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Care priority and warning signs
Care priority
Routine Management / Treat Complication
Red flags
- Development of any sign of severe complicated measles (danger signs, corneal clouding, deep/extensive ulcers).
- Eye infection or mouth ulcers worsening despite treatment.
- Reduced feeding due to mouth ulcers.
Assessment
- Ask: Does the child have fever?
- Ask: Has the child had measles within the last 3 months?
- If Yes to Measles:
- Confirm absence of General Danger Signs.
- Confirm absence of Clouding of Cornea.
- Confirm mouth ulcers are NOT deep or extensive.
- Look: Look for pus draining from the eye.
- Look: Look for mouth ulcers (superficial).
Classification
- Measles now or within last 3 months AND (Pus draining from the eye OR Mouth ulcers) AND No signs of Severe Complicated Measles -> MEASLES WITH EYE OR MOUTH COMPLICATIONS
Key features
- History of measles within last 3 months.
- Presence of Pus draining from eye OR Mouth ulcers (not deep/extensive).
- Absence of severe complications (danger signs, corneal clouding, deep ulcers).
- Requires Vitamin A and specific local treatment for eye/mouth.
Management
Non-pharmacological management
- Advise on increased fluids and continued feeding.
- For mouth ulcers: Advise soft, non-irritating foods. Avoid spicy, salty, acid foods. Chop foods finely.
- For eye infection: Teach mother how to clean the eyes before applying ointment.
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.
- If pus draining from the eye: Treat eye infection with Tetracycline eye ointment (1%). Teach mother to: Wash hands, clean eyes gently with clean cloth/water, apply ointment inside lower lid, 4 times daily until discharge stops. Treat both eyes.
- If mouth ulcers: Treat with Gentian Violet (0.25% aqueous solution - half strength). Teach mother to: Wash hands, wash child's mouth with clean soft cloth wrapped on finger and wet with salt water, paint mouth ulcers with GV using clean applicator, twice daily for 5 days or until 48 hours after ulcers heal. Give Paracetamol for pain relief if needed.
Follow-up
- Follow-up in 3 days.
- At follow-up (Day 3):
- Reassess eyes and mouth.
- For Eye Infection: If pus worse or same and treatment was correct, refer. If incorrect treatment, teach correct method. If pus gone but redness remains, continue treatment. If no pus/redness, stop treatment.
- For Mouth Ulcers: If worse or very foul smell, refer. If same or better, continue GV for total 5 days.
- Check for other problems.
Counselling points
- Explain the complication (eye or mouth) and the need for Vitamin A and local treatment.
- Teach how to give Vitamin A (correct dose, 2 days).
- If eye infection: Teach how to clean eyes and apply Tetracycline ointment correctly, frequency (4x/day), duration.
- If mouth ulcers: Teach how to clean mouth and apply Gentian Violet correctly, frequency (2x/day), duration. Advise on soft foods.
- Advise on continuing feeding and fluids.
- Advise when to return immediately (danger signs, eye/mouth problem worsening, corneal clouding).
- Advise on follow-up visit in 3 days.
Differential diagnosis
- Severe Complicated Measles
- Uncomplicated Measles
- Bacterial conjunctivitis (non-measles)
- Viral conjunctivitis (non-measles)
- Herpetic gingivostomatitis
- Aphthous ulcers
- Hand, foot, and mouth disease
Complications
- Progression to severe eye complications (corneal ulcer/scarring) if eye infection untreated/severe.
- Secondary bacterial infection of mouth ulcers.
- Poor feeding and malnutrition due to mouth pain.
- Dehydration.
Prevention
- Measles vaccination (2 doses).
- Vitamin A supplementation (routine).
- Good nutrition.
- Good hygiene practices.
References
IMCI Chart Booklet - Page 4, Page 18 (Eye/Mouth Treatment), Page 15 (Paracetamol), Page 20 (Vit A), Page 23 (Follow-up)