WEEK 17: Integrated Management of Childhood Illness (IMCI)

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Created by
Arron Rex

Cards (36)

  • Integrated Management of Childhood Illness (IMCI)

    A systematic approach to child health that focuses on the well being of the whole child
  • OBJECTIVES OF IMCI
    • To contribute to health, growth and development of children
    • To signify reduce the global mortality and morbidity associated with the major cause of disease in children
  • TRIAGING OF IMCI
    a.Pink
    • Needs immediate referral to other healthcare facility, patient is showing danger signs, needs pre-referral treatment
    b. Yellow
    • Needs immediate treatment, can be managed at home
    c. Green
    • Health education, to be managed at home
  • Danger Signs: Immediate referral even with just 1 manifestation
    • C - convulsion
    • U - unable to drink or breastfeed
    • V - vomiting
    • A - abnormally sleepy/ Lethargic
    • C - Chest indrawing
    • S - Stridor
  • Assess for Main Symptoms of Danger Signs:
    • C - cough/ difficulty breathing
    • D - diarrhea
    • E - ear problem
    • F - fever
  • Pneumonia is an infection of the lungs that causes inflammation and fluid build-up
  • TWO CLINICAL SIGNS OF PNEUMONIA:
    • Fast breathing – PNEUMONIA
    • Chest indrawing – SEVERE PNEUMONIA
  • TREATMENT FOR Severe Pneumonia or Very Severe Disease (PINK)
    • Give the first dose of an appropriate antibiotic (give an intramuscular antibiotic: ampicillin (50 mg/kg) and gentamicin (7.5 mg/kg)
    • IF REFERRAL IS NOT POSSIBLE OR DELAYED, repeat the ampicillin injection every 6 hours, and the gentamicin injection once daily
    • Refer URGENTLY to hospital
  • TREATMENT FOR PNEUMONIA (YELLOW)
    • Give an appropriate oral antibiotic for 5 days
    • First line antibiotic: Amoxicillin
    • Second line antibiotic : Cotrimoxazole
    • Give Vitamin A
    • Soothe the throat and relieve the cough with safe remedy
    • Breastmilk for exclusive breastfed infant
    • Tamarind, calamansi and ginger
    • Advise mother when to return immediately
    • Follow up in 2 days
  • TREATMENT FOR PNEUMONIA (GREEN; home management)
    • If coughing for more than 30 days, refer for assessment
    • Soothe the throat and relieve the cough with safe remedy
    • Advice mother when to return immediately
    • Follow up in 5 days if not improving
  • TYPES OF DIARRHEA
    • Acute Diarrhea - diarrhea lasts for less than 14 days
    • Persistent Diarrhea - diarrhea last for 14 days or more
    • Dysentery - diarrhea with blood
  • CLASSIFICATION OF DIARRHEA (Based on dehydration)
    • Severe Dehydration (Pink)
    • Some dehydration (Yellow)
    • No Dehydration (Green)
  • TREATMENT FOR DYSENTERY
    • Treat for 5 days with oral antibiotic recommended for shigella in your area.
    • First line antibiotic for shigella: COTRIMOXAZOLE
    • Second-line antibiotic for shigella: NALIDIXIC ACID
    • Follow up in 2 days
  • Treatment for severe dehydration
    1. If you can give Intravenous fluid immediately:
    2. Start IV fluid immediately
    3. If the child can drink, give ORS by mouth while the drip is set up
    4. Give 100 ml/kg Ringer's Lactate Solution (or, if not available, normal saline), divided as follows:
    5. Infants (under 12 mos.): Give 30ml/ kg in 1 hour, Then give 70ml/ kg in 5 hours
    6. Children (12 months to 5 years): Give 30ml/ kg in 30 minutes, Then give 70ml/ kg in 2 1/2 hours
    7. Reassess the child every 1- 2 hours. If hydration status is not improving, give the IV drip more rapidly
    8. Also give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after 3-4 hours (infants) or 1-2 hours (children)
    9. Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment
  • Severe Dehydration: If IV treatment available nearby within 30 minutes
    1. Refer URGENTLY to hospital for IV treatment
    2. If the child can drink, provide the mother with ORS solution and show her how to give frequent sips during the trip or give ORS by naso-gastic tube
  • Severe Dehydration: If the health care provider is trained to use NGT for rehydration/ Can the child drink
    1. Start rehydration by tube or mouth with ORS solution: give 20 ml/kg/hr for 6 hrs (total of 120 ml/kg)
    2. Reassess the child every 1-2 hours while waiting for transfer
    3. If there is repeated vomiting or abdominal distension, give the fluid more slowly. If the hydration status is not improving after 3 hours, send the child for IV therapy
    4. After 6 hours reassess the child. Classify dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment
  • Treat for Some Dehydration with ORS (PLAN B)
    1. In the clinic, give recommended amount of ORS over 4-hour period
    2. Determine amount of ors to give during first 4 hours
    3. If the child wants more ORS than shown, give more
    4. For infants below 6 months who are not breastfed, also give 100-200ml clean water during this period
    5. Show the mother how to give ors solution
    6. After 4 hours: Reassess the child and classify the child for dehydration, Select the appropriate plan to continue treatment, Begin feeding the child in clinic
    7. If the mother must leave before completing treatment: Show her how to prepare ORS solution at home, Show her how much ORS to give to finish 4-hour treatment home, Give her instructions how to prepare salt and sugar solution for use at home, Explain the 4 Rules of Home Treatment
  • Determine amount of ORS to give during first 4 hours

    Use the child's age only when you do not know the weight, The approximate amount of ORS required (in ml) can also be calculated by multiplying the child's weight in kg times 75
  • How to give ORS solution
    • Give frequent small sips from a cup, If the child vomits, wait 10 minutes then continue - but more slowly, Continue breastfeeding whenever the child wants
  • 4 Rules of Home Treatment
    • Give extra fluid
    • Give zinc (age 2 months up to 5 years)
    • Continue feeding (exclusive breastfeeding if age less than 6 months)
    • When to return
  • Treat for Diarrhea at Home (PLAN A)
    1. Counsel the mother on the 4 Rules of Home Treatment
    2. Give Extra Fluid (as much as the child will take)
    3. Breastfeed frequently and for longer at each feed
    4. If the child is exclusively breastfed, give ors or clean water in addition to breast milk
    5. If the child is not exclusively breastfed, give one or more of the following: food-based fluids (such as soup, rice water, and yoghurt drinks), or ors
    6. Teach the mother how to mix and give ors. Give the mother 2 packets of ors to use at home
    7. Show the mother how much fluid to give in addition to the usual fluid intake
    8. Tell the mother to: Give frequent small sips from a cup, If the child vomits, wait 10 minutes then continue - but more slowly, Continue giving extra fluid until the diarrhea stops
    9. Give Zinc Supplements (age 2 months up to 5 years)
    10. Tell the mother how much zinc to give (20 mg tab)
    11. Show the mother how to give zinc supplements
    12. Continue Feeding (exclusive breastfeeding if age less than 6 months)
    13. When to Return
  • MALARIA
    • Causative agent: Plasmodium spp. Protozoan
    • Biological vector: Anopheles mosquitoes
    • Warning sign: Stiff Neck
    • HIGH RISK AREAS in the Philippines: Palawan
    • Plasmodium falciparum dangerous species of Plasmodium
  • TREATMENT FOR MALARIA; Very Severe Febrile Disease (PINK)
    • Give first dose of an appropriate antibiotic ( Quinine; it should be under medical supervision or if a hospital is not accessible within 4 hours)
    • 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.
    • Send a blood smear with the patient
  • TREATMENT FOR MALARIA (YELLOW)
    • If no cough with fast breathing, treat with oral antimalarial
    • If cough with fast breathing, treat with cotrimoxazole for 5 days
    • 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.
  • TREATMENT FOR FEVER (UNLIKELY MALARIA; GREEN)
    • 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
  • SIGN AND SYMPTOMS OF MEASLES
    • Cough
    • Runny nose
    • Red eyes
    • Corneal clouding due to vitamin A deficiency that may lead to blindness.
  • TREATMENT FOR SEVERE COMPLICATED MEASLES (PINK)
    • 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
  • TREATMENT FOR MEASLES WITH EYE OR MOUTH COMPLICATIONS (YELLOW)
    • 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
  • TREATMENT FOR MEASLES; <3 months (GREEN)
    • Give Vitamin A
  • Mastoiditis (PINK)
    a.Signs
    • Tender swelling behind the ear
    b. Treatment
    • Give the first dose of an appropriate antibiotic
    • Give the first dose of paracetamol for pain
    • Refer URGENTLY to hospital
  • Acute ear infection (YELLOW)
    a.Signs
    • Ear pain
    • Pus is seen draining from the ear, and discharge is reported for less than 14 days.
    b. Treatment
    • Give an antibiotic for 5 days
    • Give paracetamol for pain
    • Dry the ear by wicking
    • Follow up in 5 days
    • Advise mother when to return immediately
  • Chronic ear infection (YELLOW)
    a.Signs
    • Pus is seen draining from the ear, and discharge is reported more than 14 days.
    b. Treatment
    • No antibiotic must be given
    • Dry the ear by wicking
    • Follow up in 5 days
    • Advise mother when to return immediately
    • Check immunization and vitamin status
  • TREATMENT FOR SEVERE MALNUTRITION OR SEVERE ANEMIA (PINK)
    • Give Vitamin A
    • Refer URGENTLY to hospital
  • TREATMENT FOR ANEMIA OR VERY LOW WEIGH (YELLOW)
    a.Assess child’s feeding
    • if feeding problem, counsel the mother according to the food box
    • Follow-up in 5 days
    b. If pallor:
    • Give iron
    • Give oral antimalarial if high risk of malaria
    • Give mebendazole if >2 years old and has not had a dose in the previous 6 months
    c. Advise mother when to return immediately
    d. if pallor, follow-up in 14 days
    e. if very low weight, follow-up in 30 days
  • TREATMENT FOR NOT ANEMIC AND NOT VERY LOW WEIGHT (GREEN)
    a.Assess the child’s feeding problem
    • counsel the mother about food box
    • if feeding problem, follow-up in 5 days
    b. Advise mother when to return immediately
  • OBSERVE CONTRAINDICATIONS TO IMMUNIZATION
    a.There are only three situations at present that are contraindications to immunization:
    • Do not give BCG to a child known to have AIDS.
    • Do not give DPT 2 or DPT 3 to a child who has had convulsions or shock within 3 days of the most recent dose.
    • Do not give DPT to a child with recurrent convulsions or another active neurological disease of the central nervous system.
    b. In all other situations, here is a good rule to follow:
    • There are no contraindications to immunization of a sick child if the child is well enough to go home