DANGER SIGNS

Rush immediately to the clinic if.......

Child has diarrhoea and Child has difficulty / fast

bloody stools breathing

Child is lethargic or unconscious

Child is not able to drink

or breastfeed

Child is convulsing Child is vomiting everything Child has fever

For More Information Contact Child Health Unit, Family Health Division
BCS
PROJECT
Ghana Health Service, Accra.

Name:

NOT FOR SALE

DO NOT COVER
anytime you attend clinic
Please bring this Booklet with you
Records

Chil
Hea d
Rec lth
ords
Child Health

Clinic Reg. No.

MOH GHANA
The Purpose of the Child Health Records

y Provides health information and enables caregivers to learn

about the useful practices they need to undertake to promote
the health and development of their children
y Enables health workers to identify healthy and useful actions
that need to be discussed with caregivers
y Helps caregivers and health workers to follow the child’s growth
and development and keep records of children’s health.

Health Workers

y Give the Child Health Records Booklet to caregivers when the

baby is born
y Use it to counsel and educate the caregiver
y Demand this Booklet each time you see a child in order to enter
records eg. illnesses, treatment, growth, immunization, nutrition,
etc. and counsel accordingly.

Caregivers

y Keep this Booklet at home, study it to know what to do at each

point of your child’s growth and development
y Take this Booklet along with you when going for “weighing”
y Take this Booklet along with you to the clinic when the child is
sick. Give it to the doctor or nurse to see your child’s progress
y Keep it safe, you may need it later to apply for school, passport
or for health history.

1
 PARENTS’ PLEDGE CLINIC/HOSPITAL: __________________________________________________

REGISTRATION No. : __________________________________________________

Child’s Personal Information

Child’s Name:

Birth Registration No. Sex: F M

Date of Birth: Birth Weight: Kg.

Chil
d
Hea
Rec
lth Place of Birth: Date First Seen:
ords

Sickle Cell Status: G6PD Status:

Mother’s Name:

Education: Nil Primary JHS SHS Tertiary

Father’s Name:

We the parents of Baby _____________________________________________ Education: Nil Primary JHS SHS Tertiary
will apply the actions included in this health booklet and do our best so that our
child is healthy, grows and develops well. Address (Where family lives):

Caregiver’s signature/ thumbprint

House No./Description

Town/Village:

Sub District: District:

Region:
2 3
 Brothers and Sisters Record of Key Messages to be Given to Caregivers
Remarks
No. Name Year of Birth Sex
Dead / Alive Health Provider:
Newborn
Mark the symbol below when these
messages have been repeated
to the caregiver. Caregiver:
y Watch out for danger signs for
the baby. e.g pus from eyes or
cord, yellow eyes
y Always keep your baby warm
and dry
y Clean the cord with only
methylated spirit twice a day
until the wound heals. Avoid
Special Care: A child with any of the following history needs special care. applying other substances
like shea butter and dusting
Tick Appropriate Box: powder
Keeping the baby warm y Give your baby only breast milk.
Birth Weight less than 2.5kg: Birth interval less than 1 year:
Feeding
Fifth Child or more: Mark the symbol below when these
messages have been repeated to the
If Child is positive for Sickle Cell Disease? caregiver. Mothers:
Single Parent: Brother/Sister Malnourished: y Give your baby only breast milk
for the first 6 months of life
Multiple Birth, e.g. Twins: y After six months, give other
foods that will help your child
Orphan: Any Bother/Sister dead: grow well and stay healthy
Others (Specify): _______________________________________________________________ y Continue to breastfeed until
baby is 2 years old or more.
_______________________________________________________________________________ Breastfeeding

Foods for complimentary feeding

Give foods that help your

baby grow well and stay healthy.

4 5
 Family Planning Malaria
Mark the symbol below when these Mark the symbol below when these
messages have been repeated to messages have been repeated to
the caregiver. Caregiver: the parents. Caregiver:
y Family planning can prevent y Prevent malaria by sleeping
unwanted pregnancy until the under ITNs
couple is ready for a baby y When the child has malaria, act
y It can prevent sickness and quickly! Sponge, give AA and
death for the woman and her paracetamol and go to a trained
baby health worker for assessment
y It helps couples plan better for and treatment.
their children’s needs
Health Worker:
y Some family planning methods
y Ask whether the caregiver and
(e.g. condom), protects you from Feel the body child are sleeping under an
sexually transmitted diseases
ITN and encourage he/she to
including HIV/AIDS
continue.
Family planning session y Talk to your health worker about
family planning.

Examining a sick child

Immunization and Vitamin A
Fill in the symbol below once the
caregiver has applied these actions. Caregiver: Diarrhoea
Mark the symbol below when these
y Immunize your baby fully before messages have been repeated to
the age of 1 year the caregiver, Caregiver:
y From six months to 5 years, y Give ORS to replace lost fluid
take your baby to the clinic for and Zinc to reduce diarrhoea
Vitamin A every 6 months.
y Bring your child quickly to the
health facility if he/she refuses to
drink or breastfeed and/or you
Immunisation notice blood in the stool
Growth Monitoring and Promotion y Continue to breastfeed/feed the
Mark the symbol below when these child.
messages have been repeated to
the caregiver. Caregiver:
y Take your baby to the clinic for
weighing every month till the
age of 2 years
y Continue to have your baby Preparing ORS
weighed every 4 months from 2
Weighing years to 5 years.

6 7
 To find out if your child has sickle cell disease, take him/her to the health
Key Information for Caregivers facility for laboratory tests as soon as possible, after birth.

Newborn baby Here are some tips on the care for a child with sickle cell disease:
y Start breastfeeding soon after delivery, within 30 minutes and give y Feed the child well. Give breast-milk only for the first 6 months of life
only breast milk for the first 6 months of life for protection against infections
y Wipe baby dry with a clean cloth, smear body with oil. (Use baby y After 6 months give baby other foods in addition to breastmilk until
oil, shea butter, palm kernel oil etc.) he/she is 2 years old and beyond
y Delay bathing the baby until next day y Protect the child from cold; do not give food/drink that is cold or iced
(6 - 24hrs) and give the baby a bath
y Let him/her sleep under an ITN every night
only once a day
y Give the child daily folic acid and other medicines prescribed by
y Always keep your baby warm and dry
your health worker
y Make sure your baby is immunized against
y Do not give iron tablets/syrup except when prescribed by your
polio and tuberculosis at birth
doctor
y Watch out for any problems such as difficult
y Give the child a lot of fluids to drink
breathing, fever or low body temperature,
yellow eyes, pus from the eye or cord, and y Always use warm water to bathe the child
report to the health worker
y Keep all appointments with your health worker even if the child is
y Clean the cord with only methylated spirit two times a day until the well.
wound heals. Avoid applying other substances like shea butter and
dusting powder
y Keep a clean environment and good personal hygiene. Immunization/Weighing

Immunize your baby fully before the age of one year.

Sickle Cell Disease y Immunization protects your baby
against many childhood diseases
In Ghana Sickle cell disease is the most common blood disease that children y Give paracetamol and sponge the
can inherit from their parents. You will not know your child has Sickle Cell Dis- child if he/she develops fever after
ease unless he/she is tested. vaccination
Signs and symptoms include: y Report to the health worker if the
child develops unusual symptoms
y Yellow eyes, mouth, palms, and other parts of the body such as, swelling, rashes, fever
y Swelling of the hands and feet and twitching/convulsion after
vaccination
y Frequent shortage of blood
y Take your baby to the clinic for weighing every month till the age of
y Enlargement of the abdomen (tummy)
2 years. From age 6 months until he/she is 5 years old, give your
y Children with sickle cell disease easily get malaria, pneumonia and child Vitamin A every 6 months.
other infections.

8 9
 Breastfeeding Feeding the Child

It is always important to feed your child with foods and fruits that would help
him/her to grow well and stay healthy. Foods can be mashed, fruits can also be
mashed, cut up or squeezed into juice.

Good positioning and attachment

y Start breastfeeding within 30 minutes after delivery
y Give your baby only breast milk for the first six months of life Feeding child with variety of
y Breast milk provides all the food and water your baby needs for the foods/fruits from the age of
6 months
first six months of life and protects the baby against infections
y The first yellowish milk (colostrum) also protects the baby against
infections, give it to your baby
y Give no water or any other liquids for the first six months of baby’s
life
y Breastfeed as often as the baby wants, day and night
y Properly position and attach the baby to the breast (see the picture
above). The baby needs to take part of the breast and not just the
nipple
y Talk to your health worker on how to feed your baby if you are HIV
positive.

Washing hands with soap and water

10 11
 Feeding a Healthy Child Feeding a Healthy Child

Birth to 6 months 6 months to 9 months 9 months to 12 months 12 months to 2 years 2 years and older
y Start breastfeeding y Breastfeed as often as y Breastfeed as often y Breastfeed as often as the child y Feed 3 times per day a variety
within 30 minutes the child wants, at least 8 as the child wants wants of family foods
after birth times during the day and
y Give 4 times a day, y Feed 3 times per day, a variety y Give also two (2) snacks daily
y Give only breast milk night
adequate serving of family foods with little or in between main meals
as often as the child y Give 3 times a day, an of a variety of foods no pepper (4 times if not
y Give fruits every day. Wash the
wants, at least 10 adequate serving of a without pepper breastfeeding)
fruits before eating
times during the day variety of foods without (5 times if not y Give also, two (2) snacks in
and night pepper. (4 times if not breastfeeding) y Serve child in a separate bowl
between main meals
breastfed) and supervise the chlid to eat
y Breastfeed long y Give also one (1) y Give fruit everyday. Wash y Wash yours and the child’s
enough to empty y Give also one (1) snack a snack a day between before eating hands with soap and water
one breast at each day between main meals main meals
feed (about 10 y Do not give water just before before eating.
minutes), before y Give fruit everyday. Wash
breastfeeding or other feeds
giving the other the fruit in salt water,
mash or squeeze into y Serve the child in a separate
breast
juice bowl and supervise the child
y Do not give water, y Give fruit everyday. when eating
sugar water, gripe y Feed new foods patiently
Wash fruit, mash, cut y Wash yours and the child’s
water, cod liver oil, y Do not give water just up, or squeeze into hands with soap and water
friut juice, pito, herbal before breast feeding or juice before eating.
preparations, koko, other feeds Feeding during and after illness:
milk or other liquids y y Do not give
Serve the child in a Birth – 5 years
or foods water just before
separate bowl Increase the frequency of
breastfeeding or y
y If you think the baby y Wash other feeds breast feeding/feeding so that
is thirsty give more yours and he/she can quickly recover
breastmilk. the child’s y Serve the child in a
weight and strength lost
hands separate bowl
with soap y Give him/her one or two
and water y Wash yours and
the child’s hands extra meals each day for two
before
feeding. with soap and water Make sure your child’s food has weeks after the child gets
before feeding. enough vitamins better to help regain lost
(See vitamin rich foods on page 23). weight.

Continue Breastfeeding for 2 years and beyond Continue Breastfeeding for 2 years and beyond.
12 13
 Family foods that you can give to the child Family foods that you can give to the child

Porridge Family Foods

Thick porridge made from maize, Waakye, rice, kenkey, fufu, aboloo,
millet, sorghum, guinea corn or gari, yam cocoyam, plantain,
rice; ekwegbemi or other thick por- cassava, sweet potato, kokonte,
ridge like tom-brown and weani- akple or tuozafi. Rice ball with groudnut soup and fish powder
mix. Add a little sugar and enrich
with one or more of the following: Serve with at least one ladle of
stew such as:
Palm oil, shea butter or other Kontomire, beans, garden egg,
vegetable oil, groundnut paste, soy okro, tomato, agushie, aleefu, Soup with fish
flour, bean flour, egg, milk or fish ayoyo, pumpkin, bokoboko all
powder. cooked with palm oil or other
Thick porridge vegetable oil and mashed fish,
For children 12 months and older, meat or egg.
porridge should be served with Rice with fish stew and palava sauce
bread, doughnuts (bofrot), koose, Or with at least one ladle of soup
kulikuli or biscuit. such as:
groundnut, palm nut, neri, okro,
vegetable soup, or green leafy
vegetable soup. All prepared with
mashed fish, meat, egg or beans. Yam porridge with fish powder and beans
Snacks: Give in between meals,
doughnuts (bofrot), koose, bread with Other family foods e.g.
margarine or groundnut paste, kulikuli, Mpotompoto, gari-foto, aprapransa
biscuit, banana, roasted or fried plantain with palm oil or other vegetable
or yam, fruit. oil and mashed fish, egg, meat, or
beans.

Fruits: Give the child everyday, fruits

such as mango, orange, watermelon,
avacado pear, pawpaw, pineapple,
banana etc.
Wash hands with soap
and water before preparing
food or feeding your child

14 15
 When Baby is Sick Treatment for malaria with MOH
Seek care at a health facility as soon as your child is sick. Do not delay. Artesunate Amodiaquin (AS-AQ)

Treatment for Worm Infestation

From the age of two years, give your child worm medicines every six months to
get rid of worms.

Home Care for Fever

When your child is sick with fever/malaria

y He/she might have malaria

y Malaria kills so treat it urgently!

Feel the body

y Sponge the child with water at

room temperature (lukewarm), give
paracetamol if available

y If your child has any of these signs: vomiting, dark urine, difficult
to wake up or convulsing, insert rectal Artemisinin (Artemisinin
suppository if available)
Sponge
y Report at once to the nearest health facility.
y See a health worker or a
Community -Based Agent
immediately for treatment

Malaria Prevention

Health worker examines

the sick child

y Give the full treatment of

Artesunate Amodiaquine (AA) as y Prevent malaria by
instructed by the health worker sleeping with your baby
or the CBA (see table on the under ITN every night.
next page).
Sleep under well tucked-in ITN

16 Give medicines and food at home 17

 Home Care For Diarrhoea

How to prepare ORS How much Zinc to give

Age Dose/ Time Period

Daily
0 – 6 months 10 mg 14 days
y Treat diarrhoea with Oral Re-
hydration Salt (ORS) and Zinc 7 months – 5 yrs 20 mg 14 days Dissolve zinc tablet in little
water or breastmilk and give
y Give your child as much fluid to the child
as possible; if your baby is still
breastfeeding, let him/her feed
more often Continue Zinc treatment for 14 days even when
the diarrhoea stops.
y You may give clean boiled water,
Pour one sachet of ORS into a bowl
rice water, porridge, mashed
kenkey or coconut juice in addition
to ORS
y Use Zinc tablets in addition to treat
diarrhoea at home. Dissolve the
zinc tablets with a little clean water,
ORS, or breast milk if the child is Other Home Fluids
still breastfeeding
y Continue feeding with the child’s
favourite food.
Add one beer bottle or two mineral y Take your child quickly to the
bottles full of water and mix well nearest clinic, if he/she refuses to Poured-off fluid from
drink, breastfeed, vomits everything, rice water
is very weak and/or you notice Fruit juice
blood in the stool.

Coconut
juice
Soup
Porridge

Give ORS to the Child

18 19
 Danger Signs When the Child is sick Family Planning

Take the child to the health facility immediately you see these signs: Family planning has several benefits for the health and welfare of the family.
y Has diarrhoea and blood in stool
y Has difficult or fast breathing
y Is lethargic or unconscious (very sleepy, difficult to awaken)
y Is convulsing Family planning
counseling session
y Is vomiting everything
y Has Fever
y Is not able to drink or breastfeed
When can you use family planning methods?
y Looks sicker (worse).
y After a baby is born
y If the couple no longer wants to have more children
Danger Signs y When the mother to be is too young or too old. (under 20 years or
above 35 years)
y To avoid pregnancies too close together. (Less than 2 years).

Why family planning?

Blood in stool Difficult or fast breathing Unable to drink or breastfeed

Mother too young Pregnancies too close

Mother too old
together
y Family planning can prevent pregnancy until the woman and
man are ready for a baby
Lethargic / unconscious Vomiting everything y It can prevent sickness and death for the woman and her baby
Fever y It helps couples plan better for their children’s needs
y Some family planning methods protect you e.g condom, from
sexually transmitted diseases, including HIV/AIDS.

There are several family planning methods available. See your health
Convulsing worker after giving birth and at any other time to help you choose the most
suitable method for you.
20 21
 Immunizations and Vitamin A
Date Batch Place Date of Foods Rich in Vitamin A
Age Period Vaccine
Given No. Given Next Visit
At Birth BCG
Polio
Hepatitis B
6 Weeks Polio
DPT/Hep B/ Hib 1 (5 in 1)
Pneumococcal
Rotavirus
10 Weeks Polio
DPT/Hep B/ Hib 2 (5 in 1)
Growth Monitoring and Promotion
Pneumococcal
Rotavirus
Use of the Growth Chart
14 Weeks Polio
y The growth charts have been developed to help caregivers to
DPT/Hep B/ Hib 3 (5 in 1)
follow the growth of the child (Pink for girls, and blue for the boys).
Pneumococcal
y Each child grows along his or her own curve based on the birth
Rotavirus
weight. Some babies may be born big, and others small.
6 Months Vitamin A
y The caregiver should make sure that the child’s weight increases
9 Months Measles
adequately every month, which can be shown at monthly
Yellow Fever weighing.
12 Months Vitamin A
y When the curve remains flat, dips or does not rise adequately then
18 Months Vitamin A
there is a problem. This means that the child may be sick or not
Measles receiving adequate food. Discuss with your health worker and take
action.
Vitamin A Continued
Vitamin A
2½ 3 3½ 4½
Age: 2 years 4 years 5 years
years years years years
Date:
Other Vaccines
Date:
Vaccine:
Batch No#
Date Given:
Date of Next Visit:
Weighing
23
 Mother, Father, Caregiver,
Stages of Growth (Developmental Milestones)
y Look at the direction of your child’s curve. Is it rising adequately
(A), flat (B) or dipping (C)? It is important to follow your child’s growth. There are a few signs that can help
you follow the growth and development of your child from birth to 5 years.

Look out for these signs

A child might have a problem in these areas when the child shows any of the
following behaviours/signs.

A B C Hearing – if the child:

y Does not turn toward the source of new
sounds or voices
y Has frequent ear infection. (discharge from
ear, earache)
y Does not respond when you call unless he
can see you
y Does not talk or talks strangely.

y Discuss your child’s growth with the health worker and take Seeing – If the child:
action, when necessary.
y Has red or discharging eyes
y A cloudy appearance of the eyes
y Frequently rubs eyes and says they hurt
y Often bumps into things while moving
around
y Holds head in an awkward position when
trying to look at something
y Has eyes which sometimes or always
look in different directions (squints)
y Has a white spot in the eye.

24 25
 Talking – If the child: Keeping Healthy
y Does not say mama/mommy/dada by 18
months of age
y Wash your hands with soap and water
y Cannot name a few familiar objects/
y Before preparing food
people by 2 years
y Before eating
y Cannot repeat simple songs/rhymes by
3 years y Before feeding the baby
y Is not talking in short sentences by age 4 years. y After visiting the toilet
y After cleaning the baby
Playing – If the child:
y After handling chemicals eg. fertilizer, chemicals that kill weed,
y Does not enjoy playing simple waving games insecticide spray
by 1 year
Wash your hands with water and soap
y Does not play with common objects (e.g.
spoons and bowls), by 2 years Before you
prepare food After visiting the toilet
y Does not join games with other children by 4
years. (e.g. catch, hide and seek) Before you feed
the baby
y Does not play like other children of the same
age.

Moving – If the child:

y Is unable to sit unsupported by 10months Before eating

y Cannot walk without help by 2 years

y Cannot balance on one (1) foot for a short
time by 4 years
After you clean
y Moves very differently from other children of your child
the same age.

y Continue to give the child nutritionally adequate diet with lots of fruits and
vegetables.
y Ensure the child gets enough rest, a nap in the afternoon
Any child with an identified problem should immediately be taken to a
health worker.
Continue to give your child healthy foods that will promote growth and
development.

26 27
 Assessment form for sick children under 5 years (IMNCI) Ear Problem (Y/N)
Pain
Health Provider Discharge (If yes state duration)
Tender swelling behind ear.
All sick children should be assessed for the following:
Nutrition
Visible severe wasting (inadequate weight gain)
Date:...................................................... Temp:............................................. Age:........................................... Palmer pallor (If yes, severe or some)
Oedema of both feet
Weight:............................................... Weight for age (very low/not very low inadequate weight gain).
Complaint:...............................................................................................................................................................................................

Check Immunisation and Vitamin A status and refer/immunise if not

Danger Signs up to date
Not able to drink/breastfeed
Vomits everything he/she eats and drinks
Convulsions (History of convulsion in present illness) Assess feeding if anaemic, low weight or less than 2 years
Lethargic/unconsciousness (very sleepy, hard to awaken) (Frequency of breast feeding / 24 hours)
For new born, yellow eyes, discharging cord. Use of feeding bottle
Frequency of other foods/drink given.
Cough/Difficult Breathing (Y/N)
Duration (days) Assess Other Problems
Breath rate per minute Diagnosis or classification
Chest indrawing Counseling on feeding (see recommendations on pages 11 & 15)
Stridor. Treatment
Referral.
Diarrhoea (Y/N)
Duration (days)
Blood in stool
Lethargic/ Unconsciousness
Sunken Eyes
Not able to drink/drinking poorly
Skin pinch (normal/abnormal).
ALWAYS USE THIS FORMAT
Fever (Y/N)
Duration (days)
ON PAGES 28 AND 29 AS
Measles within last 3 months A GUIDE FOR YOUR CLINICAL NOTES
Neck stiffness
Measles rash
Cough/runny nose/red eyes
If yes for measles, look for mouth ulcers/pus in eyes/cloudy cornea.

28 29
 Progress Notes/ Agreements Reached

Key Health Actions for Date

Child Growth and Development

30 31
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

32 33
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

34 35
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

36 37
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

38 39
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

40 41
 Progress Notes/ Agreements Reached Progress Notes/ Agreements Reached

Date Date

42 43
 Progress Notes/ Agreements Reached

Date

44