Integrated

Management of
Childhood Illnesses
Refresher Course Feb. 5, 2016
Hamtic rhu

PRAYER

LECTURE OUTLINE
1. PRE-TEST 10 MINS.
2. INTRODUCTION 30 MINS
3. SICK CHILDREN 2MONTHS- 5 YEARS OLD 3
HOURS
4. SICK CHILDREN 0- 2 MONTHS
2 HOURS
5. TREATING THE SICK CHILD 30 MINS
6. FOLLOW UP CARE 30 MINS
7. POST TEST 10 MINS

PRE-TEST
1.What does IMCI stands for?

2-3 Two age groups covered by the

IMCI protocol?

4-8. Conditions that can be classified

using IMCI.

9. FIRST LINE ANTIBIOTIC FOR

PNEMONIA AND EAR INFECTION

10-13. NAME 4 DANGER SIGNS

14. HOW TO MAKE SUGAR WATER?

15. TRUE or FALSE.

Instructing a caretaker to give
Calamansi juice to soothe the throat
and relieve cough is recommendable.

16. A 2 year old, female child was brought to the

clinic and was classified to have PNEUMONIA. The
health worker knows that the child would come back
for a follow up assessment after how many days?
a. 2 days
b. 3 days
c. 4 days
d. 1 day

17-19. 3 classic signs of MEASLES

20. FAST BREATHING FOR A CHILD

AGED 12 MONTHS UP TO 5 YEARS IS?

Check your own paper

1.What does IMCI stands for?
Integrated Management of
Childhood Illnesses

2-3 Two age groups covered by the

IMCI protocol?
Sick children birth up to 2 months (Sick
Young Infant)
Sick children 2 months up to 5 years old
(Sick child)

4-8. Conditions that can be classified using IMCI.

Pneumonia
Diarrhea
Malaria
Measles
Malnutrition
Anemia
Ear infection

9. FIRST LINE ANTIBIOTIC FOR

PNEMONIA AND EAR INFECTION

AMOXICILLIN

10-13. NAME 4 DANGER SIGNS

14. HOW TO MAKE SUGAR WATER?

DISSOLVE 4 TSP OF SUGAR IN

A 200 ML CUP OF CLEAN
WATER

15. TRUE or FALSE. Instructing a

caretaker to give Calamansi juice to
soothe the throat and relieve cough is
recommendable.

TRUE

16. A 2 year old, female child was brought to the

clinic and was classified to have PNEUMONIA. The
health worker knows that the child would come back
for a follow up assessment after how many days?
a. 2 days
b. 3 days
c. 4 days
d. 1 day

17-19. 3 classic signs of MEASLES

Conjunctivitis
Cough
Coryza
C'scough, coryza (head cold,fever,sneezing),
and conjunctivitis (red eyes)along
withfeverand rashes.

20. FAST BREATHING FOR A CHILD

AGED 12 MONTHS UP TO 5 YEARS IS?

40 BREATHS OR MORE

PART 1 INTRODUCTION

IMCI
is a major strategy for child survival, healthy growth
and development and is based on the combined
delivery of essential interventions at community,
health facility and health systems levels.
IMCI includes elements of prevention as well as
curative and addresses the most common
conditions that affect young children.

 In the Philippines, IMCI was started

on a pilot basis in 1996, thereafter
more health workers and hospital
staff were capacitated to implement
the strategy at the frontline level.

Objectives of IMCI
Reduce death and frequency and
severity of illness and disability
Contribute to improved growth and
development

Who are the children covered by the IMCI

protocol?

Sick children birth up to 2 months

(Sick Young Infant)
Sick children 2 months up to 5 years
old (Sick child)

Conditions that can be classified

through IMCI:

Pneumonia
Diarrhea
Malaria
Measles
Malnutrition
Anemia
Ear infection

Strategies/Principles of IMCI
All sick children aged 2 months up to 5 yearsare
examined forGENERAL DANGER signsand all Sick
Young Infants Birth up to 2 months are examined for VERY
SEVERE DISEASE AND LOCAL BACTERIAL
INFECTION.These signs indicate immediate referral or
admission to hospital.
The children and infantsare then assessed for main
symptoms.

 For sick children, the main symptoms include: cough

or difficulty breathing, diarrhea, fever and ear infection.
For sick young infants,local bacterial infection,
diarrhea and jaundice.
All sick children are routinely assessed for
nutritional, immunization and deworming status
and for other problems.

 IMCI management procedures use limited

number of essential drugs and encourage
active participation of caretakers in the
treatment of children
Counseling of caretakers on home care, correct
feeding and giving of fluids, and when to return
to clinic is an essential component of IMCI

IMCI case management

Assess the sick child or sick young infant
Classify the illness
Identify treatment
Treat the child or young infant
Counsel the mother
Give follow-up care

The childs illness is classified based on

acolor-coded triage system:

PINK- indicates urgent hospital

referral or admission
YELLOW-indicates initiation of
specific Outpatient Treatment
GREEN indicates supportive
home care

MANAGEMENT OF SICK CHILD AGE 2

MONTHS UP TO 5 YEARS

CASE NO. 1: Fatima is 18 months old. She weighs

11.5 kg. Her temperature is 37.5 C. The health
worker asked, What are the childs problems? The
mother said Fatima has been coughing for 6 days,
and she is having trouble breathing. This is the
initial visit for this illness.

 ASK THE MOTHER WHAT THE CHILDS

PROBLEMS ARE
DETERMINE IF THIS IS AN INITIAL OR
FOLLOW UP VISIT
ASSES THE CHILD COMPREHENSIBLY
USING THE IMCI CHART AND FORM.
USE ALL BOXES THAT MATCH THE CHILDS
SYMPTOMS AND PROBLEMS TO CLASSIFY
THE ILLNESS

CHECK FOR GENERAL DANGER SIGNS

 A lethargic child is not awake and alert when she

should be. Often the lethargic child does not look at
his mother or watch your face when you talk. The
child may stare blankly and appear not to notice what
is going on around him.
The child is drowsy and does not show interest in
what is happening around him.
An unconscious child cannot be wakened. He does
not respond when he is touched, shaken or spoken to.

IF THE CHILD HAS A GENERAL DANGER SIGN, COMPLETE THE REST OF

THE ASSESSMENT IMMEDIATELY. THIS CHILD HAS A SEVERE PROBLEM.
THERE MUST BE NO DELAY IN HIS OR HER TREATMENT.

PNEUMONIA

Then ask
about the
main
symptoms:
Does the child
have cough/
difficulty of
breathing? Yes/
No?

QUESTION:
The child who is exactly 12 months old
has fast breathing if you count 40
breaths per
Minute. True or False?

TRUE

CHEST INDRAWING
The child has
chest
indrawing if
the lower chest
wall goes IN
when the child
breathes IN.

Note:
For chest indrawing to be present, it
must be clearly visible and present
all the time.
If you only see chest indrawing when
the child is crying or feeding, the
child does not have chest indrawing.

STRIDOR
To look and listen for stridor, look to see when the child
breathes IN. Then listen for stridor. Put your ear near the
childs mouth because stridor can be difficult to hear.
Sometimes you will hear a wet noise if the childs nose is
blocked. Clear the nose, and listen again. A child who is not
very ill may have stridor only when he is crying or upset.
Be sure to look and listen for stridor when the child is calm.
You may hear a wheezing noise when the child breathes OUT.
This is not stridor.

THEN CLASSIFY

CASE STUDY

Fatima is 18 months old. She weighs 11.5 kg. Her temperature is 37.5
C. The health worker asked, What are the childs problems? The
mother said Fatima has been coughing for 6 days, and she is having
trouble breathing.
This is the initial visit for this illness. The health worker checked
Fatima for general danger signs. The mother said that Fatima is able
to drink. She has not been vomiting. She has not had convulsions
during this illness. The health worker asked, Does Fatima seem
unusually sleepy? The mother said, Yes. The health worker
clapped his hands. He asked the mother to shake the child. Fatima
opened her eyes, but did not look around. The health worker talked to
Fatima, but she did not watch his face. She stared blankly and
appeared not to notice what was going on around her.

DIARRHEA

Does the
child have
diarrhea?
Yes or No?

Types of Diarrhea
Acute
Persistent
Dysentery

Going back to Fatima

The health worker asked, Does the child have
diarrhea? The mother said, Yes, for 3 days. There
was no blood in the stool. Fatimas eyes looked
sunken. The health worker asked, Do you notice
anything different about Fatimas eyes? The mother
said, Yes. He gave the mother some clean water in a
cup and asked her to offer it to Fatima. When offered
the cup, Fatima would not drink. When pinched, the
skin of Fatimas abdomen went back slowly.

FEVER

Measles

If Measles now or within the last 3

months.classify

Going back to Fatima

Because Fatimas temperature is 37.5 C and she feels
hot, the health worker assessed Fatima further for signs
related to fever. The mother said Fatimas fever began 2
days ago. It is the dry season, and the risk of malaria is
low. The mother said that Fatima did not travel away
from home in the last two weeks. Fatima has not had
measles within the last 3 months, and there are no signs
suggesting measles. She does not have stiff neck. The
health worker noticed that Fatima has a runny nose.

If yes.. Classify DHF

EAR PROBLEM

If yes.. classify

THEN CHECK
FOR ACUTE
MALNUTRITIO
N

Classify NUTRITIONAL STATUS

Anemia

Management of Sick Young Infant

aged up to 2 months

CHECK FOR
VERY SEVERE
DISEASE AND
LOCAL
BACTERIAL
INFECTION

Classify Jaundice

What is diarrhea in a young infant?

A young infant has diarrhea if the
stools have changed from usual
pattern and are many and watery
(more water than fecal matter).
The normally frequent or semi-solid
stools of a breastfed baby are not

Classify
DIARRHEA
for
DEHYDRATION

THEN CHECK
FOR FEEDING
PROBLEM OR
LOW WEIGHT
FOR AGE

Good attachment??

THEN CHECK FOR

FEEDING
PROBLEM OR
LOW WEIGHT
FOR AGE IN NONBREASTFED
INFANTS

Treat the young infant

COUNSEL THE MOTHER

POST-TEST
1.What does IMCI stands for?
Integrated Management of
Childhood Illnesses

2-3 Two age groups covered by the

IMCI protocol?
Sick children birth up to 2 months
(Sick Young Infant)
Sick children 2 months up to 5 years
old (Sick child)

4-8. Conditions that can be classified using IMCI.

Pneumonia
Diarrhea
Malaria
Measles
Malnutrition
Anemia
Ear infection

9. FIRST LINE ANTIBIOTIC FOR

PNEMONIA AND EAR INFECTION
AMOXICILLIN

10-13. NAME 4 DANGER SIGNS

14. HOW TO MAKE SUGAR WATER?

DISSOLVE 4 TSP OF SUGAR IN

A 200 ML CUP OF CLEAN
WATER

15. TRUE or FALSE. Instructing a

caretaker to give Calamansi juice to
soothe the throat and relieve cough is
recommendable.

TRUE

16. A 2 year old, female child was brought to the

clinic and was classified to have PNEUMONIA. The
health worker knows that the child would come back
for a follow up assessment after how many days?
a. 2 days
b. 3 days
c. 4 days
d. 1 day

17-19. 3 classic signs of MEASLES

Conjunctivitis
Cough
Coryza
C'scough, coryza (head cold,fever,sneezing),
and conjunctivitis (red eyes)along
withfeverand rashes.

20. FAST BREATHING FOR A CHILD

AGED 12 MONTHS UP TO 5 YEARS IS?

40 BREATHS OR MORE