IMCI - CHN sick child age

Severe pneumonia or very severe disease

• Pink

— Any general danger signs

— Chest indrawing 

— Stridor in a calm child

• 1st dose of amox/cotri

• Vitamin A

• Bronchodilator 

• Breastfeeding/sugar water

• Urgent referral 

Pneumonia

• Yellow

— Fast breathing

• Antibiotic for 3 days

• Bronchodilator for 5 days

• Safe remedy for soothing the throat and cough

• Recurrent wheezing - refer for assessment 

• 3 weeks of cough or recurrent wheezing; refer for possible Tb or asthma

• Advise the mother when to return immediately 

• Advise 

No pneumonia: Cough or cold

— No signs of pneumonia or a very severe disease

• If cough more than 30 days, refer to hospital for assessment

• Relieve cough with safe remedy 

• Bronchodilator for 5 days

• Follow up in 5 days if no improvement 

Dysetary

— blood in the stool

less than 14 days of diarrhea

— Acute diarrhea

More than 14 days of diarrhea

— Persistent diarrhea

Severe dehydration

• Pink

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

• Plan C(IV) if no other severe classification

• Refer hospital and continue breastfeeding if with other severe disease

• Give tetracycline for cholera if there is cholera in the area and the child is 2 years-5 years

Some dehydration

• Yellow

2 of the following:

— Restless, irritable

— Sunken eyes

— Drinks eagerly, very thirsty

— Skin pinch goes back slowly 

• Give ORS, zinc supplement and food for dehydration

• Plan b

• If with other severe disease, refer

• Follow up in 5 days

  • Advice when to return 

Not enough signs to classify as SEVERE DEHYDRATION or SOME DEHYDRATION

• Green

• Give ORS, zinc and food to treat diarrhea at home

• Plan A

• Follow up in 5 days

• Advice mother when to return immediately 

• Continue breastfeeding longer and frequently at each feeding. Give soup, rice, buko juice or rice water if cannot BF

• Know when to return 

Persistent diarrhea + diarrhea = severe persistent diarrhea

• Pink

• Treat dehydration before referral, unless with other severe disease

  • Plan B

• Give Vitamin A and zinc

• Follow-up in 5 days

Persistant diarrhea - dehydration = persistent diarrhea

• Yellow

• Plan A

• Advise regarding feeding

• Give Vitamin A

• Give vitamins and minerals including zinc for 14 days

• Follow up in 5 days

• Advise when to return immediately

Blood in the stool = Dysentery

• Yellow

• Oral antibiotic for shigella for 2x for 3 days (Ciprofloxacin) 

• Follow up in 2 days

• Advise when to return immediately 

Mastoiditis

• Pink

— Tender swelling behind the ear

• 1st dose of antibiotic 3x a day, 5 days

• Paracetamol

• Urgent referral

Acute ear infection

• Yellow

— Ear discharge, <14 days or more

• Antibiotic for 5 days

• Paracetamol for pain

• Dry wicking( quinolone after;2-3 drops, 3x a day, 2 weeks)

• Follow up in 5 days\Advice to return 

Chronic ear infecto

• Yellow

— Ear discharge, > 14 days or more

• Wicking

• Instill quinolone otic drops, BID for two weeks

• Follow up in 5 days 

• Advice the mother when to return immediately 

No ear infection

• Green

— No ear pain or pus draining form ear

• No additional treatment

• Advice mother when to return immediately

Severe malnutrition or severe anemia

• If age up to 6 months 

: Visible severe wasting 

: Edema on both feet 

• If age 6 months and above

: MUAC is less than 155 cm

: edema on both feet

: Severe muscle wasting

• Treat to prevent lo blood sugar

• Vitamin A

• Urgent referral

Not very low weight 

• Green

— Not very low weight for age and no other sign of malnutrition 

• Assess feeding and counsel mother regarding feeding recommendation and care for development if less than 2 years old

• If feeding becomes a problem, follow up in 5 days

• Advise when to return immediately

Very low weight 

• Yellow

— Very low weight for age

• Assess feeding and counsel mother regarding feeding recommendation and care for development

• Vitamin A

• Follow up in 30 days

• Advise when to return immediately

Severe anemia

• Pink

— Severe palmar pallor

• Refer urgently to hospital

Anemia

• Yellow

— Some palmar pallor

• Assess feeding and counsel mother regarding feeding recommendation and care for development

• Give iron - 14 days

• Give albendazole/mebendazole if child is 1 year or older and has not received a dose for previous 6 months

• Follow up in 14 days

• Advise when to return immediately 

No anemia

• Green

— No palmar pallor

• Assess feeding and counsel mother regarding feeding recommendation and care for development

• If feeding becomes a problem, follow u in 5 days

• Advise when to return immediately 

Severe complicated measles

• Pink

— Measles now or within last 3 months

— Any general danger sign or clouding of cornea

— Deep or extensive mouth ulcers 

• 1st dose of antibiotic

• Vitamin A

• Apply tetracycline ointment if corneal clouding is present

• Urgent referral

Measles with eye or mouth complications

• Yellow

— Measles now or within last 3 months

— Pus draining from the eye

— Mouth ulcers

• Vitamin A

• Tetracycline eye ointment

• Gentian violet for ulcers

• Follow up in 2 days

• Advise mother when to return immediately

Measles 

— Measles now or within last 3 months: no other signs

• Vitamin A

• Advise mother to return immediately 

Very severe febrile disease/malaria

• Pink

— Malaria: Any general danger sign or stiff neck

• 1st dose of quanine(under med. supervision or if hospital is 4 hours away)

• 1st dose of antibiotic, paracetamol

• Treat to prevent low blood sugar 

• Urgent refrral 

Malaria

• Yellow

— Malaria risk: Positive blood smear

• Oral antimalaria

• Paracetamol

• Follow up in 2 days

• >7 days fever —> hospital for assessment 

Very severe febrile disease

• Pink

— No malaria risk: Any general danger sign or stiff neck

• 1st dose of antibiotic

• Paracetamol for fever 38.5ndeg above

• treat for low blood sugar

• Urgent referral

Severe Dengue Hemorrhagic fever

• Pink 

— Any of the danger sign or bleeding gums, nose, in vomitus or stools or black vomitus or stools or persistent abdominal pain or persistent vomiting or skin petechiae or cold and clammy skin or slow capillary refill or tourniquet test(+)

• If skin petechiae or persistent abdominal pain or vomiting, or + tourniquet test are only signs - Blan B

• Any other signs of bleeding- plan c

• Urgent referral

• Do not give aspirin