IMCI: ASSESS AND CLASSIFY FEVER

Child w/ fever may have: MEASLES

 Malaria  ASK: For howlong?

 Measles  ASK: Has child has measled within last 3
 Another severe disease months?
 Simple cough / cold  LOOK & FEEL: stiff neck & bulging fontanelle
 Other viral infection  LOOK:
o Mouth ulcers
ASSESS FEVER o Are they deep & extensive?
 LOOK: pus draining from eye
Ask: Does child have fever?
 LOOK: clouding of cornea
 Check to see if child has fever
Signs & symptoms
o if none, ask about next main
symptom (ear problem) 1) Fever
o Do not assess for signs related to 2) Generalized rashes
fever 3) Runny nose
 If w/ fever, assess child for additional signs 4) Red eyes
related to fever 5) cough
 History of fever to assess child for fever
Complications
Decide malaria risk
1) Diarrhea
MALARIA 2) Pneumonia
3) Stridor
 Caused by parasites in blood cells (Plasmodia) 4) Mouth ulcers
transmitted through bite of mosquito of (F) 5) Ear infection
anopheles mosquitoes 6) Severe eye infection ( lead to corneal ulceration
& blindness)
Signs & symptoms 7) Encephalitis
8) Malnutrition
1) Fever
a. Main symptom DENGUE HEMORRHAGIC FEVER
b. Preset all the time / go away but
return @ regular intervals  Caused by virus; spread by Aeded Aegyptae
2) Shivering mosquitoes
3) Sweating  All regions of country are endemic for dengue
4) Vomiting  NCR is highly endemic all yr. round w/ peak 2
5) Chronic anemia (no fever) \ months after rainfall
Malaria risk areas in Phil. Assessment

 Assess children 2 months of age & older w/

fever where there is risk for DHF
 Decide dengue risk
 ASK, LOOK, FEEL
o Bleeding manifestations
o Skin petechia
 LOOK & FEEL: signs suggesting shock
o Cold clammy extremities
o Check for slow capillary refill
o Perform tourniquet test

Tourniquet test

Malaria risk areas in Region VI\ 1) Take systolic & diastolic pressure using
pediatric cuff
1) Caluya Island, Antique 2) Inflate cuff to pressure halfway bet. Systolic &
2) CHICKS area in Negros diastolic pressure & keep pressure for 5 mins.
a. Candone 3) Release pressure & draw 1 sized square below
b. Hinoba-an cuff on front surface of forearm; count # of
c. Ilog petechiae inside square
d. Calatrava a. If 20 / more test is (+)
e. Kabankalan
f. Sipalay ASSESS FEVER
  If child has fever & no signs of measles, classify  Child who has main symptom “fever” & measles
child for fever only now / within last 3 moths is classified for fever &
 If child has signs of both fever & measles, measles
classify child for fever & measles o 1st classify fever
 If there is risk of dengue, classify child for o Classify measles
malaria & measles & then DHF  If child has no signs suggesting measles / has
not had measles within last 3 months, do not
classify measles

HOW TO ASSESS EAR PROBLEM, MALNUTRITION, ANEMIA, HIV, &

TB
ASSESS & CLASSIFY EAR PROBLEM\
 ASK: Does child have ear problem?
 ASK: Does child have ear pain? Does it wake
child @ night?
 ASK: Is there ear discharge? If yes, for how
long?
 LOOK: pus draining from ear
 FEEL: tender swelling behind ear
 Child should be immediately referred for
supplementation
Yellow color
 125 mm (12.5 cm) – 135 mm (13.5 cm)
 Child is @ risk for acute malnutrition & should
be counselled & followed-up for growth
promotion & monitoring (GPM)

CHECK FOR MALNUTRITION & ANEMIA Green color

 Check children for signs suggesting  Over 135 mm (13.5 cm)

malnutrition & anemia  Child is well nourished
 When child has protein-energy (P-E)
MUAC PROCEDURE
malnutrition child:
o Severely wasted, sign of kwashiorkor 1) Find midpt. Bet. Top of shoulder & tip of elbow
o May not grow well & become stunted while child’s left arm is bent
(too short) 2) Wrap measuring tape around upper arm of
midpt.
Marasmus 3) Read MUAC while arm is hanging down side of
body & relaxed
 Mixed deficiency of both protein & calories

Kwashiorkor MUAC <115 mm should be treated for severe

malnutrition regardless of weight-for-height
 Due to diet deficient in protein & energy-
producing foods Pitting edema (PE) of both feet is indication of SAM

Anemia PE is verified by applying thumb pressure for 3 sec.

on top of both feet
 Reduced no. of red cells / reduced amount of
hemoglobin in each red cell Pit remains in both feet for several sec

CHECK FOR MALNUTRITION If edema is not bilateral, its not indication of

malnutrition
Mid-upper arm circumference (MUAC)
3 grades of edema
 Estimate lean body mass / skeletal muscle
reserves 1) Grade + (mild) – both feet / ankles
 Taken on left arm 2) Grade ++ (moderate) – both feet, loer legs,
hands / lower arms
INTERPRETATION & INDICATORS OF MUAC 3) Grade +++ (severe) – both feet, legs, hands,
arms, legs
Red color
Baggy pants
 Less than 110 mm (11.0 cm)
 Indicate severe acute malnutrition (SAM)  Describe loose skin on buttocks bc. Of loss of
 Child should be immediately referred for subcutaneous & muscle tissues
treatment  Helps in detecting visible severe wasting
Red color (3-color tape) / Orange color (4-color tape) Determine weight for age
 Bet. 110 mm (11.0 cm) & 125 mm (12.5 cm) 1) Calculate child’s age in months
 Moderate acute malnutrition (MAM)
 2) Weigh child if he has not already been weighed
today
a. Child should wear light clothing when
weighed
b. Ask caregiver to help remove coat,
sweater, shoes
3) Use weight for age chart to determine weight
for age
a. Look @ left-hand axis to locate line
that shows child’s weight
b. Look @ bottom axis of chart to locate
line that shows child’s age in months
c. Find pt. on chart where line for child’s
weight meets line for child’s age
CHECK IMMUNIZATION, VITAMIN A, HIV, TB
IMMUNIZATION SCHEDULE
CONTRAINIDCATIONS TO IMMUNIZATION
 No C/I to immunization of sick child if child is
well enough to go home
 Conditions considered false C/I:
o Malnutrition
o Low-grade fever
o Mild respiratory infection
o Diarrhea
Do not give:
ASSESS CONGENITAL PROBLEMS (BIRTH – 2 MONTHS)
ASK: Does mother’s PCR tested during pregnancy?
LOOK & FEEL: measure head circumference w/ tape
measure drawn across center of forehead & around most
prominent portion of posterior head
LOOK & FEEL: cleft lip / palate
LOOK & FEEL:
 Imperforate anus
 Nose not patent
 Macrocephaly ( HC> 29 cm)
 Ambiguous genitalia
 Abdominal distention
 Very low birth weight
LOOK: abnormal signs
 Head & neck
4) Decide if pt. is above on / below bottom curve
a. Pt below bottom curve: child is very
low weight for age
b. Pt. above / on bottom curve: child is
not very low weight for age
CHECK FOR ANEMIA
Child develop anemia as result of:
 Infections
 Parasites (hookworm / whipworm)
 Malaria
LOOK: palmar pallor (PP)
 Pentavalent vaccine to child over 5 yrs. Old
 Pentavalent to child w/ recurrent convulsions /
another active neurological disease of CNS
 Pentavalent 2 / 3 to child who has convulsions /
shock within 3 days of most recent dose
 Rotavirus when child has hypersensitivity to
previous dose of vaccine, intussusceptions /
intestinal malformation / acute gastroenteritis
 BCG ( other live attenuated vaccine) to child
who has AIDS / other immune deficiency / who
are immunosuppressed
To decide if child gives immunization:
 LOOK: child’s age on clinical record
 ASK: mother if child has immunization card
CHECK VITAMIN STATUS
 Check vitamin A status of sick children
 Use recommended vitamin A schedule
o Children 6 months should receive
100,000 IU of vitamin A
o Should receive 200,000 IU of vitamin
A every 6 months thereafter up to
age of 59 months
 Limbs & trunk
o Abnormal position of limbs
o Clubfoot
o Abnormal fingers & toes, palms

o Abnormal chest, back & abdomen

o Undescended testis / hernia