Integrated Management of Childhood Checking the nutrition and If 2 months old up to 5 years old assess

Illnesses (IMCI) immunization status. according to steps on the SICK CHILD

3. IDENTIFY SPECIFIC TREATMENTS
Objectives : 2. CLASSIFYING THE ILLNESS FOR THE CHILD
If the child is 1 wk old up to 2 months old
 To reduce significantly global Making decision regarding the severity of If the child requires urgent referral (Give
follow according to steps on the YOUNG
mortality and morbidity illness essential treatment before transfer)
INFANT
associated with the major causes
of disease in children. Uses a COLOR CODED TRIAGE If the child will be sent home (Develop
2. ASK THE MOTHER WHAT THE
 To contribute to healthy growth SYSTEM integrated plan and give first dose of the
CHILD’S PROBLEMS ARE
drug in the health facility)
and development of children. o PINK
Good communication skills reassure the
o YELLOW 4. TREAT THE CHILD
PREVENTABLEAND TREATABLE mother that her child will receive good
CONDITION o GREEN care.
o Teach the mother to give oral
1. Pneumonia COLOR CODED TRIAGE SYSTEM drugs at home. -Listen carefully to the mother
2. Diarrhea (PINK) o Treat local infections at home -Use words that she will understand
3. Malaria o Give treatments in the health -Give her time to answer
o Give pre-referral treatment center
4. Measles -Ask additional questions if mother is not
5. Dengue-hemorrhagic fever o Advice the parents o Give extra fluid for Diarrhea sure of her answer
o Refer the child URGENTLY o Immunization
CASE MANAGEMENT PROCESS 3. DETERMINE IF THIS IS AN INITIAL
COLOR CODED TRIAGE SYSTEM 5. COUNSEL THE MOTHER OR FOLLOW-UP VISIT FOR THIS
For sick child 2 months to 5 years old this (YELLOW) PROBLEM
is presented in 3 charts. o Food
SPECIFIC MEDICAL TREATMENT AND o Fluid The purpose of the follow-up visit is
 Assess and classify the sick child ADVICED o When to return different from an initial visit.
 Treat the child o About her own health
o Treat the local infection CHECK FOR GENERAL DANGER
 Counsel the Mother
o Give an approximate antibiotics SIGNS
6. GIVE FOLLOW-UP CARE
THE CASE MANAGEMENT PROCESS o Advice and teach the caregiver
o Follow-up o Reassess the child for new A general danger sign is present if:
1. Assess the child or young infant.
problems
2. Classify the illness. COLOR CODED TRIAGE SYSTEM  The child is OT ABLE TO
o Vitamins and immunizations
3. Identify treatment. (GREEN) DRINK OR BREASTFED
o Teaching the mother specific
4. Treat the child  The child VOMITS
5. Counsel the mother SIMPLE ADVICE ON HOME treatments at home. EVERYTHING HE OR SHE
6. Give follow-up check MANAGEMENT o Counseling the mother TAKES IN
ASSESS AND CLASSIFY A SICK  The child is ABNORMALLY OR
6 PROCESSES OF THE CASE o Teach the mother or caregiver
CHILD AGED 2 MOTNHS TO 5 YEARS DIFFICULT TO AWAKEN
MANAGEMENT SYSTEM OF THE IMCI how to give oral drugs and treat
 The child has HAD
local infections at home.
1. ASSESS THE CHILD OR INFANT 1. GREET THE MOTHER CONVULSION
o Counseling the mother or other
APPROPIATELY  Most children with GENERAL
History, PE caregiver about food (feeding
DANGER SIGNS NEED AN
Checking for the DANGER problems), fluids, when to return Knows the child’s age URGENT REFERRAL to a
SIGNS to the health facility, and her own
hospital
Examining the child health.
  May also needs life saving
treatment with injectable
antibiotics, 02 and other
treatments not available in your
health center
IS THE CHILD ABLE TO DRINK
ORBREASTFEED?
 Too weak to drink
 Not able to suck or swallow when
offered a drink or breast milk
 Ask the mother what happens
when she
 offers the child something to
drink
 Clear the nostrils if they are
blocked
DOES THE CHILD VOMIT EVERYTIME
HEOR SHETAKES IN?
 Ask the mother how often the
child vomits
 Ask if the child vomits each time
she or he swallows foods or
fluids
 Ask the mother to offer the child
a drink and see if the child vomits
HAS THE CHILD HAD CONVULSION?
 Ask the mother regarding loss of
 Consciousness or may not be
able to
 respond to spoken direction or
handling
 Ask if the child's arm and legs
stiffens because the muscles are
contracting
 Use words such as "jerky
movements", "spasms", "fits"
 Ask if there is fever at the height
of convulsion
SEE IF THE CHILDISABNORMALLY
SLEEPY OR DIFFICULT TO AWAKEN
 Is the child drowsy and does not
show interest?
 If the child doesn't look at
mother’s face if she talks
 If the child doesn't respond if
touched
 shaken or spoken to
ASSESS AND CLASSIFY COUGH OR
DIFFICULTY IN BREATHING
Pneumonia is an infection of the lungs.
The most common cause is due to
bacterial
infections which are STREPTOCOCCUS
PNEUMONIAE and HEMPHILUS
INLUENZAE.
ldentify pneumonia with these 2 important
clinical signs:
 FAST BREATHING
 CHEST INDRAWING
Does the child have cough or difficulty of
breathing?
 unusual pattern of breathing?
 "fast", "noisy", or "interrupted"
breathing
 Count the breaths in one full
minute
 Look at the child's chest
 Ask mother to lift the child's shirt
if you cannot see the breathing
count only if the child is CALM
 If you ARE NOT SURE about the
number of breaths, REPEAT
THE COUNT
In NORMAL BREATHING, the whole
chest wall and the abdomen MOVE OUT
WHEN THE CHILD BREATHS IN
When CHEST INDRAWING is present,
THE CHEST WALL GOES IN when the
CHILD BREATHS IN
ALERT!!
IF THE SOFT TISSUE BETWEEN THE
RIBS GOES IN WHEN THE CHILD
BREATHS IN (also called "intercostal
indrawing" or "intercostal retractions'"),
THE CHILD DOES NOT HAVE CHEST
INDRAWING
- Chest indrawing happens when the
lungs become stiff
LOOK and LISTEN for STRIDOR
o harsh noise when the child
BREATHS IN
o due to swelling of the larynx,
trachea, or epiglottis
o if mother cannot hear, ask her to
put near the child's mouth
ALERT!!!!
 WHEEZING when the child
breaths out is
 NOT STRIDOR
 CLASSIFY COUGH OR
DIFFICULTY IN BREATHING
ALERT!!!!
If the child has SIGNS APPEARING IN
MORETHAN ONE ROW, SELECT THE
MORE SERIOUS CLASSIFICATION
SEVERE PNEUMONIA OR VERY
SEVERE DISEASE
- Presence of ANY OF ANY DANGER
SIGN, CHEST INDRAWING or
STRIDOR in calm child
NOTE: CHEST INDRAWING may be a
child's ONLY SIGN of severe pneumonia
PNEUMONIA
- A child with FAST BREATHING
and NO GENERAL DANGER
SIGNS
TREATMENT:
 Give appropriate antibiotic
 Soothe the throat and relieve the
cough with a safe remedy
 Advise mother when and when to
return immediately Follow up in
2days
NO PNEUMONIA: COUGH OR COLD
- No general danger signs, no chest
indrawing, no stridor when calm,
and no fast breathing
 Child does not need antibiotic
 Give mother advise about good
home care
 Teach her to soothe the child's
throat with safe remedies
 Advise mother when to return
immediately
 Follow up in 5days if not
improving
ALERT!!!!
IF COUGHING more than 30days
A child who has a CHRONIC COUGH
(30days) may have TB, asthma,
whooping cough, or other problem.
REFER the child for ASSESSMENT
ASSESS AND CLASSIFY DIARRHEA
- Diarrhea occurs when stool
contains more water than normal
(loose or watery stools)
A child with diarrhea is assessed for:
 How long the child has had
diarrhea
 The presence of blood in the
stools
 DEHYDRATION
- Diarrhea that lasts 14 days or more
is PERSISTENT DIARRHEA
- Diarrhea is common in children,
especially between 6 months to 2
years of age
- When there is dehydration, the
child is AT FIRST RESTLESS AND
IRRITABLE
- If dehydration continues he
beccomes ABNORMALLY
SLEEPY AND DIFFICULT TO
AWAKEN
- Eyes may look SUNKEN
- Skin will go back SLOWLY or
VERY SLOWLY
LOOK AND FEEL for the following signs:
 Look at the child's general condition
1s the child abnormally sleepy or
difficult to awaken?
 Restless or Irritable
 Look for sunken eyes
 Offer the child fluid. Is the child not
able to drink, or is he or she drinking
poorly? 1s he or she drinking
eagerly? or is thirsty?
 Pinch the skin of the abdomen Does
it go back to its original state very
slowly (longer than 2 seconds?
Slowly or immediately)
 Look at the child's general condition.
Is the child abnormally sleepy or
difficult to awaken? Restless or
Irritable
ALERT!!!
- If they can be calmed and consoled
they Do NOT HAVE THE SIGN
"RESTLESS AND IRRITABLE"
 Offer the child fluid. ls the child not
able to drink, or is he or she drinking
poorly? Is he drinking eagerly? or is
thirsty?
- Watch the child dink
- A child may not able to drink because
he is abnormally sleepy or difficult to
awaken
- A child is drinking poorly if he is weak
and cannot drink it without help, but
may be able to swallow
when something is put into his mouth
 Pinch the skin of the abdomen.
Does it go back to its original state
very slowly (longer than 2 second?
- Use the area between the umbilicus
and the side of the abdomen. Use
your thumb and your finger
- The fold of the skin should be in
vertical line on the child's body and
not across thin vertical in child's
body
Always BEGIN from the PINK ROW
- If 2 or more of the signs in the PINK
ROW are present classify as
SEVERE DEHYDRATION
Then look at the YELLOW ROW
- look if there are 2 or MORE available
signs and symptoms the classify as
SOME DEHYRATION
- If there are 2 or MORE available signs
and symptoms, then classify as SOME
DEHYRATION
- If there are NO 2 or MORE signs and
symptoms from the yellow row, then
classify as NO DEHYRATION
SEVERE DEHYDRATION
Has 2 of the following signs:
 abnormally sleepy or difficult to
awaken
 not able to drink or drinking
poorly
 sunken eyes
 skin pinch goes back VERY
SLOWLY
TREATMENT
If the child has no other severe
classification treat the of child with IV
fluids according to plan C
SOME DEHYDRATION
Has 2 of the following signs
 restless and irritable
 drinks eagerly or is thirsty
 sunken eyes
 skin pinch goes back SLOWLY
IF THERE'S ONLY 1SIGN IN THE PINK
ROW AND 1 SIGN IS YELLOW, THEN
CLASSIFY AS SOME DEHYDRATION
- Give fluid and food for some
dehydration (PLAN B)
- IF child has severe classification.
REFER giving frequent sips of ORS
- Continue Breastfeeding
- Advise when to return
- Follow up in 5days if not improving
NO DEHYDRATION
o A child with no 2 or more signs
in either pink or yellow row
3 RULES OF HOME TREATMENT
(PLAN A)
- Give the child extra fluid
- Continue feeding the child
- Know when to return to the health
center
-
CLASSIFY PERSISTENT DIARRHEA
SEVERE, PERSISTENT DIARRHEA
 Diarrhea lasting for 14 days or
more
 Dehydration present
TREATMENT:
 Treat Dehydration before
REFERRAL unless child has
another severe classification
 Give, Vit A
 Refer to hospital
PERSISTENT DIARRHEA
 Has rhea for more than 14 days
 With NO SIGNS of dehydration
TREATMENT:
 Vitamin A
 Special feeding as explained in
counseling the mother
 Follow up in 5days
CLASSIFY DYSENTERY
DYSENTERY
-Has blood in her or his stool
TREATMENT
 Treat for 5days with an oral
antibiotic
  recommended for Shigella in your
area.
 1.LINE COTRIMOXAZOLE
 2.LINE NALIDIXIC ACID
 Follow up in 5days
 Advise mother when to return
ASSESS AND CLASSIFY FEVER
ASSESS FEVER
 A child has the main symptom
fever if
 The child has history of fever
 The child feels hot or
 The child has axillary temperature
of 37.5C or above
Ask the child leaves in Malaria Risk Area
or has been there in the past 4 weeks
MALARIA
ASSESS AND CLASSIFY FEVER-
MALARIA
 Caused by parasites in the blood
called
 "plasmodia"Transmitted thru bite
of anopheline mosquito
 There are 4 species of plasmodia
 Plasmodium falciparum is most
dangerous
 FEVER is the main
symptomShivering, sweating,
persistent vomiting and
 chronic anemia (without fever)
MEASLES
ASSESS AND CLASSIFY FEVER-
MEASLES
 Caused by a virus
 Infects the skin and cells that line
the lungs, gut, eyes mouth and
throat
 Damages the immune system
 Leaves the child at risk for other  NCR is highly endemic all year
infections round
 FEVER and GENERALIZED  Disease frequency vary
RASH are the according to season
 main signs  Peak two months after the start
 Maternal antibodies protects the of rainy season
infants from measles for about 6  Rainy season increases the
months transmission
 Most cases occur from 6 months
to 2 years old
 Over crowding and poor housing
increases the risk
Complications occur in 30% of cases:
 Diarrhea (persistent and dysentery)
 Pneumonia
 Stridor
 Mouth ulcers
 Ear infection
 Severe eye infection (may lead to
corneal ulceration and to blindness)
 Encephalitis
ASSESS AND CLASSIFY FEVER-
DENGUE HEMORRHAGIC FEVER
(DHEF)
 Caused by a virus
 Spread by Anopheles
mosquitoes
 FEVER may last from 2-7 days
 Causes damage to blood and
blood vessels
 Bleeding in skin, mouth and
nose, black
 Vomitus, shock and death
Severe signs occur on the SECOND DAY
AFTER FEVER HAS DISAPPEARED
 Shock may be treated with IV
fluid