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Care priority and warning signs
Care priority
Routine Management / Home Care
Red flags
- Development of any danger sign.
- Development of eye complications (pus, clouding).
- Development of mouth ulcers.
- Development of signs of pneumonia (fast/difficult breathing).
- Development of stridor.
- Development of diarrhoea.
- Development of ear discharge.
Assessment
- Ask: Does the child have fever?
- Ask: Has the child had measles within the last 3 months? (Generalized rash + one of: cough, runny nose, red eyes).
- If Yes to Measles:
- Confirm absence of General Danger Signs.
- Confirm absence of Clouding of Cornea.
- Confirm absence of Deep/extensive mouth ulcers.
- Confirm absence of Pus draining from eye.
- Confirm absence of Mouth ulcers.
Classification
- Measles now or within last 3 months AND No signs of Severe Complicated Measles AND No Eye/Mouth Complications -> MEASLES
Key features
- History of measles within last 3 months.
- Absence of any danger signs or specific eye/mouth complications.
- Requires supportive care and Vitamin A to prevent complications.
Management
Non-pharmacological management
- Advise on increased fluids and continued feeding.
- Advise on soothing cough with safe remedies (see Cough/Cold).
- Advise keeping eyes clean if needed (gentle wiping).
Pharmacological treatment
- Give Vitamin A treatment dose TODAY (Day 1) and TOMORROW (Day 2). Dose: Age 6-11 months: 100,000 IU daily x 2 days. Age 12 months - 5 years: 200,000 IU daily x 2 days.
Follow-up
- No routine follow-up required unless complications develop.
- Advise mother to return immediately if any danger signs or signs of complications (pneumonia, diarrhoea, ear infection, eye/mouth problems) develop.
Counselling points
- Explain the diagnosis (measles) and reassure that there are no current complications.
- Explain the importance of Vitamin A for preventing complications and teach how to give the 2 doses.
- Advise on supportive care at home: fluids, feeding, cough relief, eye care.
- Advise WHEN TO RETURN IMMEDIATELY: Danger signs, difficulty breathing, pus from eye, corneal clouding, mouth ulcers, diarrhoea, ear pain/discharge.
- Advise on isolating the child to prevent spread.
Differential diagnosis
- Severe Complicated Measles
- Measles with Eye/Mouth Complications
- Other viral exanthems (Rubella, Roseola, Enterovirus)
- Drug rash
Complications
- Pneumonia
- Diarrhoea
- Otitis Media
- Encephalitis
- Eye/Mouth complications
- Malnutrition
Prevention
- Measles vaccination (2 doses).
- Vitamin A supplementation (routine).
- Good nutrition.
- Isolation of cases.
References
IMCI Chart Booklet - Page 4, Page 20 (Vit A), Page 18 (Safe Remedies), Page 30 (Return Signs)