16.3  Identify urgent pre-referral treatment

When a young infant or a child needs urgent referral to hospital, you must quickly identify and begin the most urgent treatments for that child before he leaves for the hospital. Urgent treatments are in bold print on the classification tables. You will give just the first dose of the relevant drugs before referral.

The following urgent pre-referral treatments are for young infants aged from birth up to two months:

  • Give the first dose of intramuscular or oral antibiotics
  • Advise the mother how to keep the infant warm on the way to the hospital. If the mother is familiar with wrapping her infant next to her body, this is a good way to keep him or her warm on the way to the hospital. Keeping a sick young infant warm is very important
  • Treat to prevent low blood sugar
  • Refer urgently to hospital with the mother giving the child frequent sips of ORS on the way. Advise the mother to continue breastfeeding.

The following urgent pre-referral treatments are for sick children aged two months up to five years:

  • Give an appropriate antibiotic
  • Give an appropriate antimalarial drug for severe malaria
  • Give vitamin A
  • Treat the child to prevent low blood sugar
  • Give paracetamol for high fever (38.5°C or above) or pain from mastoiditis
  • Apply tetracycline eye ointment (if clouding of the cornea or pus draining from the eye)
  • Provide ORS solution so that the mother can give the child frequent sips on the way to the hospital.

The first four treatments above are critical because they can prevent serious consequences such as progression of bacterial meningitis or cerebral malaria, corneal rupture due to lack of vitamin A, or brain damage from low blood sugar. The other treatments listed are also important in order to prevent worsening of the child’s illness.

Do not delay referral to give non-urgent treatments.

Non-urgent treatments, for example wicking the ear, giving oral iron treatment, or teaching a mother how to treat a local infection, should not be done before referral. If immunizations are needed, do not give them before referral. Let hospital personnel determine when to give immunizations to avoid delaying referral.

You should write the urgent pre-referral treatments identified for each classification on the reverse side of the case recording form.

Box 16.1 below summarises the main steps to take when you refer an infant or child to hospital.

Box 16.1  Refer the infant or child

There are four steps you need to follow when referring an infant or child to hospital:

  1. Explain to the mother the need for referral, and get her agreement to take the child. If you suspect that she does not want to take the child, find out why.
  2. Calm the mother’s fears and help her resolve any problems. This might include reassuring her about the treatment her child will receive and helping her to find someone to look after any other children she has at home.
  3. Write a referral note for the mother to take with her to the hospital. Tell her to give it to the health worker there.
  4. Give the mother any supplies and instructions needed to care for her child on the way to the hospital, such as ORS and keeping her child warm.

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

16.4  When to return immediately