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‫”قالوا سبحانكل علم لناإل ما علمتنا‬


‫إنك أنت العليم الحكيم“‬
‫صدق الله العظيم‬
‫سورة البقرة ايه ‪32‬‬
INTEGRATED MANAGEMENT
OF CHILDHOOD ILLNESS

IMCI
THE IMCI STEPS
A-Methods of Assessment
Ask-1

Look-2

Listen-3

Feel-4
B-Management
I-Give 1st aid & Urgently refer to Hospital

II-Give treatment in Clinic

III-No treatment
C-Counsel the Mother

I-Food

II-Fluid

III-Follow up
IMCI
ASK Personal History + Whether it is an initial or follow up visit

Check For Dangerous Signs

Assess & Classify & Treat


The Main Symptoms
Fever-Cough-Diarrhea

.Check for nutrition & immunization

Counsel The Mother


Dangerous signs
CHECK FOR GENERAL DANGER SIGNS
ASK LOOK

     Is the child able to drink or breast-feed?  See if the child is lethargic or
 

unconscious
 Does the child vomit every thing?
See if the child is convulsing now
 Has he had had convulsions? (during
present illness)
FEEL does the child has stiff neck

SIGNS CLASSIFY AS TREAT

    Treat convulsions IF present now


    Complete assessment immediately

Any
       
    Give 1
st
dose of appropriate
Danger VERY antibiotic
SEVERE     Treat child to prevent low blood

Sign DISEASE sugar


    Refer URGENTLY to hospital
Cough
Does the child have Cough or Difficult breathing?

IF YES, ASK LOOK listen

•       For how long      Count the breaths in one minute


   for stridor
       Look for chest indrawing for
wheeze
     Give 1st dose of appropriate antibiotic
        Any danger sign, OR SEVERE
PNEUMONIA     Treat wheezing, if present
       Stridor in calm child, OR OR     Treat child to prevent low blood sugar
       Chest indrawing
VERY
SEVERE     Refer URGENTLY to hospital
If Wheeze, go directly to treat DISEASE
wheeze, then reassess)

•       Fast breathing Give appropriate antibiotic for 5 days


    

    Treat wheezing, if present


(If Wheeze, go directly to treat
    If coughing more than 30 days ,refer for
wheeze, then reassess) PNEUMONIA assessment
    Relieve cough with a safe remedy
    Advise mother when to return immediately
    Follow up in 2 days

•        No signs of pneumonia or Treat wheezing, if present


    
very severe disease NO
 If coughing more than 30 days ,refer for
PNEUMONIa
(If Wheeze, go directly to assessment
treat wheeze)     Relieve cough with a safe remedy
    Advise mother when to return immediately
    Follow up in 2 days, if wheezing
    Follow up in 5 days if not improving
Diarrhea
Does the child have diarrhea
:IF YES ASK : LOOK
For how• Look at the child’s general•
?long :condition, Is he
Is there• ?Lethargic or unconscious–
blood in ?Restless or irritable–
the stools Look for sunken eyes•
Offer the child fluid. Is the•
:child
Not able to drink or drinking–
?poorly
?Drinking eagerly, thirsty–
FEEL: Pinch the skin on the•
.abdomen
1- CLASSIFY FOR DEGREE OF DEHYDRATION
Two of the following signs:      If child has no other severe
       Lethargic or unconscious classification: Give fluids for
SEVERE
       Sunken eyes severe dehydration (Plan C) OR
DEHYDRATION
       Drinks poorly or unable to    If child has also another severe
drink
classification: Refer URGENTLY
       Skin pinch goes back very
slowly to hospital while giving ORS sips
Advise to continue breastfeeding

Two of the following signs:      Give fluids and food for some
       Restless, irritable dehydration (Plan B)
       Sunken eyes    If child has also a severe
SOME
       Thirsty, drinks eagerly classification:
DEHYDRATION
       Skin pinch goes back slowly - Refer URGENTLY to hospital
while giving frequent ORS sips
-Advise to continue breastfeeding
    Advise when to return immediately
    Follow up in 5 days IF not improving

•       NO enough signs to      Give fluids and food to treat diarrhea
classify as some or NO
severe dehydration at home (Plan A)
DEHYDRATION
    Advise when to return immediately
    Follow up in 5 days IF not improving
CLASSIFY FOR PERSISTENT DIARRHEA-2

SEVERE Treat dehydration before referral unless the


    

        Dehydration present PERSISTENT child has another severe classification


DIARRHEA
     Refer to hospital
    Advise mother on feeding child with
PERSISTENT
Persistent Diarrhea
DIARRHEA
    Give multivitamin / mineral supplement
        No dehydration
    Advise mother when to return immediately
    Follow up in 5 days

CLASSIFY FOR DYSENTERY .3


•Blood in the •Treat for 5 days with an oral
stools antibiotic recommended for
•DYSENTERY Shigella(trimethoprim) for 5
days
•Give metronidazole for 10 days
•Advise mother when to return
immediately
•Follow-up in 2 days