(Integrated Management of

Neonatal and Childhood Illnesses)

-Lakshmi Radhakrishnan

IMCI
Mid 1990s
UNICEF
Other
agencies
WHO

IMCI combines
Improved management of
common childhood illnesses

Prevention of diseases

Promotion of health ( by
dealing with feeding &
immunization)

Adapted & expanded in India
to include
Neonatal care
@ home & health facilities
Renamed as
Improvements in case management skills
of health staff through locally adapted
guidelines
Improvements in the overall health
system
Improvements in family & community
health care practices
PRINCIPLES
Examined for conditions which indicate IMMEDIATE
REFERRAL
ROUTINE ASSESSEMENT major symptoms, nutritional,
immunization status, feeding & other problems
SELECTED CLINICAL SIGNS
COLOUR CODED CLASSIFICATION (pink, yellow, green)
MOST COMMON, and not
ALL pediatric problems
Use a limited number of
ESSENTIAL DRUGS
CARE TAKERS active
involvement
COUNSELLING of caretakers
ASSESS CLASSIFY
IDENTIFY
Rx
TREAT COUNSEL
FOLLOW
UP

< 2 months
2months
5 years
CLASSIFICATION TABLES
URGENT HOSPITAL REFERRAL
INITIATION OF TREATMENT
ADVICE & SENT HOME
OUTPATIENT MANAGEMENT OF
YOUNG INFANTS (age upto 2 months)
ASSESS CLASSIFY
IDENTIFY
Rx
TREAT COUNSEL
FOLLOW
UP
ASSESS:
History taking about the babys problem
Check for
1. Possible bacterial infections
2. Jaundice
3. Diarrhoea
4. Feeding problems
5. Malnutrition
IMMUNIZATION STATUS
Assess other problems

1. Possible bacterial infections

Possible SERIOUS bact. Infections
(CNS infection, very severe pneumonia, extensive skin
infection, temp >37.5 or <35.5c)
Local bact. Infections
(umbilical, ear, mild skin infection)

2. JAUNDICE
Severe jaundice
(palms & soles yellow, age <24hrs or >14days)
Jaundice
Low body temperature (35.5-36.4c)
3. DIARRHOEA
o Severe dehydration
o Some dehydration
o No dehydration
o Severe persistent diarrhoea
o Severe dysentery

4. FEEDING PROBLEM & MALNUTRITION
o Unable to feed, Severe Malnutrition
o Feeding problem, Low weight
o No feeding problem

IDENTIFY Rx, TREAT, Counsel, Follow up
Refer urgently
1
st
dose IM ampicillin & gentamicin
Rx of severe dehydration, ORS sips on the way.
Prevent hypoglycemia BF/ expressed milk
Warm skin to skin contact (KMC), Keep warm on the way.
Initiate Rx in the clinic, cotd @ home
Infection oral co-trimoxazole X 5 days,
gentian violet locally, wicking ear.
How to treat @ home, keep warm
When to return immediately
Follow up in 2 days
Counsel, Home care
When to return
immediately
Follow up in 5 days
OUTPATIENT MANAGEMENT OF SICK
CHILD ( Age 2 months 5 years)
ASSESS:
History taking about the childs problem
Check for GENERAL DANGER SIGNS
Check main symptoms
1. Cough, difficult breathing
2. Diarrhoea
3. Fever
4. Ear problems
Malnutrition, Anemia.
Immunization status
Other problems

GENERAL DANGER SIGNS

Convulsions

unconciousness/lethargy

inability to drink/breastfeed

vomits everything
COUGH/ DIFFICULT BREATHING
Very severe OR Severe pneumonia
Pneumonia
No pneumonia cough/ cold

DIARRHOEA
Severe dehydration, Severe persistent diarrhoea
Some dehydration, Persistent diarrhoea, Dysentery
No dehydration

FEVER

Very severe febrile disease
(danger signs, stiff neck, bulging fontanelle)

Malaria ( no other cause for fever)

Fever- malaria unlikely (runny nose, measles, or
other cause for fever)

If MEASLES now or within last 3 months, classify as:

Severe complicated measles
( danger sign, corneal clouding, severe mouth ulcers)

Measles with eye or mouth complications
(pus from eye, mouth ulcers)

Measles

EAR PROBLEM
Mastoiditis
Acute ear infection
Chronic ear infection
No ear infection

MALNUTRITION & ANEMIA
Severe malnutrition, Severe Anemia
Very low weight, Anemia
Not very low weight, No Anemia

URGENT REFERRAL
Convulsions - Diazepam PR (2
nd
dose after 10
mts)
pnemonia, fever, measles, mastoiditis -
IM Chloramphenicol/ amp+genta/
ceftriaxone
severe malaria- quinine 1
st
dose
measles, persistent diarrhoea, severe
malnutrition- Vitamin A
prevent hypoglycemia - BF
Paracetamol >38.5C
tetracycline eye ointment
ORS sips on the way
OP & home
Pneumonia, a/c ear infection,
dysentery - co-trimoxazole
Cholera >2yrs old, doxycycline
single dose
Diarrhoea - ORS, Zinc, Vit A
Anemia- IFA x 14 days
Local infection tetracycline eye
ointment, wicking ear, gentian
violet mouth
Cough & cold home remedies
EFFECTIVE COMMUNICATION
& COUNSELLING
APAC
Ask & listen
Praise
Advise & teach
Check