The Integrated

Management of
Childhood Illness
 IMCI Case Management

Focused Assessment Classification

Danger signs
Need to Refer
Main Symptoms
Nutritional status
Immunization status Specific treatment
Vitamin A status
Deworming
Home
Feeding Problem
Other problems management

Counsel & Follow-up Treatment

Counsel caretakers Identify treatment

Follow-up Treat
 Check for general danger signs

Not able to drink or breastfeed, or

Vomits everything, or
Convulsions, or
Abnormally sleepy or difficult
to awaken

If YES: URGENT REFERRAL is needed

 Ask about the main symptoms

Cough or difficulty in breathing

Diarrhea
Fever
Ear problem
 Cough or difficulty in breathing

Look for:
Count RR The child
Chest indrawing must be
Listen for Stridor calm & not
Listen for wheezing eating
 If with:
- Any general danger sign or
- Chest indrawing or
- Stridor

SEVERE PNEUMONIA OR
VERY SEVERE DISEASE

1st dose of antibiotic

Vitamin A
URGENT REFERRAL
Prevent low blood sugar
 If Fast breathing only:
2 12 months old: 50/minute
1 year or older: 40/minute
Note: Exactly 12 mos: 40

PNEUMONIA

Antibiotic for 3 days (Amoxycillin)

safe throat remedy
(calamansi, breast milk)
Follow-up in 2 days

If wheezing, give trial of rapid-acting inhaled

bronchodilator (up to three cycles for up to 15-20 minutes
apart)
 If No signs of pneumonia
or a very severe disease

NO PNEUMONIA: COUGH OR COLD

If cough 30 days
refer to hospital for assessment
safe throat remedy
Follow-up in 5 days.

If wheezing, give inhaled bronchodilator for 5 days

If with Diarrhea, then classify

For dehydration

If persistent

If with blood in the stool

 Classify for dehydration

2 or more of the following:

- Abnormally sleepy/difficult to wake
- Sunken eyes
- Not able to feed/drinking poorly
- Skin pinch goes back very slowly (2 sec)

If with no other
severe classification:
Plan C- IVF in RHU
SEVERE DEHYDRATION
If less than 2 yrs & there is cholera
In the area, give TETRACYCLINE
 Classify for dehydration

2 of the following:
- Restless, irritable
- Sunken eyes
- Drinks eagerly, thirsty
- Skin pinch goes back slowly (2 sec)

Plan B : ORS,
SOME DEHYDRATION zinc supplement
in RHU
 Classify for dehydration

Not enough signs to classify as

SEVERE DEHYDRATION or
SOME DEHYDRATION

Plan A: Extra Fluids

NO DEHYDRATION Give Zinc supplement
Follow-up in 5 days
 Persistent diarrhea: 14 days or more

Dehydration present- severe persistent

diarrhea

Treat dehydration
Give Vitamin A
REFER to hospital
 Persistent diarrhea: 14 days or more

No dehydration- persistent diarrhea

Advise regarding feeding

Give Vitamin A
Give multivitamins & minerals
with zinc for 14 days
Follow-up in 5 days
 If with blood in the stool - dysentery

Oral antibiotic- CIPROFLOXACIN for 3

days
Follow-up in 2 days
 If with fever?

Determine: Malaria risk?

Measles now or w/in last 3 mos

Dengue risk?
 Fever: Ask about malaria risk

Residing in endemic area?

OR:
Travel & overnight
w/in past
stay in endemic area 4 weeks

If YES, then do a blood smear.

 If with Malaria risk:
& with any general danger sign or stiff
neck

Very severe febrile disease/malaria

Quinine (under med. supervision)

1st dose of antibiotic, Paracetamol
Prevent low blood sugar
Send the blood smear with patient
URGENT REFERRAL
 If Malaria risk
(+) blood smear

Malaria

Oral antimalarial
Paracetamol for fever
Follow-up in 2 days
 If Malaria risk
(-) blood smear

Fever, malaria
unlikely

Paracetamol for fever

Treat other causes of fever
Follow-up in 2 days
 If no malaria risk but with
Any general danger sign or stiff neck

Very severe febrile disease

One dose of antibiotic, Paracetamol

Treat to prevent low blood sugar
URGENT REFERRAL
 If no malaria risk & NO sign of very
severe febrile disease

FEVER, NO MALARIA

One dose Paracetamol

If with fever every day for more than 7
days, REFER for assessment
 If with Measles & with clouding of
cornea or
with deep or extensive mouth ulcers or
ANY danger sign

Severe complicated measles

1st dose of antibiotic, Vitamin A

tetracycline eye ointment
Urgent referral
Measles now or w/in last 3 mos
Pus draining from the eye or
Mouth ulcers

Measles with eye or

Mouth complications

Vitamin A
Tetracycline eye ointment
Gentian violet
Follow up in 2 days
Measles now or w/in last 3 mos
No other signs

Measles

Vitamin A
Advise mother when
to return immediately
 Assess Dengue risk

Bleeding gums, nose, in vomitus or

stools ,or
Persistent vomiting & abdominal pain,
Skin petechiae, or
Cold clammy extremities, or
Slow capillary refill (more than 3 secs)
+ Tourniquet test
 Any of the mentioned symptoms

Severe Dengue hemorrhagic fever

Plan C if with + bleeding

Plan B if with either abdominal plain,
or skin petechia, or + torniquet test
Do not give aspirin
Treat to prevent low blood sugar.
URGENT REFERRAL
 If No sign of Severe Dengue
Hemorrhagic Fever

FEVER, DHF UNLIKELY

DO NOT GIVE ASPIRIN

Follow-up in 2 days
 Classify Ear problem:
Tender swelling behind ear

Mastoiditis

1st dose of antibiotic

Paracetamol for pain
URGENT REFERRAL
If with ear problem: with ear discharge
< 14 days

Acute ear infection

Antibiotic for 5 days

Paracetamol for pain
Wicking
Follow-up in 5 days
Ear discharge for 14 days or more

Chronic ear infection

Wicking
Quinolone ear drops for 2 weeks
Follow-up in 5 days
Then check for malnutrition
& anemia
Look for:
Visible severe wasting
Edema of both feet
Palmar pallor
If 6 months or older, determine if
MUAC (Mid-upper Arm Circumference)
is less tha 115 mm.

Determine weight for age

If up to 6 months and:
Visible severe wasting or
Edema on both feet
If 6 mos & above: Above symptoms &
MUAC is less than 115 mm

Severe malnutrition

Vitamin A
Treat to prevent low blood sugar
URGENT REFERRAL
 Very low weight for age

Very low weight

Assess for feeding problem

Counsel the mother on feeding
Vitamin A
 Severe palmar pallor

Severe anemia

URGENT REFERRAL
 Some palmar pallor or

Anemia

Assess for feeding problem / counsel mother

Give iron & Albendazole (if 1 yr old & older)
 Then CHECK CHILDS IMMUNIZATION
STATUS

Birth BCG HepB1

6 weeks OPV1 HepB2 DPT1 Hib1
10 weeks OPV2 _____ DPT2 Hib2
14 weeks OPV3 HepB3 DPT3 Hib3
9 months Measles
15 months MMR
 New Immunization Schedule

Birth BCG HepB0

6 weeks Pentavalent1 OPV1 RTV1* PCV1*

10 weeks Pentavalent2 OPV2 RTV2* PCV2*
14 weeks Pentavalent3 OPV3 RTV3* PCV3*
9 months Measles
12 months MMR

RTV*PCV* - in selected areas only due to limited

supplies
Pentavalent vaccine includes DPT, HIB, HepB
 Then CHECK VITAMIN A
SUPPLEMENTATION STATUS
(for children 6 months or older)

Given if child was not given in the past 6

months.
May be given even if given one in the
past 6 months if Vit. A is part of urgent
pre-referral treatment.
 Then check the childs DEWORMING
status

ROUTINE WORM TREATMENT:

Give every child ALBENDAZOLE/
MEBENDAZOLE every 6 months
from the age of one year.
 Then ASSESS THE CHILDS FEEDING
If the child has ANEMIA or VERY LOW WEIGHT or LESS
THAN 2 YEARS OLD.
Examples of feeding problems:
Difficulty in breastfeeding
Child less than 6 months taking other milk/ food
Use of breastmilk substitute/ cows milk, evap
Use of feeding bottles
Child 6 months above not yet given complementary
food
 ASSESS CARE DEVELOPMENT:

Ask questions about how the mother

cares for her child. ASK
- How does she play with your child?
- How does she communicate with
the child?
Then ASSESS OTHER PROBLEMS
Let us take good care of our children. They
are natures way of giving the world
another chance!
 Alagaan
Maramingnatin ang
mgasalamat
batapo!sila ang
pag-asang ibinigay
sa atin ng kalikasan,
MayparaGod
sa isang
bless
magandang
us all!
kinabukasan