INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Flashcards
The Integrated Management of Childhood Illnesses
(IMCI) chart serves as a
nutritional assessment tool for case
management of sick children seeking services at the health
center.
The six childhood illnesses included in the IMCI are
malnutrition, pneumonia, diarrhea, measles, dengue,
hemorrhagic fever, and malaria.
These are all preventable
and treatable with simple and low-cost interventions
malnutrition, pneumonia, diarrhea, measles, dengue,
hemorrhagic fever, and malaria.
PINK:
SEVERE (Referral, Pre – referral)
o YELLOW:
SPECIFIC TREATMENT (appropriate
antibiotic, an oral anti – malarial or other treatment;
also teaches the mother how to give oral drugs or to
treat local infections at home)
GREEN:
MILD (Home Management)
(IMCI only covers children
_____)
2 weeks – 5 years of age
- Table Format: ASSESS – CLASSIFY – TREAT
Identify the patient.
o Ask for the purpose of the visit/child’s problem
o Ask for the patient’s age.
Check for general danger signs (if severe, REFER!) –
o Check for main symptoms–
Assess status—
Classify Conditions
o Treat the Child
o Give follow up care: 1, 3, 5, 7, 14, 30 (to clients
belong to yellow & green)
o Counsel the mother
Check for general danger signs (if severe, REFER!)
C – convulsion
▪ U – Unable to drink/breastfeed
▪ V – vomits everything
▪ A – abnormally sleeping (lethargic;
difficult to awaken)
Check for main symptoms
▪ Assess for cough or difficulty of breathing
▪ Assess for diarrhea
▪ Assess for fever
▪ Assess for ear problem
o Assess status
▪ Check for acute malnutrition and anemia
▪ Check for HIV/AIDS status
▪ Check for immunization status
▪ Check for Vit. A status (retinol/fat soluble)
* For immunity to reduce severity
of disease
▪ Assess other problems (deworming – 1
yr & up every 6mos until 5y/0
SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS
ABCD
A. ASSESS THE CHILD:
B. CLASSIFY THE CHILD’S ILLNESS:
C. IF URGENT REFERRAL is needed and possible
IF NO URGENT REFERRAL is needed and possible.
SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS
A. ASSESS THE CHILD:
- Check for danger signs (or possible bacterial infection).
- Ask about main symptoms.
- If a main symptom is reported, assess further. Check
nutrition and immunization status. - Check for other problems
SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS
B. CLASSIFY THE CHILD’S ILLNESS:
- Use a color-coded triage system to classify the child’s main
symptoms and his or her nutrition or feeding status.
SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS
C. IF URGENT REFERRAL is needed and possible.
- Identify urgent pre – referral treatment(s) needed prior to
referral of the child according to classification. - Treat the child:
o Give urgent pre-referral treatment(s) needed. - Refer the child:
o Explain to the child’s caretaker the need for referral.
o Calm the caretaker’s fears and help resolve any
problems. Write a referral note.
o Give instructions and supplies needed to care for the
child on the way to the hospital.
SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS
D. IF NO URGENT REFERRAL is needed and possible
- Identify treatment(s) needed for the child’s classifications:
identify specific medical treatments and/or advice. - Treat the child:
o Give the first dose of oral drugs in the clinic and/or
advice the child’s caretaker.
o Teach the caretaker how to give oral drugs and how
to treat local infections at home.
o If needed, give immunizations. - Counsel the mother:
o Assess the child’s feeding, including breastfeeding
practices, and solve feeding problems, if present.
o Advise about feeding and fluids during illness and
about when to return to a health facility.
o Counsel the mother about her own health. - Follow – up care:
o Give follow – up care when the child returns to the
clinic and, if necessary, reassess the child for new
problems.
MALNUTRITION AND ANEMIA
Look – Feel Assessment
* Look for visible severe wasting, edema of both feet, and
palmar pallor.
* Determine weight for age using growth monitoring chart
MALNUTRITION AND ANEMIA
FOR A YOUNG INFANT – LESS THAN 2 MONTHS
- Check for Feeding Problem of Low Weight
- ASK – LOOK – LISTEN – FEEL Assessment
- Look, Listen, Feel: Determine weight for age.
MALNUTRITION AND ANEMIA
CLASSIFY FEEDING:
- Not Able to Feed – Possible Serious Bacterial Infection
- Feeding Problem or Low Weight
- No Feeding Problem
MALNUTRITION AND ANEMIA
CLASSIFY FEEDING:
Not Able to Feed – Possible Serious Bacterial Infection
Signs:
Treatment:
Signs: Not able to feed, no attachment at all or not
sucking at all
Treatment:
▪ Give the 1st dose of intramuscular
antibiotic.
▪ Treat to prevent low blood sugar.
▪ Advise the mother how to keep the young
infant warm on the way to the hospital.
▪ Refer urgently to hospital.
MALNUTRITION AND ANEMIA
CLASSIFY FEEDING:
2. Feeding Problem or Low Weight
Signs:
Treatment:
Signs: Not well attached to breast, not sucking
effectively, less than 8 breastfeeds in 24 hours,
receives other foods or drinks, low weight for age, or thrush (ulcers or white patches in mouth)
MALNUTRITION AND ANEMIA
CLASSIFY FEEDING:2. Feeding Problem or Low Weight
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MALNUTRITION AND ANEMIA
CLASSIFY FEEDING:
No Feeding Problem
Signs:
Treatment:
o Signs: Not low weight for age and no signs of
inadequate feeding.
o Treatment:
▪ Advise mother to give home care for the
young infant.
▪ Praise the mother for feeding the infant
well.
CLASSIFY NUTRITIONAL STATUS
. Severe Malnutrition or Sever Anemia
Anemia or Very Low Weight
No Anemia and Not Very Low Weight
CLASSIFY NUTRITIONAL STATUS
a. Signs:
Treatment:
- Severe Malnutrition or Sever Anemia
a. Signs: Visible severe wasting or edema of both
feet or severe palmar pallor.
b. Treatment:
i. Give Vit A
ii. Refer urgently to hospital
CLASSIFY NUTRITIONAL STATUS
a. Signs:
Treatment:
. Anemia or Very Low Weight
Signs: Some palmar pallor or very low weight for
age
Treatment:
child’s feeding and counsel
the mother on feeding
If feeding problem, follow-up in 5 days
pallor: give Iron, mebendazole if
child is 2 years or older
If very low weight for age: give vitamin A;
follow-up in 30 days
Advise mother when to return
immediately
CLASSIFY NUTRITIONAL STATUS
a. Signs:
Treatment:
No Anemia and Not Very Low Weight
a. Signs: Not very low weight for age and no other
signs of malnutrition
b. Treatment:
i. If the child is less than 2 years old,
assess the child’s feeding and counsel
the mother on feeding.
ii. If feeding is a problem, follow-up in 5
days
iii. Advise mother when to return
immediately
COUGH OR DIFFICULTY IN BREATHING
ASK - LOOK - LISTEN Assessment
* Ask: for how long? (cough that persist for more than 14
weeks or 30 days is considered chronic cough.
Look:
o Count the breaths in one minute. Look for fast
breathing and chest indrawing.
o Fast breathing is;
60bpm more -less 2 months
50bpm if 2-12 months
40 bpm if 12-5 years
Listen: for stridor
Chronic cough is not related to pneumonia but
relation to other conditions such as:
▪ Emphysema
▪ Asthma
▪ Diphtheria
▪ Orthosis
COUGH OR DIFFICULTY IN BREATHING
. Very Severe Disease
signs n treatment
Signs: stopped feeding well, convulsions,
abnormally sleepy or difficult wake, stridor or
wheezing, fever or low body temperature.
b. Treatment:
i. give 1% dose of antibiotic
ii. keep warm
iii. refer urgently to the hospital
COUGH OR DIFFICULTY IN BREATHING
Severe Pneumonia
signs n treatment
a. Signs: with fast breathing or severe chest in –
drawing
b. Treatment:
i. give 1st dose of antibiotic
ii. keep warm
iii. refer urgently to the hospital
COUGH OR DIFFICULTY IN BREATHING
No Pneumonia: Cough or Cold
signs n treatment
a. Signs: no fast breathing, no severe chest indrawing or danger signs.
b. Treatment:
i. instruct mother on home care
ii. advise the mother when to return
immediately
iii. no antibiotics needed.
CHECK FOR POSSIBLE BACTERIAL INFECTION
1. Possible Serious Bacterial Infection
Signs: With fast breathing, severe chest indrawing,
convulsion, nasal flaring or grunting, bulging
fontanelle, pus draining fiom car umbilical redness
extending to the skin,
Treatment:
i. Give the 1° dose of intramuscular
antibiotic
ii. Treat to prevent low blood sugar
iii. Advise mother how to keep the infant
warm on the way to the hospital
iv. Refer urgently to the hospital
CHECK FOR POSSIBLE BACTERIAL INFECTION
2. Local Bacterial Infection
a. Signs: Red umbilicus or draining pus or skin
pustules.
b. Treatment:
c. Give an appropriate oral antibiotic.
d. Treat local infection in the health center and teach the mother to treat local infection at home.
e. Advise mother to give home care to the young
infant.
f. Follow up in 2 days.
For Local Bacterial Infection:
a. First-line antibiotic: Cotrimoxazole
b. Second-line antibiotic: Amoxicillin
DIARRHEA
- Check: How long? (Classify if persistent diarrhea)
- Assess for:
o General Danger Signs
o Sunken eyes, capillary refil
Dysentery
– blood in the stoo
If more than 14 days + No DHN –
- If more than 14 days + DHN –
Persistent Diarrhea
Severe Persistent Diarrhea
FEVER
MEASLES
o Filterable virus of measles
o Check if there are complications
MEASLES
plications.
▪ Cloudy cornea –
▪ Mouth ulcerations -
keratomalacia/xeropthalmia (causes
blindness = give Vit A
half strength
gentian violet
DENGUE
Best management
st management:
▪ ORS / Fluid Replacement Therapy
▪ Paracetamol
▪ Aspirin – BIG NO! - * Aspirin damages the platelet;
there would be deliberate
decrease of platelet.
* Complication: Hypovolemic
Shock
- MALARIA
Check if the family lives or visited a malaria endemic
area.
Severe Malaria
* Nucchal rigidity / stiff neck +
GDS
* Give first dose of quinine.
▪ Malaria
* Check for positive malaria
smear
Causative agents of malaria:
o Plasmodium species:
▪ P. falciparum
(dangerous)
▪ P. vivax
▪ P. ovale
(rarest)
▪ P. malariae
- MALARIA Drug of choice:
Drug of choice: chloroalkanes/ quinine
EAR PROBLEM
Check for ear pain – ask for how long, where is it located?
o Mastoiditis
▪ Pain behind the ear: danger sign;
(requires immediate management of
antibiotics and referral because it may
lead to permanent ear damage.
EAR PROBLEM
Acute ear problem
Chronic ear problem
Acute ear problem: less than 14 days
▪ Give antibiotic for 5 days
▪ Paracetamol for pain\
Chronic ear problem: more than 14 days
▪ Dry the ear by wicking
For Pneumonia, Acute Ear Infection or Very Severe
Disease
First line Antibiotic:
o Second line antibiotic:
Cotrimoxazole
Amoxicillin
