CHILDREN’S CLINIC CARD

CHILD’S PARTICULARS IMMUNISATION RECORD PMTCT

Name of Health Facility CE MSU CNE IMPORTANT:

IMMUNISATION against Tuberculosis (TB) ? All infants and young children should be breastfed exclusively for
BCG (at birth) Date .............................. the first six months of life and continue to breastfeed up to two
Child’s No. If no scar after 12 weeks, years and beyond with adequate complementary feeding from six
repeat dose. Unless symptomatic HIV Date .............................. Test by: months of age unless medically indicated.

Child’s Name Boy/Girl ? Babies born to HIV positive mothers have special feeding needs.
IMMUNISATION against Polio (OPV), Diphtheria, Whooping Discuss with a health worker.
Cough, Tetanus, Hib, Hepatitis B, Meningitis, Pneumonia DATE R NR I
(DPT-HepB-Hib) & Measles
Mother’s or Guardian’s Name NRC no. PCR
6
52
IF THE CHILD HAS DIARRHOEA
OPV 0 (at birth to 13 days) Date ....................................... 12
Rapid Test
12 ? If the child is still on breast milk, continue breast feeding.
Father’s or Guardian’s Name NRC no. OPV 1 (at 6 weeks) DPT-HepB-Hib 1 (at 6 weeks) 18
Rapid Test
Date .................................... Date .............................................. 12 After each loose stool, do the following:

Date first seen OPV 2 DPT-HepB-Hib 2 ? Give ORS

Date of Birth Birth weight (at least 4 weeks after OPV 1) (at least 4 weeks after DPT-HepB-Hib1) ? Give extra fluids
Date .................................... Date ..................................................... MGA IGA ? Continue to feed the child.

OPV 3 DPT-HepB-Hib 3 Note: (dilute 1 sachet of ORS in 1 litre of boiled cooled water)
Place of Birth: (at least 4 weeks after OPV 2) (at least 4 weeks after DPT-HepB-Hib 2) Follow up time 6 Weeks 2 Months 3M 4M 5M 6M 7M
Date ........................................... Date ..................................................... Go immediately to the nearest Health Centre.
Cotrimoxazole
Where the family lives: address OPV 4 (at 9 months, only if OPV 0 Measles (at 9 months, or soon after.
was not given) Unless symptomatic HIV) Follow up time 8M 9M 10M 12M 15M 18M 24M PNEUMONIA
Date .......................................... Date ....................................................
Cotrimoxazole If a child has a cough with:
! Fast Breathing
! Difficulties in breathing
OTHER IMMUNISATIONS Date baby referred for ART............/.........../.......... ! Difficulties in breast-feeding
Tick if the child has/is: Date Date initiated on ART............../.............../.............
Birth weight less than 2.5kg The child may have Pneumonia, Go immediately to the nearest
Date Age at initiation of ART......................................... Health Centre.
Birth defect/handicap MONITORING OF INFANT AND YOUNG CHILD FEEDING
Born within 2 years of last delivery
VITAMIN A SUPPLEMENTATION Follow up time Birth 6 Days 1M 6W 2M 3M 4M 5M 6M DISCUSS
Fully protected against Tetanus at birth Dosage: 0-5 months, 50,000 IU only if not breastfed;
6-11 months,100,000 IU; Infant feeding code
Mother dead ? Breastfeeding ? Feeding during and after illness
12-59 months, 200,000 IU every six months ? Complementary feeding ? Safe food and drinking water
Follow up time 7M 8M 9M 10M 11M 12M 15M 18M 24M
Father dead Date Dosage Date Dosage ? Immunisation ? Treatment of diarrhoea
? Vitamin A supplementation ? HIV/AIDS
Alive Infant feeding code ? Family planning ? Malaria
Number of brothers and sisters
Dead
Alive
Twin child Dead Feeding Code:
Any other reason for special attention: 1) Exclusive breast feeding (in the first 6 months, breast-feeding only, no water,
no other fluids except medicines indicated by medical personnel)
2) Exclusive Alternative Infant Formula
DEWORMING
For children aged 12 months and above, 500 mg Mebendazole every six months 3) Animal Milk

Date Medication Date Medication MOTHER 4) Mixed feeding (breast milk and other foods)
5) Continued breast feeding after six months in addition to other foods
Date Vit. A given to the mother
6) Milk based feed after six months in addition to other foods

Vitamin A (1 dose of 200,000 IU) to be given soon after 7) Other, specify

birth or within two months of delivery. .......................................................................................................................
Ministry of Health
......................................................................................................................
 NUTRITION RECORD Kg 28 28
Record of visits and nutrition counselling follow up 27 WATCH THE DIRECTION OF THE LINE SHOWING THE CHILD’S GROWTH 3-5 years
27

26 GOOD DANGER SIGN VERY DANGEROUS 26

Date Nutritional Advice Follow up Means the child Suggest feeding the Child may be ill,
25 is growing well. child at least 5 times needs extra care. 25
status given date
24
each day. 3 main meals and 2 snacks per day 24
Kg
If inadequate weight gain for 2 months or more, seek
23 23 23 23
medical attention from a health care provider. If
22 oedema on both feet, point an arrow on the growth 22 22
22
curve and then seek medical attention from nearest 2-3 years
21 health centre. Kg 21 21 21 21

20 20 20 20 20
+ +
19 19 19 19 19
18 18 18 18 18
3 main meals and 2 snacks per day
17 + Kg 17 17 17 17 17

16 16
1 - 2 years 16 16 16 16
3 meals per day
15 15 15 15 15 15
Weight (Kgs)

14 14 14 14 14 14
Birth - 6 months - 1 year
13 13 13 13 13 13

12 12 12 12 12 12

11 11 11 11 11
49 50 51 52 53 54 55 56 57 58 59 60
10 10 10 10 10
9 9 9 9
Birth Weight

37 38 39 40 41 42 43 44 45 46 47 48
8 8 8 8

7 7 7
25 26 27 28 29 30 31 32 33 34 35 36
6 6 6
4 years 5 years
5 Add these other
5
13 14 15 16 17 18 19 20 21 22 23 24
Birth Date

foods to the
4 baby’s porridge 4
Rice

3 + 3

2 or give with 2
nshima.
1 1
Milk

0 Use a variety of locally available foods such as 0

1 2 3 4 5 6 7 8 9 10 11 12 Continue breastfeeding and vegetables, kapenta, beans, groundnuts,
feed the child with 3 main meals sweet potatoes, cassava, millet, rice, fresh milk
and 2 snacks per day.
or sour milk, fruits, oil.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

5 years
 CHILDREN’S CLINIC CARD
CHILD’S PARTICULARS IMMUNISATION RECORD PMTCT

Name of Health Facility CE MSU CNE IMPORTANT:

IMMUNISATION against Tuberculosis (TB) ? All infants and young children should be breastfed exclusively for
BCG (at birth) Date .............................. the first six months of life and continue to breastfeed up to two
Child’s No. If no scar after 12 weeks, years and beyond with adequate complementary feeding from six
repeat dose. Unless symptomatic HIV Date .............................. Test by: months of age unless medically indicated.

Child’s Name Boy/Girl ? Babies born to HIV positive mothers have special feeding needs.
IMMUNISATION against Polio (OPV), Diphtheria, Whooping Discuss with a health worker.
Cough, Tetanus, Hib, Hepatitis B, Meningitis, Pneumonia DATE R NR I
(DPT-HepB-Hib) & Measles
Mother’s or Guardian’s Name NRC no. PCR
6
52
IF THE CHILD HAS DIARRHOEA
OPV 0 (at birth to 13 days) Date ....................................... 12
Rapid Test
12 ? If the child is still on breast milk, continue breast feeding.
Father’s or Guardian’s Name NRC no. OPV 1 (at 6 weeks) DPT-HepB-Hib 1 (at 6 weeks) 18
Rapid Test
Date .................................... Date .............................................. 12 After each loose stool, do the following:

Date first seen OPV 2 DPT-HepB-Hib 2 ? Give ORS

Date of Birth Birth weight (at least 4 weeks after OPV 1) (at least 4 weeks after DPT-HepB-Hib1) ? Give extra fluids
Date .................................... Date ..................................................... MGA IGA ? Continue to feed the child.

OPV 3 DPT-HepB-Hib 3 Note: (dilute 1 sachet of ORS in 1 litre of boiled cooled water)
Place of Birth: (at least 4 weeks after OPV 2) (at least 4 weeks after DPT-HepB-Hib 2) Follow up time 6 Weeks 2 Months 3M 4M 5M 6M 7M
Date ........................................... Date ..................................................... Go immediately to the nearest Health Centre.
Cotrimoxazole
Where the family lives: address OPV 4 (at 9 months, only if OPV 0 Measles (at 9 months, or soon after.
was not given) Unless symptomatic HIV) Follow up time 8M 9M 10M 12M 15M 18M 24M PNEUMONIA
Date .......................................... Date ....................................................
Cotrimoxazole If a child has a cough with:
! Fast Breathing
! Difficulties in breathing
OTHER IMMUNISATIONS Date baby referred for ART............/.........../.......... ! Difficulties in breast-feeding
Tick if the child has/is: Date Date initiated on ART............../.............../.............
Birth weight less than 2.5kg The child may have Pneumonia, Go immediately to the nearest
Date Age at initiation of ART......................................... Health Centre.
Birth defect/handicap MONITORING OF INFANT AND YOUNG CHILD FEEDING
Born within 2 years of last delivery
VITAMIN A SUPPLEMENTATION Follow up time Birth 6 Days 1M 6W 2M 3M 4M 5M 6M DISCUSS
Fully protected against Tetanus at birth Dosage: 0-5 months, 50,000 IU only if not breastfed;
6-11 months,100,000 IU; Infant feeding code
Mother dead ? Breastfeeding ? Feeding during and after illness
12-59 months, 200,000 IU every six months ? Complementary feeding ? Safe food and drinking water
Follow up time 7M 8M 9M 10M 11M 12M 15M 18M 24M
Father dead Date Dosage Date Dosage ? Immunisation ? Treatment of diarrhoea
? Vitamin A supplementation ? HIV/AIDS
Alive Infant feeding code ? Family planning ? Malaria
Number of brothers and sisters
Dead
Alive
Twin child Dead Feeding Code:
Any other reason for special attention: 1) Exclusive breast feeding (in the first 6 months, breast-feeding only, no water,
no other fluids except medicines indicated by medical personnel)
2) Exclusive Alternative Infant Formula
DEWORMING
For children aged 12 months and above, 500 mg Mebendazole every six months 3) Animal Milk

Date Medication Date Medication MOTHER 4) Mixed feeding (breast milk and other foods)
5) Continued breast feeding after six months in addition to other foods
Date Vit. A given to the mother
6) Milk based feed after six months in addition to other foods

Vitamin A (1 dose of 200,000 IU) to be given soon after 7) Other, specify

birth or within two months of delivery. .......................................................................................................................
Ministry of Health
......................................................................................................................
 NUTRITION RECORD Kg 30 30
Record of visits and nutrition counselling follow up 29 29
WATCH THE DIRECTION OF THE LINE SHOWING THE CHILD’S GROWTH 3-5 years
28 GOOD DANGER SIGN VERY DANGEROUS 28
Date Nutritional Advice Follow up Means the child Suggest feeding the Child may be ill,
27 27
status given date is growing well. child at least 5 times needs extra care.
3 main meals and 2 snacks per day
26 each day. 26
Kg
25 If inadequate weight gain for 2 months or more, seek 25 25 25
medical attention from a health care provider. If
24 24 24 24
oedema on both feet, point an arrow on the growth
23 curve and then seek medical attention from nearest 23 23 23
health centre.
22 2-3 years 22 22 22
21 Kg 21 21 21 21
20 + + 20 20 20 20
19 19 19 19 19
3 main meals and 2 snacks per day
18 + 18 18 18 18
1 - 2 years
17
3 meals per day
Kg 17 17 17 17 17
16 16 16 16 16 16
Weight (Kgs)

15 15 15 15 15 15
14
Birth - 6 months - 1 year 14 14 14 14 14
13 13 13 13 13 13
12 12 12 12 12 12
11 11 11 11 11 11
10 10 10 10 10 10
9 9 9 9 9
Birth Weight

49 50 51 52 53 54 55 56 57 58 59 60
8 8 8 8
37 38 39 40 41 42 43 44 45 46 47 48
7 7 7
25 26 27 28 29 30 31 32 33 34 35 36
6 6 6
4 years 5 years
5 5
13 14 15 16 17 18 19 20 21 22 23 24 Add these other
Birth Date

foods to the
4 Rice
baby’s porridge 4
3 + 3
2 2
or give with
nshima.
1 1
Milk

0 Use a variety of locally available foods such as 0

1 2 3 4 5 6 7 8 9 10 11 12 Continue breastfeeding and vegetables, kapenta, beans, groundnuts,
feed the child with 3 main meals sweet potatoes, cassava, millet, rice, fresh milk
and 2 snacks per day.
or sour milk, fruits, oil.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
5 years