Module guide · Clinical

Paediatrics

Consultations, growth, development and the feeding programme — built around the two things that decide a child's outcome in an outpatient service: whether the danger signs were asked about, and whether the child keeps coming back.

Overview Dashboard Consultations Growth monitoring Developmental screening Nutrition programme Child health record Analytics & export Good practices

What this module is for

Everything a paediatric outpatient service records between a child's first visit and their discharge from the feeding programme.

Who uses it

Paediatricians, neonatologists, nurses, nutritionists and dietitians, plus administrators and directors for the analytics.

Where to find it

Open Paediatrics from the sidebar. Six screens: a dashboard, Consultations, Growth monitoring, Developmental screening, the Nutrition programme and a per-child record, plus Analytics and Import & export.

1
See the child
Child, date, visit type and clinician open a draft consultation; the rest is filled in on the record page.
2
Ask all four danger signs
Unable to drink, vomiting everything, convulsions, unrousable — each answered, not left blank.
3
Weigh and measure
Measurements are written to the child's growth record, not to the consultation, so the curve stays whole.
4
Screen development where it applies
Score each domain separately, against corrected age for a premature child.
5
Enrol and follow up
Admit malnourished children to the nutrition programme and record every visit, including the missed ones.

A few terms you'll see throughout

MUAC is mid-upper-arm circumference. Oedema is the swelling that marks severe acute malnutrition regardless of weight. A Z-score places a measurement against the WHO growth standard. A defaulter is a child who stopped coming.

Dashboard

Activity, malnutrition burden, and the children the service is at risk of losing.

Queues

Field	What it means
Danger signs	Children who arrived unable to drink, vomiting everything, convulsing or unrousable.
Missed nutrition visits	In an outpatient programme, the child who stops coming is at more risk than most of the ones who do not.
Not gaining	On the programme and no heavier than at admission.
Awaiting referral	A screening programme that flags children and never tracks the referral has measured its own activity and nothing else.
Drafts	Consultations opened and not yet finalised.

The counters cover consultations, severe and moderate malnutrition, recovery rate and defaulter rate over closed enrolments, and the share of consultations where immunisation status was actually asked about.

Consultations

Every paediatric consultation on file.

What a consultation records

Field	What it means
Child, date, visit type, clinician*	Enough to open the consultation as a draft.
General danger signs	All four asked and answered. A sign that was not asked about is not the same as one that was absent.
Growth measurements	Written to the child's growth record rather than to this consultation, so the curve stays whole.
Immunisation status	Asked or not asked — the dashboard reports the share where somebody asked.
Assessment, treatment, advice	Free text, plus prescribing.

Weight-based doses are written out by the prescriber

Nothing in this module multiplies a dose by a weight. A calculated dose that nobody checked is a class of error this service will not introduce.

Growth monitoring

Every weighing, from clinic and from outreach.

A weight, a height or an arm circumference — any one of them is enough to record a measurement. Z-scores are read from the growth chart or from WHO Anthro and entered; this module does not calculate them.

What happens when there is no Z-score

Left blank, the nutritional classification falls back to arm circumference and oedema, which need no chart. That is the same rule an outreach worker with a MUAC tape already follows.

Developmental screening

What the child can do, against what a child that age is expected to do.

How a screen is scored

Field	What it means
Per domain	Each developmental domain is scored separately, so one child can appear in several.
Prematurity	Weeks early, so the screen is read against the corrected age. Applied up to two years.
Caregiver concern	A caregiver worry is one of the better predictors of a real delay, so it raises an otherwise clean screen to monitor.
Outcome	Left blank, the worst domain sets the outcome; override it when clinical judgement says otherwise.
Referral	Flagged children are tracked through to the referral, not just counted.

Nutrition programme

Admission to discharge, and everyone who stopped coming in between.

1
Admit
Admission measurements are copied from the child's most recent weighing when left blank.
2
Set the target
The target weight is set at admission and left alone, so progress stays legible on a card a caregiver reads.
3
Record every visit
Attended and missed alike — a programme that only records the sessions that happened cannot see a child slipping away.
4
Weigh
Each weighing is written to the child's growth record as well as to the programme card.
5
Discharge with an outcome
Recovered, defaulted, died, or transferred out.

Recovered — reached the target weight and was discharged

Defaulted — stopped coming — an outcome, not a blank

Died — recorded as an outcome like any other

Transferred — care continued elsewhere

A recovery rate over only the children who came back flatters the service

Defaulted and died are outcomes like any other and are counted in the denominator. That is why the defaulter rate sits on the dashboard next to the recovery rate rather than behind it.

Child health record

One child, the whole picture.

Search by name or medical record number. The record brings the child's consultations, growth curve, screenings and nutrition enrolments together in one place.

Analytics, import and export

What the service did, and how well it did it.

What is measured

Field	What it means
Defaulter rate	The children the programme lost.
Average weight gain	Below 5 g/kg/day is a poor response.
Length of stay	Admission to discharge.
Exclusive breastfeeding	Under six months, where feeding was recorded.
Malnutrition trend	Over the measurements that could be classified, not over every weighing.
Age distribution	A neonate, a toddler and a fifteen-year-old are three services sharing a waiting room.
Domain concerns	Counted per domain, so one child appears in every domain that was flagged.

Growth measurements can be imported in bulk, which is what an outreach weighing round produces. Exports come as CSV, Excel or PDF; the PDF stops at 500 rows.

Good practices

Answer all four danger signs, every time

They take seconds and they are the questions that decide whether a child goes home or is admitted. A blank is indistinguishable from a "no" to everyone who reads the record later, except that it is not one.

Record the missed visit on the day it was missed

The missed-visit queue is the only mechanism that finds a child slipping out of the programme. It can only work off entries somebody made.

Enter Z-scores, do not guess them

The module deliberately does not compute them. If the chart or WHO Anthro is not to hand, leave them blank and let the classification fall back to MUAC and oedema.

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