Integrated management of neonatal and childhood illness


FEEL for bulging fontanelle



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module 5
FEEL for bulging fontanelle
The fontanelle is open for most of the period of infancy before it is closed by the growth of the surrounding bones. If the fontanelle is open, feel for bulging fontanelle just as you did for young infants.
LOOK for runny nose. A runny nose in a child with fever may mean that the child has a common cold. If the child has a runny nose, ask the mother if the child has had a runny nose only with this illness. If she is not sure, ask questions to find out if it is an acute or chronic runny nose.

When malaria risk is low , a child with fever and a runny nose does not need an antimalarial. This child's fever is probably due to the common cold.


LOOK for signs suggesting MEASLES. Assess a child with fever to see if there are signs suggesting measles. Look fora generalized rash and for one of the following signs cough, runny nose, or red eyes.
Generalized rash In measles, a red rash begins behind the ears and on the neck. It spreads to the face. During the next day, the rash spreads to the rest of the body, arms and legs. After 4 to 5 days, the rash starts to fade and the skin may peel. Some children with severe infection may have more rash spread over more of the body. The rash becomes more discoloured (dark brown or blackish, and there is more peeling of the skin. A measles rash does not have vesicles (blisters) or pustules. The rash does not itch. Do not confuse measles with other common childhood rashes such as chickenpox, scabies or heat rash. (The chickenpox rash is a generalized rash with vesicles. Scabies occurs on the hands, feet, ankles, elbows, buttocks and axilla. It also itches. Heat rash can be a generalized rash with small bumps and vesicles which itch. A child with heat rash is not sick) You can recognize measles more easily during times when other cases of measles are occurring in your community.
Cough, Runny Nose, or Red Eyes To classify a child as having measles, the child with fever must have a generalized rash AND one of the following signs cough, runny nose, or red eyes. The child has "red eyes" if there is redness in the white part of the eye. Ina healthy eye, the white part of the eye is clearly white and not discoloured.

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