1. CONTROL OF ACUTE RESPIRATORY INFECTION (CARI)
BASIC TRAINING FOR BARANGAY HEALTH WORKERS
Calasiao, Pangasinan
CONTROL OF ACUTE RESPIRATORY INFECTION (CARI)

2. Respiratory infections can affect the following areas of the respiratory tract: nose, throat and lungs. If not detected and treated early enough, it may also lead to pneumonia and eventual death.
As a BHW, you can be a big help in the early detection of Acute Respiratory Infection (ARI) as you perform home care, referrals and follow-up.

3. A. Signs and Symptoms
These are the important points that the BHW have to observe and should ask about the child before we can say that a child has ARI.
Cough
Fast breathing
Noisy/difficult breathing
Runny nose or colds
May or may not have fever
Chest In drawing

4. Cough Ask if the child has cough If YES, ask for how long?
Coughing is one of the most common symptoms of childhood illness. Coughing is a healthy and important reflex that helps protect the airways in the throat and chest.

5. Cough
There are many causes of a cough in children, including infections (both viral and bacterial), irritations (cold air, smoke, inhaled foreign body), allergies, asthma and psychological causes (habit cough).
By far the most common cause of cough is a viral infection, with the cough usually occurring as part of a cold.
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6. Is the child breathing fast?
Normal breathing
Birth to 2 months
60 or less breaths per minute
2 months to 12 months
50 or less breaths per minute
12 months up to 5 years
40 or less breaths per minute

7. Is the child breathing fast?
Fast Breathing- the child is breathing faster than normal.
His breath is fast like a child that has been running. Listen for fast breathing when a child is resting.
If the child is breathing fast only when crying or excited, this is not fast breathing.

8. Is the child breathing fast?
Fast breathing in children can be a cause for alarm. In many instances, fast breathing in a child is normal. If it is accompanied by other symptoms, however, it may be an indicator that the child is experiencing respiratory distress. Symptoms that should give rise to concern include labored breathing, changes in a child's skin color, wheezing and fever.
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9. Is the child having noisy or difficult breathing?
When the child breaths in, there is a harsh noise. If you hear wheezing when the child breathes out or is crying, this is not a danger sign.
Listen when the child breathes in.

10. Is the child having noisy or difficult breathing?
Infants and children will experience a variety of types of breathing difficulty from several different illnesses:
Whistling noise: A small blockage in the nostrils tends to make a whistling noise that clears when you suction it out.
Hoarse cry and a "barking" cough: A blockage in the larynx (windpipe), often due to mucus, makes a hoarse cry and a "barking" cough.

11. Fast, labored breathing: Pneumonia causes fast, labored breathing.
Deep raspy sound: A blockage in the trachea (which is in the neck) makes a deep raspy sound during breathing
Deep cough: A blockage in the large bronchi (divisions of the trachea, which lead into the lungs) makes a deep cough.
Whistling sound (wheezing): A blockage in the small airways makes a whistling sound as in bronchiolitis or asthma later on.
Fast, labored breathing: Pneumonia causes fast, labored breathing.
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12. Does the child have colds or runny nose?
Colds are the most common illness among children of all ages.  Because colds are viral infections, antibiotics, which treat bacterial infections, are not useful for treatment.
Except in newborns, colds in healthy children are not dangerous. Colds usually go away in four to 10 days without any special treatment.

13. Sometimes fatigue, stress, poor nutrition or the type of cold virus may promote a bacterial infection somewhere in a child's body, such as the lungs, throat, ears, or sinuses.
The bacterial infection weakens the body's immune system and at this point, requires treatment with an antibiotic.
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14. Does the child have fever?
Ask if the child have fever now or did the child have fever anytime during the last 3 days?
Take the temperature of the child, if the temperature taken and the reading is 37.50C and above, then the child has fever.

15. Does the child has convulsion?
Check if
“tumitirik ang mata ng bata”
“nangingisay ba ang kamay at paa ng bata”
Kung minsan humihinto sa paghinga ang bata
Kung minsan pa ay nawawalan ng malay at mahirap gisingin ang bata.
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16. Identify chest in-drawing
Chest In-drawing -The lower chest goes in when the child breathes in.
Steps to check Chest In drawing:
The child must be calm
Child should not be breastfeeding
If the child is asleep, try not to waken the child.
Child’s body should not be bent at the waist.

17. There should not be enough light
Look for chest in drawing when the child breathes IN.
Slowly roll up the child’s shirt to expose the lower chest
Look at the chest wall (lower ribs)
Look for chest in drawing when the child breathes IN and it must
be clearly visible and
present at all times.

18. What is the difference between these two pictures?
The child is breathing OUT
The child is breathing IN

19. B. Home Care of ARI Cases
The mother of the patient can be advised to do the following:
1. Give the child more fluids. Continue breastfeeding the child.
2. Keep the child home so he/she can get enough rest.
3. Feed the child nutritious food.

20. If the child can gargle with warm salt solution at least 3 times a day to help relieve the sore throat( 3 pinched of salt to a glass of warm water).
Teach the child to cover his/her mouth when coughing or sneezing.
Clean the nose if it interferes with feeding.
7. Bring the child to a health facility if he/she becomes worse.

21. C. Danger Signs and Referrals
The difficult breathing becomes fast breathing
The child develops fever
Unable to suck, swallow or drink
Child vomits every time he eats or drinks
Child does not respond when touched or spoken to
Convulsion

22. D. Follow-up/Home Visits
When you go for a home visit and make follow-ups, remember to do the following:
Check if the mother continues giving the antibiotic to the child.
Check if the mother gives the right dosage and on the right time as per the instruction of the personnel.
Check if the mother has enough supply of antibiotics to finish the whole treatment.

23. D. Follow-up/Home visits
Check the condition of the child if there is improvement or not.
Give health and nutrition tips to the mother.
Please do not forget to give your feedback to the health personnel after your home visit/ follow-up

24. E. Tips on Preventing ARI
IMMUNIZATIONS( measles and DPT)
BREADTFEED BABIES(up to 2 years old)
NUTRITIOUS FOOD/ BALANCED DIET
VITAMIN A SUPPLEMENT
KEEP AWAY FROM SMOKE/SMOKERS
AVOID EXPOSURE TO EXTREME COLD/HEAT
AVOID CROWDED PLACES

25. Carlos
Age 2 years old, has a breathing rate of 45bpm
Yes
Allan
Age 4 ½ years old, has a breathing rate of 38 bpm No
Abel
Age 2 months, has a breathing rate of 55bpm
Yes
Jan
Age 3 months, has a breathing rate of 47bpm No
James
Age 3 years old, has a breathing rate of 35bpm No

26. Andy
Age 4 months old, has a breathing rate of 45bpm No
Joseph
Age 10 weeks, has a breathing rate of 57 bpm
Yes
Anne
Age 4 years, has a breathing rate of 36bpm No
Becky
Age 36 months, has a breathing rate of 47bpm
Yes
Willy
Age 8months old, has a breathing rate of 45bpm No