15.4.3 Assess and classify diarrhoea
After you assessed for cough or difficult breathing, the next step is to assess the child for diarrhoea.
How to classify diarrhoea
The three classifications for diarrhoea are dehydration, persistent diarrhoea and dysentery. Dehydration and persistent diarrhoea are classified as follows:
Dehydration
- Severe dehydration
- Some dehydration
- No dehydration.
Persistent diarrhoea
- Severe persistent diarrhoea
- Persistent diarrhoea.
Dysentery does not have any other classification.
Fever
The next main symptom you need to assess is fever. A child with fever may have malaria, measles or another severe disease. Or, a child with fever may only have a simple cough or cold or other viral infection.
How to assess fever
Ask about fever in ALL sick children.
If you open your chart booklet at p.24 you will find the assessment box for fever. You can see that the assessment of fever has two parts. The upper part of the box (above the broken line) describes how to assess the child for signs of malaria, measles, meningitis and other causes of fever. The lower part of the box describes how to assess the child for signs of measles complications, if the child has measles now or has had measles within the last three months.
Because fever can be caused by serious illnesses, such as malaria, measles and meningitis, as well as more simple illnesses (such as a common cold), it is important that you are able to recognise and assess fever and classify the illness that is causing it.
If the child has a fever, what are the three levels of malaria risk?
You will need to decide whether a child with fever has a high risk, a low risk or no risk for malaria. You should ask about the duration of the fever and, if the child has recently travelled, whether it was to a high or low risk area. If you are not certain, you should assume a high risk of malaria.
What signs should you look for in the child with fever?
You should examine the child for stiff neck, runny nose and signs suggestive of measles, such as a generalised rash, cough or red eyes.
How to classify fever
If the child has fever and no signs of measles, classify the child for fever only. If the child has signs of both fever and measles, classify the child for fever and for measles.
There are three possible classifications for fever in an area with low malaria risk:
- Very severe febrile disease
- Malaria
- Fever – malaria unlikely.
There are two possible classifications for fever in an area with no malaria risk:
- Very severe febrile disease
- Fever – malaria unlikely.
There are three possible classifications for measles:
- Severe complicated measles
- Measles with eye or mouth complications
- Measles.
You are now going to look at the management of children with ear problems.
15.4.2 Assess and classify cough or difficult breathing