Initial Assessment of Malaria in Children
Malaria in children can deteriorate rapidly, particularly with Plasmodium falciparum.
Any febrile child with recent travel to an endemic area must be assumed to have malaria until proven otherwise.
Severe malaria is a medical emergency requiring immediate hospital management.
- 📝 History
- 🌍 Recent travel to malaria-endemic area (within past 12 months)
- 🤒 Fever (often intermittent), chills, rigors
- 🤢 Vomiting, headache, lethargy, poor feeding
- ⚠️ Red flags: altered consciousness, seizures, breathing difficulty, jaundice, dark urine
- 💊 Previous malaria treatment or prophylaxis use
- 🩺 Physical Examination
- 🎯 Vital signs - fever, tachycardia, hypotension
- 🩸 Pallor (anaemia), jaundice
- 🫁 Respiratory distress (acidotic breathing)
- 🧠 Neurological assessment (AVPU/GCS, seizures)
- 📏 Hepatosplenomegaly
🔬 Investigations to Support Diagnosis
- 🧫 Microscopy (Gold Standard)
- Thick smear → sensitive for detection
- Thin smear → species identification + parasitaemia %
- ⚡ Rapid Diagnostic Tests (RDTs)
- Detect malaria antigens (e.g., HRP2)
- Useful in urgent settings but confirm with microscopy
- 🩸 Blood Tests
- FBC → anaemia, thrombocytopenia common
- Glucose → hypoglycaemia frequent in children
- U&E, creatinine → renal function
- LFTs → jaundice, hepatic involvement
- Blood gases → metabolic acidosis
📊 Classification of Malaria (WHO Framework)
- 🟢 Uncomplicated Malaria
- Fever with parasitaemia
- No signs of organ dysfunction
- Child alert and haemodynamically stable
- 🔴 Severe Malaria
- 🧠 Cerebral malaria (coma, repeated seizures)
- 🩸 Severe anaemia (Hb <5 g/dL)
- ⚡ Hypoglycaemia (<3 mmol/L)
- 🫁 Respiratory distress / acidosis
- 🩺 Shock or multi-organ failure
💊 Management
- 🟢 Uncomplicated Malaria
- 💊 Artemisinin-based Combination Therapy (ACT)
- Artemether–Lumefantrine
- Artesunate–Amodiaquine
- 🌡️ Paracetamol for fever
- 💧 Maintain hydration
- 🔁 Reassess clinically within 48 hours
- 🔴 Severe Malaria (Emergency)
- 🚑 Admit urgently
- 💉 IV Artesunate (first-line)
- Alternative: IV Quinine (if artesunate unavailable)
- 🩸 Blood transfusion for severe anaemia
- 🍬 IV dextrose for hypoglycaemia
- 🧠 Seizure control (Lorazepam/Diazepam)
- 🫁 Oxygen ± ventilatory support
- 💧 Careful fluid management (avoid overload)
🛡️ Prevention
- 🛏️ Insecticide-treated bed nets (ITNs)
- 🏠 Indoor residual spraying (IRS)
- 💊 Chemoprophylaxis for travellers (e.g., Atovaquone–Proguanil, Mefloquine, Doxycycline if age-appropriate)
- 🌍 Education on mosquito avoidance measures
⚠️ Complications to Monitor
- 🧠 Cerebral malaria
- 🩸 Severe anaemia
- ⚡ Hypoglycaemia
- 🫁 Metabolic acidosis / respiratory failure
- 🩺 Acute kidney injury
- 🫀 Shock
🧠 Clinical Teaching Pearl
Children deteriorate faster than adults. Always check glucose early and repeatedly.
A child with fever + travel history + thrombocytopenia should trigger immediate malaria testing.
Do not delay treatment in severe malaria while awaiting confirmatory results.
