GuidelinesIMCI

Ear Problem and Sore Throat (Age 2 months up to 5 years)

IMCI - Child (Age 2 months up to 5 years)

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Does the Child Have an Ear Problem?

If Yes, Ask:

Is there ear pain?
Does it wake the child at night?
Is there ear discharge?
If yes, for how long?

Look and Feel:

Look for pus draining from the ear
Feel for tender swelling behind the ear

Classify Ear Problem

Mastoiditis
Tender swelling behind the ear	Give ceftriaxone IM Give first dose of paracetamol Refer URGENTLY
Acute Ear Infection
Pus seen draining from the ear and discharge is reported for less than 14 days OR Ear pain which wakes the child at night	Give amoxicillin for 5 days If ear discharge: Teach caregiver to clean ear by dry wicking Give paracetamol for pain. Give for two days. Follow-up in 5 days if pain or discharge persists Follow-up in 14 days
Chronic Ear Infection
Pus is seen draining from the ear. AND Discharge is reported for 14 days or more.	Teach caregiver to clean ear by dry wicking Then instill recommended ear drops, if available Tell the caregiver to come back if she suspects hearing loss Follow up in 14 days
No Ear Infection
No ear pain or ear pain which does not wake the child at night AND No pus seen draining from the ear	No additional treatment

If the child is 3 years old or older ask, does the child have a sore throat?

If Yes, Ask:

Does the child have a rash? (The typical streptococcal rash is red, becomes pale when pressed and has a rough feel (like sandpaper)).
Does the child have a runny nose?
Does the child have a cough?

Look and Feel:

Enlarged tonsils
White or yellow exudate on tonsils
Scarlatiniform rash (The typical streptococcal rash is red, becomes pale when pressed and has a rough feel (like sandpaper)).

Classify Sore Throat

Possible Streptococcal Infection
Enlarged tonsils with white or yellow exudate AND One or more of the following: No runny nose No cough Scarlatiniform rash	Give penicillin Treat pain and fever Soothe the throat with a safe remedy Follow-up in 5 days if symptoms worse or not resolving
Sore Throat
Not enough signs to classify as streptococcal sore throat	Soothe the throat with a safe remedy

Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; Sore Throat

Last checked for updates: June 2023

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