IMCI

1. IMCI
PRESENTED BY : DR. HAYAT AL KIYUMI

2. OBJECTIVES
1 ) NURSE ROLE IN APPROCHING CHILD AT TRIAGE .
2 ) CHILD FOR VACCINATION.
3) DOCTOR ROLE IN APPROCHING CHILDREN AGE 2 MOTHNS TO 5 YRS.
4) DOCTOR ROLE IN APPROCHING YOUNG INFANT AGE 1 WEEK UP TO 2
MONTHS.

3. INTRODUCTION
•IMCI : INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS .
•CHILDREN < 5 YRS

4. MANAGEMENT OF A CHILD AGED 2
MONTHS – 5 YRS
•AT TRIAGE :
•WEIGHT
•HEIGHT : ONCE/MONTH
•TEMPERATURE
•REASON FOR VISIT
•PULSE RATE
•RESPIRAOTY RATE

5. RESPIRATORY RATE
•ABNORMAL RR FOR DIFFRERNT AGE GROUPS
•RR IN NEONATE > 60 /MIN
•RR IN 2 – 12 MONTHS > 50/MIN
•RR IN 1 – 5 YRS OLD > 40/MIN
•CHEST IN DRAWING ( NOT DURING BREASTFEEDING)

6. DANGER SIGNS
•1 – LETHARGY / UNCONSCIOUSNESS
•2 – VOMITING
•3 – CONVULSIONS
•4 – INABILITY TO DRINK OR BREASTFEEDED
•** IF ONE OR MORE OF THESE SIGNS ------ > SERIOUSLY ILL ------ >
REFERRED.
•* IF NO ABOVE DANGER SIGNS ( & NO FEVER OR SOB) …. > THEN CHECK
NUTRITIONAL STATUS.

7. NUTRITIONAL STATUS
•1 ) PEM :
•A) CHILDREN WITH SEVERE MALNUTRITION ( INCREASE RISK FOR
MORTALITY & NEED URGENT REFERRAL )
•B ) IDENTIFY CHILDREN WITH SUB – OPTIMAL GROWTH

8. CHART FOR CLASSIFICATION OF PEM
Weight for age below –ve 3rd red zone PEM SEVERE
Weight for age between –ve 2nd and –ve 3rd orange zone PEM MODERATE
Weight above –ve 2nd green zone NO PEM

9. PEM
•IF CHILD HAS PEM , OR MOTHER C/O FEEDING DIFFICUTY … CHECK
BREASTFEEDING.
FEEDING IS NOT < 8 TIMES/DAY
•ASK IF THERE IS H/O UTI , FREQUENT DIARRHEA & COUGH
•INVESTIGATION:
URINE ROUTINE
HGB
•STOOL ROUTINE ( PARACITE)

10. PEM
•Severe PEM …… > REFERED
•MODERATE PEM ----- > 1) DO IX
•2) REFERRAL TO DIETITION
•3) F/U AFTER 2 WKS, THEN REVIEW EVERY
MONTH

11. CHART FOR CLASSIFICATION OF ANEMIA
SEVERE ANEMIAHB < 7 GM/DL
ANEMIAHB ( 7 – 11 ) GM/DL
NO ANEMIAHB > 11 GM/DL

12. F/U ANEMIA
•REPEAT HGB , IF RAISE BY 0.5 TO 1 GM IN 2 WKS , CONTINUE ORAL IRON
FOR 3 MONTHS THEN REVIEW.

13. CONTUNIED ASSESSMENT
•CHECK IMMUNIZATION STATUS
•PSYCHOSOCIAL ASSESSMENT TO DETECT DEVELOPMENTAL DELAY.

14. VACCINATION
•WHAT TO WRITE IN NOTES FOR VACCINATED CHILD :
•1) DUE FOR VACCINATION …….
•2) WEIGHT IN GREEN ZONE & UPGOING
•3) NO DANGER SIGNS
•4) NORMAL PSYCHOSOCIAL ASSESSMENT CHECKED BY BOTH NURSE &
DOCTOR.

15. VACCINATION
IF NO TSH THERE ASK LAB TECHNICION TO TALK TO FOCAL POINT OF
DELIVERY HOSPITAL . ON NO TEL NUMBER , TO CALL DGHS TO GIVE YOU
-ANY MURMUR REFER.
-EYE EXAMINATION: BY TORCH ABOUT 30 CM ……. > IF WHITE PUPIL (
CATARACT)
-IF RED PUPIL (
NORMAL )
-ONLY MARKED SQUINT REFER & DO NOT WAIT.
-

16. VACCINATION
F/U AT 9 MONTHS ….. > HGB + BLOOD GROUP
NO VACCINATION AT THIS AGE.
COMPLIMENTARY FOOD STARTED.
AT 13 MONTHS TO BE SEEN BY DR.
FOR OPV , IF CHILD HAS DIARRHEA BETTER TO GIVE HER/HIM & TO REEPAT
IT AFTER ONE MONTH.

17. VACCINATIONA
•IF BOWING LEG REFER
•AT 18 MONTHS .. REPEAT IX
•IF NO TEETH REFER ( VITAMIN D DEFICIENCY)
•IF TEETH DECAY … REFER TO DENTIST.
•- TO F/U OBESITY

18. ASSESSMENT & CLASSIFICATION OF SICK
CHILD ( 2 MONTHS – 5 YRS)
•HISTORY: ASK CARE GIVER
•1) DOSE THE CHILD HAVE COUGH OR DIFFICULT BREATHING ?
•2) ANY EAR PROBLEMS ?
•3) DIARRHEA ?
•4) FEVER ?
•5) ANY THROAT PROBLEM ?
•6) ANY OTHER PROBLEM ?

19. CHART FOR CALSSIFICATION OF
COUGH OR DIFFICULT BREATHING
SEVERE PNEUMONIAANY GENERAL DAANGER SIGN OR CHEST
IN –DRAWING
PNEUMONIAFAST BREATHING
PNEUMONIA WITH WHEEZFAST BREATHING & AUDIBLE WHEEZ
CORYZA WITH WHEEZAUDIBLE WHEEZ
CORYZANO CHEST IN- DRAWING , FAST
BREATHING OR WHEEZ

20. COUGH
RX OF PENUMONIA :
ORAL ANTIBIOTICS ( EX ; AMOXYCILLIN ) FOR 5 DAYS.
REVIEW AFTER 2 DAYS
EXTENT ANTIBIOITCS TO 7 DAYS IF NECESSARY .
GIVE AUGMENTEN IF NO IMPROVEMENT.
ADVICE FOR SAFE REDEMY

21. COUGH
•CHILD WITH PERSISTENT COUGH > 15 DAYS ….. REFER TO R/O :
•TB
•ASTHMA
•WHOOPING COUGH
•** COUGH SYRUP WITH CODEIN ………… > CONSTIPATION.

22. EAR PROBLEM
•* MAIN CAUSE OF DEFENNESS ….. > LEARNING PROBLEMS
•1)ASK FOR EAR PAIN ( OR RUB EAR)
•2) LOOK FOR EAR DISCAHRGE OR PUS
•3) LOOK FOR TENDER SWELLING BEHIND THE EAR.

23. CHART FOR CLASSIFICATION OF EAR
PROBLEM
MASTODITISEAR DISCHARGE & TENDER SWELLING
BEHIND THE EAR
ACUTE OTITIS MEDIAIF EAR PAIN OR EAR DISCHARGE IS PUS
FOR < 14 DAYS
CHRONIC O. MIF EAR PAIN OR EAR DISCAHRGE > 14
DAYS
OTHER PROBLEMNO SIGN OF EAR INFECTION FOUND

24. EAR PROBLEM
•ACUTE O. M :
•AMOXYCILLIN FOR 5 DAYS
•REVIEW AFTER 2 DAYS
•IN DISCHARGE NOT REDUCE , GIVE 2ND LINE ANTIBIOTICS
•GIVE PARACETAMOL FOR PAIN RELIEF
•DRY EAR BY SOFT WICKS
•REVIEW AFTER 5 DAYS , IF NO IMPROVEMENT TO BE REFERRED TO ENT
CHRONIC O. M … REFER TO ENT

25. THROAT PROBLEM
•THROAT INFECTION ( IF CAUSED BY STERPTOCOCCUS ) ---- > RHEUMATIC
FEVER -------- > CARDIA PROBLEM.
•MORE COMMON IN > 2 – 3 YRS
•ALL CHILD > 2 YRS ….. EXAMIN THROAT.
•CHILD < 2 YRS …. EXAMIN IF ONLLY FEVER IS THERE.

26. CHART FOR CLASSIFICATION OF THROAT
PROBLEM
STERPTOCOCCAL SORE THROAT
(TAKE THROST SWAB IF POSSIBLE ,
START OSPEN 10 DAYS , IF C/S –VE STOP
IT)
ENLARGED TENDER LN IN FRONT OF
NECK .
WHITE/YELLOW EXUDATE OR SEVERE
CONGESTION
NON- STERPTOCOAL SORE THROT
CONGESTION OF THROAT WITH NO
ENOUGH SIGNS TO CLASSIFY AS
STERPTOCOCCAL SORE
THROAT

27. DIARRHEA
•STOOL IN BREASTFEED CHILD …. SOFTER & MORE FREQUENT.
•DIARRHEA LAST < 14 DAYS ( ACUTE DIARRHEA)
•> 14 DAYS ( PERSISTENT DIARRHE) ---- > reduce weight --- >
PEM
•DIARRHEA :
•1) DYSENTERIC ( BLOOD IN STOOL ) … 10 %
•2) NON- DYSENTERIC
•ASK : 1 ) FOR HOW LONG IS DIARRHEA ? 2) IS THERE BLOOD IN STOOL ?

28. CLASSIFICATION OF DEHYDRATION
SEVERE DEHYDRATION
TWO OF 0 SIGNS :
-LETHRGIC OR UNCONSCIOUS
-SUNKEN EYES
-NOT ABLE TO DRINK OR DRINKING POORLY
-SKIN PINCH GOES BACK VERY SLOWLY > 2 S
MILD TO MODERATE
DEHYDRATION
2 OF FOLLOWING SIGN
RESTLESS , IRRITABLE
SUNKEN EYES
DRINK EAGERLY, THIRSTY
SKIN PINCH GOSE BACK SLOWLY
NO
DEHYDRATION
NOT ENOUGH SIGNS TO CLASSIFY

29. TREATMENT OF DIARRHEA
•IF NO DEHYDRATION :
•1) EDUCATE MOTHER HOW TO PREPARE ORS
•2) GIVE 100 ML OF ORS /STOOL FOR CHILD < 1 YR
•3) GIVE 200 ML OF ORS /STOOL FOR CHILD > 1 YRS
•4 ) GIVE OTHER FLUID IN ADDITION TO ORS
•5) ADVICE MOTHER TO RETURN TO THE CLINIC , IF CHILD DEVELOPS
BLOOD IN STOOL, DRINKS POORLY , BECOES SICKER , OR IS NOT BETTER
IN THREE DAYS .

30. TREATMENT OF DIARRHEA
•IF CHILD HAS MILD TO MODERATE DEHYDRATION :
•- GIVE 75 ML/KG OF ORS /4 HRS
•- CONTINUE BREASTFEEDING IF CHILD IS BREAST- FED
•- REASSES & RECLASSIFY AFTER 4 HRS…. IF 1) NO DEHYDRATION… SEND
HOME.
•2) STILL MODERATE
DEHYDRATED… REPEAT THE ABOVE RX
**

31. TREATMENT OF DIARRHEA
•3) if severe dehydration … refer
•** HOW TO TREAT PERSISTENT DIARRHEA ???
•TREATMENT OF DYSENTERY DIARRHEA:
•A) NALIDIXIC ACID X 5 DAYS , IF G6PD +VE , USE CEPRADINE
•B) F/U IN 2- 3 DAYS & CHANGE TO ANOTHER ANTIBIOTIS IF NO RESPONSE
•C) REFER URGENTLY IF CHILD IS < 1 YR OR IF PEM +VE.

32. FEVER
•TEMPERATURE : > 37.5 C BY AXILLA
•DURATION IF > 5 DAYS ( SERIOUSE ILLNESS ) .. REFER URGENTLY

33. CHART FOR CLASSIFICATION OF FEVER
VERY SEVERE FEBRILE DISEASE /
MENINGITIS
ANY DANGER SIGN OR STIFF NECK ,
BULGING FONTANEL
MALARIANO RUNNY NOSE , NO MEASLES , NO
OTHER CAUSE OF FEVER & MALARIA
PARASITE ON BLOOD SMEAR
FEVER CAUSE KNOWNCHILDREN ALREADY CLASSIFIED AS
PNEUMONIA, EAR INFECTION, OR SORE
THROAT
MEASLES / RUBELLAGENERALIZED RASH & COUGH , RUNNY
NOSE OR RED EYES
UTICRYING WHILE PASSING URINE
URINE MICROSCOPY , > 20 WBC/CMM
FEVER CAUSE UNKNOWNNO OBVIOUS CAUSE OF FEVER

34. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
•ASSESS & CALSSIFY
•- CHECK FOR BACTERIAL INFECTION.
•- LOOK FOR JAUNDICE.
•- IF THERE IS DIARRHEA
•- FEEDING PROBLEM OR LOW WEIGHT
•- CHECK IMMUNIZATION STATUS
•- ASSESS FOR OTHER PROBLEM

35. CHART FOR CLASSIFICATION OF INFECTION IN
YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS
CLASSIFY ASSIGNS
SEVERE BACTERIAL INFECTION / SEPSISANY ONE OF THE FOLLOWING :
LETHARGY OR UNCONSCIOUSNESS,
CONVULSIONS , NOT ABLE TO SUCK ,
PERSISTENT VOMITING, FAST BREATHING>
60/MIN, SEVERE CHEST INDRAWING /NASAL
FLAIRE & GRUNTING, REDNESS AROUND
UMBILICUS EXTENDING TO SKIN & TISSUE
> 1 CM , MULTIPLE SKIN PUSTULES, PUS
DISHARGING FRO EAR, SEVERE PURULENT
EYE DISCHARGE, HYPOTONIA, TEMP ( 37.6 –
37.9 WITH ANY OF ABOVE SIGNS) TEMP >
37.9 OR BELOW 35 C
CORYZA ( COUGH, COLD)RUNNY NOSE , TEMP ( 37.6 TO 37.9 )
BABY ACTIVE & FEEDING WELL

36. CHART FOR CLASSIFICATION OF INFECTION IN
YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS
CLASSIFY ASSIGNS
LOCAL INFECTION OF :
UMBILICUS
SKIN
EYES
ANY ONE OF THE FOLLOWING :
REDNESS & SWELLING OF SKIN
EXTENDING < 1 CM BEYOND UMBILICUS.
SOME SKIN PUSTULES.
SOME PURULENT EYE DISCHARGE
NO INFECTIONNONE OF THE ABOVE

37. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
•- JAUNDICE IN 1ST 24 HRS …. SERIOUSE
•- JAUNDICE AFTER 48 HRS EITHER :
•1) SIGNIFICANT ….. JAUNDICE UP TO PALMS & SOLES
•2) NOT SIGNIFICANT …… NOT EXTENDING UPTO PALMS & SOLES.

38. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
ASSESS DIARRHEA
REFER ALL CASES OF DYSENTRY TO HOSPITAL URGENTLY AS IT LIKELY TO CAUSE SEPTCEMIA
& SHOCK.
•- SEVERE DEHYDRATION , ANY TWO OF :
•A) LETHARGIC OR UNCONSCIOUS
•B) SUNKEN EYES
•C) SKIN PINCH GOES VERY SLOWLY
•- SOME OF DEHYDRATION , ANY TWO OF:
•A) RESTLESS OR IRRITABLE
•B) SUNKEN EYES
•C) SKIN PINCH GOES SLOWLY

39. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
•- CHECK FOR FEEDING PROBLEMS OR LOW WEIGHT.
•- CHECK IMMUNIZATION STATUS
•- DO ROUTINE CLINICL CHECK UP
•**WHEN TO FOLLOW UP ?????

40. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
•TO RETURN IMEDIATELY IF INFANT HAS ANY OF THESE SIGNS :
•- NOT BREASTFEEDING OR DRINKING POORLY
•- BECOMES SICKER
•- DEVELOPS A FEVER
•- FAST BREATHING
•- DIFFICULT BREATHING
•BLOOD IN STOOL

41. MANAGEMENT OF YOUNG INFANT AGED 1
WEEK UP TO 2 MONTHS
•ADVICE FOR FOLLOW – UP VISIT.
RETURN FOR FOLLOW-UP NOT
LATER THAN :
IF THE INFANT HAS :
2 DAYSLOCAL BACTRIAL INFECTION
ANY FEEDING PROBLEM
THRUSH
14 DAYSLOW WEIGHT FOR AGE

42. THANK YOU