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care professionals who see sick infants and children aged 1 week to 5 years. It is a case management process for a first-level facility such as clinic, health center, or the outpatient department of a hospital. Three Components of the IMCI 1. Upgrading the case management and counselling skills of health care providers 2. Strengthening the health system for effective management of childhood illness. 3. Improving family and community practices related to child health and nutrition The complete IMCI case management process involves the following elements: • ASSESS a child by checking first for danger signs, asking questions about common conditions, examining the child and checking nutrition and immunization status. Assessment includes checking the child for other problems CLASIFY a child’s illness using color-coded triage system. Because many children have more than one condition, each illness is classified according to whether it requires: Urgent pre-referral treatment and referral (PINK), or Specific medical treatment and advice (YELLOW), or Simple advice on home management (GREEN) • After classifying all conditions, IDENTIFY specific treatments for the child. If the child requires urgent referral, give essential treatment before the patient is transferred. If the child needs treatment at home, develop an integrated treatment plan for the child and give the first dose of drugs in the clinic. If a child should be immunized, give immunization. Provide practical TREATMENT instructions, including teaching the caretaker how to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at home. Ask the caretaker to return for follow-up on a specific date, and teach her how to recognize signs that indicate that the child should return immediately to the health facility.
These signs were selected considering the conditions and realities of first-level health facilities. of the major reasons a sick child is brought to the clinic. 2. The IMCI guidelines address most. difficulty of breathing. When a child is brought back to the clinic as requested. An essential component of the IMCI guidelines is the counselling of caretakers about home management. if necessary.• • Assess feeding. For children aged 1 week to 2 months: bacterial infection and diarrhea. based on evidence of their sensitivity and specificity to detect disease. fever. Then. counsel the mother about her own health. 5. which indicate the need for immediate referral or admission to the hospital. 3. A combination of individual signs leads to a child’s classification/s rather than diagnosis. COUNSEL to solve any feeding problems found. fluids. including BF practices. but not all. ASSESS . All sick children must be routinely assessed for major symptoms. and when to return to a health facility. including counselling about feeding. For children aged 2 months to 5 years: cough. 4. ear problem. Only a limited number of carefully-selected clinical signs are used. reassess the child for new problems. The Principles of Integrated Care The IMCI guidelines are based on the following principles: All sick must be examined for “GENERAL DANGER SIGNS”. 6. diarrhea. GIVE FOLLOW-UP CARE and. The classifications are color-coded. IMCI management procedures use a limited number of essential drugs and encourage active participation of caretakers in the treatment of children. 1.
ask her to offer the child a drink. . • ASK: is the child able to drink or breastfeed? A child has this sign if he/she is too weak to drink and is not able to suck or swallow when offered a drink. CHECK FOR GENERAL DANGER SIGNS Check ALL sick children for general danger signs • • • • The child is not able to drink or breastfeed The child vomits everything The child has convulsions The child is abnormally sleepy or difficult to awaken. A child with any of the danger signs has a serious problem and needs urgent referral to the hospital.ASK THE MOTHER WHAT THE CHILD’S PROBLEM ARE When you see the mother and the sick child: • • Greet the mother appropriately Use good communication and reaasure the mother that her child will receive good care Listen carefully to what the mother tells you Use words that the mother understands Give the mother time to answer the questions Ask additional questions when the mother is not sure about her answer. If you are not sure about the mother’s answer. Look to see the childs response.
• ASK: has the child had convulsions? Use other terms for convulsions like “fits”. The health worker can identify almost all cases of pneumonia by checking for these two clinical signs: FAST BREATHING AND CHEST INDRAWING. “spasms”. • ASK: does the child everything? A child who is not able to hold anything down at all has the sign “vomits everything”. or spoken to. shaken. • ASSSESS COUGH OR DIFFICULT BREATHING. • LOOK: see if the child is abnormally sleepy or difficult to awaken. He/she may stare blankly and does not notice what is going on around him/her. or “jerky movements”. • . An abnormally sleepy child is drowsy and does not show interest in what is happening around him/her. He/she does not respond when she/he is touched. Breastfeeding children may have difficulty sucking when their nose is blocked. A child with cough or difficult breathing may have pneumonia or another severe respiratory infection. clear it first. Fast breathing Chest indrawing Stridor in a calm child. A child with cough or difficult breathing is assessed for How long the child has had cough or difficult breathing. He/she does not look at his/her mother or watch your face when you talk. which the mother understands. THEN ASK ABOUT THE MAIN SYMPTOMS: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? I.
there is NO chest indrawing. there is NO CHEST INDRAWNG. Chest indrawing is when the lower chest wall (lower ribs) goes IN when the cild breathes IN. do not wake the child up. • LOOK and LISTEN for stridor. The cuttoff for fast breathing depends on the child’s age. It could be life-threatening when swelling causes the child’s airway to be blocked. Remember that the child must be calm so if the child is sleeping. which interferes with air entering the lungs. If you still do not see the lower chest wall go INas the child breathes IN. this is wheezing and NOT stridor II. it must be clearly visible and present ALL THE TIME. Lift the child’s shirt to do this. they are categories that are used to determine the appropriate action or treatment. Intercostal indrawing is NOT chest indrawing. CLASSIFY means to make a decision about the severity of illness. If seen only during feeding or crying. 2 months-12 months (11 months and 29 days): 50 or more breaths per minute 12 months-5 years (4 years. This could be caused by a swollen larynx. If you are not sure if this is present. or epiglottis. ask the mother to change the child’s position so he/she is LYING FLAT. COUNT the breaths in one minute. put your ear near the child’s mouth and see if it is present as the child breathes in. Stridor is a harsh noise when the child breathes in. • CLASSIFY COUGH OR DIFFICULT BREATHING.• In determining fast breathing. Be sure to listen for stridor only when the child is calm. For chest indrawing to be present. Instead. 11 months and 29 days): 40 or more breaths per minute • LOOK for chest indrawing. trachea. If the sound is heard when the child breathes out. They are not exact disease diagnoses. . To listen for stridor.
PINK/RED-NEEDS URGENT ATTENTION AND REFERRAL OR ADMISSION FOR IN-PATIENT CARE-SEVERE CLASSIFICATION YELLOW-APPROPRIATE TREATMENT GREEN-HOME MANAGEMENT SIGNS Any General danger sign. or Chest indrawing. or Stridor in calm child Fast breathing No signs of pneumonia or very severe disease CLASSIFY AS SEVERE PNEUMONIA OR VERY SEVERE DISEASE TREATMENT PNEUMONIA NO PNEUMONIA. COUGH. OR COLD .
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