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COLLEGE OF NURSINGSilliman University

Dumaguete City

INTEGRATED

MANAGEMENT OF

CHILDHOODILLNESS (IMCI)

Submitted by:

Guevara, Marianne Daphne F.Perez, Jemimah Jane

Rondario, Jezro Mari T.CHN- A3

Submitted to:

Asst. Prof. Lourdes Babes OlivaClinical Instructor

November 14, 2012INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)


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I. Definition

The Integrated Management of Childhood Illness (IMCI) as a

strategy deals with the management of common childhood

illnesses done in an integrated manner to reduce the mortality

and morbidity with the major causes of childhood illnesses.

II. Objectives

1.To significantly reduce global mortality and morbidity

associated with the major causes of disease in children.

2.To contribute to healthy growth and development of

children.

III. Components

1. Improving case management skills of health workers

2. Improving the health system to deliver IMCI

3. Improving family and community health practices

IV. Case Management Process

1.Assess the child or young infant. Take history and do physical examination.

Identify any danger sign present.

a.convulsions (during this illness)

o lethargy/unconsciousness

o inability to drink/breastfeed

o vomiting

Ask about the four main symptoms.

o cougho diarrhea

o fever

o ear problem

Review nutrition, immunization, vitamin A, deworming

status, and other problems.


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MAKE SURE THAT A CHILD WITH ANY GENERAL

DANGER SIGN IS REFERRED after the first dose of an

appropriate antibiotic and other urgent treatments.

2.Classify the illness.

Take a decision of the severity of the illness.

Select a category or classification for each of the childsmajor symptoms which corresponds to the severity of

the disease. (Classifications are not specific disease

diagnoses but they are categories used to determine

treatment.)

o PINK urgent referral

IMMUNIZATION SCHEDULE

AGE VACCINE

Birth BCG, Hep B16 Weeks DPT 1, OPV 1, Hep B 2, Hib

1

10 weeks DPT 2, OPV 2, Hib 2

14 Weeks DPT 3, OPV 3, Hep B 3, Hib

3

9 Months Measles

12 to 15 months MMR

VITAMIN A PROPHYLAXIS

VITAMIN A SUPPLEMENTATION SCHEDULE:

The first dose at 6 months or above.

Subsequent doses every 6 months.

ROUTINE WORM TREATMENT

Give every child ALBENDAZOLE/MEBENDAZOLE every

6 months from the age of one year. Record the dose

on the childs card.


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o YELLOW specific medical treatment and advice

o GREEN simple advice on home care

3. Identify the treatment.

Choose the treatment that corresponds to the

classification of the illness.

An integrated treatment plan is developed.

4.Treat the child. Refer.

Give treatment in the health center, prescribe drugs or

other treatments to be given at home, and teach the

mother how to carry out the treatments (e.g. oral

drugs, ORS, treatment of local infections, signs to come

back immediately, when to return for routine follow-up.

5.Counsel the mother.

Assess how the child is fed and tell her about the foods

and fluids to give to the child, and when to bring the

child back to the health center.

6.Give follow-up care.

Give instructions on when to return to the clinic.

V. Child Health Interventions

A.Case Management Interventions

pneumonia

diarrhea

o dehydration

o persistent diarrhea

o dysentery

meningitis

sepsis

malaria

malnutrition

anemia


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measles

ear infection

dengue hemorrhagic fever

B.Preventive Interventions

immunization during sick child visits

nutrition counseling

breastfeeding

VI. Choosing Appropriate Management Chart

1.Decide which age group the child is in.

birth up to two months

two months up to five years2.Use the appropriate chart based on the childs age.

VII. Management for Sick Child Aged 2 Months to 5 Years

A.Assess and classify the sick child.

1.Check for general danger signs.

2.Ask the mother about the main symptoms.

cough/difficulty breathing

diarrhea fever

ear problem

3.When a main symptom is present:

Assess the child further for signs related to the

main symptom.

Classify the illness according to the signs which

are present or absent.

B.Treat the child.

1.Give an appropriate antibiotic.

Pneumonia, acute ear infection/mastoiditis, or

very severe disease

o first-line antibiotic: Amoxicillin


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2 times daily for 3 days (pneumonia)

3 times daily for 5 days (acute ear

infection/mastoiditis)

o second-line antibiotic: Cotrimoxazole

2 times daily for 3 days (pneumonia)

3 times daily for 5 days (acute ear

infection/mastoiditis)

Dysentery

o Give antibiotic recommended for Shigella in

your area for 3 days.

o first-line antibiotic: Ciprofloxacin

Cholerao Give an antibiotic recommended for

Cholera in your area for 3 days.

o first-line antibiotic: Tetracycline

o alternative antibiotic: Erythromycin (250

mg)

If the classification is dysentery AND with any of

the following: pneumonia, acute ear infection,

very severe disease, and mastoiditis, give onlyCiprofloxacin as antibiotic.

2.Teach the mother how to give oral drugs at home.

Give an oral antimalarial.

o first-line antibiotic:

Artemether-Lumefantrine tablet twice

a day on days 1-3

Primaquine tablet on day 4 (single

dose)o second-line antibiotic:

Quinine Sulfate + Doxycycline OR

Tetracycline OR Clindamycin


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Give Paracetamol for high fever (38.5C or above)

or ear pain (give every 6 hours until fever or ear

pain is gone).

Give Iron therapeutic supplementation one

dose daily for 14 days.

Give Vitamin A.

o treatment

1 capsule today (day 1)

1 capsule tomorrow (day 2)

1 capsule 2 days after day 2

o supplementation

Give one dose in the health center if: child is 6 months of age or older, AND

child has not received a dose of Vitamin A in the past 6 months

Give Mebendazole or Albendazole.

o Give 500 mg Mebendazole or 400 mg

Albendazole as a single dose in the health

center if the child is 12 months up to 59

months and has not had a dose in the

previous 6 months. Give oral Salbutamol for wheezing.

Give Multivitamins and Minerals for persistent

diarrhea.

3.Teach the mother to treat local infections at home.

Treat eye infection with Tetracycline Eye

Ointment.

Dry the ear by wicking. Instill Quinolone Otic

Drops.

Treat mouth ulcers with Gentian Violet.

Soothe the throat and relieve cough with a safe

remedy.

o Breastmilk for exclusively breastfed infant


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o Calamansi juice

4. Identify treatments to be given in the Health Center

only.

Give IM antibiotic.

o Give to children being referred urgently.

o Give Gentamicin and Benzyl Penicillin.

Give Quinine for severe malaria.

Give Artesunate Suppository indicated for

children below 1 year with probable malaria or

confirmed P. falciparum.

Give inhaled Salbutamol for wheezing.

o use of a spacer Treat the child to prevent low blood sugar.

o Breastfeed the child.

o If unable to breastfeed, give expressed

breast milk or 30-50 ml of milk or sugar

water.

o If unable to swallow, give 50 ml of milk or

sugar water by nasogastric tube.

o If child is difficult to awaken or unconscious,start IV infusion.

5.Give extra fluid for diarrhea. Continue feeding.

Plan A: Treat diarrhea at home.

o Give extra fluid ORS (oral rehydration

solution)

o Give zinc supplement.

2 months up to 6 months old tab

daily for 14 days 6 months old or more 1 tablet daily

for 14 days

o Continue breastfeeding if age is less than 6

months.


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Plan B: Treat some dehydration with

reformulated ORS.

o Give in the health center the recommended

amount of reformulated ORS over a 4-hour

period.

Plan C: Treat severe dehydration quickly.

o Give IV fluid immediately.

o If IV treatment is available, within 30

minutes refer urgently to the hospital.

o If trained to use NGT for rehydration and if

the child can drink, start rehydration by

tube or mouth with ORS solution.o If none of the above is applicable, refer

urgently to a hospital for IV or NG

treatment.

6. Immunize every sick child (as needed).

7.Give Vitamin A supplementation.

8.Give Mebendazole or Albendazole.

9.Give follow-up care.C.Counsel the mother.

1.Food

Assess childs feeding.

Assess childs care for development.

2.Fluid

Advise mother to increase fluid intake for any sick

child.

3.When To Return Advice mother when to return to the health

worker.


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If the child has: Return for follow-up in:

Pneumonia

Wheeze

Dysentery

Diarrhea

Malaria, if fever persists

Fever, malaria unlikely, if fever

persists

Fever, no malaria, if fever persists

Measles with eye or mouth

complications

Dengue hemorrhagic feverunlikely, if fever persists

2 days

Persistent diarrhea

Acute ear infection

Chronic ear infection

Feeding problems

Any other illness, if not improving

5 days

Anemia 14 days

Very low weight for age 30 days4.About Her Own Health

VIII. Management for Sick Young Infant from Birth up to 2 Months

A.Assess, classify, and treat the sick young infant.

1.Check for severe disease and local infection and

classify the illness.

2.Check for jaundice and classify.

3.Check for diarrhea and classify.4.Check for feeding problems or if low-weight-for-age

(for breastfed infants).

5.Check the sick young infants immunization and

vitamin A status.

6.Assess other problems.


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o mouth not wide open, lips pushed forward

o lower lip turned in

o more areola (or equal amount) seen below

infants botton lip than above upper top lip

6.Advise mother to give home care for the sick young

infant.

food and fluid

o Breastfeed frequently, as often and for as

long as the infant wants day and night,

during sickness and health.

when to return

If the infant has: Return for follow-up in:Jaundice 1 day

Local bacterial infection

Diarrhea

Any feeding problem

Thrush

2 days

Low weight for age 14 days

C.Give follow-up care for the sick young infant.

Sources:

IMCI Chart Booklet (2011 Edition)


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