This document provides guidelines for Integrated Management of Childhood Illnesses (IMCI). It describes how to assess, classify, and treat common childhood illnesses in children ages 2 months to 5 years. Key steps include checking for general danger signs requiring urgent referral, assessing main symptoms like cough, diarrhea, fever, ear problems, and malnutrition. Conditions are classified and specific treatments are recommended, including antibiotics, antimalarials, oral rehydration solution, zinc, and vitamin A. The document also provides guidance on immunizations, deworming medications, and teaching mothers how to provide treatment at home.

1. IMCI
Integrated Management of
Childhood Illnesses

2. GENERAL DANGER SIGNS (URGENT
REFERRAL):
• GENERAL DANGER SIGNS (URGENT
REFERRAL):
-inability to drink or breastfeed
-child vomiting everything
-convulsions
-lethargy/unconsciousness
• MAIN SYMPTOMS: (ASSESS AND TREAT)
-cough or difficult breathing; (simple cough,
pneumonia, severe pneumonia)
-diarrhea: watery or bloody, acute or persistent,
state of hydration

3. -fever: malaria, measles, other infectious
disease
-Ear problems: acute or chronic ear infection
-Malnutrition or anemia: weight for age on
growth chart
-Immunization status
-Vitamin A status

4. ASSESS & CLASSIFY THE
SICK CHILD
AGE 2 MONTHS UP TO 5 YRS

5. ASSESS
ASK THE MOTHER WHAT THE CHILD’S
PROBLEMS ARE
• Determine if this is an initial or follow-up visit
for this problem
• If follow up visit, use the follow up instructions
• If initial visit, assess the child as follows

6. CHECK FOR GENERAL DANGER SIGNS
ASK
• Is the child able to drink or breastfeed?
• Does the child vomit everything?
• Has the child had a convulsion?
LOOK
• See if the child is lethargic or unconscious

7. • A child with any general danger sign needs
URGENT attention.
• Complete the assessment & give any pre-
referral Rx immediately so referral is not
delayed.
• If the child is convulsing now, treat current
convulsion with diazepam

8. THEN ASK MAIN SYMPTOMS
• Does the child have cough or difficult
breathing?******
• IF YES , THEN ASK!
• For how long?
• LOOK, LISTEN, FEEL- child must be calm
• Count the breaths in 1 minute
• Look for chest indrawing
• Look & listen for stridor

9. CLASSIFY COUGH OR DIFFICULT BREATHING
• Signs
• Any danger sign or
• Chest indrawing or
• Stridor in calm child
• Classify
• SEVERE PNUEMONIA
• OR VERY SEVERE DISEASE

10. Treatment
• Give fist oral dose of oral cotrimoxazole
• Give Vit A
• Refer URGENTLY to hospital
• Signs
• Fast breathing
• Classify as
• PNEUMONIA

11. Treatment
• Give first dose of oral cotrimoxazole for 5 days
• Soothe the throat & relieve the cough with a
safe remedy
• Give vit A
• Advise mother when to return immediately
• Follow up in 2 days

12. • Signs
• No signs of pneumonia or very severe disease
• Classify as
• NO PNEUMONIA or
• COUGH or
• COLD
• Treatment
• If coughing is more than 30 days, refer for assessment
• Soothe the throat & relieve the cough with a safe
remedy
• Advise the mother when to return immediately
• Follow-up in 5 days if not improving

13. • Definition of fast breathing
If the child is Fast breathing is
2 -12 months 50bpm or more
12-months-5yrs 40bpm or more

14. Does the child have diarrhoea?
IF YES, THEN ASK!
• For how long?
• Is there blood in the stool?
LOOK, & FEEL
• Look at the child’s general condition, is the
child lethargic? Or unconscious? Restless? Or
irritable?
• Look for sunken eyes

15. • Offer the child fluid. Is the child not able to
drink or drinks poorly?, drinks eagerly, thirsty?
• Pinch the skin of the abdomen, does it go
back, very slowly? (longer than 2 seconds) or
slowly?

16. CLASSIFY DIARRHOEA
For dehydration
Signs
• Two of the following
• Lethargic or unconsciousness
• Sunken eyes
• Not able to drink or drinking poorly
• Skin pinch goes back very slowly

17. • Classify as
• SEVERE DEHYDRATION
• Treatment
• If child has no other severe classification, give
fluid for severe dehydration-plan C
• If child has another severe classification, refer
urgently to hospital with mother giving
frequent sips of ORS on the way
• Advise mother to continue BF

18. • If child is 2yrs or older & there’s cholera in your
area, give oral cotrimoxazole for cholera
• Signs
• Two of the following
• restless, irritable
• Sunken eyes
• Drinks eagerly, thirsty
• Skin pinch goes back slowly
• Classify as
• SOME DEHYDRATION

19. Treatment
• Give fluid & food for some dehydration
(plan B)
• If child also has a severe classification, refer
URGENTLY to hospital with mother giving
frequent sips of ORS on the way
• Advise mother when to return immediately
• Follow up in 5 days if not improving

20. • Signs
• Not enough signs to classify as some or severe
dehydration
• Classify as
• NO DEHYDRATION
• Treatment
• Give fluid & food to treat diarrhoea at home
(plan A)
• Advise mother when to return immediately
• Follow up in 5 days if not improving

21. And if diarrhoea 14 days or more Signs
• Dehydration present
Classify as
• SEVERE PERSISTENT DEHYDRATION
• Treatment
• Give vit A
• Treat dehydration before referral unless the
child has another severe classification
• Refer to hospital

22. • Signs
• No dehydration
• Classify as
PERSISTENT DIARRHOEA
• Treatment
• Advise the mother on feeding the child who
has PERSISTENT DIARRHOEA
• Give vit A
• Follow up in 5 days

23. • And if blood in stool
• Signs
• Blood in the stool
• Classify as
• DYSENTRY
• Treatment
• Treat for five days with cotrimoxazole for
shigella
• Follow up in two days

24. • Does the child have fever?****
• By history or feels hot or temp 37.5 oc or
above
• IF YES, THEN ASK!
• For how long?
• If more than 7 days, has fever been present
every day?
• Has the child had measles within the last 3
months?

25. LOOK AND FEEL
• Look or feel for stiff neck
• Look for signs of MEASLES e.g. generalized
rash, and one of cough, runny nose, or red
eyes
• If child has measles now or within the last 3
months, then
• Look for mouth ulcers, are they deep or
extensive?
• Look for pus draining from the eyes
• Look for clouding of the cornea

26. CLASSIFY FEVER
• Signs
• Any general danger sign or
• Stiff neck
• Classify as
VERY SVEVERE FEBRILE DISEASE
• Treatment
• Give first dose qnn for severe malaria
• Give first doe of oral cotrimoxazole
• Treat the child to prevent low blood sugar
• Give one dose of paracetamol in the clinic for high
fever, 38.5 degrees & above
• Refer URGENTLY

27. • Signs
• Fever- by history or feels hot or temp 37.5 degrees or
above
• Classify as
• MALARIA
• Treatment
• Treat with oral CQ & SP (currently coartem)
• Give one dose of paracetamol in clinic for high fevet
38.5 degrees & above
• Advise mother when to return immediately
• Follow up in 2 days if fever persists
• If fever is present every day for more than 7 days, refer
for assessment

28. • If measles now or last 3 mothers
• Signs
• Any general danger sign
• Clouding of cornea
• Deep or extensive mouth ulcers
• Classify as
• SEVERE COMPLICATED MEASLES
• Treatment
• Give vit A
• Give first dose of oral cotrimoxazole
• If clouding of cornea, or pus draining from the eyes, apply
tetracycline eye ointment
• Refer URGENTLY to hospital

29. • Signs
• Pus draining from the eye
• Or mouth ulcers
• Classify as
• MEASLES WITH EYE OR MOUTH COMPLICATIONS
• Treatment
• Give vit A
• If pus draining from the eye, treat infection with
tetracycline eye ointment
• If mouth ulcers, treat with gentian violet
• Follow up in 2 days

30. • Signs
• Measles now, or within the last 3 months
• Classify as
• MEASLES
• Treatment
• Give vit A

31. • Does the child have an ear problem?*****
• IF YES, THEN ASK!
• Is there ear pain?
• Is there ear drainage?
• If yes, for how long?
• LOOK AND FEEL
• Look for pus draining from the ear
• Feel for tender swelling behind the ear

32. CLASSIFY EAR PROBLEM
• Signs
• Tender swelling behind the ear
• Classify as
MASTOIDITIS
• Treatment
• Give first dose of oral cotrimoxazole
• Give first dose of paracetamol for pain
• Refer URGENTLY to hospital

33. Signs
• Pus is seen draining from the ear and discharge is
reported for less then 14 days or
• Ear pain
Classify as
ACUTE EAR INFECTION
Treatment
• Give oral cotrimoxazole for 5 days
• Give paracetamol for pain
• Dry the ear by wicking
• Follow-up in 5 days

34. • Signs
• Pus is seen draining from the ear and
discharge is reported for 14 days and more
• Classify as
CHRONIC EAR INFECTION
• Treatment
• Dry the ear by wicking
• Follow-up in 5 days

35. • Signs
• No ear pain & no pus seen draining from the
ear
• Classify as
NO EAR INFECTION
• Treatment
• No additional treatment

36. • Then check for malnutrition and anaemia!**
LOOK AND FEEL
• Look for visible wasting
• Look for palmar pallor, is it severe palmar
pallor? Some palmar pallor?
• If pallor, is the child a sickler?
• Look for oedema of both feet
• Determine wt for age

37. CLASSIFY NUTRITIONAL STATUS
• Signs
• Visible severe wasting or
• Severe palmar pallor or
• Oedema of both feet
• Classify as
SEVERE MALNUTRITION OR SEVERE ANAEMIA
• Treatment
• Give vit A
• Refer URGENTLY to hospital

38. • Signs
• Some palmar pallor or
• Very low weight for age
• Classify as
ANAEMIA OR VERY LOW WEIGHT
• Treatment
• Assess the child’s feeding & counsel the
mother on feeding according to the food box
on the COUNSEL THE MOTHER CHART, if
feeding problem, follow up in 5 days

39. • Give mebendazole if child is 1yr or older & has
not had a doze in the previous 6 months
• If pallor, give iron- if child is not sickler, if
sickler-give F/A, give oral antimalarial
• Advise mother when to return immediately
• If pallor, follow up in 14 days
• If very low wt for age, follow up in 30 days

40. • Signs
• No very low wt for age & no other signs of malnutrition
• Classify as
 NO ANAEMIA AND NOT VERY LOW WEIGHT
• Treatment
• Give mebendazole if child is 1yr or older & has not had
a doze in the previous 6 months
• If child is less than 2yrs old, assess the child’s feeding &
counsel the mother on the child’s feeding according to
the FOOD box on the COUNSEL THE MOTHER chart
• If feeding problem, follow up in 5 days
• Advise the mother when to return immediately

41. • Then check the child’s immunization status!*
• Immunization schedule
Age Vaccine
Birth (14days) BCG OPV-0
6wks DPT-1 OPV-1
10wks DPT-2 OPV-2
14wks DPT-3 OPV-3
9mths Measles

42. • Give measles immunization to a child age 6
months up to 9 months if exposed to a case
• Repeat the immunization at 9 months
• Give OPV-0 at birth or to an infant less or
equal to 14 days if not received previously

43. • Then check the child’s vitamin A
supplementation status***
• If the child is 6 months or older, ask if the child
has had vit A previously
• If not, give Vit A
• Give vit A every 6 months
• Then check for mebendazole supplementation
status****
• If the child is 1 yr or older, ask if child has had
mebendazole prviously
• If not, give mebendazole
• Give mebendazole every 6 months

44. • Assess other problems
• Make sure child with any general danger sign
is referred after a doze of an appropriate
antibiotic & urgent treatments

45. TREAT THE CHILD
• CARRY OUT THE TREATMENT STEPS
IDENTIFIED ON THE ASSESS AND CLASSIFY
CHART
• TEACH THE MOTHER TO GIVE ORAL DRUGS
AT HOME
• Follow the instructions below for every oral
drug to be given at home
• Also the instructions listed with each drug’s
dose

46. • Determine the appropriate drugs & dosage for
the child’s age or wt
• Tell the mother the reason for giving the drug to
the child
• Demonstrate how to measure the dose
• Watch the mother practice measuring a dose by
herself
• Ask the mother to give the first dose to her child
• Explain carefully how to give the drug, then label
& package the drug

47. • If more than one drug will be given, collect,
count & package each drug seperately
• Explain that all the oral drugs- tablets or syrup
must be used to finish the course of RX, even
if the child gets better
• Check the mother’s understanding before she
leaves the clinic

48. • Give an appropriate oral antibiotic****
• For pneumonia, acute ear infection or very
severe disease
• First line abx- cotrimoxazole
• Second line abx- amoxycillin or PPF
• For cholera
• Give abx recommended for cholera for 3days
• First line abx- cotrimoxazole
• Second line abx- erythromycin

49. • For malaria ******
• First line antimalarial- coartem- currently
• Second line- SP
• For fever ≥38.5 degrees & ear pain ****
• Give paracetamol every 6hrs for 24hrs
• For measles, persistent diarrhoea, severe
malnutrition ****
• Give vit A- 3 doses
• 1st dose in clinic
• 2nd dose at home the nxt day
• Ask mother to bring child back for 3rd dose 2-4 wks

50. • For anaemia*****
• Give iron or folic acid
• If child is not sickler, give iron
• If a child is sickler, give folic acid
• Give one dose of iron or F/A daily for 14 days
• Deworm****
• Give mebendazole if
• The child is 1yr or older and
• The child has not had a dose in the previous 6 months
• If a child is below 2yrs- give 250mg, if 2yrs & above-
give 500mg as single dose

51. TEACH THE MOTHER TO
TREAT LOCAL INFECTIONS
AT HOME
• Explain to the mother what the Rx is & why it
should be given.
• Describe the RX steps listed
• Watch the mother as she does the 1st Rx in the
clinic.
• Tell her how often to do the Rx at home
• Check the mother’s understanding before she
leaves the clinic.

52. • Treat eye infection with tetracycline eye
ointment
• Clean both eyes 3 times daily
• - wash hands
• -ask child to close eyes
• - use clean cloth & water to gently wipe away
pus
• Then apply tetracycline eye ointment in both
eyes 3 times daily

53. • -ask the child to look up
• -Squirt a small amount of the ointment on the
inside of the lower eye lid
• -Wash hands again
• Treat until redness is gone
• Do not use other eye ointments or drops or
put anything else in the eye

54. • Dry the ear by wicking
• Dry the ear 3 times daily
• -roll clean absorbent cloth or soft gauze into a
wick
• -place the wick in the child’s ear
• -Remove the wick when wet
• -Replace the wick with a clean one & repeat
these steps until ear is dry

55. • Treat mouth ulcers with gentian violet
• Treat the mouth ulcers twice daily
• -wash hands
• -Wash the child’s mouth with clean soft
wrapped around the finger & wet with salt
water
• -paint the mouth with half-strength gentian
violet
• Wash hands again

56. • Soothe the throat, relive the cough with a
safe remedy
• Safe remedies to recommend
• -breast milk for exclusively breastfed infant
• Simple linctus
• Tea with honey
• Lemon tea

57. • Give these treatments only in the clinic
• Intramuscular antibiotic e.g. PPF, CAF for
acute ear infection, very severe disease, &
pneumonia
• Quinine for severe malaria
• Diazepam rectally for convulsing child
• Sugar water or milk by NGT in
treatment/prevention of low blood sugar for
child who can not swallow

58. TREATMENT OF
DEHYDRATION
• Plan A: treat diarrhea at home
• Rx of child with diarrhoea, with no s/s
dehydration
• Counsel the mother on the 3 rules of home Rx
• - give extra fluid
• -continue feeding
• -when to return

59. • GIVE EXTRA FLUID
• As much as the child will take
• Tell the mother
• Breast feed frequently & longer at each feed
• If the child is exclusively breast fed, give ORS
or clean water in addition to breast milk
• If child is not exclusively breast fed, give one
or more of the following, ORS, food based
fluids e.g. soup, rice water, & yoghurt or clean
water

60. • Teach the mother how to mix & give ORS
• Give the mother 2 packets of ORS to use at
home
• Instruct that each packet is to be dissolved in
1 litre of cold boiled water
• Show the mother how much fluid to give in
addition to the usual fluid intake
• Up to 2yrs 50-100mls after each loose stool
• 2yrs & above 100-200mls after each loose
stool

61. • Tell the mother
• Give frequent small sips from a cup
• If the child vomits, wait 10 minutes, then
continue, but more slowly
• Continue giving extra fluid until the diarrhea
stops
• Instruct on CONTINUE FEEDING
• Instruct on WHEN TO RETURN

62. • Plan B: treat some dehydration with ORS
• Give in the clinic recommended amount of
ORS over 4-hr period
• Determine amount of ORS to give during first
4 hrs
Age Up to 4
mths
4-12
months
12mths-
2yrs
2-5yrs
Weigh
t
<6kg 6-<10kg 10-<12kg 12-19kg
In ml 200-400 400-700 700-900 900-1000

63. • If the child wants more ORS than shown, give
more
• For infants under 6 months who are not
breast fed, also give 100-200ml clean water
during this period
• Show the mother how to give ORS
• Give frequent small sips from a cup
• If the child vomits, wait 10 minutes, then
continue, but more slowly
• Continue BF whenever the child wants

64. • After 4hrs
• Reassess the child & classify the child for dehydration
• Select the appropriate plan to continue Rx
• Begin feeding the child in the clinic
• If the mother must leave before completing Rx
• Show her how tom prepare ORS at home
• Show her how much ORS to give to finish the 4hr Rx at
home
• Give her enough ORS packets to complete rehydration,
also give her 2 packets as recommended in plan A
• Explain the 3 rules of home Rx as outlined below

65. • - give extra fluid
• -continue feeding
• -when to return

66. • Plan C: treat severe dehydration quickly
• Can you give IV fluids?
• If YES
• Start IVFDS immediately, if child can drink,
give ORS by mouth while drip is set up
• Give 100ml/kg RL or NS solution as divided
below

67. • Repeat once if radial pulse is still very weak or
not detectable
• Reassess the child every 1-2hours, if hydration
status is not improving, give IV drip more rapidly
• Also give ORS 5ml/kg/hr as soon as the child can
drink, usually after 3-4 hrs(infants), 1-2hrs older
children
Age First give
30ml/kg in
Then give
70ml/kg in
Infant
Under 12 months
1hour 5hours
Child
12months -5yrs
30minutes 2 & half hours

68. • Reassess an infant after 6hrs, child after 3hrs,
classify dehydration
• Then choose appropriate plan i.e. A,B, or C

69. • If NO i.e you can not give IVFDS
• Is IV Rx available nearby within 30 minutes?
• If YES
• Then refer URGENTLY to hospital for IV
treatment
• If the child can drink, provide the mother with
ORS solution & show her how to give frequent
sips during the trip

70. • If NO i.e. Is IV Rx not available nearby within
30 minutes
• Then, are you trainedf to use NGT for
rehydration?
• If YES
• Then
• Start rehydration by NGT
• Give 20ml/kg for 6hrs
• Reassess the child every 1-2 hrs

71. • If there is repeated vomiting or increasing
abdominal distension, give fluids more slowly
• If hydration status is not improving after 3hrs,
send the child for IV therapy
• After 6hrs, reassess the child
• Classify dehydration
• Then treat appropriately i.e. Plan A,B, or C

72. • If NO i.e. you can give NGT rehydration!
• Then can the child drink?
• If NO
• Then refer URGENTLY to hospital for IV or NGT
rehydration

73. GIVE FOLLOW UP CARE
• Care for child who returns for follow up
• if the child has any new problem, assess,
classify & treat the new problem
PNEUMONIA
• Follow up after 2days
• Check the child for general danger signs
• Assess the child for cough or difficult in
breathing

74. • Ask!
• Is the child breathing slower?
• Is there less fever?
• Is the child eating better?
• In case of any problem, classify & treat or refer
URGENTLY
PERSISTENT DIARRHOEA
• Follow up after 5 days
• Ask!

75. • Has the diarrhoea stopped?
• How many loose stools is the child having per
day?
• In case of any problem, classify, treat & or
refer URGENTLY
• DYSENTRY
• Follow up after 2days
• Assess the child for diarhoea
• Ask!
• Are there fewer stools?

76. • Is there less blood in the stool?
• Is there less fever?
• Is there less abdominal pain?
• Is the child eating better?
• Assess for persistence of the problem,
establish any new problem, classify, treat or
refer URGENTLY
• MALARIA
• If fever persists after 2days or returns after 14
days, then follow up is necessary

77. • Do full assessment of the child, classify, treat
or refer URGENTLY
MEASLES
• Follow up after 2days
• Look for red eyes & pus draining from the eyes
• Look at mouth ulcers
• Smell the mouth
• Reassess, classify, treat or refer URGENTLY

78. EAR INFECTION
• Follow up after 5days
• Reassess ear problem
• Measure child’s temp
• Classify- acute or chronic ear infection, treat
or refer URGENTLY
• FEEDING PROBLEM
• Follow up after 5days
• Reassess feeding

79. • Ask about any feeding problems found on
initial visit
• Counsel the mother about any new or
continuing feeding problems
• If the child is very low weight for age, ask the
mother to return 30days after the initial visit
to measure the child’s weight

80. PALLOR
• Follow up after 14days
• If child is not sickler give iron
• If child is sickler give F/A
• Advise mother to return after 14 days for
more Fe or F/A
• Continue giving iron or folic acid every 14 days
for 2 months
• If child has palmar pallor after 2 months, refer
URGENLTY

81. VERY LOW WEIGHT
• follow up after 30days
• Weigh the child & determine if the child is still
very low wt for age
• Reassess feeding
• If child still low weight for age, counsel about any
feeding problem
• Ask mother to return in 1 month
• Continue reassess & counseling till child is no
longer low weight for age
• If child increasingly looses weight refer URGENTLY

82. • IF ANY MORE FOLLOW VISITS
ARE NEEDED BASED ON THE
INITIAL VISIT OR CURRENT VISIT,
ADVISE THE MOTHER OF THE
NEXT FOLLOW UP VISIT
• ALSO ADVISE THE MOTHER WHEN
TO RETURN IMMEDIATELY

83. COUNSEL THE MOTHER
FOOD
• Assess the child’s feeding
• Ask qns abt the child’s usual feeding
• Compare the mother’s answers to the feeding
recommendations
• Ask!
• Do you breast feed your child?
• -how many times during the day?
• Do you breast feed during the night?

84. • Does the child take any other foods or fluids?
• -what food or fluids?
• -How many times per day?
• -What do you use to feed the child?
• -If very low weight for age: how large are the
servings? does the child receive his/her own
serving? who feeds the child & how?
• During the illness has the child’s feeding
changed? If yes. How?

85. FEEDING RECOMMENDATIONS DURING
SICKNES AND HEALTH FOR CHILDREN
UP TO 6MONTHS OF AGE
• BF often as the child wants day and night, at
least 8 times in 24hrs
• Do not give other foods or fluids
• Only if the child btn 4-6 months appears
hungry after BF or is not gaining weight
adequately you can add complementary food
as listed under 6-12 months of age

86. • Give these foods 1-2 times per day after BF
• 6-12 OF AGE
• BF as often as the child wants
• Give adequate serving of
• A) Thick porridge made either maize or
cassava or millet or soya floor. Add sugar and
oil, mix either milk or pounded ground nuts

87. • B) Mixtures of mashed foods made out of
posho (maize or millet) or rice or Matooke,
potatoes or cassava. Mix with fish or beans or
pounded ground. Add green vegetables, give a
snack like an egg or banana or bread. 3
times/day if breast fed, 5 times/day if not
breast fed

88. • 12 MONTHS – 2YRS OF AGE
• BF as often as the child wants
• Give adequate serving of
• Mixtures of mashed foods made out of either
matooke or potatoes or cassava or posho
(maize or millet) or rice

89. • Mix with either fish or beans or meat or
pounded ground nuts
• Add green vegetables
• Thick porridge made of either maize or
cassava or millet or soya floor, add sugar and
oil, mix with either milk of pounded ground
nuts
• Snack like an egg or banana or bread or family
food 5 times a day

90. • 2YRS OF AGE AND OLDER
• Give family foods at 3 meals each day, also
twice daily give nutritious snacks btn meals
such as banana or eggs or bread
• NB- a good daily diet should b e adequate in
qty and include an energy rich food (e.g. thick
cereal with added oil), meat, fish, eggs, fruits
and vegetables

91. COUNSEL THE MOTHER ABOUT FEEDING
PROBLEMS
• If the child is not being fed as described in
the a above recommendations, counsel the
mother accordingly
• If the mother reports difficulty with BF, assess
BF as needed
• Important is to show the mother correct
positioning and attachment for BF, ensure
general breast hygiene before BF

92. • If the child is less than 6 months of age and
is taking other milk or foods
• Build mother’s confidence that she can
produce all the breast milk that the child
needs
• Suggest giving more frequent, longer BF day
and night and gradually reducing other milk
or foods
• If the mother is away from the child due to
work, suggest that mother expresses breast
milk to leave for the baby

93. • But if other milk needs to be continued,
counsel the mother to
• BF as much as possible including night
• Make sure that other milk is locally
appropriate breast milk substitute such as
cow’s milk
• Make sure other milk is correctly and
hygienically prepared and given in adequate
amounts
• Finish prepared milk within an hour

94. • If the child is being given diluted milk or thin
porridge
• Remind mother that thick foods which are
dense in energy and nutrients are needed by
infants and young children
• Do not dilute the milk
• Increase the thickness of porridge

95. • If the mother is using a bottle to feed the
child,
• Recommend substituting a cup for a bottle
• Show the mother how to feed the child with a
cup
• If the child is not being fed actively, counsel
the mother to
• Sit with the child and encourage eating

96. • Give the child an adequate serving on a
separate plate or bowel
• If the mother is not giving green leafy
vegetables or other foods rich in vit A
• Encourage her to provide vit A rich foods
frequently e.g. green leafy vegetables, carrots,
liver.

97. • If the child is 6 months of age and above and
appropriate complementary foods have not
been introduced
• Gradually introduce thick porridge mixed with
available protein e.g. milk, add sugar and fat
• Gradually introduce mixture of mashed food
mixed with relish, add green leafy vegetables
and fat
• Give nutritious snack

98. • Child eats solid food but without enough
nutrient density or variety
• Give a variety of mixtures of mashed food
made out of local staples mixed with relish
made out of animal or plant protein
• Add green leafy vegetables and fat
• Follow up any feeding problem in 5 days

99. • Advise the mother to increase fluid during
illness
• For any sick child
• BF more frequently & for longer at each feed
• Increase fluid e.g. rice water, yoghurt, clean
water, if not exclusive BF
• For child with diarrhoea
• Giving extra fluid can be life saving
• Give fliud according to plan A, B, C

100. • Advise mother on when to return to the
health worker
If the child has Follow up
in
pneumonia, dysentry, malaria, measles 2days
persistent diarrhoea, acute/chronic ear
infection, feeding problem, any other not
improving
5days
Pallor 14 days
Very low weight for age 30days

101. • Advise on when to return immediately
Advise mother to return immediately if the child has any of these signs
Any sick child -not able to drink or
BF
-becomes sicker
-develops a fever
If child has no pneumonia: cough or
cold, return if
-fast breathing
-difficult breathing
If child has diarrhoea: return if -blood in stool
Drinks or breast
feeds poorly

102. • Counsel the mother about her own health
• If mother is sick, provide care for her or refer
• If she has a breast problem e.g. engorgement,
sore nipples, breast infection provide care or
refer
• Advise to eat well
• Check her immunization, give TT if needed
• Make sure she has access to FP, STD?AIDS
counseling/prevention, antenatal if pregnant

103. ASSESS, CLASSIFY AND
TREAT THE SICK YOUNG
INFANT
AGE 1 WEEK UP TO 2 MONTHS

104. • Ask the mother what the child’s problems are?
• Determine if this is an initial or follow up visit
for this problem
• - if initial visit, assess the young infant as
follows

105. • check for possible bacterial infection *****
• ASK
• Has the infant had convulsions?

106. • LOOK, LISTEN & FEEL
• Count the breathes in one minute
• Repeat the count if elevated
• Look for severe chest indrawing
• Look for nasal flaring
• Look & listen for grunting
• Look and feel for bulging fontanelle
• Look for pus draining from the ear
• Look at umbilicus, is it red or draining pus? Does
the redness extend to the skin

107. • Measure the temperature
• Look for skin pustules
• See if the infant is lethargic or unscoscious
• Look at the young infant’s movements, are
they lesser than normal?

108. • Signs
• Convulsion or
• Fast breathing (60bpm or more) or
• Severe chest indrawing or
• Nasal flaring or
• Grunting or
• Bulging fontanelle or
• Pus draining from the ear or
• Umbilical redness extending to the skin or
• Fever 37.5 degrees & above, or hypothermia
<35.5 degrees or

109. • Many or severe pustules or
• Lethargic or unconscious or
• Less than normal mov’ts
• Classify as
• POSSIBLE SERIOUS BACTERIAL INFECTION
• Rx
• Give first doe of IM abx
• Treat to prevent low blood sugar
• Advise mother how to keep the infant warm on
the way to hospital
• Refer URGENTLY to hospital

110. • Signs
• Red umbilicus or draining pus or
• Skin pustules
• Classify as
• LOCAL BACTERIAL INFECTION
• Rx
• Give an appropriate oral abx
• Teach the mother to treat local infections at home
• Advise mother to give home care for the young infant
• Follow up in 2 days

111. • Then ask! Does the young infant have
diarrhoea.
• If yes ASK!
• For how long?
• Is there blood in the stool?
• LOOK, AND FEEL
• Look at the young infant’s general condition, is
the infant lethargic or unconscious?, restless
or irritable?

112. • Look for sunken eyes
• Pinch the skin of the abdomen, does it go back
very slowly (longer than 2 seconds)? Or slowly?
• Classification for dehydration in diarrhoea
• Signs
• Two of the ff signs
• Lethargic or
• Unconscious
• Sunken eyes
• Skin pinch goes back very slowly

113. • Classify as
• SEVERE DEHYDRATION
• Rx
• If infant does not have POSSIBLE SERIOUS
BACTERIAL INFECTION give fluid for severe
dehydration-plan C
• Or
• If infant also has POSSIBLE SERIOUS BACTERIAL
INFECTION- refer URGENTLY to hospital with
mother giving frequent sips of ORS on the way
• Advise mother to continue BF

114. • Signs
• Two of the ff signs
• Restless, irritable
• Sunken eyes
• Skin pinch goes back slowly
• Classify as
SOME DEHYDRATION
• Rx
• Give fluid & food for some dehydration-Plan B
• Advise mother when to return immediately

115. • Follow up in 2 days if not improving
• If also has POSSIBLE SERIOUS BACTERIAL
INFECTION- refer URGENTLY to hospital with
mother giving frequent sips of ORS on the way
• Advise mother to continue BF
• Signs
• Not enough signs to classify as some or severe
dehydration
• Classify as
• NO DEHYDRATION

116. • And if diarrhoea 14 days or more
• Signs
• Dehydration lasting 14 days or more
• Classify as
• SEVERE PERSISTENT DIARRHOEA
• Rx
• If the young infant is dehydrated treat
dehydration before referral unless infant has
also POSSIBLE SERIOUS BACTERIAL INFECTION
• Refer to hospital

117. • Signs
• Blood in the stool
• Classify as
• DYSENTRY
• Rx
• Give first dose of appropriate antibiotic
• Refer to hospital

118. • Then check for feeding problem or low
weight***
• Ask!
• Is there any difficulty feeding?
• Is the infant breast fed, if yes how many times
in 24hrs?
• Does the infant usually receive any other
foods or drinks? If yes how often?
• What do you use to feed the infant?

119. • Look, listen, feel
• Determine weight for age
• Find out! if infant-
• -has any difficult in feeding
• -Is breast feeding less than 8 times in 24hrs
• -Is taking any other foods or drinks or
• -Is low weight for age
• -Has no indications to refer urgently to
hospital

120. • Assess breast feeding
• Ask
• Has the infant breastfed in the previous hour?
• If mother has not fed in the previous hour, ask
mother to put infant to the breast, observe
breastfeed for 4 minutes
• Find out!
• -is infant able to attach?
• Is the infant sucking effectively?
• -look for ulcers/thrush in the mouth

121. • To check attachment! Look for!
• Chin touching breast
• Mouth wide open
• Lower lip turned outward

122. • Classify feeding problem
• Signs
• Not able to feed
• No attachment at all
• Not sucking at all
• Classify as
• NOT ABLE TO FEED, POSSIBLE SERIOUS
BACTERIAL INFECTION

123. • RX
• Treat to prevent low blood sugar
• Give first dose of IM abx
• Advise the mouth how to keep the infant
warm on the way to the infant
• Refer URGENTLY to hospital

124. • Signs
• Not well attached to breast or
• Not sucking effectively or
• Less than 8 breastfeeds in 24hrs or
• Receives other foods or drinks or
• Low wt for age
• Thrush in the mouth
• Classify as
• FEEDING PROBLEM OR LOW WEIGHT

125. • Rx
• Advise the mother to breast feed as often &
for as long as the infant wants, day & night
• If not well attached or not sucking effectively,
teach correct positioning & attachment
• If breast feeding less than 8 times in 24 hrs,
advise to increase frequency of feeding
• If receiving other foods or drinks, counsel
mother about breast feeding more, reducing
other foods or drinks & using a cup

126. • If not breastfeeding at all
• -refer for breastfeeding counseling & possible re-
lactation
• -advise about correct preparing breast milk
substitutes such as fresh cow’s milk & using a cup
• If thrush, teach the mother to treat thrush at
home
• Advise mother to give home care for young infant
• Follow up any feeding problem or thrush in 2days
• Follow up low wt for age in 14 days

127. • Signs
• Not low wt for age & no other signs of
inadequate feeding
• Classify as
• NO FEEDING PROBLEM
• Rx
• Advise mother to give home care for the
young infant
• Praise the mother for feeding the infant well

128. • CHECK THE YOUNG INFANT’S IMMUNIZATION
STATUS
• Birth (<14days) BCG OPV-0
• 6wks DPT-1 OPV-1
• 10wks DPT-2 OPV-2
• ASSESS OTHER PROBLEMS
• ASSESS THE MOTHERS’ OWN HEALTH

129. • TREAT THE YOUNG INFANT & COUNSEL THE
MOTHER
• Give appropriate oral abx for local bacterial
infections- 1st line cotrimoxazole, 2nd line
amoxycillin, give IM abx only in the clinic e.g.
CAF, Benzyl penicillin
• Treat diarrhoea appropriately
• Immunize every sick young infant as needed
• Teach mother to treat local infections at home

130. • Teach mother to treat local infections at home
• Explain how the Rx is given
• Watch her as she does the first Rx in the clinic
• Tell her to do the Rx twice daily
• She shd return to the clinic when infaction worsens
• To treat skin pustules or umbilical infection
• The mother shd-
 -gently wash hands
 -gently wash off pus & crusts with soap & soap
• Dry the area
• Paint with gentian violet
• Wash hands

131. To treat thrush
The mother shd-
• -wash hands
• -Wash mouth with clean soft cloth wrapped
around the finger & wet with salt water
• -Paint the mouth with half-strength gentian
violet
• -Wash hands

132. Teach correct positioning & attachment for
BF
Show the mother how to hold her infant
• -with the infant’s head & body straight
• -Facing her breast, with infant's nose opposite
her nipple
• -With infant’s body close to her body
• -Supporting infant’s whole body, not just neck
& shoulders

133. Show her how to help the infant to attach, she
shd-
• -touch her infant’s lips with her nipple
• -Wait until her infant’s mouth is opening wide
• -Move her infant quickly onto her breast
aiming the infant’s lower lip well below the
nipple look for signs of good attachment &
effective suckling
If the attachment or sucking is not good, try
again

134. • Advise on follow up!
If the infant has Return for follow up
in
Local bacterial infection, any
feeding problem, thrush
2days
Low weight for age 14 days

135. • Advise on when to return immediately
Advise the mother to return immediately if the
young infant has any of these signs
Breastfeeding or drinking poorly
Becomes sicker
Develops fever
Fast breathing
Difficult breathing
Blood in stool

136. FOLLOW UP CARE FOR THE SICK
YOUNG INFANT
• Local bacterial infection
• Follow up in 2days
• Look at the umbilicus, if red, draining pus?
Does redness extend to the skin
• Look at the skin pustules, are there many or
severe pustules?
• Re-assess, classify, treat, or refer

137. • Feeding problem
• Follow up after 2 days
• Re-assess feeding
• Check for feeding problem or low wt for age
• Ask about any feeding problem
• Counsel mother about any new or continuing
feeding problems
• Ask mother to bring the infant back after 14days for
measurement of infant’s wt
• If infant’s wt does not improve, refer URGENTLY to
hospital

138. • Low weight
• Follow up after 14 days
• Weight infant & determine if still low wt for age
• Reassess feeding
• If infant is no longer low wt for age, praise the
mother & encourage to continue
• If still low wt for age, counsel abt feeding, advise
to come back after 14 days
• If infant is increasingly loosing wt, refer
URGENTLY to hospital

139. • Thrush
• Follow up after 2 days
• Look for ulcers or white patches in the mouth
• Reassess feeding
• Check for feeding problems or low wt for age
• If thrush is worse, with problems in feeding-
refer to hospital

140. End