Midwife Licensure Exam Infant & Child Health (Growth, Development & IMCI) — Communicable & Infectious Diseases in Children (IMCI)Revision Notes

Exam Tips

• Make a quick mental table: Disease → Transmission → Hallmark → Main complication → Key nursing action.
• If the question mentions 'pathognomonic' or 'hallmark,' think: Measles = Koplik spots; Diphtheria = pseudomembrane; Pertussis = inspiratory whoop; Dengue = tourniquet test.
• Questions about isolation: identify the transmission route FIRST, then choose the correct precaution level.
• Any child who is lethargic, unconscious, convulsing, vomiting everything, or unable to drink = URGENT REFERRAL under IMCI (Pink classification).

Key Points

• Most classic childhood communicable diseases are vaccine-preventable through the DOH Expanded Program on Immunization (EPI).
• The THREE most important items to know for each disease: (1) causative agent and MODE OF TRANSMISSION, (2) hallmark/pathognomonic sign, and (3) main complication.
• Isolation precautions follow transmission route: AIRBORNE (measles, varicella) requires N95 mask and negative-pressure room; DROPLET (mumps, rubella, pertussis, diphtheria) requires surgical mask and 1-meter distance; CONTACT (varicella — also) requires gloves and gown.
• The nursing process guides all management: ASSESS (signs/symptoms, vitals, hydration, rash, lymph nodes), DIAGNOSE (NANDA), PLAN, IMPLEMENT, EVALUATE.
• Priority nursing diagnoses across communicable diseases include: Hyperthermia (Maslow physiologic), Risk for Infection Transmission, Impaired Skin Integrity (varicella), Ineffective Airway Clearance (pertussis, diphtheria), and Deficient Fluid Volume (dengue, diarrhoea).
• Under RA 9173 (Philippine Nursing Act of 2002), the RN has the legal authority to assess, plan, implement, and evaluate nursing care — including initiating isolation precautions and health education independently.

Definitions

Section Title

Overview: Key Concepts in Childhood Communicable Diseases

Common Mistakes

• Confusing AIRBORNE vs. DROPLET precautions — measles and varicella are AIRBORNE (N95 required); mumps, rubella, pertussis, diphtheria are DROPLET.
• Forgetting that varicella requires BOTH airborne AND contact precautions.
• Mixing up which disease's complication is orchitis (mumps) vs. myocarditis (diphtheria) vs. encephalitis (measles).
• Giving aspirin for fever in varicella — this causes REYE'S SYNDROME; always use paracetamol.

Exam Tips

• Memory aid: 'KOPLIK SPOTS COME BEFORE KOPLIK STOPS' — they appear before the rash and stop when the rash begins.
• If a question asks 'Which sign is PATHOGNOMONIC for measles?' — always answer KOPLIK SPOTS.
• Vitamin A is given in measles to reduce blindness and pneumonia risk — this is a WHO/DOH-recommended nursing action.
• Rash direction: CEPHALOCAUDAL = top to bottom = measles. This distinguishes it from other rashes.

Key Points

• Causative agent: Measles virus. Transmission: AIRBORNE — the most contagious of all childhood diseases.
• Incubation period: 10–14 days. Infectious period: from 4 days BEFORE to 4 days AFTER rash onset.
• PRODROMAL PHASE (3–4 days): High fever, the '3 C's' — Cough, Coryza (runny nose), and Conjunctivitis — plus photophobia.
• PATHOGNOMONIC SIGN: KOPLIK SPOTS — tiny bluish-white spots on a red base found on the BUCCAL MUCOSA (inner cheek). They appear BEFORE the rash and disappear as the rash emerges.
• RASH: Erythematous (red) maculopapular, begins at the HAIRLINE/FACE and spreads CEPHALOCAUDALLY (downward). Fades in the same order (brownish discoloration, then desquamation).
• Complications: PNEUMONIA (most common cause of measles death in children), otitis media, encephalitis, blindness.
• Management: Supportive — adequate fluids, paracetamol for fever, dim room for photophobia. GIVE VITAMIN A to ALL children with measles (reduces severity and mortality). AIRBORNE precautions.
• Vitamin A dose in measles: 50,000 IU (<6 months), 100,000 IU (6–11 months), 200,000 IU (≥12 months) — given for 2 consecutive days.
• Prevention: MMR (Measles-Mumps-Rubella) vaccine — given at 9 months and 12–15 months per EPI schedule.

Definitions

Section Title

Measles (Rubeola)

Common Mistakes

• Saying Koplik spots appear WITH or AFTER the rash — they appear BEFORE and disappear as rash emerges.
• Giving the wrong dose of Vitamin A for the child's age group during measles management.
• Forgetting that PNEUMONIA (not encephalitis) is the most common cause of death in measles.
• Using contact-only precautions — measles requires AIRBORNE precautions (N95 mask, negative-pressure room).

Exam Tips

• Memory aid for mumps diet: 'No sour, no salty — keep it bland and soft.'
• If the question mentions a teenage boy with mumps developing testicular pain → orchitis → risk for infertility.
• Mumps = DROPLET (surgical mask, 1-meter distance) — NOT airborne.

Key Points

• Causative agent: Mumps virus. Transmission: DROPLET. Incubation: 14–21 days.
• HALLMARK: Painful, tender swelling of the PAROTID GLANDS (salivary glands just below and in front of the ears), bilateral in most cases — giving a 'chipmunk' facial appearance.
• Symptoms: Fever, earache, pain on chewing and swallowing (especially with sour/acidic foods which stimulate saliva flow).
• Complications: ORCHITIS (testicular inflammation — can cause infertility in post-pubertal males), oophoritis (in females), aseptic meningitis, encephalitis, sensorineural DEAFNESS.
• Management: Supportive — analgesics/antipyretics (paracetamol/ibuprofen), soft BLAND diet, AVOID SOUR/ACIDIC foods (triggers pain), warm or cool compresses to parotid area. SCROTAL SUPPORT if orchitis develops. DROPLET precautions.
• Prevention: MMR vaccine.

Definitions

Section Title

Mumps (Epidemic Parotitis)

Common Mistakes

• Giving sour foods or juices (like orange juice) to a child with mumps — this stimulates saliva and WORSENS pain.
• Forgetting to apply scrotal support for orchitis — important comfort nursing measure.
• Confusing mumps complications with measles complications — orchitis = mumps; pneumonia = measles; myocarditis = diphtheria.

Exam Tips

• Key phrase: 'All stages at once' = varicella. This is the single most important differentiating feature.
• 'Dewdrops on a rose petal' = varicella vesicles on an erythematous base — a classic NLE descriptor.
• Reye's syndrome prevention = NO ASPIRIN in children with ANY viral illness, especially varicella or influenza.
• Isolation is lifted only when ALL lesions are crusted — not when new lesions stop appearing.

Key Points

• Causative agent: Varicella-Zoster Virus (VZV). Transmission: AIRBORNE + DIRECT CONTACT with vesicle fluid. Incubation: 10–21 days.
• HALLMARK: Pruritic (very itchy) vesicular rash appearing in 'CROPS' — meaning lesions are present in ALL stages simultaneously: macule → papule → vesicle → crust. Vesicles are described as 'dewdrops on a rose petal.'
• The rash starts on the TRUNK (face, scalp, trunk) and spreads CENTRIFUGALLY (outward) to extremities — opposite pattern from measles.
• CONTAGIOUS PERIOD: From 1–2 days BEFORE rash until ALL lesions have CRUSTED OVER (no more weeping vesicles).
• Management: Symptomatic relief — CALAMINE LOTION (soothes itch), ANTIHISTAMINES (oral), COOL BATHS, KEEP NAILS SHORT (prevent scratching → secondary bacterial infection). ACYCLOVIR for immunocompromised/high-risk children. AIRBORNE + CONTACT precautions.
• CRITICAL: NEVER GIVE ASPIRIN to children with varicella — causes REYE'S SYNDROME (acute encephalopathy and liver failure). Use PARACETAMOL.
• Prevention: Varicella vaccine (Varivax) — 2 doses.

Definitions

Section Title

Varicella (Chickenpox)

Common Mistakes

• Giving aspirin for fever in a child with varicella — this is a SERIOUS MEDICATION ERROR leading to Reye's syndrome.
• Discharging the child before ALL lesions have crusted — the child remains contagious until complete crusting.
• Using only CONTACT precautions — varicella requires BOTH AIRBORNE and CONTACT precautions.
• Forgetting to keep fingernails short — scratching breaks vesicles, causing secondary bacterial infection (impetigo).

Exam Tips

• Memory aid: 'Rubella = 3 days, Mild, but Menace to the Mother's baby.'
• If a question mentions a pregnant nurse exposed to a child with rubella — the concern is CRS in the fetus.
• Postauricular lymphadenopathy + 3-day rash + low-grade fever = RUBELLA (not measles).
• MMR vaccine protects against all three: Measles, Mumps, Rubella — given at 9 months and 12–15 months per EPI.

Key Points

• Causative agent: Rubella virus. Transmission: DROPLET. Incubation: 14–21 days. Generally MILD in children.
• HALLMARK: A pink maculopapular rash starting on the FACE, spreading downward — lasts only ~3 days (hence '3-day measles'). Accompanied by LOW-GRADE FEVER.
• DISTINCTIVE SIGN: POSTAURICULAR (behind the ears), OCCIPITAL (back of head), and POSTERIOR CERVICAL LYMPHADENOPATHY — tender lymph nodes in these areas, appearing BEFORE the rash.
• GREATEST DANGER: NOT to the infected child, but to the FETUS. Rubella in a pregnant woman (especially first trimester) causes CONGENITAL RUBELLA SYNDROME (CRS): cataracts, congenital heart defects (PDA, VSD), sensorineural deafness, intellectual disability ('CCHD' triad).
• Nursing action: KEEP INFECTED CHILDREN AWAY FROM PREGNANT WOMEN. Report to local health authority (communicable disease is reportable).
• Management: Supportive — analgesics, fluids, rest. DROPLET precautions.
• Prevention: MMR vaccine — the most important intervention.

Definitions

Section Title

Rubella (German Measles / 3-Day Measles)

Common Mistakes

• Thinking rubella is dangerous for the CHILD — it is MILD in children; the danger is to the FETUS of a pregnant contact.
• Confusing rubella (3-day mild rash + postauricular nodes) with measles (3 C's + Koplik spots + pneumonia risk).
• Forgetting to segregate rubella-infected children from pregnant women — a critical nursing responsibility.

Exam Tips

• Pertussis drug of choice: MACROLIDE (erythromycin/azithromycin) — NOT penicillin, NOT cephalosporins.
• Infant + apnea + cough = suspect pertussis — hospitalize immediately and monitor respirations.
• The 'whoop' is caused by the forced inhalation after prolonged expiratory coughing — the airway is briefly obstructed by thick mucus.
• Pertussis = DROPLET precautions = surgical mask + 1-meter distance + hand hygiene.

Key Points

• Causative agent: Bordetella pertussis (bacteria). Transmission: DROPLET. Incubation: 6–20 days.
• THREE STAGES: (1) CATARRHAL stage (1–2 wks) — resembles URI, runny nose, mild cough, most contagious; (2) PAROXYSMAL stage (2–4 wks) — HALLMARK: severe coughing paroxysms ending with a high-pitched inspiratory 'WHOOP,' followed by post-tussive vomiting and cyanosis; (3) CONVALESCENT stage — gradual recovery.
• Most DANGEROUS in YOUNG INFANTS (< 6 months) — instead of a 'whoop,' infants may have APNEA (life-threatening cessation of breathing). Requires hospitalization and monitoring.
• Complications: Pneumonia (most common), apnea, seizures (from hypoxia), subconjunctival hemorrhage (from coughing pressure).
• Management: MACROLIDE ANTIBIOTICS — erythromycin, azithromycin, or clarithromycin (antibiotic of choice). Supportive: gentle suctioning, supplemental oxygen, small frequent feeds, hydration, APNEA MONITORING for infants. DROPLET precautions.
• Prevention: DPT/Pentavalent vaccine (given at 6, 10, 14 weeks per EPI). Tdap booster for caregivers (cocooning strategy).

Definitions

Section Title

Pertussis (Whooping Cough)

Common Mistakes

• Forgetting that young infants may NOT produce the 'whoop' — instead presenting with APNEA, making pertussis harder to recognize in this age group.
• Using penicillin instead of macrolides — the drug of choice is ERYTHROMYCIN or AZITHROMYCIN (macrolide class).
• Administering large feeds — should be SMALL, FREQUENT FEEDS to reduce post-tussive vomiting and aspiration risk.

Exam Tips

• Priority nursing action in diphtheria: Give ANTITOXIN first (neutralize toxin), then antibiotics (eliminate bacteria).
• Complication to always monitor: MYOCARDITIS — watch for dysrhythmias, chest pain, poor pulse quality.
• Airway emergency: Have tracheostomy set at bedside for possible airway obstruction from pseudomembrane extension.
• Strict bed rest rationale: Prevents increased cardiac demand in a heart already compromised by the toxin.

Key Points

• Causative agent: Corynebacterium diphtheriae (bacteria, produces exotoxin). Transmission: DROPLET. Incubation: 2–5 days.
• HALLMARK: A tough, adherent, GREYISH-WHITE PSEUDOMEMBRANE over the tonsils and pharynx that BLEEDS when removed — DO NOT attempt to forcibly remove it (causes bleeding and spreads toxin).
• Clinical features: Sore throat, LOW-GRADE FEVER, 'BULL NECK' appearance (from cervical lymphadenopathy and edema), hoarseness, and possible stridor (airway obstruction).
• COMPLICATIONS: (1) AIRWAY OBSTRUCTION (from membrane extension to larynx/trachea) — have emergency airway equipment ready; (2) MYOCARDITIS (cardiac toxicity from diphtheria exotoxin — leading cause of death); (3) Neuritis (peripheral nerve damage).
• Management: (1) DIPHTHERIA ANTITOXIN (DAT) — neutralizes unbound toxin, given IMMEDIATELY regardless of culture results; (2) ANTIBIOTICS — penicillin or erythromycin (to eliminate the bacteria); (3) STRICT BED REST (to reduce cardiac workload — myocarditis risk); (4) Keep emergency airway equipment (tracheostomy set) at bedside; (5) DROPLET precautions.
• Prevention: DPT/Pentavalent vaccine.

Definitions

Section Title

Diphtheria

Common Mistakes

• Attempting to remove the pseudomembrane — this causes BLEEDING and can dislodge pieces that obstruct the airway. NEVER remove it forcibly.
• Forgetting to prescribe strict BED REST — diphtheria toxin causes myocarditis, and physical exertion can trigger fatal cardiac arrhythmias.
• Waiting for culture results before giving antitoxin — DAT must be given IMMEDIATELY on clinical suspicion.
• Using only antibiotics without antitoxin — antibiotics eliminate bacteria but do NOT neutralize the toxin.

Exam Tips

• Dengue fever = DAY-biting mosquito + CLEAN stagnant water = Aedes aegypti. NOT Anopheles (malaria).
• Warning signs mnemonic: 'SUPER ABD' — Severe abdominal pain, Unstable (restless/lethargic), Persistent vomiting, Epistaxis/mucosal bleeding, Rapid drop in temperature, Abdominal bleeding, BP narrowing, Diaphoresis (cold clammy).
• Fluid management in dengue: oral hydration first; escalate to IV if warning signs appear.
• DOH 4-S: Search → Self-protect → Seek early → Support fogging. Know all 4 for NLE.

Key Points

• Causative agent: Dengue virus (DENV 1–4, four serotypes). Vector: Aedes aegypti mosquito — a DAY-BITING mosquito that breeds in CLEAN, STAGNANT WATER (pots, tires, flower vases).
• NOT transmitted person-to-person. Second infection with a DIFFERENT serotype carries higher risk of severe dengue.
• CLINICAL PHASES: (1) FEBRILE phase (Days 1–3) — high fever, severe headache, retro-orbital pain, myalgia/arthralgia ('breakbone fever'), flushed face, rash; (2) CRITICAL phase (Days 4–6) — fever defervesces, plasma leakage → hemoconcentration, risk of DENGUE SHOCK SYNDROME (DSS); (3) RECOVERY phase (Day 7+) — reabsorption of fluids, diuresis.
• TOURNIQUET TEST (Rumpel-Leede test): Inflate BP cuff to midpoint between systolic and diastolic for 5 minutes. POSITIVE if ≥20 petechiae per 1 square inch — indicates capillary fragility.
• WARNING SIGNS (must report/admit IMMEDIATELY): Severe abdominal pain, persistent vomiting, mucosal/gum bleeding, restlessness or sudden lethargy, rapid drop in temperature with cold clammy skin (early shock).
• Laboratory: THROMBOCYTOPENIA (↓platelets <100,000/mm³), HEMOCONCENTRATION (↑hematocrit ≥20% above baseline).
• Management: NO specific antiviral. FLUID RESUSCITATION is the priority — oral fluids for mild dengue, IV fluids (Ringer's lactate or normal saline) for severe dengue/DSS. Monitor platelet count and hematocrit q4–6h. Use PARACETAMOL for fever. AVOID ASPIRIN and NSAIDs (increase bleeding risk).
• DOH '4-S' Prevention Strategy: (1) Search and destroy breeding sites; (2) Self-protection (repellents, long clothing, window screens); (3) Seek early consultation; (4) Support fogging (only during outbreaks, not routine).

Definitions

Section Title

Dengue Fever and Dengue Hemorrhagic Fever

Common Mistakes

• Giving aspirin or ibuprofen (NSAIDs) for dengue fever — these inhibit platelet function and WORSEN BLEEDING. Always use PARACETAMOL.
• Fogging as a routine prevention measure — DOH 4-S specifies fogging ONLY during outbreaks, not for regular prevention.
• Missing warning signs during the afebrile 'critical phase' — mistaking defervescence for recovery when it actually signals plasma leakage.
• Forgetting to monitor BOTH platelets AND hematocrit — platelet count alone is insufficient.

Formulas

Exam Tips

• IMCI dehydration plans: No dehydration = Plan A (home/ORS + zinc); Some dehydration = Plan B (ORS 75 mL/kg × 4h supervised); Severe dehydration = Plan C (IV fluids immediately).
• ORS + Zinc = the two non-negotiable components of diarrhoea management at all levels.
• Zinc duration: 10–14 days regardless of how quickly the diarrhoea resolves.
• If a question asks about IV fluid choice in severe dehydration → Ringer's Lactate is preferred over Normal Saline.

Key Points

• Leading cause of under-5 death globally and in the Philippines. The DANGER is DEHYDRATION.
• Most common cause in children: ROTAVIRUS (viral — vaccine now available); also bacterial (E. coli, Salmonella, Shigella) and parasitic (Entamoeba, Giardia).
• IMCI/DOH DEHYDRATION ASSESSMENT and TREATMENT PLANS:
• PLAN A (No Dehydration): Home management — give EXTRA FLUIDS after each loose stool, continue breastfeeding/feeding, give ZINC, return if worsens.
• PLAN B (Some Dehydration — 2 signs: restless/irritable, sunken eyes, drinks eagerly/thirsty, decreased skin turgor): Supervised ORS administration — 75 mL/kg over 4 HOURS at health facility, then REASSESS.
• PLAN C (Severe Dehydration — lethargic/unconscious, sunken eyes, unable to drink, very poor skin turgor): IV FLUIDS IMMEDIATELY — Ringer's Lactate (preferred) or Normal Saline. If unable to insert IV, use nasogastric ORS or refer to hospital.
• ZINC SUPPLEMENTATION: 10 mg/day for infants < 6 months; 20 mg/day for children ≥ 6 months — given for 10–14 DAYS to reduce duration, severity, and recurrence of diarrhoea.
• CONTINUE BREASTFEEDING and FEEDING throughout diarrhoea — DO NOT withhold food (worsens malnutrition and prolongs illness).
• ORS formula: Low-osmolarity ORS (DOH/WHO standard) — sodium 75 mEq/L, glucose 75 mmol/L, osmolarity 245 mOsm/L.
• Nursing diagnosis priorities: Deficient Fluid Volume (priority), Diarrhoea, Risk for Impaired Skin Integrity (perianal), and Deficient Knowledge (caregivers).

Definitions

Section Title

Diarrhoeal Disease and ORS/ZINC Management

Common Mistakes

• Withholding food or breastfeeding during diarrhoea — this is WRONG and worsens nutritional status. CONTINUE feeding.
• Giving the wrong zinc dose: 10 mg (<6 months) vs. 20 mg (≥6 months) — mixing these up is a common NLE error.
• Stopping zinc after 2–3 days when the diarrhoea improves — zinc must be given for the FULL 10–14 days.
• Confusing Plan B volume — it is 75 mL/kg over 4 HOURS (not 100 mL/kg, not 1 hour).

Exam Tips

• Mnemonic for IMCI danger signs: 'VLC-B' — Vomits everything, Lethargic/unconscious, Convulsions, Cannot drink/Breastfeed.
• Fast-breathing cutoffs: Under 2 months = 60; 2–12 months = 50; 1–5 years = 40. Think: '60-50-40 going down with age.'
• IMCI color sequence: Pink = serious/refer; Yellow = treat at facility; Green = home. Think traffic light: Red (stop/refer), Yellow (treat), Green (go home).
• Chest indrawing in a child ≥2 months = severe pneumonia = Pink = refer. But in a young infant <2 months, ANY chest indrawing = severe disease = refer.
• IMCI integrates curative AND preventive care: always check immunizations and nutrition at every visit.

Key Points

• IMCI is a WHO/UNICEF/DOH strategy to reduce under-5 mortality by managing the WHOLE sick child — not one disease at a time — at the PRIMARY CARE (RHU/health center) level.
• The approach: ASSESS → CLASSIFY → TREAT → COUNSEL → FOLLOW-UP.
• TWO AGE-BASED CHARTS: (1) YOUNG INFANT: 1 week to 2 months; (2) CHILD: 2 months to 5 years.
• COLOUR-CODED CLASSIFICATION SYSTEM: PINK = Urgent referral/hospitalise (severe disease); YELLOW = Treat at facility + home care; GREEN = Home management with advice.
• GENERAL DANGER SIGNS (any sign = URGENT REFERRAL, PINK classification): (1) NOT ABLE TO DRINK OR BREASTFEED; (2) VOMITS EVERYTHING; (3) CONVULSIONS during current illness; (4) LETHARGIC OR UNCONSCIOUS.
• MAIN SYMPTOMS ASSESSED IN CHILDREN 2 MONTHS – 5 YEARS: (1) Cough or difficult breathing; (2) Diarrhoea; (3) Fever; (4) Ear problem; PLUS check nutrition/anaemia, immunisation, feeding, and counsel the caregiver.
• FAST BREATHING THRESHOLDS (pneumonia cutoffs): <2 months = ≥60 breaths/min; 2–12 months = ≥50 breaths/min; 12 months–5 years = ≥40 breaths/min.
• CHEST INDRAWING (lower chest wall draws IN with inspiration) = SEVERE PNEUMONIA → urgent referral (PINK). Non-severe fast breathing without indrawing → oral amoxicillin + home care.
• YOUNG INFANT DANGER SIGNS (trigger urgent referral): Not feeding well, convulsions, fast breathing ≥60/min, severe chest indrawing, fever ≥37.5°C OR low temperature <35.5°C, movement only when stimulated or no movement at all.
• The IMCI chart also assesses: breastfeeding/attachment (young infant), jaundice, malnutrition (MUAC, oedema), and immunisation status — integrating preventive care with curative care.
• The RHU nurse in the Philippines is the front-line IMCI implementer — this aligns with the community health nursing role under RA 9173.

Definitions

Section Title

Integrated Management of Childhood Illness (IMCI)

Common Mistakes

• Counting respiratory rate for less than a full MINUTE — must count for a full 60 seconds for accuracy.
• Applying the wrong fast-breathing threshold for the child's age group — memorize all three cutoffs.
• Forgetting to check GENERAL DANGER SIGNS first in every sick child visit.
• Confusing chest indrawing with intercostal retractions — IMCI specifically refers to LOWER chest wall indrawing.
• Failing to counsel the caregiver on when to RETURN IMMEDIATELY — a required component of every IMCI visit.

Exam Tips

• Vitamin A memory aid: '6–11 months = 100,000 IU (1 dose once); 12–59 months = 200,000 IU (every 6 months).' The dose DOUBLES after 12 months.
• GP = April + October (twice a year) = Vitamin A + Deworming + Immunization catch-up.
• EPI schedule: Birth (BCG + Hep B); 6–10–14 weeks (Pentavalent + OPV + PCV ± Rotavirus); 9 months (MCV1/Measles); 12–15 months (MMR).
• NLE often presents scenarios about which vaccines are due — calculate age and match to the EPI schedule.

Key Points

• EXPANDED PROGRAM ON IMMUNIZATION (EPI): The DOH's national program to prevent vaccine-preventable childhood diseases, providing free vaccines through RHUs and health centers.
• EPI SCHEDULE KEY VACCINES: BCG + Hepatitis B (at BIRTH); Pentavalent (DPT-HepB-Hib) + OPV + PCV at 6 weeks, 10 weeks, and 14 weeks; Measles-containing vaccine (MCV1) at 9 months; MMR (MCV2) at 12–15 months; Rotavirus vaccine (2 doses) at 6 and 10 weeks.
• GARANTISADONG PAMBATA (GP): A DOH program delivering a package of health services to children TWICE a year (biannual) — typically in April and October.
• GP PACKAGE includes: (1) Vitamin A supplementation; (2) Deworming (mebendazole/albendazole); (3) Immunisation catch-up; (4) Weight monitoring; (5) Health education for caregivers.
• VITAMIN A DOSES under Garantisadong Pambata: 100,000 IU ONCE for infants 6–11 months; 200,000 IU every 6 months for children 12–59 months (1 year to 4 years 11 months).
• Vitamin A is ALSO given therapeutically in MEASLES cases (regardless of age) to reduce complications.
• These programs align with NCM 103 (Community Health Nursing) competencies and are frequently referenced in NLE scenario questions.

Definitions

Section Title

DOH Programs Supporting Child Health: EPI and Garantisadong Pambata

Common Mistakes

• Giving 200,000 IU of Vitamin A to a 9-month-old infant — the dose for 6–11 months is 100,000 IU (NOT 200,000 IU).
• Saying Garantisadong Pambata is annual — it is BIANNUAL (twice a year, typically April and October).
• Forgetting that measles cases ALSO receive therapeutic Vitamin A, separate from the GP schedule.