INTEGRATED

MANAGEMENT
OF
CHILDHOOD
ILLNESS
GROUP 3
WHAT IS IMCI?
IMCI is an integrated
approach to child health
that focuses on the well-
being of the whole
child.
IMCI
- It aims to reduce
death, illness and
disability and to
promote improved
growth and
development among
children under five
years of age.
 OBJECTIVES OF IMCI

1. Reducing infant mortality

2. Reducing the incidence and seriousness of
illnesses and health problems that affect boys
and girls.
3. Improving growth and development during
the first five years of a child’s life.
 PRINCIPLES OF THE IMCI CASE
MANAGEMENT GUIDELINES
● All sick children aged up to 5 years are examined for general
danger signs and all sick young infants are examined for very
severe disease. These signs indicate immediate referral or
admission to hospital.
● The children and infants are then assessed for main symptoms. For
older children, the main symptoms include: cough or difficulty
breathing, diarrhea, fever and ear infection. For young children,
local bacterial infection, diarrhea and jaundice. All sick children
are routinely assessed for nutritional and immunization and
deworming status and other problems.
 PRINCIPLES OF THE IMCI CASE
MANAGEMENT GUIDELINES
● Only a limited number of clinical signs are used.
● A combination of individual signs leads to a child’s classification
within one or more symptom groups rather than a diagnosis.
● IMCI management procedures use limited number of essential
drugs and encourage active participation of caretakers in the
treatment of children
● Counseling of caretakers on home care, correct feeding and giving
of fluids, and when to return to clinic is an essential component of
IMCI.
 BENEFITS OF THE IMCI
STRATEGY
● Addresses major child health problems because it systematically
address the most important causes of children illness and death.
● Responds to demands.
● Promotes prevention as well as cure because IMCI emphasizes
important preventive interventions such as immunization and
breastfeeding.
● Is cost-effective- most cost-effective interventions in low and
middle income countries (World Bank).
● Promotes cost-saving.
● Improves equity – IMCI improves inequity in global health care.
 THE FOCUS OF IMCI

● Improving case management skills of health

workers
● Improving overall health systems
● Improving family and community health
practices
WHAT ARE THE STEPS IN THE
IMCI CASE MANAGEMENT
PROCESS?
1. ASSESS THE CHILD’S ILLNESS
2. CLASSIFY THE ILLNESS BASED
ON SIGNS
3. IDENTIFY TREATMENT
4. TREAT THE CHILD
5. COUNSEL THE CARETAKER
6. FOLLOW-UP
 USING THE CASE MANAGEMENT
CHARTS AND CASE RECORDING
FORMS
The case management steps are the same for all
sick children from age 1 week up to 5 years.
However, because signs, classifications,
treatments and counselling differ between sick
young infants and sick children, it is essential to
start the case management process by selecting
the appropriate set of IMCI charts.
USING THE CASE MANAGEMENT
CHARTS AND CASE RECORDING
FORMS

Neptune
Neptune
Neptune
Neptune
Neptune
USING THE CASE MANAGEMENT CHARTS AND CASE
RECORDING FORMS
 WHAT IS THE EXTENT OF
IMCI IMPLEMENTATION?
IMCI is implemented in 70% of all health
facilities nationwide. It is also integrated in
the Nursing, Midwifery and Medical Pre-
Service Education.
 IMCI FOR THE SICK
CHILD (2 MONTHS TO 5
YEARS)
IMCI FOR THE SICK CHILD (2 months up to 5 years of age)

Neptune
WHAT IS THE FIRST THING YOU DO WHEN
THE CAREGIVER AND PATIENT COME TO
THE CLINIC?
The first step in the IMCI process is to greet the caregiver
and ask about the child. Greeting the caregiver has two
purposes.
- First, greeting makes a caregiver feel welcome in the
clinic.
- Second, it helps you to gather important information
about why the child is coming to the clinic.
 WHAT IS THE IMPORTANT INFORMATION
YOU GATHER DURING A GREETING?
● Age
● Child’s problem
● Weight and temperature
● Initial or follow up visit
○ This is an initial visit if it is the child’s first for this episode of illness.
○ This is a follow-up visit if the child was seen a few days ago for the same problem.
 AFTER GREETING THE CAREGIVER,
HOW DO YOU BEGIN ASSESSING THE
CHILD?
The first thing you check every sick child for is general danger signs.
General danger signs for the sick child
✔ Child is not able to drink or breastfeed
✔ Child vomits everything
✔ Child has had more than one convulsion or
prolonged convulsions, or is convulsing
✔ Child is lethargic or unconscious
 HOW WILL YOU CHECK FOR A
GENERAL DANGER SIGN?
Assessing for general danger signs involves four steps. You will ASK
three questions and LOOK to observe the child’s actions.
1. ASK – IS YOUR CHILD ABLE TO DRINK OR BREASTFEED?
2. ASK – DOES YOUR CHILD VOMIT EVERYTHING?
3. ASK – HAS YOUR CHILD HAD CONVULSIONS?
4. LOOK – IS THE CHILD LETHARGIC OR UNCONSCIOUS?
WHAT DO YOU DO IF A CHILD SHOWS
ONE OR MORE GENERAL DANGER
SIGNS?
If a child has a general danger sign, you must take
IMMEDIATE ACTION
1. Complete assessment immediately – the child has a
severe problem. There must be no delay in treatment.
2. Provide urgent pre-referral treatment
3. Refer child to hospital
 HOW DOES THE ASSESSMENT CONTINUE
AFTER CHECKING FOR GENERAL DANGER
SIGNS?
 MAIN
SYMPTOMS
 COUGH OR DIFFICULT
BREATHING
1. ASSESS A CHILD FOR COUGH OR DIFFICULT
BREATHING

What causes cough or difficult breathing?

- Some children with cough or difficult breathing may have pneumonia or
another serious respiratory infection
- Children can die from bacterial pneumonia because they can’t get enough
oxygen (hypoxia) or they get a generalih zed infection (sepsis)
 HOW CAN YOU IDENTIFY
PNEUMONIA?
Two clinical signs:
1. FAST BREATHING
2. CHEST INDRAWING
HOW WILL YOU ASSESS A CHILD FOR
COUGH OR DIFFICULT BREATHING?
ASK: DOES THE CHILD HAVE COUGH OR
DIFFICULT BREATHING?
● If the child does not have a cough or difficult breathing, move to the
next symptom: diarrhoea. You do not need to assess the child further
for cough or difficult breathing.
● IF YES: Open to your ASSESS chart for cough or difficult breathing.
ASK: FOR HOW LONG?
LOOK: DOES THE CHILD HAVE FAST
BREATHING?
LOOK: FOR CHEST INDRAWING
Chest indrawing occurs when the child needs to make a greater effort
than normal to breathe in.
- The child has chest indrawing if the lower chest wall (lower ribs)
goes IN when the child breathes IN
LOOK AND LISTEN FOR STRIDOR
- Stridor is a harsh noise made when a child breathes IN
LOOK AND LISTEN FOR WHEEZING
- Wheeze is a high-pitched whistling or musical sound heard at the
end of the breathing OUT
 COUGH OR DIFFICULT
BREATHING
2. CLASSIFY COUGH OR DIFFICULT BREATHING
 COUGH OR DIFFICULT
BREATHING
3. TREAT THE CHILD WITH COUGH OR DIFFICULT
BREATHING
 COUGH OR DIFFICULT
BREATHING
4. COUNSEL THE CAREGIVER
a. Give information
b. Show an example
c. Let her practice
5. PROVIDE FOLLOW-UP CARE FOR COUGH OR
DIFFICULT BREATHING
 DIARRHEA
1. ASSESS A SICK YOUNG INFANT & CHILD FOR
DIARRHOEA

First, you will ASK all caregivers if the child has diarrhoea.
- NO diarrhoea, ask about the next main symptom, fever. You do not
need to further assess.
- YES or reported earlier that diarrhoea was the reason for coming to
the clinic, record her answer. You will then assess in two parts:
1. Type of diarrhoea
2. Signs of dehydration
DIARRHEA
 DEHYDRATION: SICK CHILD &
YOUNG INFANT
Dehydration is when the child loses too
much water and salt from the body. This
causes a disturbance of electrolytes,
which can affect vital organs.
 DEHYDRATION: SICK CHILD &
YOUNG INFANT
SIGNS
- restless or irritable
- eyes may look sunken
- skin loses elasticity
- If dehydration continues, the child becomes
lethargic or unconscious.
 DEHYDRATION: SICK CHILD &
YOUNG INFANT
HOW WILL YOU ASSESS
DEHYDRATION?
1. Look: at the child’s general condition
2. Look for sunken eyes
3. Look: to see how the child drinks
4. Feel: by pinching the skin of the abdomen
 DIARRHEA

2. CLASSIFY DIARRHOEA &

DEHYDRATION
✔ All children with diarrhoea are classified for dehydration
✔ If the child has had diarrhoea for 14 days or more, classify for
persistent diarrhoea
✔ If the child has blood in the stool, classify the child for dysentery
 DIARRHEA
There are three possible classifications for the type of diarrhoea. These are:
HOW DO YOU CLASSIFY PERSISTENT
DIARRHOEA IN A CHILD?
 DIARRHEA
3. TREAT THE CHILD WITH DIARRHOEA
✔ Plans A, B, and C for giving fluids and food
- PLAN A – treat diarrhoea at home
- PLAN B – treat SOME DEHYDRATION with low osmolarity oral
rehydration salts (ORS)
- PLAN C – treat SEVERE DEHYDRATION quickly with
intravenous (IV) fluids
✔ Giving ORS for dehydration
✔ Zinc supplementation
✔ Ciproflaxacin for dysentery
 DIARRHEA

4. COUNSEL THE CAREGIVER

WHAT ARE THE 4 RULES OF HOME TREATMENT?
1. Give extra fluid – as much as the child will take
2. Give zinc
3. Continue feeding
4. When to return (for a follow-up visit, or immediately if danger
signs develop)
 DIARRHEA

5. PROVIDE FOLLOW-UP CARE FOR

DIARRHOEA
STEPS FOR PROVIDING FOLLOW-UP CARE?
- First, you will reassess your earlier classifications.
- Second, you will reassess the child using IMCI to see if there are any new
issues.

DIARRHOEA IN SICK YOUNG INFANT (FOLLOW-UP 2 DAYS)

PERSISTENT DIARRHOEA (FOLLOW-UP 5 DAYS)
DYSENTERY (FOLLOW-UP 3 DAYS)
 IMCI: FEVER

 IMCI: FEVER
1. ASSESS

NO fever, ask about the next main symptom using the

IMCI process.

YES fever is present, you will assess in three parts:

1. Determine if malaria risk is high or low
2. Assess for causes of fever
3. Assess for complications from measles, if child
shows signs of measles or has had measles
 IMCI: FEVER
HOW
WILL YOU
ASSESS
FOR
CAUSES
OF
FEVER?
RECORDING FORM
IMCI: FEVER
 IMCI: FEVER
2. CLASSIFY FEVER
 IMCI: FEVER
Classification of fever
3. TREAT
THE
CHILD
WITH
FEVER
 IMCI: FEVER
No malaria risk or no travel to malaria risk area
3. TREAT
THE
CHILD
WITH
FEVER

Measles and Complications

 IMCI: FEVER
4.
COUNSEL
THE
CAREGIV
ER
 IMCI: FEVER
5.
FOLLOW-
UP
 IMCI: EAR PROBLEM


 IMCI: EAR PROBLEM
ASSESS
RECORDING FORM
 IMCI: EAR PROBLEM
CLASSIFY EAR PROBLEM AND IDENTIFY TREATMENT
 IMCI: EAR PROBLEM

COUNSEL
ON WHEN
TO
RETURN
IMCI: MALNUTRITION AND
ANEMIA
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU
CHECK FOR
MALNUTRITION?
 IMCI: MALNUTRITION AND
ANEMIA
FOR ALL
CHILDREN:
LOOK FOR
EDEMA OF BOTH
FEET
 IMCI: MALNUTRITION AND
ANEMIA
FOR ALL CHILDREN: DETERMINE WFH/L** Z-
SCORE
 IMCI: MALNUTRITION AND
ANEMIA
FOR ALL CHILDREN: MEASURE MUAC* IN MM
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU After you complete the assessment for
CLASSIFY SIGNS malnutrition, you will classify. There are

OF FOUR classifications for malnutrition:

MALNUTRITION? 1. COMPLICATED SEVERE ACUTE

MALNUTRITION
2. UNCOMPLICATED SEVERE ACUTE
MALNUTRITION
3. MODERATE ACUTE MALNUTRITION
4. NO MALNUTRITION
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU CLASSIFY SIGNS OF
MALNUTRITION?
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU CLASSIFY SIGNS OF
MALNUTRITION?
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU CLASSIFY SIGNS OF
MALNUTRITION?
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU
CHECK FOR
ANEMIA?
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU What do you observe about the classification

CLASSIFY SIGNS chart for anaemia? You will see how

OF ANEMIA? palmar pallor is the important sign. There

are 3 classifications for anaemia. These are:
1. SEVERE ANAEMIA
2. ANAEMIA
3. NO ANAEMIA
 IMCI: MALNUTRITION AND
ANEMIA
HOW DO YOU CLASSIFY SIGNS OF
ANEMIA?
 IMCI: MALNUTRITION AND
ANEMIA
WHEN WILL CHILDREN FOLLOW-UP FOR
PROBLEMS RELATED TO NUTRITION?
Notice that there are several different follow-up times related to nutrition. You
will
read about each of these follow-up visits in this section.
➞ Follow-up in 1 week: the child classified as UNCOMPLICATED SEVERE
ACUTE
MALNUTRITION that is receiving RUTF
➞ Follow-up in 5 days: If a child has a feeding problem and you have
recommended changes in feeding, to see if the caregiver has made the changes.
You will counsel more if needed.
➞ Follow up in 14 days:
• If a child is classified as MODERATE ACUTE MALNUTRITION
 IMCI: MALNUTRITION AND
ANEMIA
WHEN WILL CHILDREN FOLLOW-UP FOR
PROBLEMS RELATED TO NUTRITION?
PALLOR (follow-up 14 days)
During this visit, follow these instructions:
✔ Give the caregiver iron for the child. Advise her to return in 14 days
for
more iron.
✔ Continue to give the caregiver iron when she returns every 14 days
for 2
months.
✔ If the child still has palmar pallor after 2 months, refer the child for
assessment.
 IMCI: MALNUTRITION AND
ANEMIA
WHEN WILL CHILDREN FOLLOW-UP FOR
PROBLEMS RELATED TO NUTRITION?
UNCOMPLICATED SEVERE ACUTE MALNUTRITION
(follow-up 1 week)
The child should return to the facility every week to have a health check-up and to receive their
supply of RUTF. During each follow-up visit, the health worker at the clinic should assess the
following:
1. Measure weight and MUAC at each visit. Measure height every four weeks. Determine WFH z-
score at every visit.
2. Check for oedema of both feed.
3. Vital signs (temperature, pulse, respiration rate) and medical check.
4. Appetite test with RUTF.
5. Provide RUTF ration and review counselling messages with caregiver.
 IMCI: HIV INFECTION
By: Nada D. Nasroden

FIRST. SECOND.

Classify HIV status

 IMCI: HIV INFECTION
By: Nada D. Nasroden
THIRD.
 IMCI: HIV INFECTION
By: Nada D. Nasroden

TAK E N O T E ! ! !

Give cotrimoxazole
prophylaxis to all If virological test is If serological test is
HIV-infected and negative, repeat test positive, do a
HIV-exposed children 6 weeks after the virological test as
until confirmed breastfeeding has soon as possible!
negative after stopped.
cessation of
breastfeeding
IMCI: HIV INFECTION
By: Nada D. Nasroden

TAK E N O T E ! ! !
IMCI: IMMUNIZATION STATUS
IMCI FOR THE SICK
CHILD (1 WEEK TO 2
MONTHS)
HOW TO CHECK A YOUNG INFANT
FOR POSSIBLE BACTERIAL
INFECTION
 CLASSIFICATION TABLE FOR
POSSIBLE BACTERIAL INFECTION
 HOW TO ASSESS AND CLASSIFY A
YOUNG INFANT FOR DIARRHOEA

After checking signs of possible bacterial infection, proceed to

ASK: DOES THE YOUNG INFANT HAVE DIARRHOEA?

IF YES: ASSESS AND CLARIFY the young infant's diarrhoea

IF NO: Then ASK about the next main symptoms: fever, ear problem
HOW TO ASSESS AND CLASSIFY A
YOUNG INFANT FOR DIARRHOEA
 CLASSIFYING DIARRHOEA

If the main symptom of the child is diarrhoea, the child can be classified for
dehydration. In classifying diarrhoea, it is divided to three categories:
● all children with diarrhoea are classified for dehydration
● if the child has had diarrhoea for 14 days or more, classify the child for
persistent diarrhoea
● if the child has blood in the stool, classify the child for dysentery.
CLASSIFYING DIARRHOEA
CHECK THE YOUNG INFANT
FOR HIV INFECTION
 CHECK FOR A FEEDING PROBLEM OR LOW
WEIGHT FOR AGE IN BREASTFED INFANTS
ASK:
• Is the infant breastfed? If yes, how many times in 24 hours?
• Does the infant receive any other foods or drink?
− If yes, how often?
− What do you use to feed the infant?
LOOK AND FEEL:
• Determine weight for age. − Weight less than 2 kg? −
Weight for age less than
-2 Z score
• Look for ulcers or white patches in the mouth (thrush).
ASSESS BREASTFEEDING:
Use this Chart When an HIV-positive Mother has Chosen
not to Breastfeed
CHECK THE YOUNG INFANT’S
IMMUNIZATION STATUS
TREAT THE SICK YOUNG INFANT
AND COUNSEL THE MOTHER
 TEACH THE MOTHER TO GIVE ORAL MEDICINES
AT HOME
Follow the instructions below to teach the mother about each oral medicine to be given at home,
and the instructions listed with the dosage table for each medicine.
➜ Determine the appropriate medicines and dosage for the infant’s age or weight.
➜ Tell the mother why the medicine is being given to the infant.
➜ Demonstrate how to measure a dose.
➜ Watch the mother practise measuring a dose by herself.
➜ Ask the mother to give the first dose to her infant.
➜ Explain carefully how to give the medicine, then label and package the
medicine.
➜ If more than one medicine will be given, collect, count and package each medicine separately.
➜ Explain that all the tablets or syrups must be used in order to finish the course of treatment,
even if the infant gets better.
➜ Check the mother’s understanding before she leaves the clinic.
-Immunize every sick young infant as necessary

Teach the mother to treat local infections at home.

➜ Explain how the treatment is given.
➜ Watch her as she gives the first treatment in the clinic.
➜ Tell her to return to the clinic if the infection worsens.
To Treat Diarrhoea, give extra fluids and continue feeding
If the young infant has NO DEHYDRATION, use Plan A. If the young infant has SOME DEHYDRATION, use Plan B.
 IF REFERRAL IS REFUSED OR NOT FEASIBLE, further assess and classify the sick
young infant with POSSIBLE SERIOUS BACTERIAL INFECTION or VERY SEVERE
DISEASE
IF REFERRAL IS REFUSED OR NOT FEASIBLE, TREAT
THE SICK YOUNG INFANT
COUNSEL THE MOTHER
COUNSEL THE MOTHER
 COUNSEL THE MOTHER
Advise the mother on giving home care to the sick young
infant.

1. EXCLUSIVELY BREASTFEED THE YOUNG INFANT (for

breastfeeding mothers).
➔ Give only breastmilk to the young infant.
➔ Breastfeed frequently, as often and for as long as the infant wants,
day and night, when sick and healthy.
2. MAKE SURE THAT THE YOUNG INFANT IS KEPT WARM AT
ALL TIMES.
➔ In cool weather, cover the infant’s head and feet, and add extra
clothing.
COUNSEL THE
MOTHER
GIVE FOLLOW-UP CARE FOR THE SICK
YOUNG INFANT
ASSESS EVERY YOUNG INFANT FOR POSSIBLE SERIOUS BACTERIAL
INFECTION OR SEVERE DISEASE, PNEUMONIA OR LOCAL
BACTERIAL INFECTION DURING FOLLOW-UP VISITS.

➔ PNEUMONIA OR SEVERE PNEUMONIA

After 3 days*: Reassess the young infant for POSSIBLE SERIOUS BACTERIAL
INFECTION or PNEUMONIA or LOCAL BACTERIAL INFECTION
GIVE FOLLOW-UP CARE FOR THE SICK
YOUNG INFANT
➔ LOCAL BACTERIAL INFECTION
After 2 days: Look at the umbilicus. Is it red or draining pus?
Look for skin pustules.

Treatment:
➜ If umbilical pus or redness remains the same or is worse, refer the infant to
hospital.
➜ If skin pustules are the same or worse, refer the infant to hospital.
GIVE FOLLOW-UP CARE FOR THE SICK
YOUNG INFANT
➜ JAUNDICE
After 1 day:
LOOK for jaundice. Are the palms or soles yellow?
➜ If the palms or soles are yellow, refer the infant urgently to hospital.
➜ If the palms or soles are not yellow but jaundice has not decreased, advise
the mother about home care and
ask her to return for follow-up again the next day.
➜ If the jaundice has started to decrease, reassure the mother, and ask her to
continue home care.
➜ After 3 weeks of age: If jaundice continues beyond 3 weeks of age, refer
the young infant to hospital for
further assessment.
GIVE FOLLOW-UP CARE FOR THE SICK
YOUNG INFANT
➜ DIARRHOEA
After 2 days:
ASK: Has the diarrhoea stopped?
➜ If the diarrhoea has not stopped, assess, classify and treat the young infant
for diarrhoea
➜ If the diarrhoea has stopped, tell the mother to continue exclusive
breastfeeding.

➜ CONFIRMED HIV INFECTION OR HIV EXPOSED

• A young infant classified as having CONFIRMED HIV INFECTION or HIV
EXPOSED should return for follow-up visits
regularly as per national guidelines.
GIVE FOLLOW-UP CARE FOR THE SICK
YOUNG INFANT
➜ LOW WEIGHT FOR AGE
After 14 days (or 7 days if the infant is not receiving breastmilk):
Weigh the young infant and determine whether he or she still has a low weight
for age.
Reassess feeding

➜ THRUSH
After 2 or 3 days:
Look for ulcers or white patches in the mouth (thrush).
Reassess feeding
➜ If the thrush is worse or the infant has problems with attachment or sucking,
refer to hospital.
References
● https://doh.gov.ph/faqs/Integrated-Management-of-
Childhood-Illness-IMCI
● https://apps.who.int/iris/bitstream/handle/
10665/104772/9789241506823_Module-1_eng.pdf?
sequence=3
● https://apps.who.int/iris/bitstream/handle/
10665/326448/9789241516365-eng.pdf?
sequence=1&isAllowed=y