16.2  How to determine if the sick young infant needs urgent referral

All severe classifications on the Assess and Classify chart are in the pink row and include:

• Severe pneumonia or very serious disease
• Severe dehydration
• Severe persistent diarrhoea
• Very severe febrile disease
• Severe complicated measles
• Mastoiditis
• Severe malnutrition
• Severe anaemia.

In the treatment column for these severe classifications there is an instruction ‘Refer URGENTLY to hospital’. This instruction means to refer the child to hospital immediately after giving any necessary pre-referral treatments. Do not give treatments that would unnecessarily delay referral.

• If the young infant up to two months old has possible serious bacterial infection, he or she needs urgent referral
• If the young infant has severe dehydration (and does not have possible serious bacterial infection), the infant needs rehydration with IV fluids according to Plan C and you should urgently refer the infant for IV therapy. The mother should be advised to give the young infant frequent sips of oral rehydration solution (ORS) on the way and she should continue breastfeeding.

There is one exception: for severe persistent diarrhoea, the instruction is simply to ‘Refer to hospital’. This means that referral is needed, but not as urgently. Therefore, there is time to identify treatments and give all of the treatments the child requires before referral to hospital.

Most children who have a general danger sign also have a severe classification. They will be referred for their severe classification (or possibly treated, if they have severe dehydration only). In rare instances, children may have a general danger sign or signs without a severe classification. These children should also be referred urgently.

The Assess and Classify chart does not include all of the problems that children may have. You have to decide whether a child has any other severe problem that cannot be treated at this health post. For example, a child may have a severe problem that is not covered on the chart, such as severe abdominal pain. If you cannot treat a severe problem, you should always refer the child to hospital.