1. WHAT IS IMCI?WHAT IS IMCI?
A strategy for reducing mortality andA strategy for reducing mortality and
morbidity associated with major causes ofmorbidity associated with major causes of
childhood illnesschildhood illness
A joint WHO/UNICEF initiative since 1992A joint WHO/UNICEF initiative since 1992
Currently focused on first level healthCurrently focused on first level health
facilitiesfacilities
Comes as a generic guidelines forComes as a generic guidelines for
management which have been adapted tomanagement which have been adapted to
each countryeach country

2. INTEGRATED MANAGEMENT OFINTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESSCHILDHOOD ILLNESS
INTRODUCTIONINTRODUCTION
Pneumonia, diarrhea, dengue hemorrhagic fever, malaria,Pneumonia, diarrhea, dengue hemorrhagic fever, malaria,
measles and malnutrition cause more than 70% of the deaths inmeasles and malnutrition cause more than 70% of the deaths in
children under 5 years of age. All these are preventable diseaseschildren under 5 years of age. All these are preventable diseases
in which when managed and treated early could have preventedin which when managed and treated early could have prevented
these deaths.these deaths.
There are feasible and effective ways that health workerThere are feasible and effective ways that health worker
in health centers can care for children with these illnesses andin health centers can care for children with these illnesses and
prevent most of these deaths. WHO and UNICEF used updatedprevent most of these deaths. WHO and UNICEF used updated
technical findings to describe management of these illnesses in atechnical findings to describe management of these illnesses in a
set of integrated guidelines for each illness. They then developedset of integrated guidelines for each illness. They then developed
this protocol to teach the integrated case management processthis protocol to teach the integrated case management process
to health worker who see sick children and know which problemsto health worker who see sick children and know which problems
are most important to treat. Therefore, effective caseare most important to treat. Therefore, effective case
management needs to consider all of a child’s symptoms.management needs to consider all of a child’s symptoms.

3. For those children who can be treated at home,For those children who can be treated at home,
caregivers are taught how to provide treatmentcaregivers are taught how to provide treatment
and when to seek care for their children. Theand when to seek care for their children. The
guidelines also identify actions to prevent illnessguidelines also identify actions to prevent illness
through the immunization of sick children,through the immunization of sick children,
supplementation of micronutrients, promotion ofsupplementation of micronutrients, promotion of
breastfeeding, and counseling of mothers to solvebreastfeeding, and counseling of mothers to solve
feeding problems. It is also an important factor tofeeding problems. It is also an important factor to
teach families when to seek care for a sick childteach families when to seek care for a sick child
as part of the case management process. Thisas part of the case management process. This
approach, which combines steps to manage andapproach, which combines steps to manage and
prevent several different conditions, isprevent several different conditions, is
comprehensive and systematic.comprehensive and systematic.

4. DISTRIBUTION OF 11.6 MILLION DEATHS AMONGDISTRIBUTION OF 11.6 MILLION DEATHS AMONG
CHILDREN LESS THAN 5 YRS OLD IN ALLCHILDREN LESS THAN 5 YRS OLD IN ALL
DEVELOPING COUNTRIES, 1995DEVELOPING COUNTRIES, 1995
MALNUTRITION 54%MALNUTRITION 54%
Others 32%Others 32%
ACUTE RESPIRATORY INFECTIONSACUTE RESPIRATORY INFECTIONS
(ARI) 19 %(ARI) 19 %
DIARRHEA 19%DIARRHEA 19%
Perinatal 18%Perinatal 18%
MEASLES 7%MEASLES 7%
MALARIA 5%MALARIA 5%

5. OBJECTIVES OF IMCIOBJECTIVES OF IMCI
To reduce significantly globalTo reduce significantly global
morbidity and mortality associatedmorbidity and mortality associated
with the major causes of illnesses inwith the major causes of illnesses in
childrenchildren
To contribute to healthy growth andTo contribute to healthy growth and
development of childrendevelopment of children

6. TheThe CASE MANAGEMENT PROCESSCASE MANAGEMENT PROCESS is used tois used to
assess and classify two age groupsassess and classify two age groups::
age 1 week up to 2 months
age 2 months up to 5 years
And how to use the process shown on the
chart will help us to identify signs of serious
disease such pneumonia, diarrhea, malaria,
measles, DHF, meningitis, malnutrition and
anemia.

7. THE CASE MANAGEMENTTHE CASE MANAGEMENT
PROCESSPROCESS
The charts describes the following steps;The charts describes the following steps;
1. assess the child or young infant1. assess the child or young infant
2. classify the illness2. classify the illness
3. identify the treatment3. identify the treatment
4. treat the child4. treat the child
5. counsel the mother5. counsel the mother
6. give follow up care6. give follow up care

8. THE CLASSIFICATION TABLETHE CLASSIFICATION TABLE
The classification tables on the assessThe classification tables on the assess
and classify have 3 ROWS .and classify have 3 ROWS .
COLOR of the row helps to IDENTIFYCOLOR of the row helps to IDENTIFY
RAPIDLY whether the child has aRAPIDLY whether the child has a
SERIOUS DISEASE requiringSERIOUS DISEASE requiring
URGENT ATTENTION.URGENT ATTENTION.

9. Each row is colored either –Each row is colored either –
PINKPINK – means the child has a severe classification and– means the child has a severe classification and
needs urgent attention and referral or admissionneeds urgent attention and referral or admission
for inpatient care.for inpatient care.
YELLOWYELLOW – means the child needs a specific medical– means the child needs a specific medical
treatment such as an appropriate antibiotic, an oraltreatment such as an appropriate antibiotic, an oral
anti-malarial or other treatment; also teaches theanti-malarial or other treatment; also teaches the
mother how to give oral drugs or to treat localmother how to give oral drugs or to treat local
infections at home. The health worker teaches theinfections at home. The health worker teaches the
mother how to care for her child at home and whenmother how to care for her child at home and when
she should return.she should return.
GREENGREEN – not given a specific medical treatment such as– not given a specific medical treatment such as
antibiotics or other treatments. The health workerantibiotics or other treatments. The health worker
teaches the mother how to care for her child atteaches the mother how to care for her child at
home.home.
Always start at the top of the classification table. If the child has signs fromAlways start at the top of the classification table. If the child has signs from
more than 1 row always select the more serious classification.more than 1 row always select the more serious classification.

10. WHY NOT USE THE PROCESS FOR CHILDRENWHY NOT USE THE PROCESS FOR CHILDREN
AGE 5 YEARS OR MORE?AGE 5 YEARS OR MORE?
The case management process is designed for children < 5yrs of age,The case management process is designed for children < 5yrs of age,
although. Much of the advise on treatment of pneumonia, diarrhea,although. Much of the advise on treatment of pneumonia, diarrhea,
malaria, measles and malnutrition, is also applicable to older children, themalaria, measles and malnutrition, is also applicable to older children, the
ASSESSMENT AND CLASSIFICATION of older children would differ. ForASSESSMENT AND CLASSIFICATION of older children would differ. For
example, the cut off rate for determining fast breathing would be differentexample, the cut off rate for determining fast breathing would be different
because normal breathing rates are slower in older children. Chestbecause normal breathing rates are slower in older children. Chest
indrawing is not a reliable sign of severe pneumonia as children get olderindrawing is not a reliable sign of severe pneumonia as children get older
and the bones of the chest become more firm.and the bones of the chest become more firm.
In addition, certain treatment recommendations or advice toIn addition, certain treatment recommendations or advice to
mothers on feeding would differ for >5yrs old. The drug dosing tables onlymothers on feeding would differ for >5yrs old. The drug dosing tables only
apply to children up to 5yrs old. The feeding advice for older children mayapply to children up to 5yrs old. The feeding advice for older children may
differ and they may have different feeding problems.differ and they may have different feeding problems.
Because of differences in the clinical signs of older and youngerBecause of differences in the clinical signs of older and younger
children who have these illnesses, the assessment and classificationchildren who have these illnesses, the assessment and classification
process using these clinical signs is not recommended for older children.process using these clinical signs is not recommended for older children.

11. WHY NOT USE THIS PROCESS FORWHY NOT USE THIS PROCESS FOR
YOUNG INFANTS AGE < 1 WEEK OLD?YOUNG INFANTS AGE < 1 WEEK OLD?
The process on young infant chartThe process on young infant chart
is designed for infants age 1 week upis designed for infants age 1 week up
to 2 months. It greatly differs fromto 2 months. It greatly differs from
older infants and young children. Inolder infants and young children. In
the first week of life, newborn infantsthe first week of life, newborn infants
are often sick from conditions relatedare often sick from conditions related
to labor and delivery. Theirto labor and delivery. Their
conditions require special treatment.conditions require special treatment.

12. IDENTIFICATION ANDIDENTIFICATION AND
PROVISION OF TREATMENTPROVISION OF TREATMENT
Curative component adapted to address theCurative component adapted to address the
most common life-threatening conditionsmost common life-threatening conditions
in each countryin each country
Rehydration (diarrhea, DHF)Rehydration (diarrhea, DHF)
Antibiotics (pneumonia, “severe disease”)Antibiotics (pneumonia, “severe disease”)
Antimalarial treatmentAntimalarial treatment
Vitamin A (measles, severe malnutrition)Vitamin A (measles, severe malnutrition)

13. PROMOTIVE AND PREVENTIVEPROMOTIVE AND PREVENTIVE
ELEMENTSELEMENTS
Reducing missed opportunities forReducing missed opportunities for
immunization (vaccination given ifimmunization (vaccination given if
needed)needed)
Breastfeeding and other nutritionalBreastfeeding and other nutritional
counselingcounseling
Vitamin A and iron supplementationVitamin A and iron supplementation
Treatment of helminth infectionsTreatment of helminth infections

14. The Integrated Case
Management Process

15. Learning ObjectivesLearning Objectives
At the end of the session, the studentsAt the end of the session, the students
will be able to:will be able to:
(1) describe the overall case(1) describe the overall case
management process;management process;
(2) state in order the steps in the(2) state in order the steps in the
management processmanagement process

16. Overall Case ManagementOverall Case Management
ProcessProcess
OutpatientOutpatient
1 - assessment1 - assessment
2 - classification and identification of treatment2 - classification and identification of treatment
3 - referral, treatment or counseling of the child’s3 - referral, treatment or counseling of the child’s
caretaker (depending on the classificationcaretaker (depending on the classification
identified)identified)
4 - follow-up care4 - follow-up care
Referral Health FacilityReferral Health Facility
1 - emergency triage assessment and treatment1 - emergency triage assessment and treatment
2 - diagnosis, treatment and monitoring of2 - diagnosis, treatment and monitoring of
patient’s progresspatient’s progress

17. SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS
For all sick children age 1 week up to 5 years who are brought to a first-level health
facility
ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If
a main symptom is reported, assess further. Check nutrition and immunization status. Check for other
problems.
CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the child’s main symptoms
and his or her nutrition or feeding status.
IF URGENT REFERRAL is needed and possible IF NO URGENT REFERRAL isneeded or possible
IDENTIFY URGENT
PRE-REFERRAL TREATMENT(S)
needed for the child’s classifications.
.
IDENTIFY TREATMENT needed for the child’s classifications:
Identify specific medical treatments and/or advice.
TREAT THE CHILD: Give urgent pre-
referral treatment (s) needed.
TREAT THE CHILD: Give the first dose of oral drugs in the clinic
and/or advise the child’s caretaker. Teach the caretaker how to
give oral drugs and how to treat local infections at home. If needed,
give immunizations.
REFER THE CHILD: Explain to the
child’s caretaker the need for
referral. Calm the caretaker’s fears
and help resolve any problems.
Write a referral note. Give
instructions and supplies needed to
care for the child on the way to the
hospital.
COUNSEL THE MOTHER: Assess the child’s feeding, including
breastfeeding practices, and solve feeding problems, if present.
Advise about feeding and fluids during illness and about when to
return to a health facility. Counsel the mother about her own
health.
FOLLOW-UP care: Give follow-up care when the child returns to the
clinic and,if necessary, reassess the child for new problems.

18. Summary of the Integrated caseSummary of the Integrated case
Management ProcessManagement Process
For all sickFor all sick
children age 1children age 1
week up to 5week up to 5
years who areyears who are
brought to a first-brought to a first-
level healthlevel health
facilityfacility

19. Summary of the Integrated caseSummary of the Integrated case
Management ProcessManagement Process
ASSESS the Child:ASSESS the Child:
Check for danger signsCheck for danger signs
(or possible bacterial(or possible bacterial
infection).infection).
Ask about main symptoms.Ask about main symptoms.
If a main symptom isIf a main symptom is
reported, assess further.reported, assess further.
Check nutrition andCheck nutrition and
immunization status.immunization status.
Check for other problemsCheck for other problems

20. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
Classify the child’s illness:Classify the child’s illness:
Use a color-codedUse a color-coded
triage system to classifytriage system to classify
the child’s mainthe child’s main
symptoms and his orsymptoms and his or
her nutrition or feedingher nutrition or feeding
status.status.

21. Summary of the IntegratedSummary of the Integrated
Case Management ProcessCase Management Process
IF URGENTIF URGENT
REFERRALREFERRAL
is needed andis needed and
possiblepossible

22. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
IDENTIFY URGENTIDENTIFY URGENT
PRE-REFERRALPRE-REFERRAL
TREATMENT(S)TREATMENT(S)
Needed prior toNeeded prior to
referral of the childreferral of the child
according toaccording to
classificationclassification

23. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
TREAT THETREAT THE
CHILD:CHILD:
Give urgent pre-Give urgent pre-
referralreferral
treatment(s)treatment(s)
needed.needed.

24. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
REFER THE CHILD:REFER THE CHILD:
Explain to the child’sExplain to the child’s
caretaker the need forcaretaker the need for
referral.referral.
Calm the caretaker’sCalm the caretaker’s
fears and help resolvefears and help resolve
any problems. Write aany problems. Write a
referral note.referral note.
Give instructions andGive instructions and
supplies needed to caresupplies needed to care
for the child on the wayfor the child on the way
to the hospitalto the hospital

25. Summary of the IntegratedSummary of the Integrated
Case Management ProcessCase Management Process
IF NO URGENTIF NO URGENT
REFERRALREFERRAL
is needed oris needed or
PossiblePossible

26. Summary of the IntegratedSummary of the Integrated
Case Management ProcessCase Management Process
IDENTIFYIDENTIFY
TREATMENTTREATMENT
needed for theneeded for the
child’schild’s
classifications:classifications:
identify specificidentify specific
medicalmedical
treatmentstreatments
and/or adviceand/or advice

27. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
TREAT THE CHILD:TREAT THE CHILD:
Give the first dose ofGive the first dose of
oral drugs in the clinicoral drugs in the clinic
and/or advice theand/or advice the
child’s caretaker.child’s caretaker.
Teach the caretakerTeach the caretaker
how to give oral drugshow to give oral drugs
and how to treat localand how to treat local
infections at home.infections at home.
If needed, giveIf needed, give
immunizations.immunizations.

28. Summary of the IntegratedSummary of the Integrated
Case Management ProcessCase Management Process
COUNSEL THE MOTHER:COUNSEL THE MOTHER:
Assess the child’s feeding,Assess the child’s feeding,
including breastfeedingincluding breastfeeding
practices, and solve feedingpractices, and solve feeding
problems, if present.problems, if present.
Advise about feeding andAdvise about feeding and
fluids during illness and aboutfluids during illness and about
when to return to a healthwhen to return to a health
facility.facility.
Counsel the mother about herCounsel the mother about her
own health.own health.

29. Summary of the Integrated CaseSummary of the Integrated Case
Management ProcessManagement Process
FOLLOW-UPFOLLOW-UP
CARE:CARE:
Give follow-upGive follow-up
care when thecare when the
child returns tochild returns to
the clinic and, ifthe clinic and, if
necessary, re-necessary, re-
asses the child forasses the child for
new problems.new problems.

30. SELECTING THE APPROPRIATE CASE MANAGEMENT
CHARTS
FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the
clinic
ASK THE CHILD’S AGE
IF the child is from 1 week up to 2 months IF the child is from 2 months up to 5
years
USE THE CHART:
œ ASSESS, CLASSIFY AND TREAT
THE SICK YOUNG INFANT
USE THE CHART:
œ ASSESS AND CLASSIFY THE SICK CHILD
TREAT THE CHILD
COUNSEL THE MOTHER

31. THE SICKTHE SICK
CHILD AGE 2CHILD AGE 2
MONTHS TO 5MONTHS TO 5
YEARS:YEARS:
ASSESS ANDASSESS AND
CLASSIFYCLASSIFY

32. Ask the mother or caretaker about the child’s problem.
If this is an INITIAL VISIT for the problem, follow the steps below. (If this is a follow-up visit for the
problem, give follow-up care according to PART VII)
Check for general danger signs.
Ask the mother or caretaker about the four When a main symptom is present:
main symptoms: œ assess the child further for signs related to
œ cough or difficult breathing, the main symptom, and
œ diarrhoea, œ classify the illness according to the signs
œ fever, and œ ear problem which are present or absent.
Check for signs of malnutrition and anaemia and classify the child’s nutritional status
Check the child’s immunization status and decide if the child needs any immunizations today.
Assess any other problems.
Then: Identify Treatment (PART IV), Treat the Child
(PART V), and Counsel the Mother (PART VI)
SUMMARY OF ASSESS AND CLASSIFY

33. Ask the mother or caretaker
about the 4 main symptoms:
cough or difficult
breathing
diarrhoea
fever, and
ear problem
SUMMARY OF ASSESS ANDSUMMARY OF ASSESS AND
CLASSIFYCLASSIFY
When a main symptom is present:
Assess the child further for signs
related to the main symptom, and
Classify the illness according to the
signs which are present or absent

34. FOR ALL SICK CHILDREN AGE 2 MONTHS UP TO 5 YEARS WHO ARE BROUGHT TO
THE CLINIC
GREET the mother appropriately
and
ask about her child.
LOOK to see if the child’s weight
and
temperature have been recorded
ASK the mother what the child’s problems
are
DETERMINE if this is an initial visit or a follow-up visit for this
problem
IF this is an INITIAL VISIT for the
problem
ASSESS and CLASSIFY the child following
the guidelines in this part of the handbook (PART II)
GIVE FOLLOW-UP CARE according to the
guidelines in PART VII of this handbook
When a child is brought to the
clinic
IF this is a FOLLOW-UP VISIT for the problem
Use Good Communication skills:
(see also Chapter 25)
— Listen carefully to what the mother tells
you.
— Use words the mother understands
— Give the mother time to answer the
questions.
---Ask additional questions when the mother is
not sure about her answer.
Record Important Information

35. When the child is brought to theWhen the child is brought to the
clinicclinic
Use Good CommunicationUse Good Communication
Skills:Skills:
Listen carefully to what theListen carefully to what the
mother tells youmother tells you
Use words the motherUse words the mother
understandsunderstands
Give mother time toGive mother time to
answer questionsanswer questions
Ask additional questionsAsk additional questions
when mother not sure ofwhen mother not sure of
answeranswer
Record important informationRecord important information

36. GENERAL DANGER SIGNS
For ALL sick children ask the mother about the child’s problem, then
CHECK FOR GENERAL DANGER SIGNS
CHECK FOR GENERAL DANGER SIGNS
A child with any general danger sign needs URGENT attention; complete the
assessment and any pre-referral treatment immediately so referral is not delayed
ASK: LOOK:
Is the child able to drink or breastfeed? See if the child is lethargic or unconscious
Does the child vomit everything?
Is the child had convulsions?
Make sure
that a child
with any
danger
sign is
referred
after
receiving
urgent
pre-
referral
treatment.
Then ASK about main symptoms: cough and difficult breathing, diarrhoea, fever, ear
problems.CHECK for malnutrition and anaemia, immunization status and for other problems.

37. GENERAL DANGER SIGNSGENERAL DANGER SIGNS
ASK:ASK:
Is the child able toIs the child able to
drink or breastfeed?drink or breastfeed?
Does the child vomitDoes the child vomit
everything?everything?
Has the child hadHas the child had
convulsions?convulsions?
LOOK:LOOK:
See if the child isSee if the child is
lethargic orlethargic or
unconsciousunconscious

38. Cough or Difficult Breathing
If NO If
YES
IF YES, ASK: LOOK, LISTEN, FEEL:
œ For how long? œ Count the breaths in one minute.
œ Look for chest indrawing
œ Look and listen for stridor
}
Classify
COUGH or
DIFFICULT
BREATHIN
G
If the child is: Fast breathing
is:
2 months up 50 breaths per
to 12 months minute or more
12 months up 40 breaths per
to 5 years minute or more
CHILD
MUST
BE
CALM
CLASSIFY the child’s illness using the colour-coded classification table for cough or difficult breathing.
Then ASK about the main symptoms : fever, ear problem, and CHECK for malnutrition
and anaemia, immunization status and for other problems
For ALL sick children ask the mother about the child’s problem, check for
general danger signs,
Ask about cough or difficult breathing and then
ASK : DOES THE CHILD HAVE COUGH?

39. Cough or Difficult Breathing?Cough or Difficult Breathing?
IF YES, ASK:IF YES, ASK:
For how long?For how long?
LOOK, LISTEN, FEEL:LOOK, LISTEN, FEEL:
Count the breaths in one minute.Count the breaths in one minute.
2-12 mos = fast breathing >/= 50/min2-12 mos = fast breathing >/= 50/min
12 mos-5yrs = fast breathing >/=12 mos-5yrs = fast breathing >/=
40/min40/min
Look for chest indrawingLook for chest indrawing
Look and listen for stridorLook and listen for stridor
Classify COUGH or DIFFICULT BREATHINGClassify COUGH or DIFFICULT BREATHING

40. •Any general danger
sign or
•Chest indrawing or
•Stridor in calm
child.
SEVERE
PNEUMONIA
OR VERY
SEVERE DISEASE
•Give first dose of an appropriate
antibiotic.
•Refer URGENTLY to hospital.
•Fast breathing
PNEUMONIA
•Give an appropriate oral
antibiotic for 5 days.
•Soothe the throat and relieve the
cough with a safe remedy.
•Advise mother when to return
immediately.
•Follow-up in 2 days.
No signs of
pneumonia
or very severe
disease.
NO PNEUMONIA:
COUCH OR COLD
•If coughing more than 30 days,
refer for assessment.
•Soothe the throat and relieve the
cough with a safe remedy.
•Advise mother when to return
immediately.
•Follow-up in 5 days if not
CLASSIFICATION TABLE FOR COUGH OR DIFFICULT BREATHING
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)

41. Diarrhea
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing and then
ASK: DOES THE CHILD HAVE DIARRHEA?
If NO If YES
Does the child have diarrhea?
IF YES, ASK: LOOK, LISTEN, FEEL:
œ For how long? œ Look at the child’s general condition.
Is the child:
œ Is there blood in the
stool Lethargic or unconscious?
Restless or irritable?
œ Look for sunken eyes.
œ Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
œ Pinch the skin of the abdomen.
Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
CLASSIFY the child’s illness using the colour-coded classification tables for diarrhea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.
Classify
DIARRHEA

42. Child with dehydrationChild with dehydration

43. DiarrheaDiarrhea
Does the child haveDoes the child have
diarrhea?diarrhea?
IFIF YESYES,, ASK:ASK:
For how long?For how long?
Is there blood in theIs there blood in the
stool?stool?
LOOK, LISTEN, FEEL:
Look at the child’s general
condition, is the child:
Lethargic or unconscious?
Restless or irritable?
Look for sunken eyes
Offer the child fluid. Is the child:
Not able to drink or drinking
poorly?
Drinking eagerly, thirsty?
Pinch the skin of the
abdomen.
Does it go back:
Very slowly (> than 2 secs)?
Slowly?

44. Two of the following signs:Two of the following signs:
Lethargic or unconsciousLethargic or unconscious
Sunken eyesSunken eyes
Not able to drink or drinkingNot able to drink or drinking
poorlypoorly
Skin pinch goes back verySkin pinch goes back very
slowlyslowly
SEVERESEVERE
DEHYDRATIONDEHYDRATION
If child has no other severe classification:If child has no other severe classification:
—— Give fluid for severe dehydration (Plan C).Give fluid for severe dehydration (Plan C).
OROR
If child also has another severe classification:If child also has another severe classification:
—— Refer URGENTLY to hospital with motherRefer URGENTLY to hospital with mother
giving frequent sips of ORS on the way.giving frequent sips of ORS on the way.
Advise the mother to continue breastfeedingAdvise the mother to continue breastfeeding
If child is 2 years or older and there isIf child is 2 years or older and there is
cholera in your area, give antibiotic forcholera in your area, give antibiotic for
cholera.cholera.
Two of the following signs:Two of the following signs:
Restless, irritableRestless, irritable
Sunken eyesSunken eyes
Drinks eagerly, thirstyDrinks eagerly, thirsty
Skin pinch goes back slowlySkin pinch goes back slowly
SOMESOME
DEHYDRATIONDEHYDRATION
Give fluid and food for some dehydration (Plan B).Give fluid and food for some dehydration (Plan B).
If child also has a severe classification:If child also has a severe classification:
—— Refer URGENTLY to hospital with motherRefer URGENTLY to hospital with mother
giving frequent sips of ORS on the way.giving frequent sips of ORS on the way.
Advise the mother to continue breastfeedingAdvise the mother to continue breastfeeding
Advise mother when to return immediately.Advise mother when to return immediately.
Follow-up in 5 days if not improving.Follow-up in 5 days if not improving.
Not enough signs toNot enough signs to
classify as some orclassify as some or
severe dehydration.severe dehydration. NONO
DEHYDRATDEHYDRAT
IONION
Give fluid and food to treat diarrhoeaGive fluid and food to treat diarrhoea
at home (Plan A).at home (Plan A).
Advise mother when to returnAdvise mother when to return
immediately.immediately.
Follow-up in 5 days if not improving.Follow-up in 5 days if not improving.
CLASSIFICATION TABLE FOR DEHYDRATION
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)

45. DehydrationDehydration
presentpresent
SEVERESEVERE
PERSISTENTPERSISTENT
DIARRHEADIARRHEA
Treat dehydration before referralTreat dehydration before referral
unless the child has anotherunless the child has another
severe classification.severe classification.
Refer to hospital.Refer to hospital.
No dehydrationNo dehydration PERSISTENTPERSISTENT
DIARRHEADIARRHEA
Advise the mother on feeding a childAdvise the mother on feeding a child
who has PERSISTENT DIARRHOEA.who has PERSISTENT DIARRHOEA.
Follow-up in 5 days.Follow-up in 5 days.
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR PERSISTENT DIARRHEA

46. Blood in theBlood in the
stoolstool
DYSENTERYDYSENTERY
Treat for 5 days with anTreat for 5 days with an
oral antibioticoral antibiotic
recommended forrecommended for
Shigella in your area.Shigella in your area.
Follow-up in 2 days.Follow-up in 2 days.
CLASSIFICATION TABLE FOR DYSENTERY
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are
in bold print.)

47. Fever
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask
about cough or difficult breathing, diarrhoea and then
ASK: DOES THE CHILD HAVE FEVER?
If
NO
If
YES
Does the child have fever?
( by history or feels hot or temperature 37.5 °C** or above)
IF YES:
Decide the Malaria Risk: high or low
THEN ASK: LOOK AND FEEL:
œ For how long? œ Look or feel for stiff neck.
œ If more than 7 days, has œ Look for runny nose.
fever been present every day?
Look for signs of MEASLES
œ Has the child had measles within
the last 3 months? œ Generalized rash and
œ One of these: cough, runny nose,
or red eyes.
If the child has measles now or œ Look for mouth ulcers.
within the last 3 months: Are they deep and extensive?
œ Look for pus draining from the eye.
œ Look for clouding of the cornea.
CLASSIFY the child’s illness using the colour-coded classification tables for fever.
Then ASK about the next main symptom: ear problem, and CHECK for malnutrition and
anaemia,
immunization status and for other problems.

48. FeverFeverDoes the child have FEVER?Does the child have FEVER?
IF YES,IF YES, decide the malaria risk:decide the malaria risk:
high or lowhigh or low
THEN ASK:THEN ASK:
For how long?For how long?
If more than 7 days, has feverIf more than 7 days, has fever
beenbeen
present every day?present every day?
Has the child had measles withinHas the child had measles within
thethe
last 3 months?last 3 months?
If the childIf the child LOOK AND FEEL:LOOK AND FEEL:
Look for runny noseLook for runny nose
Look or feel for stiff neckLook or feel for stiff neck
LOOK FOR SIGNS OF MEASLESLOOK FOR SIGNS OF MEASLES
has measles now or within the last 3has measles now or within the last 3
monthsmonths
-Rash-Rash -Mouth ulcers-Mouth ulcers
-Cough-Cough -Pus from eyes-Pus from eyes
-Runny nose -Clouding of cornea-Runny nose -Clouding of cornea
-Red eyes-Red eyes
LOOK FOR SIGNS OF
DENGUE/DHF
-bleeding tendencies
-flushing
-(+) tourniquet test
-rash

49. •Any general danger
sign
•Stiff neck
VERY SEVERE
FEBRILE
DISEASE
•Give first dose of an appropriate
antibiotic.
•Treat the child to prevent low blood
sugar.
•Give one dose of paracetamol in clinic
for high fever (38.5° C or above).
•Refer URGENTLY to hospital.
•NO general danger
sign
AND
•NO Stiff neck.
FEVER—
MALARIA
UNLIKELY
•Give one dose of paracetamol in clinic
for high fever (38.5° C or above).
•Advise mother when to return
immediately.
•Follow-up in 2 days if fever persists.
•If fever is present every day for more
than 7 days, REFER for assessment.
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR NO MALARIA RISK AND NO TRAVEL TO A
MALARIA RISK AREA

50. •Any general danger
sign or
•Clouding of cornea or
•Deep or extensive
mouth ulcers.
SEVERE
COMPLICATED
MEASLES***
•Give vitamin A.
•Give first dose of an appropriate
antibiotic.
•If clouding of the cornea or pus
draining from the eye, apply
tetracycline eye ointment.
•Refer URGENTLY to hospital.
•Pus draining from the
eye or
•Mouth ulcers
MEASLES WITH
EYE OR MOUTH
COMPLICATIONS*
**
•Give vitamin A.
•If pus draining from the eye, treat
eye infection with tetracycline eye
ointment.
•If mouth ulcers, treat with gentian
violet.
•Follow-up in 2 days.
•Measles now or within
the last 3 months. MEASLES
•Give vitamin A.
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR MEASLES
(IF MEASLES NOW OR WITHIN THE LAST 3 MONTHS)
*** Other important complications of measles—pneumonia, stridor, diarrhoea, ear infection, and malnutrition—are classified in
other tables.

51. Fever With RashesFever With Rashes

52. For ALL sick children ask the mother about the ask about cough or difficult breathing,
diarrhoea, fever and then
ASK: DOES THE CHILD HAVE AN EAR PROBLEM?
Does the child have an ear problem?
IF YES ASK:
•Is there ear pain?
•Is ther ear discharge?
If yes, for how long?
LOOK AND FEEL:
•Look for pus draining from the
ear.
•Feel for tender swelling behind
the ear.
CLASSIFY the child’s illness using the colour-coded-classification table for ear
problem.
Then CHECK for malnutrition and anaemia, immunization status and for other problems.
If NO If YES
Ear Problem

53. Ear ProblemEar Problem
Does the child have an EARDoes the child have an EAR
PROBLEM?PROBLEM?
IFIF YESYES, ASK, ASK
Is there ear pain?Is there ear pain?
Is there ear discharge?Is there ear discharge?
If yes, for how long?If yes, for how long?
LOOK AND FEEL:LOOK AND FEEL:
Look and pus drainingLook and pus draining
from the earfrom the ear
Feel for tender swellingFeel for tender swelling
behind the ear.behind the ear.

54. •Tender swelling
behind the ear. MASTOIDITIS
•Give first dose of an appropriate
antibiotic.
•Give first dose of paracetamol for
pain.
•Refer URGENTLY to hospital.
•Pus is seen draining
from the ear and
discharge is reported
for less than 14 days,
or
•Ear pain.
ACUTE EAR
INFECTION
•Give an oral antibiotic for 5 days.
•Give paracetamol for pain.
•Dry the ear by wicking.
•Follow-up in 5 days.
•Pus is seen draining
from the ear and
discharge is reported
for 14 days or more.
CHRONIC EAR
INFECTION
•Dry the ear by wicking.
•Follow-up in 5 days.
•No ear pain and No
pus seen draining
from the ear.
NO EAR
INFECTION
No additional treatment
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR EAR PROBLEM

55. For ALL sick children ask the mother about the child’s difficult breathing, diarrhoea,
fever, ear problem and then
CHECK FOR MALNUTRITION AND ANAEMIA.
THEN CHECK FOR MALNUTRITION AND ANAEMIA
CLASSIFY the child’s illness using the colour-coded-classification table for malnutrition
and anemia
Then CHECK immunization status and for other problems.
LOOK AND FEEL:
•Look for visible severe wasting.
•Look for palmar pallor. Is it: Severe palmar
pallor?
Some palmar pallor?
•Look for oedema of both feet.
•Determine weight for age.
Classify
NUTRITIONAL
STATUS
Malnutrition and Anemia

56. Malnutrition and AnemiaMalnutrition and Anemia
CHECK FOR MALNUTRITIONCHECK FOR MALNUTRITION
AND ANEMIAAND ANEMIA
LOOK AND FEEL:LOOK AND FEEL:
Look for visible severe wastingLook for visible severe wasting
Look for palmar pallor. Is it:Look for palmar pallor. Is it:
Severe palmar pallor?Severe palmar pallor?
Some palmar pallor?Some palmar pallor?
Look for edema of both feetLook for edema of both feet
Determine weight for ageDetermine weight for age
CLASSIFY NUTRITIONALCLASSIFY NUTRITIONAL
STATUSSTATUS

57. Child with Anemia andChild with Anemia and
MalnutritionMalnutrition

58. •Visible severe wasting or
•Severe palmar pallor or
•Oedema of both feet.
SEVERE
MALNUTRITION OR
SEVERE ANAEMIA
•Give Vitamin A.
•Refer URGENTLY to hospital.
•Some palmar pallor or
•Very low weight for age.
ANAEMIA OR VERY
LOW WEIGHT
•Assess the
feeding according to the FOOD box on the COUNSEL
THE MOTHER chart.
— If feeding problem, follow-up in 5 days.
•If pallor:
— Give iron.
— Give oral antimalarial if high malaria risk.
— Give mebendazole if child is 2 years or older and
has not had a dose in the previous 6 months.
•Advise mother when to return immediately.
•If pallor, follow-up in 14 days.
If very low weight for age, follow-up in 30 days.
•Not very low weight for age
and no other signs or
malnutrition.
NO ANAEMIA AND NOT
VERY LOW WEIGHT
•If child is less than 2 years old, assess the
feeding and counsel the mother on feeding
according to the FOOD box on the COUNSEL THE
MOTHER chart.
— If feeding problem, follow-up in 5 days.
•Advise mother when to return immediately.
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR MALNUTRITION AND ANAEMIA

59. THEN CHECK THE CHILD’S IMMUNIZATION STATUS
For ALL sick children ask the mother about the child’s about cough or difficult
breathing, diarrhoea, fever, ear problem, and then check for malnutrition and anaemia
and
CHECK IMMUNIZATION STATUS.
IMMUNIZATION
SCHEDULE:
AGE
Birth
6 weeks
10 weeks
14 weeks
9 months
VACCINE
BCG
DPT-1
DPT-2
DPT-3
Measles
OPV-0
OPV-1
OPV-2
OPV-3
DECIDE if the child needs an immunization today, or if the mother should be
told to come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child
if the child is well enough to go home.
Then CHECK for other problems.
Immunization Status

60. Immunization StatusImmunization Status
CHECK IMMUNIZATIONCHECK IMMUNIZATION
STATUS:STATUS:
IMMUNIZATIONIMMUNIZATION
SCHEDULESCHEDULE
BirthBirth - BCG, HepB1- BCG, HepB1
6 weeks6 weeks - DPT1, OPV1,- DPT1, OPV1,
HepB2HepB2
10 weeks -10 weeks - DPT2,DPT2,
OPV2,OPV2,
HepB3HepB3
14 weeks14 weeks - DPT3, OPV3,- DPT3, OPV3,
HepBboosterHepBbooster
9 mos9 mos - measles- measles

61. How to check the ImmunizationHow to check the Immunization
StatusStatus
If an infant has notIf an infant has not
received anyreceived any
immunization, then giveimmunization, then give
–BCGBCG
–DPT 1 , OPV 1DPT 1 , OPV 1
–Hepatitis B 1Hepatitis B 1

62. THE SICK YOUNGTHE SICK YOUNG
INFANT AGE 1 WEEKINFANT AGE 1 WEEK
UP TO 2 MONTHS:UP TO 2 MONTHS:
ASSESS ANDASSESS AND
CLASSIFYCLASSIFY

63. Ask the mother or caretaker about the youngAsk the mother or caretaker about the young
If this is an INITIAL VISIT for the problem, follow the steps below.
(If this is a follow-up visit for the problem, give follow-up care according to
PART VII)
Check for POSSIBLE BACTERIAL INFECTION and classify the illness.
Ask the mother or caretaker about
DIARRHOEA:
If diarrhoea is present:
•assess the infant further for signs related to
diarrhoea, and
•classify the illness according to the signs
which are present or absent.
Check for FEEDING PROBLEM OR LOW WEIGHT and classify the
Check the infant’s immunization status and decide if the infant needs any
immunization today.
Assess any other problems.
Then: Identify Treatment (PART IV), Treat the Infant (PART V),
and Counsel the Mother (PART VI)
SUMMARY OF ASSESS AND CLASSIFY

64. CHECK FOR POSSIBLE BACTERIAL INFECTION
For ALL sick young infants check for signs of POSSIBLE BACTERIAL INFECTION
ASK:
•Has the infant had
convulsions?
LOOK, LISTEN, FEEL:
•Count the breaths in one minute.
Repeat the count if elevated.
•Look for severe chest indrawing.
•Look for nasal flaring
•Look and listen for grunting.
•Look and feel for bulging fontanelle.
•Look for pus draining from the ear.
•Look at the umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
•Measure temperature (or feel for fever or low body temperature)
•Look for skin pustules. Are there many or severe pustules?
•See if the young infant is lethargic or unconscious.
•Look at the young infants’s movements. Are they less than normal?
YOUNG
INFANT
MUST BE
CALM
CLASSIFY the infant’s illness using the COLOUR-CODED-CLASSIFICATION TABLE FOR POSSIBLE BACTERIAL
INFECTION.
Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status and for other
problems.
How to check a young infant for possible bacterial infection

65. •Convulsions or
•Fast breathing (60 breaths
per minute or more) or
•Severe chest indrawing or
•Nasal flaring or
•Grunting or
•Bulging fontanelle or
•Pus draining from ear or
•Umbilical redness
extending to the skin or
•Fever (37.5 C* or above or
feels hot) or low body
temperature (less than 35.5
C* or feels cold) or
•Many or severe skin
pustules or
•Lethargic or unconscious or
•Less than normal
movement.
POSSIBLE
SERIOUS
BACTERIAL
INFECTION
•Give first dose of intramuscular
antibiotics.
•Treat to prevent low blood sugar.
•Advise mother how to keep the infant
warm on the way to hospital.
•Refer URGENTLY to hospital
•Red umbilicus or
draining pus or
•Skin pustules.
LOCAL
BACTERIAL
INFECTION
•Give an appropriate oral antibiotic.
•Teach the mother to treat local infections
at home.
•Advise mother to give home care for the
young infant.
•Follow-up in 2 days
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
*These thresholds are based on axillary temperature. The thresholds for rectal temperature readings are approximately 0.5 ° C higher.
CLASSIFICATION TABLE FOR POSSIBLE BACTERIAL INFECTION

66. For ALL sick young infants check for signs of possible bacterial infection and
then
ASK: DOES THE YOUNG INFANT HAVE DIARRHOEA?
IF YES: ASSESS AND CLASSIFY the young infant’s diarrhoea using the
DIARRHOEA box in the YOUNG INFANT chart. The
process is very similar to the one used for the sick child (see Chapter 8).
Then CHECK for feeding problem or low weight, immunization status and other
problems.
How to assess and classify a young infant for diarrhea?

67. For ALL sick young infants check for signs of possible bacterial infection, ask about
diarrhoea and then CHECK FOR FEEDING PROBLEM OR LOW WEIGHT.
THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT
ASK: LOOK, LISTEN, FEEL:
œ Is there any difficulty feeding? œ Determine weight for age.
œ Is the infant breastfed? If yes,how many times in 24 hours?
œ Does the infant usually receive any other foods or drinks?
If yes, how often?
œ What do you use to feed the infant?
IF AN INFANT: Has any difficulty feeding,
Is breastfeeding less than 8 times in 24 hours,
Is taking any other foods or drinks, or
Is low weight for age,
AND
Has no indications to refer urgently to hospital:
ASSESS BREASTFEEDING:
œ Has the infant If the infant has not fed in the previous hour, ask the mother to put her
breastfed in the infant to the breast. Observe the breastfeed for 4 minutes.
previous hour?
(If the infant was fed during the last hour, ask the mother if she can wait
and tell you when the infant is willing to feed again.)
œ Is the infant able to attach?
no attachment at all not well attached good attachment
TO CHECK ATTACHMENT, LOOK FOR:
— Chin touching breast
— Mouth wide open
— Lower lip turned outward
— More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)
Is the infant suckling effectively (that is, slow deep sucks,
sometimes pausing)?
no suckling at all not suckling effectively suckling effectively
Clear a blocked nose if it interferes with breastfeeding.
œ Look for ulcers or white patches in the mouth (thrush).
CLASSIFY the infant’s nutritional status using the colour-coded classification table for feeding problem or low weight.
Then CHECK immunization status and for other problems.

68. •Not able to feed or
• No attachment at all or
•Not suckling at all.
NOT ABLE TO FEED
POSSIBLE
SERIOUS BACTERIAL
INFECTION
•Give first dose of intramuscular antibiotics.
•Treat to prevent low blood sugar.
•Advise the mother how to keep the young infant warm on the way
to hospital.
•Refer URGENTLY to hospital.
•Not well attached to breast or
•Not suckling effectively or
•Less than 8 breastfeeds in 24 hours
or
•Receives other foods or drinks or
•Low weight for age or
•Thrush (ulcers or white patches in
mouth).
FEEDING PROBLEM OR LOW
WEIGHT
• Advise the mother to breastfeed as often and for as long as the infant
wants, day and night.
-If not well attached or not suckling effectively, teach correct
positioning and attachment.
-If breastfeeding less than 8 times in 24 hours, advise to
increase frequency of feeding.
• If receiving other foods or drinks, counsel mother about breastfeeding
more, reducing other foods or drinks, and using a cup.
•If not breastfeeding at all:
— Refer for breastfeeding counselling and possible
relactation.
— Advise about correctly prepared breastmilk
substitutes and using a cup.
• If thrush, teach the mother to treat thrush at home.
• Advise mother to give home care for the young infant.
•Follow-up any feeding problem or thrush in 2 days. Follow-up low
weight for age in 14 days.
•Not low weight for age and no other
signs of inadequate feeding. NO FEEDING
PROBLEM
•Advise mother to give home care for the young infant.
•Praise the mother for feeding the infant well.
SIGNS CLASSIFY AS
IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print.)
CLASSIFICATION TABLE FOR FEEDING PROBLEM OR LOW WEIGHT

69. Communicate and CounselCommunicate and Counsel

70. How will you prepare the ORS solution? Do you remember how to mix the
ORS?
GOOD CHECKING QUESTIONS POOR QUESTIONS
How often should you breastfeed your child? Should you breastfeed your child?
On what part of the eye do you apply Have you used ointment on your child
the ointment? before?
How much extra fluid will you give after each Do you know how to give extra
loose stool? fluids?
Why is it important for you to wash your hands? Will you remember to wash your
hands?

71. GIVE FOLLOW-UPGIVE FOLLOW-UP
CARECARE

72. Follow-up care for the sick youngFollow-up care for the sick young
infantinfant
When to return immediatelyWhen to return immediately
– Signs of any of the following:Signs of any of the following:
–Breastfeeding or drinkingBreastfeeding or drinking
poorlypoorly
–Becomes sickerBecomes sicker
–Develops a feverDevelops a fever
–Fast breathingFast breathing
–Difficult breathingDifficult breathing
–Blood in the stoolBlood in the stool

73. Follow-up care for the sick youngFollow-up care for the sick young
infantinfant
Follow-up in 2 daysFollow-up in 2 days – on– on
antibiotics for local bacterialantibiotics for local bacterial
infection or dysenteryinfection or dysentery
Follow-up in 2 daysFollow-up in 2 days - with a- with a
feeding problem or oral thrushfeeding problem or oral thrush
Follow-up in 14 daysFollow-up in 14 days – with low– with low
weight for ageweight for age

74. If the child has: Return for follow-up in:
PNEUMONIA
DYSENTERY
MALARIA, if fever persists
FEVER—MALARIA UNLIKELY, if fever
persists
MEASLES WITH EYE OR MOUTH
COMPLICATIONS
2 days
PERSISTENT DIARRHOEA ACUTE
EAR INFECTION
CHRONIC EAR INFECTION
FEEDING PROBLEM
ANY OTHER ILLNESS, if not improving
5 days
PALOR VERY 14 days
LOW WEIGHT FOR AGE 30 days
FOLLOW-UP VISIT TABLE IN THE COUNSEL THE MOTHER CHART

75. CHECK FOR POSSIBLE BACTERIAL INFECTION
•Has the infant had convulsions?
•Count the breaths in one minute. _______ breaths per minute
Repeat if elevated ________ Fast breathing?
•Look for severe chest indrawing.
•Look for nasal flaring.
•Look and listen for grunting.
•Look and feel for bulging fontanelle.
•Look for pus draining from the ear.
•Look at umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
•Fever (temperature 37.5 C or feels hot) or low body temperature
(below 35.5° C or feels cool).
•Look for skin pustules. Are there many or severe pustules?
•See if young infant is lethargic or unconscious.
•Look at young infant's movements. Less than normal?
DOES THE YOUNG INFANT HAVE DIARRHOEA?
•For how long? _______ Days
•Is there blood in the stools?
Yes _____ No ______
•Look at the young infant's general condition. Is the infant: Lethargic
or unconscious?
Restless or irritable?
•Look for sunken eyes.
•Pinch the skin of the abdomen. Does it go back: Very slowly
(longer than 2 seconds)?
Slowly?
MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS
Name:___________ Age:___________ Weight:____________________ kg________________________
Temperature:_______________C
ASK: What are the infant's problems?__________________________________ Initial visit?_________________ Follow-up Visit?______________
ASSESS (Circle all signs present) CLASSIFY

76. THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT
•Is there any difficulty feeding? Yes_____ No______
•Is the infant breastfed? Yes_____ No_____
•IfYes, how many times in 24 hours?_____ times
•Does the infant usually receive any
other foods or drinks? Yes_____ No_____
If Yes, how often?
•What do you use to feed the child?
ASSESS BREASTFEEDING:
•Has the infant breastfed in the previous hour?
•Determine weight for age. Low _____ Not Low _____
If infant has not fed in the previous hour, ask the mother to put her
infant to the breast. Observe the breastfeed for 4 minutes.
•Is the infant able to attach? To check attachment, look for:
— Chin touching breast Yes _____ No
_____
— Mouth wide open Yes _____ No _____
— Lower lip turned outward Yes _____ No _____
— More areola above than below the mouth
Yes _____ No _____
no attachment at all not well attached good attachment
•Is the infant suckling effectively (that is, slow deep sucks,
sometimes pausing)?
not suckling at all not suckling effectively suckling effectively
•Look for ulcers or white patches in the mouth (thrush).
CHECK THE YOUNG INFANT'S IMMUNIZATION STATUS
BCG DPT1 DPT2
OPV 0 OPV 1 OPV 2
Circle immunizations needed today. Return for next
immunization on:
(Date)
MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS
Name:___________ Age:___________ Weight:____________________ kg________________________
Temperature:_______________C
ASK: What are the infant's problems?__________________________________ Initial visit?_________________ Follow-up Visit?______________
ASSESS (Circle all signs present) CLASSIFY
If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or drinks, or is low weight for age AND has no indications to refer urgently to
hospital:

77. TREAT
Return for follow-up on _________________
Give any immunization/s needed today.

78. CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING
CONVULSION
LETHARGIC OR UNCONSCIOUS
General danger signs
present?
Yes ___ No ___
Remember to use
danger sign when
selecting classifications
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
•For how long? ____ Days
Yes ___ No ___
•Count the breaths in one minute.
________ breaths per minute. Fast breathing?
•Look for chest indrawing.
•Look and listen for stridor.
DOES THE CHILD HAVE DIARRHOEA?
•For how long? _____ Days
•Is there blood in the stools?
Yes ___ No ___
•Look at the child's general condition. Is the child:
Lethargic or unconscious?
Restless or irritable?
•Look for sunken eyes.
•Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
•Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
Name: ____________________________________________________________________Age:____________________Weight:_______kg Temperature:________ C
ASK: What are the child's problems?_______________________________________________________________________Initial visit?________________Follow-up Visit?__________
ASSESS (Circle all signs present) CLASSIFY
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Decide Malaria Risk: High Low
•For how long? _____ Days
•If more than 7 days, has fever been present every day?
•Has child had measles within the last three months?
If the child has measles now
or within the last 3 months:
•Look or feel for stiff neck.
•Look for runny nose.
Look for signs of MEASLES:
Generalized rash and
One of these: cough, runny nose, or red eyes.
•Look for mouth ulcers.
If Yes, are they deep and extensive?
•Look for pus draining from the eye.
•Look for clouding of the cornea.
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5 C or above) Yes ___ No ___

79. DOES THE CHILD HAVE AN EAR PROBLEM?
•Is there ear pain?
•Is there ear discharge?
IfYes, for how long? ___ Days
Yes___ No___
•Look for pus draining from the ear.
•Feel for tender swelling behind the ear.
THEN CHECK FOR MALNUTRITION AND ANAEMIA •Look for visible severe wasting.
•Look for palmar pallor.
Severe palmar pallor? Some palmar pallor?
•Look for oedema of both feet.
•Determine weight for age.
Very Low ___ Not Very Low ___
CHECK THE CHILD'S IMMUNIZATION STATUS
_____ ______ ______ ______
BCG DPT1 DPT2 DPT3
_______ _______ ______ ______
________
OPV 0 OPV 1 OPV 2 OPV
3 Measles
Circle immunizations needed today. Return for next immunization
on:
(Date)
•Do you breastfeed your child? Yes____ No ____
IfYes, how many times in 24 hours? ___ times.
Do you breastfeed during the night? Yes___ No___
•Does the child take any other food or fluids? Yes___ No ___
IfYes, what food or fluids?
___________________________________________________
___________________________________________________
__
How many times per day? ___ times.
What do you use to feed the child? _____________________
If very low weght for age: How large are servings?
_________________________________________________
Does the child receive how own serving? ________________
Who feeds the child and how? ________________________
•During the illness, has the child's feeding changed?
Yes ____ No ____
If Yes, how?
FEEDING PROBLEMS
ASSESS CHILD'S FEEDING if child has ANAEMIA OR VERY LOW WEIGHT or is less than 2 years old

80. TREAT
Return for follow-up on ______________
Advise mother when to return immediately.
Give any immunization/s needed today.
Feeding Advice

81. CATEGORIES OF PROVINCES CONSIDEREDCATEGORIES OF PROVINCES CONSIDERED
WITH MALARIAWITH MALARIA
Category A – Provincews with no significant improvement inCategory A – Provincews with no significant improvement in
malaria situation in the last 10 years or situation worsened in themalaria situation in the last 10 years or situation worsened in the
last 5 yrs; average no. of cases >1000 in the last 10 yrslast 5 yrs; average no. of cases >1000 in the last 10 yrs
- Kalinga - Mindoro Occ - Compostela valley- Kalinga - Mindoro Occ - Compostela valley
- Apayao - Palawan - Saranggani- Apayao - Palawan - Saranggani
- Mt. Province - Quezon - Zamboanga del Sur- Mt. Province - Quezon - Zamboanga del Sur
- Ifugao - Misamis Or - Agusan del Sur- Ifugao - Misamis Or - Agusan del Sur
- Isabela - Davao del Norte - Agusan del Norte- Isabela - Davao del Norte - Agusan del Norte
- Cagayan - Davao del Sur - Surigao del Sur- Cagayan - Davao del Sur - Surigao del Sur
- Quirino - Davao oriental - Tawi-tawi- Quirino - Davao oriental - Tawi-tawi
- Zambales - Bukidnon - Sulu - Basilan- Zambales - Bukidnon - Sulu - Basilan

82. Category B – Provinces where situation has improved in theCategory B – Provinces where situation has improved in the
last 5yrs or average no. of cases 100 to <1000 cases/yrlast 5yrs or average no. of cases 100 to <1000 cases/yr
- Abra - Laguna- Abra - Laguna
- Pangasinan - Camarines Norte- Pangasinan - Camarines Norte
- Ilocos norte - Camarines Sur- Ilocos norte - Camarines Sur
- Nueva Vizcaya - Sultan Kudarat- Nueva Vizcaya - Sultan Kudarat
- Nueva Ecija - So. Cotabato- Nueva Ecija - So. Cotabato
- Bulacan - North Cotabato- Bulacan - North Cotabato
- Bataan - Lanao del Sur- Bataan - Lanao del Sur
- Mindoro Or - Lanao del Norte- Mindoro Or - Lanao del Norte
- Rizal - Maguindanao- Rizal - Maguindanao
- Aurora - Zamboanga del Norte- Aurora - Zamboanga del Norte
- Tarlac - Romblon- Tarlac - Romblon

83. Category C – Provinces with significant reductionCategory C – Provinces with significant reduction
in cases in the last 5 yrsin cases in the last 5 yrs
- Benguet - Antique- Benguet - Antique
- Ilocos Sur - Sorsogon- Ilocos Sur - Sorsogon
- La Union - Negros Occ- La Union - Negros Occ
- Pampanga - Negros Or- Pampanga - Negros Or
- Batangas - Eastern Samar- Batangas - Eastern Samar
- Cavite - Western Samar- Cavite - Western Samar
- Marinduque - Misamis Occ- Marinduque - Misamis Occ
- Masbate - Surigao del Norte- Masbate - Surigao del Norte
- Batanes - Albay- Batanes - Albay

84. Category D – Provinces that are malaria-freeCategory D – Provinces that are malaria-free
although some are still potentially malarious sue toalthough some are still potentially malarious sue to
toe presence of the vector.toe presence of the vector.
Cebu Iloilo BiliranCebu Iloilo Biliran
Bohol Capiz Leyte Norte andBohol Capiz Leyte Norte and
and Surand Sur
Catanduanes GuimarasCatanduanes Guimaras
Aklan SiquijorAklan Siquijor
Northern Samar CamiguinNorthern Samar Camiguin

85. IMCIIMCI
Thank you!Thank you!