf 4 120 rDvD§uDvkd &uf 5 140 rDvD§uDvkd &uf6š 150 rDvD§uDvkd

&uf 1 60 rDvD§uDvkd &uf 2 80 rDvD§uDvkd &uf 3 100 rDvD§uDvkd &uf 4 120 rDvD§uDvkd &uf 5 140 rDvD§uDvkd &uf 6 160 rDvD§uDvkd &uf 7 180 rDvD§uDvkd &uf8š 200 rDvD§uDvkd

wpf=udrfauGs;&mwGif ay;&rnfh yrm%:

1? 24 em&DtwGif; uav;pkd@oifhonfh Ekd@yrm%ukd wGufcsufyg?2? xkdyrm%ukd 24 jzifhpm;yg?3? Ekd@wkdufonfh t=udrfta&twGufjzifh ajrSmufyg?

(Ekd@wkdufonfhESpf=udrf=um; em&Dta&twGuf)

vraphaom/ a&m*g&Sdaom/ ao;i,faomuav;rsm;onf vaphusef;rmaom uav;rsm;uJhokd@ tpmaumif;pGm rpm;Ekdifyg? xkd@a=umifh wpfem&Djcm;wpfcg tpmauGs;&ef vkdtyfonf? usef;rmaom rdcifEkd@pkd@uav;rsm;onf 2- 4em&Djcm;wpfcg Ekd@pkd@onf? rpkd@Ekdifaom uav;rsm;ukd


ESmacgif;rS tpmoGif;ykdufoGif;jcif;Inserting a nasogastric tube

ESmacgif; tpmoGif;ykdufNasogastric tube

tpma&rsdKjyGefOesophagus

tpmtdrfStomach

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correct location must be confirmed. Listen over the stomach while a small amount of air is injected: if it is in the correct place, a woosh of air can be heard.

Calculate the correct amount of milk to give per 24 hours using the baby’s weight. Babies need less milk when they are first born and this amount increases over a few days. This is be-cause a mother’s milk takes a few days to get to the full amount, so the amount you give should be increased over a few days. If a baby is > 2.5 kg work up to 150 ml/kg. If the baby is < 2.5 kg work up to 200 ml/kg.

Milk per 24 hours

> 2.5 kg < 2.5 kg

Day 1 60 ml/kgDay 2 80 ml/kgDay 3 100 ml/kgDay 4 120 ml/kgDay 5 140 ml/kgDay 6+ 150 ml/kg

Day 1 60 ml/kgDay 2 80 ml/kgDay 3 100 ml/kgDay 4 120 ml/kgDay 5 140 ml/kgDay 6 160 ml/kgDay 7 180 ml/kgDay 8+ 200 ml/kg

Amount to give per feed:Calculate the amount of milk the baby should have in 24 hoursDivide this amount by 24 Multiply by the frequency of feeds (by the number of hours between two feeds)

1.

2.3.

Premature, small and sick babies do not toler-ate feeds as well as healthy term babies so start by giving feeds every 1 hour. Breast fed babies feed every 2-4 hours: we want to make NGT feeding as much like breast feeding so that it

is easier for the baby to establish breast feed-ing. Therefore gradually (over several days) in-crease the time between feeds to make it more like breast feeding, increasing to feeds every 2 hours and then every 3 hours.

Antibiotics

Check for risk factors for sepsis in newbornsPre term (less than 37 weeks gestation)Waterbag leaking for more than 6 hours and no antibiotics given to the mother or antibiotics given less than four hours before deliveryTemperature in Mother (if not due to malaria)Infection in Mother (if not due to ma-laria) even if started treatmentMother has had previous infant deaths in the first week

If the infant has two risk factors or a fever, the infant needs antibiotics. If one risk fac-tor the infant needs close observation for 48 hours.Fever = temperature ≥ 38°C on one occasion or ≥37.5 °C on two occasions (> 4 hours apart)Take a blood culture and CBC and start IV ampicillin and gentamicin IV Antibiotics should continue until the blood culture result is known and should only be stopped or changed to oral by a doctor.

Cord

A good method of clamping the cord is to use a rubber band. After clamping the cord with forceps and cutting it short (6-7cm) a rubber band can be applied with the help of forceps.

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tpmoGif;ykdufjzifh wpfem&Djcm;wpfcg auGs;jyD;rS wjznf;jznf; tcsdefwkd;um 2 em&Djcm;/ ykHrSef 3em&Djcm;a&mufonftxd (ykHrSef rdcifEkd@wkdufonfh tcsdefZ,m;a&mufonftxd) tpmoGif;ay;&rnf?

yÉDZD0aq;0g;rsm;arG;uif;puav;rsm;wGif aoG;wGif;a&m*gykd;ys@HESH@jcif;twGuf jzpfEkdifajcrsm;ukd ppfaq;yg?

vraphbJarG;jcif; (ukd,f0efaqmifumv 37 ywf atmuf)6 em&DxufykdI a&jr$ma& aygufjyD; rdciftm; yÉDZD0aq;0g;rsm; wkdufauGs;rxm;jcif; okd@r[kwf uav;rarG;cif 4 em&DtwGif;wGifom yÉdZD0 aq;0g;rsm; wkdufxm;Ekdifjcif;rdcifwGif ukd,fylcsdefjrifhjcif; (iSufzsm;a&m*ga=umifh r[kwfygu) rdcifwGif iSufzsm;r[kwfaom ul;pufa&m*g 0ifa&mufjcif; (ukor_&&Sdonf jzpfapumrl)rdcifwGif ,cifuarG;jyD; yxrywftwGif; uav;aoqkH;zl;ygu

arG;uif;puav;wGif tEW&m,fjzpfEkdifajc ESpfckokd@r[kwf tzsm;&Sdygu yÉdZD0aq;0g;rsm;wkdufauGs;&ef vkdtyfonf? tEW&m,fjzpfEkdifajc wpfck&Sdygu arG;uif;puav;tm; 24 em&DtwGif; teD;uyfapmifh=uyfuko&ef vkdtyfonf? tzsm;&Sdjcif;- wpf=udrfwkdif;&mwGif ukd,ftylcsdef ≥ 38 'D*&D &SdjyD; okd@r[kwf ESpf=udrfwkdif;wm&mwGif (4 em&Dxuf ykdjcm;I) ≥ 37³ 5'D*&D &Sdjcif;aoG;wGif ykd;arG;jyD; pDbDpD ppfaq;I tifyDqDvifESifh *sifwmrkdifqif ta=umaq;ay;yg?

aoG;wGif ykd;arG;jcif;tajzukd od&onftxd yÉDZD0aq;0g;rsm; wkdufauGs;jyD; q&m0efn$ef=um;rS aq;xkd;&yfjcif; okd@r[kwf yg;pyfrS ajymif;aomufjcif;ukd aqmif&Gufyg?

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csuf=udK;csuf=udK;ukd pnf;aESmif&ef aumif;rGefaomenf;vrf;rSm &mbm=udK;ukd tokH;jyKjcif;yifjzpfonf? csuf=udK;ukd nSyfESifh nSyfukdifjyD;aemuf 6-7 pifwDrDwmjzpfatmif jzwfnSyfjyD;aemuf nSyfukd tokH;jyKI &mbm=udK;ukd tokH;jyK Ekdifonf? &mbm=udK;rsm;ukd ykd;owfxm;aom ta=umaq; ykdufvkdif;rsm;rS 4 pifwDrDwm&Sdf &mbmykdufykdif;rsm;ukd tokH;jyKI jyKvkyfEkdifonf?

&mbmykdufykdif;rsm;ukd 3-5 pifwDrDwmt&Snf&Sd tykdif;rsm; jzpfatmif jzwfI ykd;owf&onf? =udK;puJhokd@qGJqef@r&onfht&mrsm; okH;rdygu uav;arG;jyD; 30rdepfrS wpfem&DtwGif; csuf=udK;ajcmufI &SKH@oGm;aomtcg =udK;avsmhjyD; aoG;a=umjyefyGifhvmEkdifonfhtwGuf aoG; ,kdpdrfhjcif;ESifh ykd;0ifjcif;tEW&m,fjzpf Ekdifajc&Sdonf?

yvwfpwpf csuf=udK;nSyfuvpfrsm;onf tvGef xda&mufr_&SdjyD; aps;=uD;I wpfcgomtokH;jyK&onf? &mbmykdufrsm;onf jrefE_ef;wGif tm;omcsuf&Sdonf? csuf=udK;ukdcsnf&mwGif okH;qwmr# tcsdefykd,ljyD; uav;tm; tylcsdefqkH;&SKH;r_ ykdjzpfEkdifajcukd wkd;yGm;aponf? oifwkef;"g;/ cGJpdwfcef;okH;"g; okd@r[kwf csuf=udK;nSyfuwfa=u;wkd@ukd tokH;jyKI csuf=udK;jzwfoifhonf? tqifhqifhukd ykd;owfxm;aom ud&d,mrsm;ESifh enf;vrf;rsm;twkdif; vkyfaqmifoifhonf? xkdtcsufonf txl;ojzifh arG;uif;puav; ar;ckdifa&m*guJhokd@aom ykd;0ifjcif;rsm;ukd umuG,fwm;qD;&ef ta&;t=uD;qkH;jzpfonf?

ykHrSeftm;jzifhcsuf=udK;ukd oef@&Sif;ajcmufaoG@aeap&rnf? csuf=udK;ae&mukd zGifhxm;jyD; tkyfxm;jcif; rjyK&? csuf=udK; ywfwD;rsm;onf qD;/ uav;i,facs;wkd@jzifh vG,fulpGm npfywfayusHEkdifjyD; csuf=udK;ukd pkdpGwfaeapEkdifonf? &kd;&m enf;vrf;rsm;jzpfaom aq;wkd@zwf/ rD;aoG;ESifh jymrsm;ukd odyfjcif;a=umifh csuf=udK;wGif; ykd;0ifjcif;ESifh toufqkH;jcif;wkd@jzpfEkdifonf? uvkd&kd[ufqD'if; okd@r[kwf ykdAD'if;wkd@ukd ae@pOf tokH;jyKjcif;onf txl;ojzifh pwufzDvkdaumhuyfpf atm&D,yfpf uJhokd@aom bufwD;&D;,m;ydk;r$m;rsm; 0ifa&muf wG,fuyfjcif;ukd umuG,fEkdifa=umif; awG@&Sd&onf?


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Rubber bands can be made from using the 4 cm rubber section of sterile IV giving sets. Cut the rubber section into 3-5mm bands and ster-ilize them. Inelastic closing materials such as string results in a temporary closing of the ves-sels and as early as ½ - 1 hour after the birth, the shrinkage of the cord loosens the string and reopens the vessels, increasing the risk of both bleeding and infection. Plastic cord clamps are very effective but are expensive and not reusable. Rubber bands have the advantage of speed. Tying the cord takes about 3 times lon-ger and increases the risk of the baby becom-ing hypothermic. A clean instrument such as a razor blade, a scalpel or a pair of cord scissors should be used to cut the cord. The procedure should be carried out using sterile instruments and technique. This is of utmost importance to prevent infection, especially neonatal tetanus.

The normal cord must be kept clean and dry. Leave the cord open and uncovered. Cord bandages are easily dirtied by urine or meco-nium and tend to moisten the cord. Tradition-al methods such as San To Bar, charcoal and ashes can lead to cord infection and death. The daily use of chlorhexidine or povidine has been


Put the band on the clamp

As the cord dries, the band contracts and holds it tight

csuf=udK;ajcmufoGm; aomtcg&mbmuGif; usKH@vmjyD; wif;usyfpGm xdef;csKyfonf?

Clamp the cord & Pull the band over the cord

csuf=udK;ukdxdef;I &mbmuGif;ukd

csuf=udK;ay:rSqGJpGyfyg?

&mbmuGif;ukd nSyfwHwGifpGyfyg?

Cut the rub-ber section&mbmtykdif;ukd

jzwfawmufyg? 5

41


70µ t&ufysHukd tokH;jyKjcif;onfvnf; xkduJhokd@yif tusdK;oufa&mufr_&Sdaomfvnf; uav;rdbrsm;tm; rSm=um;oifhonfrSm t&ufysHukd csuf=udK;ae&mwGifom vdrf;&efjzpfjyD; t&ufysHavmifEkdifojzifh teD;0ef;usif&Sd tom;aumif;rsm;ukd rxdrdap&ef owday;xm;&rnf?

tylcsdefarG;uif;puav; ukd,fwGif;tylcsdef xdef;nSd&mwGif pnf;urf; 4 csuf&Sdonf?

uav;arG;onfhae&m aEG;axG;r_&Sdjcif;ajcmufaoG@I aEG;axG;aom uav;t0wftpm;rsm;arG;jyD;24em&DausmfrSom a&csdK;ay;jcif;ta&jym;tcsif;csif; okd@r[kwf aEG;axG;aom t0wftpm;rsm;jzifh axG;ywfxm;jcif;jzifh aEG;axG;aom ywf0ef;usifukd zefwD;ay;jcif;

pkdpGwfaeaom uav;i,fonf tylcsdefukd vsifjrefpGm qkH;&SKH;EkdifjyD; ta&;jym;tylcsdefonf arG;jyD;jyD;csif; puUef@ykdif;twGif; 3-4 'D*&Dusqif;oGm;onf? uav;ukd toufp&Skap&ef E_d;aqmfr_jyif;xefpGm&Sdaomfvnf; trd 0rf;rS uGswfjyD;aemuf tylcsdefukd awmufavsmufqkH;&SKH; aeygu uav;wGif ukd,fylcsdefusqif;jcif; (ukd,fylcsdef < 35 'D*&D ) jzpfvmEkdifonf?

ukd,fylcsdefusqif;jcif;ESifh toufqkH;&SKH;jcif;wkd@onf eD;uyfpGm csdwfqufaeaoma=umifh ukd,fylcsdefusqif;jcif; tqifhedrfhrsm;ukdaomfrS umuG,f&ef =udK;pm;r_wkdif;ukd aqmif&Guf&rnf? csuf=udK;ukd wpf=udrfjzwfay;jyD;onfESifh arG;jyD;jyD;csif;uav;ukd vsifjrefpGm ajcmufaoG@apjyD; uav; t0wfopftajcmufrsm;jzifh &pfywfaxG;xm;&rnf?

ukd,fylcsdefusqif;jcif;onf arG;uif;puav;i,ftm; aoG;wGif; o=um;"gwf usqif;jcif;ukd,ftav;csdef ykHrSefxuf avsmhenf;jcif;touf&SKvrf;a=umif;qkdif&m tcuftcJjy\em rsm; jzpfyGm;Ekdifajcukd wkdf;yGm;aponf?

1—2—3—4—

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ukd,fylcsdef usqif;jcif;ukd ukojcif;tqifh 1ukd,fylcsdef 36 - 36³ 5 'D*&D

uav;onf pkdpGwfraea=umif;aocsmygap?uav;ukd apmiftykdrsm;jzifh &pfywfv$rf;jcKHxm;yg?uav;ab;wGif a&aEG;ykvif;rsm;csxm;ay;yg?uav;ukd a&aEG;ykvif;aysmhay:wGif wifxm;ay;yg?wpfem&DtwGif; ukd,fylcsdefukd jyefvnfwkdif;yg?ukd,fylcsdefwufrvmygu tqifh 2 twkdif; qufvufvkyfyg?

tqifh 2ukd,fylcsdef 35³ 5 - 36 'D*&D

rdcif okd@r[kwf zcifrS om;ykdufaumifjyKpkapmifh a&Smufr_ vkyfaqmifyg?30 rdepftwGif; ukd,fylcsdefjyefwkdif;yg?ukd,fylcsdefwufrvmygu tqifh 3 twkdif; qufvuf aqmif&Gufyg?tu,fI aemuf 4em&DtwGif; ukd,fylcsdef > 36 'D*&D jzpfaeygu tqifh 1 okd@jyefajymif;yg?

tqifh 3ukd,fylcsdef < 35³ 5 'D*&D

tyljzef@v$wf ud&d,matmufwGif aEG;axG;apyg?30 rdepftwGif; ukd,fylcsdefukd jyefwkdif;wmyg? tu,fI ukd,fylcsdefonf > 35³ 5 'D*&D jzpfaeygu rdcif okd@r[kwf zcifrS om;ykdufaumifjyKpk apmifha&Smufr_ vkyfaqmifyg?aoG;wGif; o=um;"gwfukd ppfaq;yg?

om;ykdufaumif jyKpkapmifha&Smufenf;pwk&ef;ykH t0wfpwpfpukd axmifhjzwfenf;twkdif; acgufyg?uav;ukd tESD;pjzifh &pfywfyg?rdcif okd@r[kwf zcif. Avmusif;&ifbwfay:wGif uav;wifxm;yg?

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shown to control the colonization of bacteria, especially Staphylococcus aureus. The use of 70% alcohol also falls into this category but inform parents to apply it only to the cord and not to the surrounding good skin which can be burned by the alcohol.

Heat

The 4 rules of infant thermoregulation1. Warm place of birth2. Dry, warm baby clothes3. Delay bathing for 24 hours4. Provide warm environment by skin-to-skin

or wrapping in warm clothes

A wet baby quickly looses heat and the skin temperature drops 3-4°C within seconds after birth. This is a strong stimulation for the baby to start breathing but if the heat loss continues following delivery, the baby will become hypo-thermic (temperature < 35°C). Hypothermia and neonatal death are closely linked, so every effort should be made to prevent even mild de-grees of hypothermia. Once the cord has been cut, babies should be dried quickly after birth and wrapped in a new dry baby cloth Hypothermia puts the infant at risk from:

Low blood sugarPoor weight gainRespiratory difficulties

Treatment of hypothermiaStep 1 Temperature 36°C – 36.5°C

Ensure the baby is not wet - needs clean baby clothWrap the baby in extra blankets

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Place warm water bottles next to babyPlace baby on warm soft water bottleRecheck the temperature in 1 hourIf not increased, move to step 2

Step 2 Temperature 35.5°C – 36°C

Kangaroo care with Mother or Father Recheck temperature in 30 minutesIf not increased, move to step 3If temperature > 36°C over next 4 hours, move to step 1

Step 3Temperature < 35.5°C

Warm under radiant heaterRecheck temperature in 30 minutesWhen temperature > 35.5°C, Kangaroo care with Mother or FatherCheck blood sugar

Kangaroo Care MethodFold a square piece of cloth diagonallyPut cloth nappy on baby

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43


t0wfpukd uav;tm; &pfywfjyD; rdb.ausmbufwGif t0wfpGef;tm;xkH;jcif; okd@r[kwf vufarmif;atmufwGif nSyfxm;jcif;wkd@ jyKvkyfyg?rdbrsm;rS uav;ukdywfI t0wftpm; 0wf&efjzpf onf?

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tu,fI tqkdyg tcsufrsm; &Sdaeygu ta=umif;&if;ukd &SmazGukojyD; atmufqD*sifay;yg?uav;rsm;wGif touf&Skjcif;qkdif&m zdpD;r_ trsm;qkH; jzpfapaom ta=umif;&if;rSm a&m*gykd;0ifjcif; jzpfonf? touf&Skjcif;qkdif&m zdpD;r_ jzpfaeaom rnfonfhuav;rqkd yÉdZD0ta=umaq;rsm; (tefyDqDvifESifh *sefwmrkdifqif) ay;yg?

•

•

1—2—

3—4—

5—6—


5

44


Place the baby on to the Mother or Fa-ther’s naked chest Place the cloth around the baby, either tie a knot around the Parent’s back or secure under the armsParent to dress with clothing around the baby

Oxygen

Assess the presence of respiratory distress for every infant.

Signs of respiratory distress:Nasal flaringCentral cyanosisTracheal tugChest indrawing (including intercostal recession, subcostal recession and Sternal recession)Abdominal breathingHead bobbing

If any of these are present, the cause should be sought and oxygen administered.The most common cause of respiratory distress in a baby is infection. Give IV antibiotics (Am-picillin and Gentamicin) to any infant with re-spiratory distress.

•

•

•

1.2.3.4.

5.6.


5

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toHtkd;a&mif&rf;emvwfwavm toHtkd;ESifh av&SkjyGefa&mif&rf;emonf uav;rsm;wGif touf&Skus,favmifoHukd tjzpfrsm; qkH;aom ta=umif;&if;jzpfonf? 4if;onf yg&mtifzvltif ZmAkdif;&yfpf/ tmtufpfADG (touf&SKvrf;a=umif;qkdif&m

••••••••

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Acute Respiratory Tract Infections (Children < 5 )

Dr. Claudia Turner (SMRU)

IntroductionAcute respiratory infections (ARI) are a leading cause of morbidity and mortality in children in the developing world. It has been estimated that the incidence of clinical pneumonia in the under five population of the developing world is 0.28 episodes per child-year. A review of mortality data from developing countries sug-gested that, in 2000, 1.9 million children died from ARI, 70% of them in Africa and South East Asia.

Results reported by the Committee for Co-ordination of Services to Displaced Person in Thailand (CCSDPT) indicate that lower re-spiratory tract infections (LRTI) were the sec-ond highest cause of morbidity and mortality in refugee infants living on the Thai-Burmese border in 2005.

BackgroundAcute respiratory tract infections can be classi-fied into lower respiratory tract infections and upper respiratory tract infections, depending on the site of the infection.

The focus of this article is the recognition and management of the more serious ARIs. For details of the management of the other condi-tions, see the BBG.

I. Upper Respiratory Tract InfectionsThese include:

Common coldPharyngitisSinusitisCroupTonsillitisEpiglottisDiphtheriaPeritonsillar abscess (quinsy)

Croup

Acute laryngotracheobronchitis (croup) is the commonest cause of acute stridor in children. It affects children from 6 months to 6 years. It is a viral condition caused by parainfluenza virus, RSV (respiratory syncitial virus) or rhi-novirus.

••••••••

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•---

••••••

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touf 5ESpfatmuf uav;rsm;wGiftouf&SKvrf;a=umif;Y vwfwavm ykd;0ifjcif;

6

48


SymptomsThe child will present with a history of com-mon cold-like symptoms and a barking cough. The mother may also complain that the child has a hoarse voice. Usually the child will not look severely unwell, with a fever < 38.5° C, he or she should not be drooling (dribbling sa-liva) and should be able to drink. However the child may have severe respiratory distress with a harsh stridor.

Epiglottitis

This is a medical emergency. It is caused by infection of the epiglottis by Haemophilus in-fluenzae type B and the peak age of presenta-tion 2-3 years of age.

SymptomsThe child is very unwell. Usually there is a short history of a high fever. He or she will be drooling and have severe respiratory distress and stridor. The child will have a muffled voice and complain of pain in the throat.

Acute Respiratory Tract Infections (Children < �)

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6

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6

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SymptomsCoryzal onset No Drooling

Barking coughAble to drinkHarsh stridorHoarse voice

Stridor

SymtomsRapid onset

Toxic appearanceDrooling

Temp > 38.5 C

SymptomsChoking

Sudden onset

Symptoms Skin rash (Urticaria)

ItchingOedema

Leave the child in a comfortable position.DO NOT distress the child.

TreatmentModerate respiratory

distress:Prednisolone 2mg/kg

(mix 40 mg) Severe repiratory

distress:Prednisolone

and 5ml 1:1000 adrenaline nebulized

Treatment Choking child

ProtocolSee BBG

Croup Epiglotitis AnaphylaxisForeign body inhalation

TreatmentEmmergency

transferPrednisolone 2mg/kg

(max 40 mg)5 ml 1:1000

Adrenaline nebulizedCeftriaxone 50 mg/

kg IM

TreatmentIM Adrenaline:

0.05ml < 6months0.012ml 6 months- 5 yrs

0.25ml 6 - 11 yrs0.5 ml 12 yrs +Hydrocortisone25mg TID< 1 yr

50 mg TID 1 - 5 yr100mg TID 6-11 yrs

250mgTID 12+yrs onwards If wheeze 5 mg nebulized salbutamol

Chlorpheniramine SC/IM/IV2.5 mg QID < 1 yr5mg QID 1-5 yrs

10 mg QID 6-1 yrs20mgQID 12+ yrs

Management of a child or infant with stridor

Definition: harsh breathing voice produced by obstructionto breathing in the larynx or trachea, mainly on inspiration.

It is one of the features of upper airway obstructionwith hoarseness and barking cough. 6

�1


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•••

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••••••

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6

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Chest indrawing:Subcostal recessionSternal recessionIntercostal recession

Tracheal tugHead bobbingNasal flaringGruntingCyanosisFast respiratory rate

•---

••••••

Signs of respiratory distress in an infant or

child

Lower Respiratory Tract InfectionThe two commonest lower respiratory tract in-fections in children and infants are bronchioli-tis and pneumonia.

Bronchiolitis

Bronchiolitis is caused by a viral infection that affects lower airways. The commonest cause is respiratory syncitial virus (RSV) but it may also be caused by influenza viruses, parainflu-enza viruses or adenovirus. It is condition that is seen in infants less than 2 years. It can present similar to pneumonia.

SymptomsThe infant will present with a history of com-mon cold-like symptoms, a cough and low grade fever. On examination, the child may have signs of respiratory distress and on auscul-tation, wheeze and coarse crepitations can be audible throughout both lung fields.

< 3 months of ageBorn premature (<37 weeks)Other medical conditions:

Heart diseaseChronic lung diseases

•••

--

Risk factors for severe bronchiolitis

Pneumonia

Pneumonia is an infection of the lungs which can be caused by a bacteria or a virus. The com-monest bacteria causing pneumonia is Strepto-coccus pneumoniae.

Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide, espe-cially in infants and young children. It is an encapsulated Gram positive diplococcus.

Diagnosis of pneumonia in infants and chil-drenThe diagnosis of pneumonia is based on fast respiratory rate in a child with cough or dif-ficulty breathing.

BronchiolitisHeart FailureBeri BeriUpper airway obstructionForeign body aspirationAsthma

••••••

Differential diagnosis of a child with fast

respiratory rate

ConclusionMany children and infants die each year from acute respiratory tract infections, particularly pneumonia. Correct identification of children and infants with pneumonia and prompt treat-ment will save lives.


6

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a&m*gtjyif;pm;tpmvkH;0rpm;jcif;

touf&SKE_ef;jrifhaejcif;touf&Skvrf;a=umif; zdpD;r_&Sdjcif;

tdrfjyefv$wfyg?uav;wGif

touf&Skvrf;a=umif; zdpD;r_ vuQ%mrsm;ay:vmygu okd@

r[kwf tpmrpm;Ekkdifygu jyefvmjyyg?

tqkwfa&mifa&m*g ukor_n$ef;wrf;twkdif;

ukoyg?

tpm;pm;&mwGif jy\em&Sdjcif;touf 3 vatmuf

vraphbJarG;jcif;tjcm;aq;ynmqkdif&m

tajctaersm;tarrS rxdef;Ekdifygu

tpmpm;jcif;ESifh touf&SKE_ef;ukd apmifh=unfh&ef aq;&kHwifyg? (uav;onf tpmjyGefxnfhI

tpmauGs;jcif; vkdtyfEkdifonf) ykHrSeftm;jzifh yg&mpDwarmwkdufyg?

tu,fI touf&SkoHjyif;ygu touf&SKAl;jzifh qmAsKwarm 5 =udrfcef@&SKckdif;ay;yg?

uav;tajctaewkd;wufr_&Sdygu wpfae@ av;=udrf touf&SKAl;jzifh wpf=udrfvsif

qmAsKwarm 5 =udrfcef@&SKckdif;yg?

touf&SKAl;jzifh ay;aom tuf'&D evif

uav;wGif touf&Sk vrf;a=umif; zdpD;r_&Sdygu

q&m0efESifhwkdifyifyg?tuf'&Devif3rDvDvDwmukd

ykHrSef qvkdif;&nf 2 rDvDvDwmjzifhay;yg?

aemufem&D0uft=um aemuf wpf=udrf xyfay;Ekdifonf?

6

�4



Management of Bronchiolitis

MildInfant feeding well

No signs of respiratory distress

ModerateFeeding for shorter time

Mild chest indrawingNo cyanosis

RR not increased

SevereNot feeding well

RR increasedSigns of respiratory

distress

Feeding compromised<3 months

Born prematureOther medical conditions

Mother not coping

Discharge homeAsk the mother to return

if the baby develops respiratory distress

or cannot feed

Admit for observation of feeding (Child might need NGT fluids)

and respiratory rate

Give regular Paracetamol

If wheeze is present, give 5 puffs of salbutamol via a spacer,

if there is an improvement in child’s condition, give 5 puffs

via a spacer QID

no Yes

Nebulized adrenaline

Discuss with the doctor if the infant has severe

respiratory distress

Adrenaline 3 mlwith 2ml NSS

Can be repeated 30 minutes later

Treat using the Pneumonia

Protocol

Common coldRunny noseBlocked nose

Wet sounding coughBilateral crepitations

Wheeze

6

��



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ta=umaq;)

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r&Sdyg&Sdygonf

tvGefjyif;xef tqkwfa&mifa&m*g omreftqkwfa&mifa&m*g

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uav;wGif &ifbwfeH&kd;tdrfcsdKifh0ifjcif; &Sdygovm;?

uav;wGif atmufazmfjyyg wpkHw&m&Sdygovm;?ukd,fwGif;A[dkwGif aoG;wGif;atmufqD*sif avsmhenf;jcif;

touf&SKvrf;a=umif;zdpD;r_ qkd;&Gm;jcif;t&nfraomufEkdifjcif;

jyif;xef tqkwfa&mifa&m*g

tefyDqvif (50rDvD*&rf§uDvkd*&rf

ajcmufem&Djcm;wpfcg tom;§ ta=umaq;) tenf;qkH; 48

em&D ay;yg?

tarmufqDqvifukd yg;pyfrS 7 &uf wkdufyg?

yxrqkH;t=udrfukd aq;cef;wGif wkdufyg?

tu,fI touf&Skjrefvmygu aq;cef;okd@ jyefjy&ef rdciftm;rSm=um;yg?

r&Sdyg

6

��


Management of Pneumonia

Cough and difficulty in breathing plus Count respiratory rate over 1 minute> 60 Breaths and Infants < 2 months> 50 Breaths and child 2-11 months

> 50 Breaths and child 1-5 years

Give ampicillin(50mg/kg IV every 6 hours)

and gentamicin(7mg/kg IV once a day)

noYes

Ensure that the child is receiving adequate fluid.Encourage breast feeding and oral fluids

If child cannot drink:- For Severe Pneumonia, pass a nasogastric tube

and give maintanence fluids in one hourly amounts- For Very Severe Pneumonia, give IV fluids, the doctos and all medics on duty, must be aware of this child, especially overnight.

A child with severe respiratory distresscan be exhausted,

so RR may be slowDoes the infant have indrawing of chest wall?

Does the infant have any of the following?Central cyanosis of oxygenSevere respiratory distress

Inability to drink

Very Severe Pneumonia Severe Pneumonia Pneumonia

Give ampicillin(50mg/kg IV/IM

every 6 hours)for at least 48 hours

Give oral amoxicillinfor 7 days

Give the first dose at clinic

Advise the mother to return if fast breathing

develops

no


6

��



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tvGefjyif;xef tqkwfa&mifa&m*g

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ay;yg? uvkdqmqvif (50 rDvD*&rf §uDvkd*&rf

ta=umaq;wpfae@ av;=udrfay;&ef pOf;pm;yg)

tarmufqmqvif (25 rDvD*&rf§uDvkd*&rf)wkdufjyD; *sifwmrkdifqifukd tom;aq;

okd@ta=umaq;wpfae@wpf=udrf aemufxyf 5 &ufay;yg?

48em&D=umjyD;aemuf wkd;wufr_&Sdygovm;?

aemufqufwGJ qkd;usdK;rsm;ukd

&SmazGyg?

jyif;xeftqkwfa&mifa&m*g

48em&D=umjyD;aemuf wkd;wufr_&Sdygovm;?

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ywf=umonftxd wkdufyg?

5 &uf=umjyD;aemuf uav;onf wkef@jyefr_&Sdvsif

tarmufqDqvifukd yg;pyfrSajymif;wkdufjyD;

*sifwmrkdifqifukd tom;aq; okd@ ta=um

aq; wpfae@wpf=udrf aemufxyf 5 &ufay;yg?

qufx&D&mZkef; 50 rDvD*&rf§ uDvkd*&rf

wpfae@ESpf=udrf 10 &uf ajymif;ay;yg?

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aemufqufwGJ qkd;usdK;rsm;wGiftqkwfwGif;jynfwnfjcif;

tqkwfwGif;a&0ifjcif;tqkwfjynfwnfemwkd@yg0ifonf?

&Sdygonf r&Sdyg

tm;vkH;aom ukor_n$ef;wrf;rsm;onf urBmhusef;rma&;tzGJ@=uD;. csrSwfxm;onfh ukocsufrsm;ay:wGif tajccHonf?

aemufqufwGJ qkd;usdK;rsm;ukd

&SmazGyg?

wkd;wufr_r&Sdygu wDbDtqkwfa&mifa&m*gokd@r[kwf attkdif'Dtufpfa&m*gjzpfyGm;Ekdifajcukd owd&xm;yg?

6

�8


On-going Management of Pneumonia

Very Severe Pneumonia Severe Pneumonia

Improvement after 48 hours

Look for complications

Change to ceftriaxone 50 mg/kg BIDfor 10 days and

consider cloxacillin(50 mg/kg IV QID

After 5 days, if the child has responded

well, change tooral amoxicillin and IV/IM Gentamicin OD for further 5

days

If the child improveson cloxacillin,

continuecloxacillin orally

4 times a dayfor a total course of 3

weeks

Yesno

Improvement after 48 hours

Oral amoxicillin(25 mg/kg TID)

and IV/IMGentamicin ODfor further 5 days

Change toceftriaxone

50 mg/kg BIDfor 10 days

Yes no

Treat complications if found

Complications include:Empyaema

Pleural EffusionLung Abscess

Note: All treatment algorithms are based on WHO guidelines

Look for complications


If there is no improvement, keep in mind the probability of Tuberculosis or AIDS.

6

��


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ta=umif;&if;rsm;t"duta=umif;&if;rSm wukd,fa&oef@&Sif;r_ESifh tpm;tpmroef@&Sif;jcif;rSonf bufwD;&D;,m;ESifh Akdif;&yfpfrsm; ul;puf jcif;a=umifhjzpfonf? tjcm;tjzpfenf;aom ta=umif;&if; rsm;rSm tpm;tpmwpfrsdK;rsdK;ESifh "mwfrwnfhjcif;/ tpm rpkyf,lEkdifjcif;ESifh tpmaumif;pGm racszsufEkdifjcif;wkd@jzpfonf?

1? vwfwavm 0rf;av#mjcif; ( < 14 &uf )tlvrf;a=umif; ykd;0ifjcif; - &kdwmAkdif;&yfpf/ tlvrf;a=umif;wGif; tqdyfoifhapaom tD;ukdvkdif; (vwfwavm 0rf;av#mjcif;twGuf tjzpfrsm;aom ykd;rsm;)? &SD*Jvm;/ pefrkdeJvm; (0rf;ukdufa&m*gtwGuf ta=umif;&if;rsm;) uefykdifvkdAufwm; *sD*sKEkdif/ ,mqD;eD;,m; tefw&kdukdvkdifwDum/ tD;[pfpwkdvkdifwDum/ oefaumifrsm;ukd,ft*FgtzGJ@rsm;twGif; ykd;0ifjcif;- aoG;qdyf wufjcif;/ qD;vrf;a=umif;wGif; ykd;0ifjcif;/ tqkwf a&mifa&m*g

1—

2—

cGJpdwfr_qkdif&m tajctaersm; - tltwuf aygufjcif;/ tluGsHjcif;/ tlvrf;a=umif; wpdwfwykdif; ydwfqkd@jcif;tjcm; - yÉdZD0aq;0g;rsm;a=umifh 0rf;av#mjcif;

2? umv&Snf 0rf;av#ma&m*g ( > 14 &uf)tlvrf;a=umif;wGif; a&m*gykd;rsm; wpfrsdK; okd@r[kwf wpfrsdK;xufykdjcif;a=umifh umv&Snf 0rf;av#ma&m*gumAkd[kduf'&dwfESifh tqDrsm;ukd aumif;pGm rpkyf,lEkdifjcif;pm;aomufxm;aom tom;"mwfukd cHEkdif&nfr&Sdjcif;

3? emwm&Snf 0rf;av#ma&m*gESifh tm[m&aumif;pGm rpkyf,lEkdifaoma&m*gpk (ykHrSefr[kwfaom 0rf;ukd vaygif;rsm;pGm oGm;jcif;)tpmacszsufr_ rrSefuefjcif;- rkH@csdKtdwf a[mfrkef; xkwfvkyfr_ csdK@wJhjcif;/ onf;ajcjyGefusOf;ajrmif; jcif; / tlodrfOD;ykdif; jzwfawmufxm;jcif;/ arG;&myg tifZkdif;rsm; csdK@wJhjcif;tpmaumif;pGm pkyfr,lEkdifjcif; - EGm;Ekd@tom; "mwfrsm;ESifh "mwfjyKr_tvGefrsm;jcif;/ *sD[m'D,m; vefAvD,m ykd;0ifjcif;/ ukd,fcHpGrf;tm; usqif;jcif;/ bufwD;&D;,m;rsm; vGefuJpGm yGm;rsm;jcif;/ tylykdif; a'otlvrf;a=umif;a&m*grsm;/ tm[m&csdK@wJhjcif;?

3—

4—

1—

2—

3—

1—

2—

uav;rsm;wGif jzpfyGm;aom 0rf;av#ma&m*gtrsdK;rsdK;ukd &SmazGazmfxkwfjcif;a'gufwmaZmf (a0gAGD;&Sif;) ESifh apwrmef�

�0


Differential Diagnosis of Diarrhoea Diseases in

ChildrenDr. Zaw (World Vision) and HM

What is Diarrhoea?

Diarrhoea is a symptom and not a disease.Diarrhoea is the passage of liquid stool more than three times a day. However, the recent change in the consistency of the stool rather than the number of stools is the more impor-tant feature.

Causes

The main cause is bacterial or viral with trans-mission from a child to another due to poor food and personal hygiene. Other less com-mon causes are allergy to certain kinds of food, malabsorption or maldigestion.

I. Acute Diarrhoea (<14 days)Enteric Infection Rota virus, Enterotoxigenic E. Coli (ETEC) (Common agents for acute diar-rhoea) Shigella, Salmonella (Causes of Dysentery or bloody diarrhoea) Campy-lobacter jejuni, Yersenia enterocolitica, E. histolytica, wormsSystemic Infection Septicaemia, UTI, pneumonia

1.

2.

Surgical condition Appendicitis, Intussusception, partial bowel obstructionOthers Antibiobic diarrhoea

II. Persistent Diarrhoea (>14 days)Persistent infection with one or more enteric pathogensMalabsorption of carbohydrates and fats Dietary protein intoleranceWorms

III. Chronic Diarrhoea and malnutrition syndrome (over several months of abnor-mal stools)Impaired digestion – Pancreatic exocrine deficiency, Bile duct atresia, Ileal resec-tion, Congenital enzyme deficienciesMalabsorption –hypersensitivity to cow milk protein, Giardia lamblia infestation, immunodeficiency, bacterial overgrowth, tropical enteropathy, malnutrition

Signs and Symptoms

Diarrhoea - loose, watery, greenish mo-tions

3.

4.

1.

2.3.4.

1.

2.

-

�

�1


a&m*gjyvuQ%mrsm;ESifh &SmazGawG@&onfh vuQ%mrsm;

0rf;av#mjcif;- yrm%rsm;aom/ t&nfrsm;aom tpdrf;a&mif rpifrsm;tefjcif;- rsm;aomtm;jzifh tpykdif;wGif jzpfwwfonf?ikdjcif;- emusifjcif;/ qmavmifjcif;/ a&iwfjcif; okd@r[kwf rl;a0jcif;a=umifh jzpfEkdifonf?tzsm;&Sdjcif;- wcgw&Hzsm;Ekdifonf?

tEW&m,f vuQ%mrsm; a&"mwfcef;ajcmufjcif;onf 0rf;av#ma&m*g. t"du tEW&m,fjzpfonf?

uav;onf vrf;aumif;pGm ravsmufEkdifbJ tm;ukefaejcif; okd@r[kwf owdvpfjcif;aoG;ckefE_ef;jrefI tm;aysmhaejcif;ta&jym; jzLazsmhI at;pufaejyD; aysmhaejcif;tmajcmufjcif;ikdaomtcg rsuf&nfrxGufjcif;qD;yrm%avsmhenf;oGm;jcif;

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-

-

-

-

-

-----

-

-

-

-

-

-

uav;rsm;wGif jzpfyGm;wwfaom 0rf;av#ma&m*gtrsdK;rsdK;ukd &SmazGazmfxkwfjcif;

"mwfqm;azsmfd&nfjyifqifjcif;ORS preparation

rSwfpk- "mwfqm;azsmf&nfjyifqifjcif;twGuf jrefrme,fpyf vrf;n$ef pm 245wGif&SKygNote: For ORS preparation, See BBG p.245

Water ac-

cording to

instructions

n$ef=um;csufrsm; twkdif;a&xnfhyg?

7

�2


Differential Diagnosis of Diarrhoea Diseases in Children

Vomiting - usually early onCrying - due to pain, hunger, thirst or nauseaFever - sometimes present

Danger Signs

Dehydration is the main risk in diarrhoeaChild limp, apathetic or unconscious Rapid weak pulse Skin pale and cold, looseSunken eyes and fontanelleDry mouth Absence of tears when crying Urine volume decreased

--

-

-------

Prevention

Children up to 6 months should be breast-fed only.Wash hands with soap before eating and after every toilet.Dispose human waste and garbage prop-erly.Should have fly-proof latrine to prevent fly-born disease.Immunization should be administered according to BBG child immunization schedule.Drinking water should be properly fil-tered and boiled.

-

-

-

-

-

-

rsufvkH;rsm;ESifh yg;rsm; cGuf0ifaejcif;

0rf;Akdufykdif; csdKifh0ifaejcif;

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ta&jym;jyefusKH@ tm;enf;aejcif;

rsuf&nftxGufenf;jcif; okd@r[kwf rxGufjcif;

yg;pyfajcmufaejcif;

Sunken fontanelle

Few or no tears

Dry mouth

Decreased skin turgor Sunken

abdomen

Sunken eyes and cheeks

a&"mwfcef;ajcmufjcif;. vuQ%mrsm;Dehydration signs

7

�3



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ukor_

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tzsm; r&Sdyg

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0rf;t&nfrsm; oGm;jcif;

tzsm;&Sdonf

0rf;csKyfjcif; okd@r[kwf z&JoD;t&nfuJhokd@ 0rf;avsmjcif;/ tzsm; ykHrSef&Sdjcif;/ abvkH;ukd prf;oyfI&onf? tm;aysmhaom aoG;ckef E_ef;/ uav; aeraumif;ykHay:onf? arG; uif;prsm;wGif wpfae&m&mY ykd;0ifjcif; &SdEkdifonf? Oyrm-t&kd;jcifqDa&mif &rf;jcif;/ 0rf;ppfjcif;- aoG;jzLOrsm; (-)

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7

�4




Major Signs Risk FactorsSymptoms and SignsStool examination

Diagnosis Treatment

Acute Diarrhoea

Profuse liquid stools

No fever

Contamination from water and food; Sudden onset; Rapid dehy-dration and circulatory collapseRice-watery stools; Usually no fe-ver or blood in stools; Unusual in breast fed; Ice-water like vomit-ing, Stool Exam: leucocytes (-)

Cholera See BBG p 78 (12.2)

See BBGDiarrhoea Treat-ment Protocol(p 283)

Epidemic among children Rotavirus See BBGDiarrhoea Treat-ment Protocol(p 283)

Children having shared same meal sick at same time: acute onset, colic, vomitingSE: Leucocytes (+) or (-), de-pending upon organisms

Collective food toxic infection (CFTI) = Food poisoning

Acute Diarrhoea

Liquid Stools

Fever

Constipation or diarrhoea with “melon juice” like stools; Con-stant fever; Spleen palpable, Relatively slow pulse; Child is toxic; Infants may have infection elsewhere e.g osteomyeolitis; Dis-sociated pulse

Salmonel-losis,Typhoid fever

See BBG p 15

Frequent liquid stools; Abdomi-nal pain or cramps and vomiting SE: leucocytes (-)

Malaria, Otitis

Malaria: see BBG p 124, Otitis: see BBG p 197

Passage of stools which gradually contain blood andlater consists of blood and mucus only (not really diarrhoea but of-ten admitted as diarrhoea) Age 6 months - 3 years, sudden attacks of pain, often vomiting, Later abdominal distension

Intussus-ception

See BBGDiarrhoea Treat-ment Protocol(p 283)If needed, refer-ral for enema or laprotomy

7

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t"du vuQ%mrsm;

jzpfyGm;aponfh ta=umif;rsm;a&m*gvuQ%mrsm;rpif (0rf;) ppfaq;jcif;

a&m*g&SmazG azmfxkwfjcif;

ukor_

emwm&Snf okd@r[kwf r=umr=um jzpfaom 0rf;av#m a&m*g (0rf;av#m a&m*gESifh tm[m& csdK@wJhjcif;)

r=umr=um jzpfjcif;

ukd,fav;csdef avsmhusjcif;

tzsm;r&Sdjcif;

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Ekd@jzwfjcif;a=umifh 0rf;av#mjcif;

jrefrme,fpyfvrf;n$ef 0rf;av#ma&m*gukor_ vrf;n$ef (pm -283)rdcifEkd@ wkdufaeyguEkd@qufpkd@apyg? Ekd@Al;wkdufaeygu &yfvkdufyg? pGrf;tm;jynfhtpmrsm;auGs; yg? umv&Snfjyefjyckdif;jyD; rdbrsm;ukd ynmay;yg?

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jrefrme,fpyfvrf;n$ef (pm -77) &Skyg?

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jrefrme,fpyfvrf;n$ef (pm -83) &Skyg?

tpm;enf;jcif;/ rsm;aomtm;jzifhykd; ul;pufjcif;r&SdbJ 10 -14 &uft=um wGif tpm;rsm;vmonfESifhjyefaumif; oGm;wwfonf? wcgw&Hykd;0ifjcif; &Sdwwfonf?

aum&Smaum tm[m&csdK@wJh jcif;ESifhqufpyf onf?

aemufykdif;aqmif;yg;jzpfaom tm[m&csdK@wJhjcif; (yDtD;trf)wGif&Skyg?

tqDrsm;I tjrSKyfxaom 0rf;oGm; rsm;jcif;/ yrm%rsm;jyD; te@Hqkd;onf? acgif;ukdufrl;a0jcif;/ uav;rsm; pkjyKHae&aom taetxm;wGif jzpfyGm;wwfonf?

*sD[m'Da&;ppf jrefrme,fpyfvrf;n$ef (pm -77) &Skyg?


7

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Major Signs Risk FactorsSymptoms and SignsStool examination

Diagnosis Treatment

Chronic or recurrent diarrhoea(diarrhoea and malnutri-tion)

Intermittent+/- abdominal pain

Weight loss

No fever

Recent cessation of breast feedingBottle feeding, Inadequate diet, Poor hygieneAge 6 months- 2 yearsVery common

Weaningdiarrhoea

See BBG Diarrhoea Treatment Protocol(p 283)If breast-feeding, continue.If bottle-used, stop.High energy infant foods.Long follow up. Educate parents

Insufficient enzyme lactaseMay follow diarrhoea due to other causes

Lactoseintolerance

Stop giving milk for a short timeGive other infant foods high in energy and protein.

Low standard of living, Not usually in breast-fed. Ab-dominal cramps, high fever, Mucus in stool and often blood, Amoebic hepatitis or liver abscess may follow.

Amoebicdysentry

See BBG p 77

Non-specific digestive distur-bances Stool Examination: ascaris, ankylo EggsLeucocytes (-)

AscaridiasisAnkylosto-miasisTrichoceph-alosis

See BBG p 83

Poor dietUsually not infective, with improve with good diet over 10-14 days, occasionally infection also present.

Associ-ated with Kwashior-kor

See next article about Protein Energy Mal-nutrition

Loose fatty frothy stools, bulby and smelly. Nausea. Occurs when children live in crowded setting.

Giardiasis See BBG p 77

7

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uav;oli,f tm[m&csdK@wJha&m*g t"dy`g,f zGifhqkdcsufuav;oli,f tm[m&csdK@wJha&m*gonf tm[m&csdK@wJhjcif;jzpfjyD; vwfwavm (a&wkd)ESifh emwm&Snf (a&&Snf) wkd@jzpfEkdifonf? uav;oli,f tm[m&csdK@wJha&m*gonf uav;a&m vl=uD;yg jzpfyGm;Ekdifaomfvnf; uav;rsm;wGif ykdtjzpfrsm;onf?

vwfwavm uav;oli,f tm[m&csdK@wJha&m*gwGif aum&SmaumESifh r&pfpfrwf[lI ykHpHESpfrsdK;&Sdonf? uGJjym;csufrSm azma&mifjcif;&Sdjcif; (aum&Smaum)ESifh r&Sdjcif; (r&pfpfrwf) yifjzpfonf? r&pfpfrwfa&m*g&Sdaom uav;onf ydefvSDaeykH&jyD; aum&Smauma&m*gjzpfaom

uav;onf 0ykHay:ae&onfrSm azma&mjcif;&Sdaoma=umifh omjzpfonf? tcsdK@uav;rsm;wGif aum&Smauma&m r&pfpfrwfyga&mI &Sdwwfonf?

vwfwavm tm[m&csdK@wJha&m*gonf uav;rnfr# avmuf tm[m&csdK@wJhaeEkdifonfay:rlwnfI tv,f tvwfa&m qkd;&GmpGmygjzpfEkdifonf? uav;oli,f tv,ftvwf tm[m&csdK@wJha&m*gukd tdrfwGif ukoEkdif aomfvnf; qkd;&Gm;aom tm[m&csdK@wJha&m*gukdrl aq;&kHokd@r[kwf aq;cef;wGif jyKpkukoavh&Sdonf?

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&&Sdaeaom tpm;tpmrsm; &kwfw&uf avsmhus oGm;jcif; (tpm;tpm;rsm;r&Sdjcif; okd@r[kwf &duQm jzef@a0r_r&Sdjcif;) tpm;tpm &&SdEkdifr_

8

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Protein Energy Malnutrition (PEM)

Andrea Menefee, MPH, RD Food Security Programme Coordinator (TBBC)

Background:

Malnutrition is globally the most important risk factor for illness and death, contributing to more than half of deaths in children world-wide.

Food shortages and nutritional problems are frequent in refugees or displaced populations, leading to high prevalence rates of malnutri-tion. Protein-energy malnutrition (PEM) is a major cause of death as malnutrition increases vulnerability and severity of diseases.

PEM Definition

Protein-energy malnutrition is a malnutrition that can be either acute (short-term) or chronic (longer-term). PEM can occur in both children and adults, but occurs more often in children.

Kwashiorkor and Marasmus are 2 forms of acute PEM. The difference is the presence (Kwashiorkor) or absence of oedema (Maras-mus). A child with marasmus will look thin, and a child with kwashiorkor with look fat, but only because they have oedema. Some children may have a mixture of marasmus and kwash-iorkor.

Acute PEM can be either moderate or severe, depending on how malnourished a person is. Moderate PEM can be treated at home, but severe PEM is usually treated at a hospital or clinic.

PEM is identified by taking the weight and height of a child and comparing it to healthy groups of children (refer to next article about Growth Monitoring for details). Mid arm circumference is also used as an indicator for assessment of nutritional status.

Common Causes and Effects of PEM:

There are 2 main reasons why malnutrition is higher in a population which has been dis-placed:

The sudden reduction in food available (due to real lack of food or distribution of rations) and in food accessibility (no way to buy food or inequities in the food distribution). The health environment is poor, and exposes people to more communicable disease, lower standard of health services, lack of water, poor hygiene, etc.

8

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uav;oli,f tm[m&csdK@wJha&m*gonf ukd,fum,ykdif; qkdif&m=uD;xGm;r_ukd ysuf,Gif;apjyD; pOf;pm;qifjcifr_ESifh tjcm;ZD0urRaA'qkdif&m vkyfaqmifcsufrsm;ukd aES;auG;aponf? (uav;=uD;xGm;zGH@+zdK;r_ tqifhqifhESifh ywfoufonfh aqmif;yg;ukd rSDjirf;zwf&Skyg) tm[m&csdK@wJhr_jzpfaomtcg ukd,fcHpGrf;tm; tajymif;tvJrsm; apmpD;pGmjzpfay:vmonf? tqkdyg ukd,fcHpGrf;tm; tajymif; tvJrsm;onf tpmpm;csifpdwf r&Sdjcif;/ tm[m&pkyf,lr_usqif;jcif;/ vkdtyfr_rsm; rsm;jym; vmjcif;ponfhtm[m&ESifh ywfoufI xdckdufapaom ul;pufvG,f 0rf;av#ma&m*guJ@okd@ jyif;xefonfh emwm&Snf ykd;0ifjcif;rsm;ukd uav;rsm;wGifjzpfyGm;aponf?

tm[m&csdK@wJhaom uav;rsm;onf OD;aESmufzGH@jzdK;r_E_ef; usqif;jcif;/ OD;aESmuftav;csdef enf;yg;jcif;tygt0if OD;aESmufykdif;qkdif&m tajymif;tvJrsm;ukd jzpfyGm;aejyD; 4if;wkd@onf ta=umif;trsdK;rddfsK;a=umifh pdwfykdif;qkdif&m wkd;wufzG@HjzdK;r_aES;auG;aomvlemrsm;ESifh o¾mefwlonf?

uav;oli,f tm[m&csdK@wJha&m*g. a&m*gjyvuQ%mrsm;ESifh prf;oyfawG@&Sd&onfh vuQ%mrsm;

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uav;oli,f tm[m&csdK@wJha&m*gukd ukopDrHjcif;tv,ftvwfESifh qkd;&Gm;aom uav;oli,f tm[m&csdK@wJha&m*gwkd@ukd ukor_. &nf&G,fcsufay:rlwnfI uGJjym; aom enf;vrf;rsm;jzihf pDrHukoavh&Sdonf?

uav;oli,f tm[m& qkd;&Gm;aomcsdK@wJha&m*gwGif ukor_onf uav;toufqkH;&SKHr_ukd umuG,f&ef OD;pGm ypfrSwfxm;aqmif&GufjyD; aemufykdif;wGif tm[m&wkd;wufatmifaqmif&Gufonf?uav;oli,f tm[m&tv,ftvwfcsdK@wJha&m*g wGif ukd,ftav;csdef vsifjrefpGmwkd;jyD; a&m*g ykd;0ifjcif;rsm;ukd uko&ef t"du ypfrSwfxm;onf?

qkd;&Gm;aom uav;oli,f tm[m&csdK@wJha&m*gukd pDrHukojcif;qkd;&Gm;aom uav;oli,f tm[m&csdK@wJha&m*gwGif txl; *&kjyKukor_qkdif&mESifh tm[m&qkdif&m ukor_rsm;yg0ifjyD; tqifhESpfqifh&Sdonf?

-

--

-

-

-

uav;oli,ftm[m&csdK@wJha&m*g (yDtD;trf)

8

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PEM impairs physical growth and slows men-tal and other physiological functions (refer to the article about Development Milestones for reference). Also, immune changes hap-pen early when malnourished. These immune changes cause children to have severe and chronic infections, like infectious diarrhoea, which further interferes with nutrition causing loss of appetite, decreased nutrient absorption, and higher needs.

Malnourished children also have brain chang-es, including reduced rate of growth of the brain, lower brain weight, and these are similar to those in patients with mental retardation of different causes.

Clinical signs and symptoms of PEM:

Poor weight gain (from growth monitor-ing) or weight loss<-2 or <-3 z-scores weight for height Slowing of linear (height) growth (low height for age)Behavioural changes - irritability, apathy, decreased social responsiveness, anxiety, and attention deficitsPhysical changesDecrease in fat and muscle: most affected areas are the legs, arms, buttocks, and face. Oedema on arms and legs Oral changes, such as angular stomatitis (sores on both sides of the mouth from vitamin B deficiency)Distended (big) stomach, and enlarged, fatty liver

-

--

-

Skin changes, such as dry peeling skin with raw exposed areasMicronutrient deficiencies, such as iron-deficiency anaemia (iron deficiency), goi-tre (iodine defiency), night blindness and xerophthalmia (vitamin A deficiency) may also be present

Management of PEM

Severe and moderate PEM are managed in dif-ferent ways according to the objective of the treatment.

Treatment of severe malnutrition is fo-cused on preventing death in the child by stabilizing them, and then later improv-ing their nutritional status.Treatment of moderate malnutrition is focused on rapid weight gain and treating any infections.

Treatment of severe PEM

Severe PEM involves intensive medical and nutritional treatment, involving two phases:

Phase 1: in the clinic, medical treatment, in-cluding rehydration, is started to control in-fection and reduce risk of death. At the same time, careful introduction of special diet will prevent child from wasting. It will allow nor-malization of metabolic functions and prepare them to manage large amounts of food given later during the rehabilitation phase.

Phase 2: the focus is on weight gain and cor-recting nutritional deficiencies.

-

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8

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aq;ynmykdif;ykdif;qkdif&m aemufqufwGJqkd;usdK;r&Sdaom uav;rsm;ukd tu,fI ukor_&if;jrpfenf;yg;aeygu 'kwd,tqifhokd@ wkduf&kdufukoEkdifonf?t&nfraomufEkdifaom uav;ukdom tpmtdrfwGif; tpmoGif;ykdufxnfhyg? okd@aomf4if;onf aemufqkH;a&G;cs,fr_om jzpfoihfonf? 24 em&DtwGif; r=umc% tpmtenf;i,fpD auGs;jcif;onf jyefvnfusef;rmvmap&ef ta&;=uD;onf?ukor_yxrqifhtwGif;wGif ykd;0ifjcif;ukd ykdrkdqkd;&Gm;ap Ekdifaom oH"mwfjznfhqnf;jcif; ray;ygESifh?

•

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owd&rSwfom;xm;oifhonfh ta&;=uD;tcsufrsm;


qkd;&Gm;aom uav;oli,f tm[m&csdK@wJha&m*gukd ukojcif;tqifhrsm;

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yxrqifh - 24 em&D apmifha&Smufjcif;

1 - 7 &uf

1? a&"mwfjyefvnf jznfhwif;jcif;

2? aq;bufqkdif&m ukor_ukd pwifyg?

3? tm[m&ykdif; qkdif&mukor_ukd pyg?

txl; "mwfqm; azsmfpyf enf;

ukd,ft*Fgykdif;qkdif&m owfrSwfxm;aom ukor_

wpf&ufvsif 8- 10=udrf pGrf;tm;jrSifhEkd@&nf (tdyfcsf tD;trf wpftufzf 75)

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pepfwus pHE_ef;ukxkH; twkdif; ukyg?

tpm;tpm yrm%ukd wajz;ajz; wkd;yg?

pm 157 pmAl; 3

pm 157 pmAl; 4

pm 156 pmAl; 1

'kwd,qifh- ae@pOf apmifha&Smufr_

(š)§(-) 14 &uf*

1? aq;ukor_ qufvuf aqmif&Gufyg?

2? tm[m&ykdif;qkdif&m jyefvnfxlaxmifjcif;

3? vlr_a&;ykdif;qkdif&m ywf0ef;usifokd@ ajymif;ypfjcif;

ukd,ft*Fgykdif;qkdif&m owfrSwfxm;aom ukor_

wpf&ufvsif 4- 6 =udrf pGrf;tm;jrifhEkd@&nf (tdyfcsf tD;trf wpftufzf 75)

tpmrsdK;pkHauGs;yg? vlr_Om%qkdif&m Ed_;qGay;jcif; aqmif&Gufyg?

pHcsdefrSDukoenf;twkdif; ukyg?

tpm;tpm yrm%ukd wajz;ajz; wkd;yg?

a'owGif;tpm;tpm rsm;a&mauGs;jcif;/ xdawG@qufqHr_ay;jcif;/ upm;ap&eftm;ay;jcif;

pm 159 pmAl; 7

pm 158 pmAl; 5

*tqifh 1 twGif; uav;ukd auGs;aeaom tpm;tpmrsm;onf tm[m&ykdif;qkdif&m jyefvnfxlaxmifjcif;ukd raqmif &GufEkdifaoma=umifh ukoaom tcsdefonf 7 &ufatmufwGifom owfrSwfxm;oifhonf? tqifh 2 rSukoaom tcsdefonf aejyefaumif;vmjcif; tajctaeay:wGif rlwnfonf?

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References:

Children without medical complications can be admitted directly to the second phase if re-sources are limited.Only use a naso-gastric tube if the child cannot drink, but this should be a last option.Small frequent feeding during 24 hours is im-portant to recoveryno iron supplements during phase 1 - iron can make infections worse

•

•

•

•

Important points to rememberPhase 1Feeding: Composition and frequencyFeeds must be given in small amounts and fre-quently. Children should generally not be force fed: use the child’s appetite as a guide.

Food requirements have to be calculated ac-cording to body weight and how often the child needs to be fed. Phase 1 High-energy milk (HEM) formula has low nutrients to help the child adjust to taking food, but will not


Treament Phase of Malnutrition

CARE ACTIONS COMMENTS BBG

PHASE 1:24-Hour Care

1 - 7 Days

1. Re-hydration

2. Start medical treatment

3. Start nutritional treatment

Dilute ORS Formula-tion

Systematic + Prescribed treatment

8-12 feeds/day of HEM 1 (F75)

All children day 1, then as required

Treatment standard protocol

Gradually increase volume of feeds

p 157 box 3

p 157 box 4

p 156 box 1

PHASE 2:Day-Care

+/- 14 days *

1. Continue medical treatment

2. Nutritional reha-bilitation

3. Transition to so-cial environment

Systematic + Prescribed Treatment

4-6 feeds/day of HEM 2 (F100)

Vary diet, provide psy-chosocial stimulation

Treatment standard protocols

Gradually increase volume of feeds

Add local foods, provide interaction / encourage playing

p 159 box 7

p 158 box 5

* The time a child spends in Phase 1 should be limited to less than 7 days as the diet provided does not allow nutritional rehabilitation. The length of time in Phase 2 depends on the rate of recovery.

8

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8

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cause weight gain so should not be given for more than 1 week.

Volume = 135 cc (ml) x body weight (kg) per day.

This amount should be provided through a high number of small feeds:

Day 1 - 2: 12 feeds (every 2 hours)Day 3 - 7: 8 feeds (every 3 hours)

If these frequencies are not possible, an abso-lute minimum is 6 feeds/ day, but at least 1 must be given during the night. Psychological stimulation of the child by caretaker and health workers is very important in getting the child to eat again.

How to make High Energy Milk (HEM) for therapeutic feeding is detailed in the BBG p 156 and 158.

Minerals A limitation of the HEM formula is that it does not contain enough potassium and other min-erals which the malnourished child has lost. HEM should be supplemented with mineral mix. If not available, 2 g of potassium chloride can be added per 1000 ml HEM.The potassium added must be very con-trolled because of the possible potassium over-loading. If uncontrollable, bananas should be added to diet as source of potassium.

Phase 2Discharge to phase 2: Until medical compli-cations (dehydration, systemic infections, and risk of hypothermia or hypoglycaemia) are un-der control, the child will stay in the 24-hour intensive care unit for treatment and observa-tion.

Once the medical complications are under con-trol, the child can be transferred to the second phase (day-care). The indications for moving to the Second Phase are:

Recovery of appetite Change of attitude/expression (i.e. the child loses his lethargy and becomes interested in the environment and may start to smile).Beginning of fading of the oedema in Kwashiorkor cases (no need of complete loss of oedema before moving to the Phase II).

Complications and Their Treatments

Treatment is focused on the main causes of death in malnourished children and towards correcting metabolic imbalances and vitamin deficiencies.

Main Causes of Death in Severe PEM

1. DehydrationChildren with severe PEM almost always have diarrhoea, resulting in severe dehydration and malabsorption. Diagnosis of dehydration in children with PEM is difficult, especially for those with Kwashiorkor.


8

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••••


8

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Give oral rehydration whenever possible and, if necessary, by a naso-gastric tube. Intrave-nous fluids are not recommended in treating severely malnourished children because there is serious danger of circulatory system overload, leading to pulmonary oedema and death. The respiratory rate should be monitored every 30 minutes to monitor cardiac overload.

References:

Indications for naso-gastric feeding are:Complete anorexia – loss of appetiteSevere dehydrationChild cannot drink (too weak)Repeated vomitingTry to breastfeed or feed by spoon each time before feeding through the tube. If possible, try not to tube-feed for more than 3-4 days. The tube should be changed every 24-48 hours by trained health staff.It is important to take time to explain the neces-sity of tube feeding to the parents to avoid fear.

•••••

•

NASO-GASTRIC FEEDING

2. InfectionAlmost all severely malnourished children are suffering from infection. The most frequent are:

Respiratory tract infectionsUrinary tract infections Measles Gastrointestinal infections

It is crucial to examine each child carefully on admission, and examine them each day dur-ing the first phase of treatment. The severe complications with measles for malnourished children lead to a very high case fatality rate (30%). Common complications with measles are bronchopneumonia, diarrhoea, stomatitis, otitis, laryngitis, and vitamin A deficiency.

••••

3. HypothermiaSeverely malnourished children cannot regulate their body temperatures adequately and cool very quickly when external temperature drops. Body temperature should be measured once or twice daily and the child should be kept warm: let the mother keep the child close and provide adequate supplies of blankets. Never wash a hypothermic child, not even with warm water.

4. HypoglycemiaDeath by hypoglycaemia occurs frequently and most often at night. So it is essential that there is regular feeding during day and night.

5. Cardiac failureCardiac failure can result from electrolyte im-balances, too much fluids or severe anaemia.Proper oral rehydration and nutritional reha-bilitation protocols will prevent those causes.

6. Severe AnaemiaFolic acid (2.5 mg/day) should be given from the day of admission. Iron should NOT be giv-en during phase 1 as it can promote bacterial growth causing some infections worsened.

Treatment of moderate PEM

Moderate PEM can be treated at home by pro-viding the child with extra – supplementary nutritious foods, and educating the caretaker on how to provide these foods so that the child can recover.

A child should always be evaluated first by a health worker to determine presence of infec-tions and vaccination status. A moderately


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••

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8

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malnourished child needs at least 500 extra kcal per day. This equals at least 2 extra meals that are high in energy and nutrients. The child should be weighed weekly, and their progress monitored to be sure that nutrition status is improving.

References:

Infections need to be treatedKeep child from becoming severely malnour-ished by providing nutritious supplementary foods Be sure that supplementary feeding foods are given to child between regular meals at least 2 times per day

••

•

IMPORTANT POINTS TO REMEMBER:

Follow up and home instructions (educa-tion about nutrition)Families and households of malnourished chil-dren should be followed up to find out the cause, and provide with nutrition/health edu-cation on hygiene, feeding practices, prepara-tion of the supplementary ration and targeting the ration to the malnourished child.

Positive gains should be praised, if weight re-mains stable or falters, the reasons for ineffec-tive treatment should be investigated. Some examples of why treatment fails are:

Supplementary ration shared among family membersSupplementary ration soldSupplementary ration eaten in place of normal mealsChild suffers from recent illness

Prevention of PEM

Prevention of malnutrition in children starts with an emphasis on prenatal nutrition and

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good prenatal care. Health care providers should emphasize the importance of breast-feeding in the first year of life. In addition, they should advise parents on the appropriate introduction of nutritious first foods. Educa-tion and improvement in hygiene practices and sanitation reduces the incidence of infectious diseases, which decreases the incidence of mal-nutrition.


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Child Growth MonitoringErika Garrity Pied, MS, RD

Nutrition Technical Officer, (TBBC)

“Children born in different regions of the world and given the optimum start in life have the potential to grow and develop to within the same range of height and weight for their age (WHO).”

Why measure growth?

Good nutrition is essential for healthy growth and development of children. One way to de-termine that a child is receiving adequate nu-trition is to monitor their growth and devel-opment. The growth status of children is also a measure of the health and well-being of the whole community.

Growth monitoring means checking regularly that a child is growing according to standards set for their age, their height, and their weight as compared to a population of healthy chil-dren. Regular measurements of growth allow for the early detection and treatment of mal-nutrition.

Growth monitoring measurements

The World Health Organization has standard-ized the growth monitoring process for consist-ent growth monitoring all over the world.

The 3 main measures needed for child growth monitoring are:

AgeHeightWeight

When these measures are used together, they provide important information about a child’s nutritional status. When two of these meas-ures are used together, they are called an in-dex. There are three commonly used indices in assessing the nutritional status of children discussed below.

Note: either “Length” or “Height” can be used in the designation of the index.

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Growth Monitoring Guidelines: In the camps, growth monitoring should be conducted for every child monthly from birth until 3 years of age and every 6 months from 3-5 years of age. The child’s weight should be plotted on a growth chart according to age. Every child should have their own growth chart.

Recording and interpreting growth monitoring measurements:Every child should have their own growth chart. The practical benefit of growth monitoring to promote better nutrition and child health are wholly dependent on effective follow-up ac-tion by health workers and parents.

Healthcare staff needs to work with the parents of at-risk, moderate or severely underweight or

malnourished children to investigate why this is happening to the child and how to improve the situation.

Growth charts reveals underweight status of a child. It is based on the weight-for-age (W/A) index and is a combined measure of stunting and wasting. It is used to determine if a child is growing well, or if their growth is faltering over time.

A child whose growth curve shows a levelling-off or flattening needs help – health workers should talk with the parents to find out why the child’s growth is faltering.

Child Growth Monitoring

UnderweightWeight-for-AgeW/A Weight-for-Height

W/H

Height-for-Age H/A

Chronic malnutrition

Acute malnutrition

Weight-for-age (W/A): identifies a child who is underweight for a specific age.It is the main index used in growth monitoring because it shows both chronic and acute malnutri-tion (but it cannot distinguish between the two).

This index is plotted on a child’s growth chart. If a child’s growth begins to slow down or falter, height can be checked, and then height-for-age (H/A) and weight-for-height (W/H) indices can be used to help determine the cause(s) of growth faltering.

Height-for-age (H/A): identifies a child with chronic malnutrition - also called stunting. This index gives an idea about nutrition well-being in the long-term and past malnutrition.

Weight-for-height (W/H): identifies children suffering from acute malnutri-tion - also called wasting. This index is used to enrol children into supplemen-tary or therapeutic feeding programs.

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Figure 1 - ykH 1


Example of a healthy growth curve

Figure 1, the child’s weight-for-age falls within the acceptable range of the growth curve and is continuing in an upward mo-tion – not levelling off or falling.

Health Worker Response:

Let the parents know that their child is growing well and show them the growth chart. You may ask how frequently the child breast feeds per day, how frequently he eats solid foods, and what he likes to eat. The responses can help you to learn how healthy children are being fed and may be useful to share with other parents whose children are struggling to gain weight.

Example of a levelling-off growth curve

Figure 2, this 9 month old child is 6.8 kg. When she was 6 months, she weighed 6.7 kg. This is an example of a levelling off or flattening growth curve. Even if the child’s weight is over -2 z-score, the child’s growth is faltering if the curve becomes flat.


Explain to the parents that the child’s growth has slowed down and show them the growth chart. Some topics and ques-tions that can be asked are:• Is the child currently breastfeeding? How many times per day?• Is the child drinking sweet milk instead of breast milk?• Child > 6 months: Is the child being weaned from exclusively breastfeeding?• How many times a day does the child have a meal and what does he eat?• Has the child been eating less than usual?• Has the child been sick lately?Next, provide recommendations to the parents based on their responses..

Figure 2 - ykH 2

Figure 3 - ykH 3

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A falling growth curve is a more urgent indica-tor requiring further investigation and help. A child whose weight-for-age (W/A) falls below -2 z-score should be checked to determine if they have wasting or stunting malnutrition.

Causes of growth faltering

Wasting, or acute malnutrition status is based on a low weight-for-height (W/H) index and is a result of a child’s weight falling significant-ly below the weight expected of a child of the same height.

Wasting indicates short-term malnutrition re-sulting from failure to gain weight or actual weight loss. Causes include inadequate food intake, incorrect feeding practices, disease, and infection or, usually, a combination of these factors.

Weight-for-height

Z-score between -2 and -3: Moderate wastingZ-score < -3: Severe wasting

References:

Moderate wasting supplementary feeding pro-gram (SFP). Severe wasting therapeutic feeding program (TFP).If such a program is not available, make sure the child receives extra nutritious foods between meals (in appropriate size and consistency for their age) such as beans, nuts, fish, eggs, or fortified foods in addition to rice.Encourage the parents to continue breastfeeding, to provide meals frequently and to seek out medical at-tention if needed.

Response for a child with wasting

malnutrition:

Stunting, or chronic malnutrition, is based on a low height-for-age (H/A) index. When a child’s growth slows down, it results in a failure to achieve expected length/height as compared to a healthy, well nourished child of the same age.

Stunting takes much longer time to develop than wasting. It is associated with long-term factors including, insufficient protein and en-ergy intake, frequent infection, sustained inap-propriate feeding practices and poverty.

In children over 2-3 years of age, the effects of these long-term factors may not be reversible.

Height-for-ageZ-score between -2 and -3: Moderate stuntingZ-score < -3: Severe stunting

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Example of a falling growth curve

Figure 3, the child is 5.8 kg. Three months ago she weighed 6.8 kg. The child’s growth curve is falling.


Determine the child’s W/A z-score. If the W/A z-score is less than -2, measure the child’s height to determine if he has wasting or stunting malnutrition.Explain the growth chart to the parents and emphasize your concern for the child’s faltering growth. Discuss with the parents to assess the reasons for the decline in the child’s growth. You can use the same ques-tions as above.

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ao;auG;aom tm[m&csdK@wJhr_&Sdonfh uav;ukd wk@Hjyefjcif;

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References:

Provide education to the parents about proper child feeding practices, good hygiene, proper sanitation and the benefits of their child not being chronically malnourished.Let them know the four outcomes of chronicle mal-nutrition for the children:1. They are shorter for their age2. They are not as physically strong for their age3. They have a more difficult time concentrating and learning in school4. They are sick more often

Response for a child with stunting

malnutrition:

Materials Needed for Growth Monitoring:

A hanging, calibrated Salter spring scale to 25 kgSarong to hang from the scale for the child to lay/sit inA height/length board in good condition that meets UNICEF specifications - up to 120cm

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WHO/NCHS normalized reference weight-for-height (Z-score tables)Pens and clipboards for recording meas-urementsChild growth chart to record measure-ments

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Intestinal Worms in Children

Dr. Marcus Rijken (SMRU )

Children in a wormy world

Worms are parasites that can live in human in-testines. Some are big enough to see with the human eye, some are very small and harder to see. Some can enter the body through the mouth as worm eggs; others enter through the skin as larvae.

It is therefore important for children to devel-op the habit of washing hands properly, keep-ing nails short and clean and wearing footwear when playing on the ground (soil).

In our region, the most common worms are called Soil Transmitted Helminths and are:

Hookworms (Necator americanus & Ancylostoma duodenale)Roundworms (Ascaris lumbricoides)Whipworms (Trichuris trichiura)

Worm infections greatly affect a child’s health and well-being. Light worm infections may have no symptoms and thus go unnoticed. When the number of worms increases, they can cause stomach ache and diarrhoea. Both light and heavy worm infections lead to poor

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health in children. Worms take nutrients in-tended for the development of the child’s body and cause:

Loss of nutrients which can lead to anaemia or worsen malnutritionRetarded growth and developmentPoor learning ability and poor school performance

Children with worm infections often feel un-well and so they are absent from school more often than healthy children. Children who are worm-free are more active, perform better at school, and are more resistant to diseases.

Route of Transmission

Worms can enter the human body through the mouth when eating or drinking contaminated food or water. Another way of becoming infect-ed is eating undercooked meat from contami-nated animals. Some worms are passed from one person to another through contaminated faeces. This usually happens when a person in-fected with worms defecates and does not wash his or her hands. The eggs of the worms are very small, and often you don’t see them being

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uav;rsm;wGif tlvrf;a=umif;wGif; oefxjcif;

Hookworm transmission

oefcsdwfaumif ul;pufysH@ESH@jcif;

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transferred to food, water or the hands of other persons.

Some worms are also transmitted from infect-ed animals. For example, animals such as cows and pigs might eat tapeworm (Taenia) eggs as they graze or search for food. These eggs then move into the flesh of the animals where they live and grow to become larva. If the meat is not cooked properly, a person might ingest the se larva and thus get infected.

Another way of getting infected with worms is entry through the skin (hookworms). Infection usually happens when walking barefoot on soil or sand that is contaminated with faeces. Lar-vae can enter the feet or buttocks of children and enter the blood stream. Once in the blood stream, they can reach the intestines.

Prevalence

The amount (prevalence) of infection with soil transmitted helminths in school age children is used as the indicator to guide programs for the whole population. The World Health Organi-zation (WHO) recommends that if the preva-lence is more than 20%, all children should be treated once a year; if it is more than 50% then treatment should be twice a year. A recent SMRU survey among pregnant women in Mae La refugee camp showed 60% of women were infected with intestinal worms.

Treatment

Worm infections are easily treated by using de-worming drugs. De-worming tablets effective-ly kill worms inside the body. De-worming can be done every six months or every year.


Tapeworm transmission

wkwfjym;aumif ul;pufys@HESH@jcif;

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uav;rsm;wGif tlvrf;a=umif;wGif; oefxjcif;

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Albendazole and mebendazole are safe to treat children over 1 year old. Drug doses of alben-dazole and mebendazole are easy to adminis-ter because there is no need to weigh the chil-dren.For most worm infections, treat with:

Mebendazole 200 mg for adults and 100 mg for children, for 3 daysAlternative treatment: Albendazole 400 mg STAT for children over 2 years, and half of this tablet for children be-tween 1 and 2 years.

Mass treatment campaignsToday, control of these infections can be achieved through regular treatment with inex-pensive, single-dose and highly effective drugs. These drugs are very safe and they can be given to all groups at risk. Recommended drug doses for such mass treatment campaigns are 1 tab-let of 500 mg mebendazole for any child or ½ tablet of 400 mg albendazole for a 1-2 year old child or 1 tablet of albendazole for a child over 2 years of age.

Especially in large deworming campaigns, administration of the relatively large tablets should be conducted in a safe manner; the children might have difficulty swallowing the tablets. For children less than 3 years of age, tablets can be broken and crushed. Mix with water to administer the de-worming treatment to younger children.

Prevention

Prevention of worm infections is done by im-proving hygiene practices and keeping food

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and water safe. Some examples of prevention are:

Worm eggs can be easily washed away with soap and water. Proper hand wash-ing is a practice that should always be observed after going to the toilet and before preparing or eating food.The meat we eat can be contaminated by worms. It is therefore important to thoroughly cook it.High temperatures when cooking is enough to destroy worm eggs, but some foods, like fruits and vegetables in salads are eaten raw. It is therefore very impor-tant that such foods are washed very care-fully with clean water.Always cover food and water containers to prevent these from being contami-nated by insects or pests carrying worm eggs. Make sure that vegetable gardens and water supplies are not contaminated with fresh faeces.Toilets should be properly constructed so that animals and insects are kept away from the faeces. They should also be kept clean and provided with soap and water to encourage hand washing after use.

The WHO claims that “controlling worms is one of the simplest and most cost-effective in-terventions for improving a child’s health – and increasing that child’s ability to learn in school – that any donor or government could dream of supporting”. Is this the case in your work as well?

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10

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Om%fprf;ya[Vdu¾oif. A[kokwukd qef;ppfvkdufyg?

atmufygar;cGef;rsm;ukd ajzqkdI tjcm;pmrsufESm&Sd tajzrSefrsm;ESifh wkdufqkdifppfaq;vkdufyg?

tykdif; (1) twGufar;cGef;rsm; - usef;rma&;qkdif&m

1? csuf=udK;. vkyfief;aqmifwmrsm;um; tb,fenf;??

2? ukd,f0efaqmifcsdeftwGif; rdcifjzpfolonf tb,fa=umifh aq;vdyfESifh t&ufwkd@ukd a&Smif&Sm;oifhoenf;?

3? uav;rsm;ukd rnfonfhtwGufa=umifh umuG,faq; apmpD;pGm xkd;ESHoifhoenf;?

4? umuG,faq;xkd;jcif;tm;jzifh wm;qD;Ekdifaom a&m*g 4rsdK;ukd azmfjyyg?

5? uav;touf 2ESpft&G,fwGif uav;vkyfaqmifEkdifonfh t&mokH;rsdK;ukd azmfjyyg?

6? uav;ukd rnfonfht&G,ftxd rdcifEkd@wpfrsdK;wnf;om wkdufauGs;oifhoenf;?

7? uav; rD;avmifcH&v#if oifrnfokd@aqmif&Gufrnfenf;?

8? uav;rsm;wGif jywf&S'%f&mrsm; § '%f&mti,fpm;rsm; xdckduf&&Sdv#if oifrnfokd@ aqmif&Gufrnfenf;?

9? uav;rsm;. tjriftm&kH jy\emrsm;ukd ausmif;wGif uGsEkfyfwkd@ rnfuJhokd@ ajc&mcH rnfenf;?

��

Q


QuizTest your knowledge.Answer to the following questionsand then check the correct answers on the next page.

Questions on part 1 - Health

1. What is the function of the umbilical cord?

2. Why should the mother avoid smoking and drinking alcohol dur-ing pregnancy?

3. Why should vaccination be given early to the child?

4. Mention 4 diseases prevented by immunization.

5. At the age of 2 years, mention three things that a child should be able to do.

6. How long should a child be exclusively breastfed?

7. What should you do if your child gets burnt?

8. What should you do in case of cuts/ small wounds in children?

9. How can we detect vision problems in children at school?

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Om%fprf;ya[Vdu¾

tykdif; (2)twGuf ar;cGef;rsm; - aq;ynmqkdif&m

10? ukd,ftav;csdef rjynfhbJarG;aom uav;rsm;twGuf tEW&m,fjzpfEkdifajcrsm;um; tb,fenf;?

11? arG;uif;puav;rsm;wGif touf&Skvrf;a=umif; zdpD;cH&jcif;. vuQ%mrsm;um; tb,fenf;?

12? uav;rsm;ESifh arG;uif;prsm;wGif tjzpftrsm;qkH;aom touf&SKvrf;a=umif; atmufykdif; ykd;0ifjcif;ESpfrsdK;ukd azmfjyyg?

13? uav;rsm;wGif eH&kd;tdrfcsdKifh0ifjcif;r&Sdonfh tqkwfa&mifa&m*gukor_ukd azmfjyyg?

14? 0rf;av#ma&m*gqkdonfrSm tb,fenf;?

15? 0rf;av#ma&m*g. tEW&m,fjy vuQ%mrsm;ukd azmfjyyg?

16? vwfwavm tm[m&csdK@wJhjcif;. ykHpHESpfrsdK;um; tb,fenf;?

17? ESmacgif;rS tpmoGif;ykdufxnfh&jcif;twGuf vkdtyfaom tajctaersm;ukd azmfjyyg?

18? uav;rsm;. tm[m&tajctaeukd wkdif;wm&mwGif tokH;jyKaomn$ef;udef;okH;rsdK;ukd azmfjyyg?

19? toufokH;ESpfatmuft&G,f&Sd uav;rsm;wGif =uD;xGm;r_apmifh=unfhppfaq;jcif;ukd b,fESpf=udrf aqmif&Gufoifhoenf;

20? uav;rsm;wGif emwm&Snftm[m&csdK@wJhjcif;. tusdK;qufrsm;ukd azmfjyyg?

21? uGsEkfyfwkd@. a'owGif;&Sd tawG@&trsm;qkH; oefaumifrsm;ukd azmfjyyg?

22? touf 1 ESpftxuf uav;rsm;ukd uko&mwGif t,fvfbif'gZkd;vfESifh rDbif'gZkd;vfwkd@ukd pdwfcspGm okH;pGJEkdifonf?

�8

Q


Quizz

Questions on Part 2 - Medical

10. What are the risks for low birth weight babies?

11. What are the signs of respiratory distress in newborn infants?

12. Name the two most common lower respiratory tract infections in children and infants.

13. Describe the management of pneumonia in children without chest wall indrawing.

14. What is diarrhoea?

15. List the danger signs of diarrhoea.

16. What are the two forms of acute Protein Energy Malnutrition?

17. Mention indications for naso-gastric feeding.

18. Name three indices used to assess the nutritional status of children.

19. How often should growth monitoring be conducted in children below 3 years old?

20. What are the consequences of chronic malnutrition in children?

21. Mention the most common worms in our region.

22. Albendazole and mebendazole are safe to treat children over 1 year old.

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tykdif; (1) twGuf tajzrsm; - usef;rma&;qkdif&m

1? csuf=udK;onf atmufqD*sifESifh tpm;tpmrsm;ukd oaE<om;xHokd@ o,f,lykd@qmifjyD; oaE<om;xHrS tnpfta=u;rsm;ukd pGef@xkwfay;onf?

2? t&ufESifh eDukdwif;wkd@onf aoG;rSo,f,loGm;jyD; rdcifxHrS uav;okd@ csuf}udK;rSwqifh a&muf&SdoGm;aoma=umifh ukd,f0efaqmifrdcifrsm;onf 4if;wkd@ukd a&Smif&Sm;oifhonf?

3? uav;rsm;onf rdcifxHrS &&Sdaom umuG,fay;r_ukd pwifqkH;&SKH;roGm;rSD umuG,faq;xkd;jcif;ukd cH,loifhonf?

4? ykdvD,kda&m*g/ 0ufoufa&m*g/ tqkwfa&mifwDbDa&m*g/ qkHqkd@a&m*g/ =uufnSma&m*g/ ar;ckdifa&m*g/ tonf;a&mif tom;0gbDa&m*g?

5? - vrf;avsmuf/ ajy;/ twuftqif;ESifh ckefEkdifonf? - trlt&mrsm;ukd wkyonf? - ukd,fhtm;ukd,fukd;I pm;aomufonf? - &kd;&Sif;aom ckdif;apr_rsm;ukd vkdufemonf? - trnfwyfvkduf&HkESifh t&m0wWKrsm;/ &kyfykHrsm;ukd n$efjyEkdifonf?

6? yxr 6vtwGif; uav;rsm;ukd rdcifEkd@wpfrsdK;wnf; wkdufauGs;oifhonf? qkdvkdonfrSm uav;ukd rdcifEkd@om pkd@apjyD; a&ukdaomfr# rwkdufoifhyg?

7? - uav;rsm;wGif rD;avmifr_rsm;jzpfygu ta&jym;ay:wGif rD;avmifcH&aom ae&mukd a&bkHykdifa&atmufwGif rdepf 20cef ha&aq;ypfyg?

- rnfonfh vdrf;aq;u&ifrf/ tqD okd@r[kwf rD;avmif'%f&mtwGuf tjcm;ukojcif; rsdK;ukdrqkd rvdrf;ygESifh?

- tu,fI rD;avmif'%f&monf ao;i,fygu 4if;ukd ykd;owfxm;aom wG,fuyfjcif; r&Sdonfh *Grf;yvmpwmjzifh zkH;tkyfxm;yg?

- rD;avmif'%f&m rao;i,fvsif uav;ukd aq;cef;okd@ ac:,ljyoyg?

8? - '%f&mrsm;ukd oef@&Sif;aom a&/ qyfjymwkfd@jzifh aq;a=umyg? - '%f&may:wGif ykd;owfaq; (bDwm'if;)ukd vdrf;ay;yg? - '%f&mukd ywfwD;pnf;I umuG,fay;yg?

9? uav;onf atmufygwkd@ukd aqmif&Guf&mwGif tcufawG@aevsif tjriftm&kH jy\emrsm;ukd oifajc&mcHEkdifonf?

- ausmufoifykef;ay:rS pmul;&mwGif - tvkyfvkyf&mwGif tm&kHpl;pkdufI *&kjyK&ef - pma=umif; ajzmifhwef;atmif a&;&mwGif

Om%fprf;ya[Vdtajzrsm;u¾

100

Q


Quiz AnswersAnswers on part 1 - Health

1. The umbilical cord carries nourishment and oxygen to the foetus and carries wastes away.

2. Pregnant women should avoid smoking and drinking because alco-hol and nicotine are carried by the blood, and therefore pass from the mother to the baby through the umbilical cord.

3. Vaccination should be done before the child starts loosing the pro-tection he has received from the mother.

4. Poliomyelitis, Measles, Tuberculosis, Diphtheria, Pertussis, Tetanus, Hepatitis B.

5. - Walk, climb and jump - Imitate behaviours - Begin to eat by self - Follow simple instructions - Point objects or pictures when they are named

6. During the first 6 months, children should be exclusively breastfed, which means they should only eat breast milk and nothing else, even not water.

7. - Hold the burn under a cold running tap water for 20 minutes - Do not put anything on the burn (no cream, grease or other treatment) - If the burn is small it can be covered with a sterile, non-stick dressing - Unless the burn is very small, take the child to a clinic.

8. - Clean the wound well with clean water and soap - Apply disinfectant (Betadine) to the wound - Protect the wound with a bandage.

9. You should suspect a vision problem when a child has difficulties: - Copying from the blackboard - Concentrating and focusing on his work - Writing in a straight line

101


Om%fprf;ya[Vdu¾

tykdif; (2) twGuf tajzrsm; - aq;ynmqkdif&m

10? - a&m*gykd;0ifEkdifajcjrifhrm;jcif; - ukd,ftylcsdefxdef;odrf;xm;&ef rwwfEkdifjcif; - tpmauGs;&mwGif jy\em &Sdjcif; - aoG;wGif; o=um;"gwf avsmhenf;jcif;

11? - ESmacgif;0 v_yfaejcif; - ukd,fwGif;ykdif; aoG;wGif; atmufqD*sif avsmhenf;jcif; - av&SkjyGefrS toHjrnfjcif; - &ifbwfcsdKifh0ifjhcif; (eH&kd;=um;ykdif;rsm; csdKifh0ifjcif;/ eH&kd;tdrfatmuf csdKifh0ifjcif;ESifh

&ifnGef@&kd; csdKifh0ifjcif;) - 0rf;Akduf azmif;vmjcif; - OD;acgif; a&S@ikdufaejcif;

12? tqkwfjyGefi,frsm;a&mif&rf;jcif;ESifh tqkwfa&mifa&m*g

13? tarmufqDqvifukd 7 &uf=um yg;pyfrSwkdufyg? yxrqkH;t=udrfukd aq;cef;wGif wkdufI uav;wGif touf&SKjrefvmygu aq;cef;jyefjy&ef tarukd rSm=um;yg?

14? 0rf;av#ma&m*gqkdonfrSm wpfae@twGif; okH;=udrfxufykdI t&nfoufouf 0rf;oGm;jcif;jzpfonf? rnfokd@jzpfap/ 0rf;trmtaysmh vwfwavmajymif;vJjcif;onf 0rf;t=udrfta&twGufxuf ykdrkdta&;=uD;aom oGifjyifjzpfonf?

15? - uav;onf vrf;aumif;pGm ravsmufEkdifbJ tm;ukefaejcif; okd@r[kwf owdvpfjcif;

- aoG;ckefE_ef;jrefI tm;aysmhaejcif; - ta&jym; jzLazsmhI at;pufaejyD; aysmhaejcif; - tmajcmufjcif; - ikdaomtcg rsuf&nfrxGufjcif; - qD;yrm%avsmhenf;oGm;jcif;

16? vwfwavm uav;oli,f tm[m&csdK@wJha&m*gwGif aum&SmaumESifh r&pfpfrwf[lI ykHpHESpfrsdK;&Sdonf? uGJjym;csufrSm azma&mifjcif;&Sdjcif; (aum&Smaum)ESifh r&Sdjcif; (r&pfpfrwf) yifjzpfonf? r&pfpfrwfa&m*g&Sdaom uav;onf ydefvSDaeykH&jyD; aum&Smauma&m*gjzpfaom uav;onf 0ykHay:ae&onfrSm azma&mjcif;&Sdaom a=umifhomjzpfonf?

102

Q


Quizz

Answers on Part 2 - Medical

10. - Increased risk of infection - Inability to maintain body temperature - Problems with feeding - Low blood dextrose

11. - Nasal flaring - Central cyanosis - Tracheal tug - Chest indrawing - Abdominal breathing - Head bobbing

12. - Bronchiolitis and pneumonia.

13. Give oral amoxicillin for 7 days. Give the first dose in the clinic and advise mother to return if fast breathing develops.

14. Diarrhoea is the passage of liquid stool more than three times a day. However, the recent change in the consistency of the stool rather than the number of stools is the more important feature.

15. - Child limp, apathetic or unconscious - Rapid weak pulse - Skin pale and cold, loose - Sunken eyes and fontanelle - Dry mouth - Absence of tears when crying - Urine volume decreased

16. Kwashiorkor and Marasmus are 2 forms of acute PEM. The dif-ference is the presence (Kwashiorkor) or absence of oedema (Mar-asmus). A child with marasmus will look thin, and a child with kwashiorkor with look fat, but only because they have oedema.

17. - Complete anorexia - loss of appetite - Severe dehydration

103


Om%fprf;ya[Vdu¾

17? - tpm;vkH;0rpm;Ekdifawmhjcif; - pm;aomufcsifpdwfaysmufoGm;jcif; - a&"mwfqkd;&Gm;pGm ukefqkH;jcif; - uav;onf t&nfraomufEkdifjcif; (tvGeftm;enf;I) - xyfwvJvJ atmhtefjcif;

18? - toufESifh,SOfaom ukd,ftav;csdef - toufESifh,SOfaom t&yftjrifh - t&yfESifh ,SOfaom ukd,ftav;csdef

19? uav;wkdif;twGuf arG;uif;prS touf 3ESpfxdukd vpOfESifh touf 3- 5 ESpftwGif; 6 vwpf=udrf =uD;xGm;zGH@jzdK;r_ukd apmifh=unfhwkdif;wmoifhonf?

20? - toufESifhpmvsif t&yfykae=uonf? - toufESifhpmvsif ukd,fum,wGif oefpGrf;r_r&Sdyg? - ausmif;wGif pmoiftH&mESifh tm&kHpl;pkduf&mwGif ykdrkdcufcJaomtcsdef&Sdonf? - r=umc% ykdrkdzsm;em=uonf?

21? - oefcsdwfaumifrsm; (eDau;wm; tar&duefeyfpfESifh tefukdifvkd pwkdrm; 'D,kd'D e,fvfav;)

- oefvkH;aumifrsm; (tufpfum;&pfpf vefA&ufuGKdif'D;pf) - oefjym;aumifrsm; (x&kdiful;&pfpf x&kdiful&D;,m;)

22? rSefonf?

104

Q


Quizz

- Child cannot drink (too weak) - Repeated vomiting

18. - Weight-for-age - Height-for-age - Weight-for-height

19. Growth monitoring should be conducted monthly from birth until 3 years of age and every 6 months from 3-5 years of age.

20. 1. They are shorter for their age 2. They are not as physically strong for their age 3. They have a more difficult time concentrating and learning in school 4. They are sick more often

21. 1. Hookworms (Necator americanus & Ancylostoma duodenale) 2. Roundworms (Ascaris lumbricoides) 3. Whipworms (Trichuris trichiura)

22. True

10�


GlossaryGlossaryIgA - Immunoglobulin A

NGT - Naso-gastric tube

ARI - Acute Respiratory Infections

CCSDPT - Committee for Coordination of Services to Displaced Person in Thailand

LRTI - Lower Respiratory Tract Infections

BBG - Burmese Border Guidelines

RSV - Respiratory syncitial virus

NSS - Normal saline solution

RR - Respiratory rate

WHO - World Health Organization

ETEC - Enterotoxigenic E. coli

UTI - Urinary Tract Infections

CFTI - Collective food toxic infection

SE - Stool Examination

ORS - Oral Rehydration Solution

UCI - Universal Child Immunization

HEM - High Energy Milk

W/A - Weight for Age

H/A - Height for Age

W/H - Weight for Height

SFP - Supplementary Feeding Program

TFP - Therapeutic Feeding Program

10�

NOTE


contents...contents aide médicale internationale 21/22-26 maetao road, maesot, tak 63110 tel: (66)...

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