IMCI | Breastfeeding | Infants


Steps in the IMCI Case Management Process:
1. Assess and Classify
2. Identify Treatment
3. Treat
4. Consel the Mother
!. "ollo#$%p
A. Assess and Classify Sick Childen ! "#n$hs %& $# ' (eas
1. &etermine #hich age grop the child 'elongs:
1 #ee( p to 2 months
2 months p to ! years
2. )ecord the child*s data : Name, Age in months, Weight in kg., temperature, etc.
3. Ask the mother what the child’s problems are.
4. Determine if this is an initial or follow – up visit
Initial +isit , 1
+isit for this episode of an illness or pro'lem
"ollo#$p +isit$ the child has 'een seen a fe# days ago for the same illness
$ if the child*s condition impro+ed- still the same or is getting 'etter
4. !heck for general danger signs
a. not a'le to drin( or 'reastfeed
• too #ea( to drin( and is not a'le to sc( or s#allo# #hen offered a drin( or
• if not sre: as( mother to offer child a drin( of clean #ater or 'reast mil(
• A child may ha+e difficlty sc(ing #hen his nose is 'loc(ed. If the nose is
'loc(ed- clean it.
'. +omits e+erything
• a child is not a'le to hold anything do#n at all
• if in do't- offer the child #ater
c. con+lsions /dring this illness0
• arms and legs stiffen 'ecase mscles are contracting
• the child may lose consciosness or not 'e a'le to respond to spo(en directions or
handling- e+en if eyes are open
• 1fits2 or 1spasms2 or 13er(y mo+ements2
4ote: Shi+er is not con+lsion. There is no loss of consciosness.
d. a'normally sleepy or difficlt to a#a(en
• dro#sy and does not sho# interest in #hat is happening arond him
• stare 'lan(ly and appear no to notice #hat is going on arond him
• does not respond #hen toched- sha(en or spo(en to
4ote: 1. If the child is asleep and has cogh or difficlt 'reathing- cont the nm'er
of 'reaths first 'efore yo try to #a(e the child.
2. If there is any general danger sign- complete the assessment and any
pre$referral treatment immediately so referral is not delayed.

!. Assess and classif" cough or difficult breathing
• ! C#""#n Ca%ses #f )ne%"#nia
1. #tretococcus pnemoniae
2. $emophilus influen%ae
• ! Ca%ses #f Dea$h
1. hypo5ia , too little o5ygen
2. sepsis , generali6ed infection
• 7ealth #or(ers can identify almost all cases of pnemonia 'y chec(ing for 2
clinical signs: 1. fas$ *ea$hin+ , 'ody*s response to stiff lngs and hypo5ia
2. ches$ inda,in+
Assess cough or difficult breathing
&oes the child ha+e cogh or difficlt 'reathing8 1fast2 or 1noisy2 or 1interrpted28
9 If the ans#er is 4:- loo( 'ac( to see if yo thin( the child has cogh or difficlt 'reathing.
• ho# long8
chronic cogh , more than 3; days
$ may 'e sign of t'erclosis- asthma- #hooping cogh or another
• fast 'reathing
a. cont the 'reaths in one minte
1. child mst 'e <iet and calm
2. no feeding- crying or angry
∗ As( the mother to lift the child*s shirt. If yo are not sre a'ot the nm'er of
'reaths yo conted- repeat the cont.
'. ct$off for fast 'reathing:
if $he child is- fas$ *ea$hin+ is-
2 months p to 12 months !; 'reaths= minte or more
12 months p to ! years 4; 'reaths= minte or more
∗&etermine if the child is 'reathing I4 or 'reathing :%T
• chest indra#ing , the lo#er chest #all goes I4 #hen the child 'reaths I4
4:)MA>: the #hole chest #all and a'domen mo+e :%T #hen the child 'reaths
.est position : lying do#n
Conditions : clearly +isi'le
4ote: intercostals indra#ing or intercostals retractions and s'costal indra#ing are
not chest indra#ing.
• >oo( or listen for stridor.
Stridor , harsh noise made #hen the child 'reaths I4
$ happens #hen there is s#elling of the laryn5- trachea- or epiglottis
∗Pt yor ear near the child*s moth and loo( at the mo+ement of the a'domen to
determine if child is 'reathing I4 or :%T
#et noise $ 'loc(ed nose
#hee6ing $ harsh noise #hile 'reathing :%T? not stridor
C>ASSI"@ C:%A7 :) &I""IC%>T .)BAT7I4A
C. Assess and classif" diarrhea
diarrhea , loose or #atery stool
$ defined as 3 or more loose or #atery stools in a 24 , hor period
• ho# long8
• 'lood in stool
• signs of dehydration
If @BS- asses for:
• dehydration
• persistent diarrhea , 14 days or more
• &ysentery
Asses for dehydration:
• A'normally sleepy or difficlt to a#a(en
• )estless and irrita'le: /all the time0
• Sn(en eyes: If not sre- as( the mother if the child*s eyes loo( nsal.
• :ffer the child flid :
4ot a'le to drin( $ if he is not a'le to ta(e flid in his moth and s#allo# it
&rin(ing poorly , if the child is #ea( and cannot drin( #ithot help.
&rin(ing eagerly- thirsty , reaches ot for the cp or spoon #hen yo offer #ater.
• Pinch the s(in of the a'domen:
Aoes 'ac( +ery slo#ly , longer than 2 seconds
Aoes 'ac( slo#ly , the s(in stays p for e+en a 'rief time after release.
C>ASSI"@ &IA))7BA ":) ?: &B7@&)ATI:4
D. Assess &ever:
A child has the main symptom fe+er if:
$ the child has history of fe+er , no fe+er no# 't had fe+er #ithin D2 hors or
$ the child feels hot or
$ the child has an a5illary temperatre of 3D.! C or a'o+e

&ecide malaria ris(:
$ child li+es in malarios area or
$ has 'een in a malaria ris( area in the past 4 #ee(s.
>oo( or feel for stiff nec(:
$ loo( to see if the child mo+es and 'ends his nec( easily as he loo(s arond or
$ dra# the child*s attention to his toes or
$ gently spport his 'ac( and 'end the head for#ard to#ard hid chest.
>oo( for rnny nose / not history of rnny nose0
>oo( for signs of Measles: generali6ed rash and any one of the follo#ing: cogh-
rnny nose- or red eyes. Measles rash: 'egins 'ehind the ears and on the nec(-
spreads to the face- and to the rest of the 'ody? does not ha+e +esicles or pstles?
does not itch.
If the child has measles no# or #ithin the last 3 months- assess for:
$ moth lcers , painfl open sore on the inside of the moth and lips or tonge
$ ps draining from the eye
$ cloding of the cornea , ha6y area in the cornea
Assess for &enge 7emorrhagic "e+er all children t#o months of age or older.$
>oo( and feel for signs of 'leeding and shoc(:
$ 'leeding from the nose and gms
$ s(in petechiae , small hemorrhages in the s(in? loo( li(e small dar( red spots
or patches in the s(in? not raised- not tender? if yo stretch the s(in they do not
lose their color.
$ Cold and clammy e5tremities
$ If #ith cold and clammy e5tremities- chec( for slo# capillary refill / longer
than 3 seconds
$ Perform the torni<et test if: there are no signs in the ASE or >::E and
"BB>- the child is C months or older- and the fe+er is present for more than 3
G. Assess 'ar (roblem
Assess the child for :
$ Bar pain
$ Bar discharge ? Present less than 2 #ee(s , Acte ear infection
Present 2 #ee(s or more , Chronic Bar Infection
$ Tender s#elling 'ehind the ear
C>ASSI"@ BA) P):.>BM
H. !heck for malnutrition and anemia
>oo( for +isi'le se+ere #asting , a child #ith +isi'le se+ere #asting has marasms- a form of
se+ere malntrition.. A child has this sign if he is thin- has no fat- and loo(s li(e s(in and 'ones.
>oo( for palmar pallor , a sign of anemia
Some palmar pallor , the s(in on the child*s palm is pale
Se+ere palmar pallor , the palm is +ery pale or so pale that it loo(s #hite
>oo( and feel for edema of 'oth feet , the child may ha+e (#ashior(or- a form of se+ere
&etermine #eight for age:
Fery lo# #eight for age , child*s #eight is 'elo# the 'ottom cr+e of a #eight for age chart.
1;. !heck the child’s immuni%ation status.
)). !heck the child’s *itamin A status.
)+. Assess other (roblems.
.. Mana+e"en$ #f $he Sick (#%n+ Infan$ A+e / 0eek 1& $# ! M#n$hs
/. Assess the sick "oung infant
!heck the "oung infant for possible bacterial infection.
1. As( if the child had con+lsion at any time after 'irth.
2. Cont the nm'er of 'reaths in one minte. "ast 'reathing is C; 'reaths per
minte or more.
3. >oo( for se+ere chest indra#ing. Mild chest indra#ing is normal in a yong
infant or yong child. Se+ere chest indra#ing is +ery deep and easy to see.
4. >oo( for nasal flaring , #idening of the nostrils #hen the yong infant 'reaths in.
!. >oo( and listen for grnting , soft- short sonds #hen 'reathing ot.
C. I>oo( and feel for 'lging fontanelle. "ontanelle is the soft spot on the top of the
yong infant*s head- #here the 'ones of the head ha+e not formed completely.
D. >oo( at the m'ilics , is it red or draining ps8
G. Measre temperatre or feel for fe+er or lo# 'ody temperatre. "e+er /a5illary
temperatre 3D.! C or more? rectal temperatre 3G C or more0. 7ypothermia
/ a5illary temperatre 'elo# 3!.! C? rectal temperatre 'elo# 3C C0.
H. >oo( for s(in pstles , red spots or 'listers #hich contain ps. A se+ere pstle
is large of has redness e5tending 'eyond the pstle.
1;. >::E: See if the child is a'normally sleepy or difficlt to a#a(en.
11. >::E at the yong infant*s mo+ement. Are they less that normal8
C>ASSI"@ A>> SICE @:%4A I4"A4T ":) .ACTB)IA> I4"BCTI:4
Assess Diarrhea
$ "or ho# long8
$ Is there 'lood in the stool8
$ >oo( at the yong infant*s general condition. Is it 1A'normally sleepy or
difficlt to a#a(en2 or 1)estless and irrita'le28
$ >oo( for sn(en eyes.
$ Pinch the s(in of the a'domen. &oes it go 'ac( +ery slo#ly8 :r slo#ly8
!heck for feeding problem or low weight.
Assess ,reastfeeding.
4 Signs of Aood Positioning?
$ #ith infant*s head and 'ody straight
$ facing her 'reast- #ith infant*s nose opposite her nipples
$ #ith infant*s 'ody close to her 'ody
$ spporting infant*s #hole 'ody- not 3st nec( and sholders
4 Sign of Aood Attachment:
$ Chin toching 'reast
$ Moth #ide open
$ >o#er lip trned ot#ard
$ More areola +isi'le a'o+e than 'elo# the moth.
Sc(ling effecti+ely , the infant sc(les #ith slo#- deep sc(s and sometimes pases.
@o may see or hear the infant s#allo#ing.
4ot sc(ling effecti+ely , he is ta(ing only rapid- shallo# sc(s. @o may see
indra#ing of the chee(s. @o do not see or hear s#allo#ing.
4ot sc(ling at all , not a'le to sc( 'reastmil( into his moth and s#allo#.
>oo( for lcers or #hite patches in the moth /thrsh0. Thrsh loo(s li(e mil( cds
on the inside of the chee(- or thic( #hite coating of the tonge. Try to #ipe it off.
Mil( crds #ill 'e remo+ed 't thrsh #ill remain.
!heck the -oung .nfant’s .mmuni%ation #tatus
Assess /ther (roblems


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