These guidelines are to assist in the care of children in emergencies. They are designed to serve as a reference manual for the evaluation and management of children in emergencies, and as the basis for the training of health care workers. The target audience is first level health workers who provide care to children under the age of 5 years. Physicians and health care workers with more advanced training are referred to the WHO Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources (2005).

These guidelines focus on care provided during the acute and chronic phases of an emergency. The acute phase of an emergency is defined by crude mortality rate and persists as long as the crude mortality rate is at least double the baseline mortality rate. This means as long as there are twice as many people dying per day compared to the normal rate of death. In sub-Saharan Africa, this threshold is set at one death per 10 000 persons per day.

These guidelines are designed for the care of children where no inpatient hospital facilities are available. It assumes that some injectable (intramuscular) and intravenous medicines can be given. If referral or hospital facilities are available, some of the treatment options in these guidelines may not be applicable and the child with severe illness is best referred to hospital.

These guidelines are designed to reduce child morbidity and mortality by addressing the major causes of child morbidity and mortality in emergencies. These causes are:

  • diarrhoeal diseases
  • acute respiratory tract infections
  • measles
  • malaria
  • severe bacterial infections
  • malnutrition and micronutrient deficiencies
  • injuries
  • burns
  • poisoning.

The evaluation and management of these conditions is based upon Integrated Management of Childhood Illness (IMCI) guidelines (Box 1). However, this manual is different in that in addition to the IMCI conditions, these guidelines address emergency resuscitation, management of trauma and burns, care of the newborn and young infant, and evaluation of mental health and psychosocial support with clinical algorithms formatted in flow charts. The guidelines conclude with suggestions for integrating the prevention and care of children within the local context and broader health care delivery system.

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Box 1

Structure showing linkages between chapters in the manual.

The provision of care to children in emergencies requires more than just the health care worker. The following considerations are important.

  • Involve the local community as much as possible. This will depend upon the type of emergency but the local community can be involved in surveillance for sick children and in the delivery of preventive health messages
  • Ensure coordination of care across the different groups providing care to children. If possible, establish a referral centre for severely ill children.
  • Establish a disease surveillance system so that outbreaks can be detected early, particularly for measles, dysentery, cholera and meningitis.
  • Ensure quality of care through monitoring and quality assurance if possible. The following are critical elements:
    • standard diagnostic protocols
    • standard treatment protocols
    • essential drugs and quality control
    • staff training and monitoring.
  • In the chronic emergency, begin planning for the transition to a sustainable health care system. The use of IMCI guidelines for the care of children should make this transition easier. Planning should include:
    • routine childhood immunizations
    • care of persons with tuberculosis
    • care of HIV-infected persons
    • provision of mental health and psychosocial support.

Adapting these guidelines to meet local needs

These guidelines need to be adapted to meet local needs based on the local disease burden. The local disease burden must be considered in caring for children in emergencies. Examples include the risk of:

  • malaria
  • meningococcal meningitis
  • yellow fever
  • haemorrhagic fevers
  • typhoid fever
  • leishmaniasis
  • trypanosomiasis
  • plague.

Coordination with Ministry of Health Guidelines

The Ministry of Health may have guidelines that are useful in the management of children in emergencies. Examples include:

  • First and second line drugs for the treatment of malaria
  • Guidelines for the treatment of tuberculosis
  • Guidelines for the prevention of mother-to-child HIV transmission.