1. The document outlines the Integrated Management of Childhood Illness (IMCI) strategy created by WHO and UNICEF in 1992 to improve child health. 2. IMCI aims to reduce child mortality by assessing, classifying, and treating common childhood illnesses in an integrated manner. It focuses on sick children aged 0-5 years. 3. The assessment involves checking for general danger signs, main symptoms, nutrition status, immunization history, and other factors. Children are then classified as mild, moderate, or severe cases and treated accordingly, with counseling of caretakers as a key component.

1. Created by WHO, UNICEF in 1992
UNICEF (NGO) - United Nations Children’s Fund
Objectives:
1. Reduce death and frequency and severity of illness and disability
2. Contribute to improved growth and development
Target:
1. Sick young infant (0 to 2 months old)
2. Sick child (2 months to 5 years old)
Steps:
1. Assessment
a. General danger signs (overt)
i. Convulsions
ii. Unable to drink/breastfeed
iii. Vomits everything
iv. Abnormally sleepy/lethargic
b. Main symptoms (covert)
i. Cough/Dyspnea
ii. Diarrhea
iii. Fever
iv. Ear infection
c. Nutrition status
i. Anemia
d. HIV status
e. Immunization status
f. Deworming status
e. Others
2. Classification - color coded approach
a. Pink - Severe
3. Treatment
Urgent referral to
the nearest hospital
4. Counseling - all will be counseled
Principles:
1. All sick children are examined for general danger signs/very severe disease
2. The children and infants are then assessed for main symptoms
3. All sick children are routinely assessed for nutritional and immunization and deworming ststus
and other problems
4. Only a limited number of clinical signs are used
5. A combination of individual signs leads to a child’s classification within one or more symptom
groups rather than a diagnosis
6. IMCI management procedures use limited number of essential drugs
7. Counseling of caretakers is an essential component of IMCI
SICK CHILD (2 MONTHS TO 5 YEARS)
1. Assessment - (+) General danger signs (CUVA)
2. Classification - classified under pink (Very severe disease)
3. Treatment
Convulsion
-give 1 doze of diazepam (rectal)
-IM antibiotics: ampicillin and gentamicin
Refer urgently
4. Counseling
Instruct guardian: keep the baby warm, continue breastfeeding
COUGH/DYSPNEA
DIARRHEA
Dehydration - minimum of 2 symptoms
b. Yellow - Moderate
Treatment at the
RHU/HC
c. Green - Mild
Home management
Severe pneumonia
Pneumonia
Cough or Colds Cough & colds Home management
Fast breathing
2-12 months old - >50bpm
1-5 years old - >40 bpm
Oral Amoxicillin/
Cotrimoxazole BID 5 days
GDS, Stridor, chest
indrawing
IM Ampicillin & Gentamicin
No Dehydration
No or not enough fluid
S/sx of dehydration
Plan A: ↑ fluid intake
<2y.o - 50-100mL fluid after each loose stools
>2y.o - 100-200mL fluid after each loose stools
Restless, sunken eyes, drinks
eagerly, slow skin turgor (2 secs)
Some Dehydration
Plan B: Oresol/ORS within 4 hrs
Wt (kg) x 75 = ORS volume
Home made: 1L water, 6tsp sugar and 1/2 tsp salt
GDS, Sunken eyes, very slow
skin turgor (>2secs)
Plan C: (can be delayed in referral)
IV (LRS) / NGT (ORS) rehydration
Severe Dehydration
Duration - 14 days or more
Blood in stool
FEVER - >37.5 C
Malaria Risk - only in patients from/who resides in places endemic of malaria (Palawan)
Measles
Vitamin A supplementation Doses per DOH:
100,000 iu - 6 to 12 months old
200,000 iu - > 1 year old q 6 months
EAR INFECTION
MALNUTRITION
MUAC - Mid-Upper Arm Cicumference
Severe persistent
diarrhea
Persistent
diarrhea
Diarrhea >14 days with dehydration
Diarrhea >14 days without
dehydration
Zinc supplements for 14 days
to lessen duration of diarrhea
Treat dehydration
(refer previous chart)
Dysentery Blood in stool Oral Ciprofloxacin BID 3 days
Very severe
Febrile disease
Malaria
Fever: No malaria (-) Malarial smear Home management for fever,
paracetamol for >38.5C temperature
(+) Malarial smear
Oral antimalarial drug
Artemether-lumefantrine BID 3 days
Paracetamol for >38.5C
Home management
GDS, stiff neck
IM Artesunate/Quinine suppository, IM
ampicillin & gentamicin, Paracetamol for
fever, Diazepam if (+) convulsion
Measles Now or within the last 3 months
Home management: symptomatic.
Vitamin A supplements to lessen
complication
Measles with eye
or mouth
complications
Severe complicated
measles
Pus draining from eyes,
mouth ulcers
Tetracycline eye ointment,
Gentian violet for mouth ulcer,
Vitamin A supplements
GDS, clouding of cornea, deep
and extensive mouth ulcers
IM ampicillin & gentamicin,
tetracycline eye ointment, Gentian
violet, Vitamin A supplement
No ear infection NO s/sx
<14 Pus draining from the ears
days, ear pain
>14 days
Ear infection:
acute
chronic
Dry the ears by wicking Oral antibiotics
BID 5 days, Paracetamol for pain
Quinolone Otic drops TID 14 days
Mastoiditis Tender swelling behind the ear
IM ampicillin &
gentamicin, Paracetamol
No acute
malnutrition MUAC: >125mm
Assess and counsel as to
feeding/nutrition
Moderate acute
malnutrition
MUAC: 115-125 mm Assess and counsel as to
feeding/nutrition
Uncomplicated
Severe Malnutrition
Complicated Severe
Malnutrition
Muscle wasting, Edema of both
feet, MUAC: <115mm, Co-
morbidities
Muscle wasting, Edema of both feet,
MUAC: <115mm
IM ampicillin & gentamicin
Oral Amoxicillin/Cotrimoxazole,
assess and counsel as to feeding/
nutrition
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
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2. ANEMIA
HIV
IMMUNIZATION
National Immunization Program
BA-HA PA-PA-RO-ON sa a-MIN
SICK YOUNG INFANT (0 TO 6 MONTHS UP)
INFECTION
JAUNDICE
No Anemia
Anemia
Severe Anemia
No s/sx Assess and counsel as to
feeding/nutrition
Some palmar pallor
Iron supplements BID 14 days,
Mebendazole for >1y.o
Severe palmar pallor Refer urgently after assessment
HIV infection
unlikely
(-) HIV Test
HIV Exposed Mother (+) HIV Test
Counsel
Oral Cotrimoxazole, Oral
antiretroviral Zidovudine
(prophylaxis)
Confirmed
HIV Infection
Child (+) HIV Test
Oral antibiotics,
oral antiretrovirals
BCG
HEPA-B
PENTAVALENT
PCV
ROTAVIRUS
OPV
MMR
Bacillus Calmette-Guein
Hepatitis B
Hepatitis B, Diphtheria,
Pertussis, Tetanus, HIB
0.05mL 1 Anytime after
birth
ID
Deltoid
region
Pneumococcal Conjugate Vaccine
Oral Polio Vaccine
0.5mL 1 At birth IM Vastus
Lateralis
Measles, Mumps, Rubella
0.5mL 3 doses (6 weeks; 10 weeks;
14 weeks)
IM Vastus
Lateralis
0.5mL 3 doses
(6 weeks; 10 weeks;
14 weeks) IM
Vastus
Lateralis
2-3 gtts 2 doses 6 weeks; 10 weeks Oral Mouth
2-3 gtts 3 doses
(6 weeks; 10 weeks;
14 weeks) Oral Mouth
*IPV (Inactivated Polio Vaccine) - 0.5mL, 1 dose at 14 weeks, IM, Vastus Lateralis
0.5mL 2 doses
9 months;
12 months SC Upper outer
portion of arms
Severe disease local
bacterial infection
unnlikely
No s/sx Counsel
Local Bacterial
infection
Umbilicus is red,
draining pus, skin
postules
Oral amoxicillin/
cotrimoxazole, gentian violet
Very Severe Disease
GDS (CUA), fast breathing
(>60bpm), chest indrawing, hypo/
hyerthermia
IM ampicillin & gentamicin
No Jaundice No S/Sx
Jaundice
Jaundice appearing >24hrs,
“physiological jaundice”
Severe Jaundice
Jaundice appearing <24hrs,
“Pathologic jaundice”
Light therapy
Refer urgently
FEEDING PROBLEM
Signs of good attachment:
1. Lip turned outward
2. Deep sucks
3. More areola visible above than below
No feeding
problem
Feeding
problem
Not well attached, not sucking
effectively, <8 breastfeedings in 24hrs,
low birth weight
No s/sx
Counseling
r
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