Imci Chart

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    04-Apr-2015
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ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSASSESSASK THE MOTHER WHAT THE CHILDS PROBLEMS ARE

CLASSIFYUSE ALL BOXES THAT MATCH THE CHILDS SYMPTOMS AND PROBLEMS TO CLASSIFY THE ILLNESS

IDENTIFY TREATMENT

Determine if this is an initial or follow-up visit for this problem. - If follow-up visit, use the follow up instructions on the TREAT THE CHILD chart. - If initial visit, assess the child as follows:

CHECK FOR GENERAL DANGER SIGNSASK: Is the child not able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions LOOK: See if the child is abnormally sleepy or difficult to awaken MAKE SURE CHILD WITH ANY GENERAL DANGER SIGN IS REFERRED after first dose of an appropriate antibiotic and other urgent treatments.

IF YES

Exception: Re-hydration of the child according to Plan C may resolve danger signs so that referral is no longer needed.

A child with any general danger sign needs URGENT attention. Complete the assessment and any prereferral treatment so referral is not delayed.

THEN ASK ABOUT MAIN SYMPTOMS:Does the child have cough or difficult breathing?IF YES, ASK For how long?

SIGNS Any general danger sign or Chest indrawing or Stridor in calm

CLASSIFY AS

TREATMENT(Urgent pre-referral treatments are in bold print)

LOOK, LISTEN: Count the breaths in one minute Look for chest indrawing Look and listen for stridor CHILD MUST BE CALM.

Classify COUGH or DIFFICULT BREATHING

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

Fast breathing

PNEUMONIA

IF the child Is: 2 months up to 12 months 12 months up

Fast Breathing Is: 50 breaths per minute or more 40 breaths per minute or more

No signs of pneumonia or very severe disease

Give first dose of an appropriate antibiotic. Give Vitamin A. Treat the child to prevent low blood sugar. Refer URGENTLY to hospital. Give an appropriate 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. 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 improving.

NO PNEUMONIA; COUGH OR COLD

THEN ASK: Does the child have diarrhea?IF YES, ASK; LOOK AND FEEL: For DEHYDRATION

Two of the following signs Classify DIARRHEA Abnormally sleepy or difficult to awaken. Sunken eyes Not able to drink or drinking poorly Skin pinch goes back very slowly. Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly Not enough signs to classify as some or severe dehydration NO DEHYDRATION SOME DEHYDRATION SEVERE DEHYDRATION

If child has no other severe classification: -Give fluid for severe dehydration (Plan C). OR If child also has another severe classification: - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. - Advise mother to continue breastfeeding. If child is 2 years or older and there is cholera in your area , give antibiotic for cholera Give fluid and food for some dehydration (Plan B). If child also has a severe classification: - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. - Advise mother to continue breastfeeding Advise mother when to return immediately Follow up in 5 days if not improving. Give fluid and food to treat diarrhea at home (Plan A). Give Zinc supplements. Advise mother when to return immediately Follow-up in 5 days if not improving

Look at the childs general For how long? Is there blood in condition. the stool? Is the child: - Abnormally sleepy or difficult to awaken? - Restless and irritable? Look for sunken eyes. Offer the child fluid. Is the child: - Not able to drink or drinking poorly? - Drinking eagerly, thirsty? abdomen. Does it go back: -Very slowly (longer than 2 seconds)? Pinch the skin of the

if diarrhea 14 days or more

Dehydration present

SEVERE PERSISTENT DIARRHEA

Treat dehydration before referral unless the child Treat dehydration before referral unless the has another severe classification. child has another severe classification. Give vitamin A.A. Give vitamin Refer to hospital. Refer to hospital. Advise the mother on feeding a child who has PERSISTENT DIARRHEA. Give vitamin A. Follow up in 5 days. Advise mother when to return immediately. Treat for 5 days with an oral antibiotic recommended for Shigella in your area. Follow up in 2 days. Advise mother when to return immediately.

No dehydration

PERSISTENT DIARRHEA

and if blood in stool

Blood in the stool

DYSENTERY

MALARIA RISK

THEN ASK: Does the child have fever?(by history, or feels hot or temperature 37.5C or above)Malaria Risk (including travel to malaria area)

Give first dose of Quanine (under medical supervision or Any general danger sign or Stiff neck VERY SEVERE FEBRILE DISEASE/ MALARIA if a hospital is not accessible within 4 hours). Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for high fever (38.5C or above) Send a blood smear with the patient Refer URGENTLY to hospital. Treat the child with an oral antimalarial. Give one dose of paracetamol in health center For high fever (38.5C 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. Give one dose of paracetamol in health center for high fever (38.5C or above) Advise mother when to return immediately Follow up in 2 days if fever persist If fever is present every day for more than 7days, refer for assessment. Treat other causes of fever

Decide Malaria Risk Ask: Does the child live in a malaria area? Has the child visited/traveled or stayed overnight in a malaria area in past 4 weeks? If Yes to either, obtain a blood smear. THEN ASK: For how long has the child had fever? If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months? LOOK AND FEEL: 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

Blood smear(+) If Blood smear not done: NO runny nose, and NO measles, and NO other causes of fever MALARIA

Classify FEVER

Blood smear(+) Runny nose ,or Measles,or Other causes of fever

FEVER MALARIA UNLIKELY

NO MALARIA RISKNo Malaria Risk

Any general danger sign orStiff neck

If the child has measles now or within the last three months: Look for mouth ulcers Are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea

VERY SEVERE FEBRILE DISEASE

Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar Give dose of paracetamol in health center for high fever(38.5C or above) Refer URGENTLY to hospital Give first dose of paracetamol in health center for high fever (38.5C) 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. Treat other causes of fever

No signs of very severe febrile disease

FEVER: NO MALARIA

Decide Dengue Risk: Yes or NoIf Dengue risk: THEN ASK: LOOK AND FEEL: Has the child had any bleeding from Look for bleeding from the nose or gums or in the vomitus or nose or gums. stools? Look for skin petechiae Has the child had tarry black stools? Feel for cold and clammy Has the child had abdominal pain? extremities. Has the child been vomiting? Check for slow capillary refill. If none of the above ASK or LOOK and FEEL signs are present and the child is 6 months or older and fever present for more than three days: - Perform the tourniquet test.If MEASLES now or within last 3 months Classify

Any general danger sign Clouding of cornea or Deep or extensive mouth ulcers Pus draining from the eye or 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 Give Vitamin A. If pus draining from the eye, apply tetracycline eye ointment. If mouth ulcers, teach the mother to treat with gentian violet. Give vitamin A. Advise mother when to return immediately.

M E A S L E S W IT H EYE OR M OUTH C O M P L IC A T IO N

. Measles now or within the last 3 monthsif DENGUE Risk, Classify

MEASLES

Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or

Skin petechiae or

Cold and clammy extremities or Capillary refill more than 3 seconds or Persistent abdominal pain or Persistent vomiting or Tourniquet test positive

SEVERE DENGUE HEMORRHAGIC FEVER

If persistent vomiting or persistent abdominal pain or skin petachiae or positive tourniquet test are the only positive signs, give ORS (Plan B) If any other signs of bleeding are positive, give fluids rapidly as in Plan C. Treat the child to prevent low blood sugar. Refer all child URGENTLY to hospital. DO NOT GIVE ASPIRIN. Advise mother when to return immediately. Follow up in 2 days if fever persist or child shows sign of bleeding. DO NOT GIVE ASPIRIN.

No signs of severe dengue hemorrhagic fever.

F E V E R :D E N G U E H E M O R R H A G IC F E V E R N L IK E L Y U

Other Causes of fever: Pneumonia Dysentery Severe complicated measl