Overview

This is the second edition of the Pocket book of hospital care for children. It is for use by doctors, nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. The Pocket Book is one of a series of documents and tools that support the Integrated Management of Childhood Illness (IMCI). It is an update of the 2005 edition, and presents up-to-date evidence based clinical guidelines from several recently updated and published WHO guidelines and recommendations. The guidelines are for use in both inpatient and outpatient care in hospitals with basic laboratory facilities and essential medicines. These guidelines focus on the management of the major causes of childhood mortality in most developing countries, such as newborn problems, pneumonia, diarrhoea, malaria, meningitis, septicaemia, measles and related conditions, severe acute malnutrition and paediatric HIV/AIDS. It also covers common procedures, patient monitoring and supportive care on the wards and some common surgical conditions that can be managed in small hospitals.

Details of the evidence on which the Pocket Book is based can be found on the WHO website from the relevant published guidelines provided in the bibliography. This bedside paediatric care guidelines are applicable in most areas of the world and may be adapted to suit country specific circumstances. However, advanced and high care treatment options, such as intensive care or mechanical ventilation, are not described. The Pocket Book is also available in hard copies although the online version will be updated regularly as new evidence emerges.

Contents

• Preface
• Acknowledgements
• Abbreviations
• 1. Triage and emergency conditions
  • 1.1 Triage
  • 1.2 Summary of steps in emergency triage assessment and treatment
  • 1.3 Assessment of emergency and priority signs
  • 1.4 Emergency treatment for a child with severe malnutrition
  • 1.5 Diagnostic considerations for children with emergency conditions
  • 1.6 Common poisoning
  • 1.7 Drowning
  • 1.8 Electrocution
  • 1.9 Common causes of envenoming
  • 1.10 Trauma and injuries
• 2. Diagnostic approaches to the sick child
  • 2.1 Relationship to the IMCI approach and stages of hospital care
  • 2.2 Taking history
  • 2.3 Approach to the sick child and clinical examination
  • 2.4 Laboratory investigations
  • 2.5 Differential diagnoses
• 3. Problems of the neonate and young infant
  • 3.1 Essential newborn care at delivery
  • 3.2 Neonatal resuscitation
  • 3.3 Routine care for all newborns after delivery
  • 3.4 Prevention of neonatal infections
  • 3.5 Management of infants with hypoxic ischaemic encephalopathy
  • 3.6 Danger signs in newborns and young infants
  • 3.7 Convulsions or fits
  • 3.8 Serious bacterial infection
  • 3.9 Meningitis
  • 3.10 Supportive care for sick neonates
  • 3.11 Preterm and low-birth-weight infants
  • 3.12 Other common neonatal problems
  • 3.13 Infants of mothers with infectious diseases
  • 3.14 Doses of common drugs for neonates and low-birth-weight infants
• 4. Cough or difficulty in breathing
  • 4.1 Child presenting with cough
  • 4.2 Pneumonia
  • 4.3 Complications of pneumonia
  • 4.4 Cough or cold
  • 4.5 Conditions presenting with wheeze
  • 4.6 Conditions presenting with stridor
  • 4.7 Conditions presenting with chronic cough
  • 4.8 Heart failure
  • 4.9 Rheumatic heart disease
• 5. Diarrhoea
  • 5.1 Child presenting with diarrhoea
  • 5.2 Acute diarrhoea
  • 5.3 Persistent diarrhoea
  • 5.4 Dysentery
• 6. Fever
  • 6.1 Child presenting with fever
  • 6.2 Malaria
  • 6.3 Meningitis
  • 6.4 Measles
  • 6.5 Septicaemia
  • 6.6 Typhoid fever
  • 6.7 Ear infections
  • 6.8 Urinary tract infection
  • 6.9 Septic arthritis or osteomyelitis
  • 6.10 Dengue
  • 6.11 Rheumatic fever
• 7. Severe acute malnutrition
  • 7.1 Severe acute malnutrition
  • 7.2 Initial assessment
  • 7.3 Organization of care
  • 7.4 General management
  • 7.5 Treatment of associated conditions
  • 7.6 Discharge and follow-up
  • 7.7 Monitoring the quality of care
• 8. Children with HIV/AIDS
  • 8.1 Sick child with suspected or confirmed HIV infection
  • 8.2 Antiretroviral therapy
  • 8.3 Supportive care for HIV-positive children
  • 8.4 Management of HIV-related conditions
  • 8.5 Prevention of mother-to-child HIV transmission, and infant feeding
  • 8.6 Follow-up
  • 8.7 Palliative and end-of-life care
• 9. Common surgical problems
  • 9.1 Care before, during and after surgery
  • 9.2 Congenital anomalies
  • 9.3 Injuries
  • 9.4 Abdominal problems
  • 9.5 Infections requiring surgery
• 10. Supportive care
  • 10.1 Nutritional management
  • 10.2 Fluid management
  • 10.3 Management of fever
  • 10.4 Pain control
  • 10.5 Management of anaemia
  • 10.6 Blood transfusion
  • 10.7 Oxygen therapy
  • 10.8 Toys and play therapy
• 11. Monitoring the child's progress
  • 11.1 Monitoring procedures
  • 11.2 Monitoring chart
  • 11.3 Audit of paediatric care
• 12. Counselling and discharge from hospital
  • 12.1 Timing of discharge from hospital
  • 12.2 Counselling
  • 12.3 Nutrition counselling
  • 12.4 Home treatment
  • 12.5 Checking the mother's health
  • 12.6 Checking immunization status
  • 12.7 Communicating with the first-level health worker
  • 12.8 Providing follow-up care
• Bibliography
• Annexes
  • ANNEX 1 Practical procedures
  • ANNEX 2 Drug dosages and regimens
  • ANNEX 3 Equipment sizes
  • ANNEX 4 Intravenous fluids
  • ANNEX 5 Assessing nutritional status
  • ANNEX 6 Job aids and charts
• Daily monitoring chart
• Antimicrobial drugs for common conditions

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