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Imci Forms Guide

This document contains general guidelines and a form for assessing and managing sick children aged 2 months to 5 years. The form includes sections to assess for general danger signs, cough/difficult breathing, diarrhea, fever, ear problems, acute malnutrition/anemia, immunization status, HIV infection, and feeding problems if the child is less than 2 years old. Information to document includes temperature, weight, symptoms, physical exam findings, classification, and treatment or follow up plan.
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0% found this document useful (0 votes)
185 views2 pages

Imci Forms Guide

This document contains general guidelines and a form for assessing and managing sick children aged 2 months to 5 years. The form includes sections to assess for general danger signs, cough/difficult breathing, diarrhea, fever, ear problems, acute malnutrition/anemia, immunization status, HIV infection, and feeding problems if the child is less than 2 years old. Information to document includes temperature, weight, symptoms, physical exam findings, classification, and treatment or follow up plan.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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General Guidelines:

- Do not fill up the rest of the items per row if


the child has not manifested the item.
- 1 pink row + 1 yellow = yellow

MANAGEMENT OF THE SICK CHILD AGED 2 MONTHS UP TO 5 YEARS


Name: Age: Sex: Weight (kg): Height/Length (cm): Temperature (°C):

Ask: What are the child's problems? Initial Visit? Follow-up Visit? Date:

ASSESS (Circle all signs present) CLASSIFY


CHECK FOR GENERAL DANGER SIGN General danger sign present?
NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING Yes No
CONVULSIONS CONVULSING NOW Remember to use Danger sign
LETHARGIC OR UNCONSCIOUS when selecting classifications
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES NO
For how long? Days Count the breaths in one minute: breaths per minute. Fast breathing?
Look for chest indrawing
Look and listen for stridor
Look and listen for wheezing
DOES THE CHILD HAVE DIARRHEA? YES NO
For how long? Days Look at the child's general condition. Is the child:
Is there blood in the stool? Lethargic or unconscious? Restless and 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?
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5°C or above) YES NO
Decide malaria risk LOOK AND FEEL:
Does the child live in malaria area? Look or feel for stiff neck Has the
child visited/travelled or stayed overnight in a Look for runny nose malaria area
in the past 3 weeks?
If malaria risk, obtain a blood smear. Look for signs of MEASLES
(+) (Pf) (Pv) (-) (Not done) Generalized rash and
For how long has the child had fever? days One of these, cough, runny nose, or red eyes If more than 7
days, has fever been present every day? Look for any other cause of fever
Has the child had measles within the past 3 months?
If the child has measles now or within the last 3 months:
Look for mouth ulcers. If yes, are they deep and extensive?
Look for clouding of the cornea. Look for pus draining from the eye.
ASSESS DENGUE HEMORRHAGIC FEVER YES NO
THEN ASK:
Has the child had any bleeding from the nose or gums or in Look for bleeding from nose or gums the vomitus
or stool? Look for skin petechiae
Has the child had black vomitus or stool? Feel for cold and clammy extremities Has the
child had persistent abdominal pain? Check capillary refill seconds.
Has the child had persistent vomiting? Perform tourniquet test if child is 6 months or older AND has no other signs
AND has fever for more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM? YES NO
Is there ear pain? Look for pus draining from theear
Is there ear discharge? If Yes, for how long? Days Feel for tender swelling behind the ear
THEN CHECK FOR ACUTE MALNUTRITION AND ANEMIA
Look for edema of both feet.
Determine WFH/L z-score:
Less than -3? Between -3 and -2? -2 or more?
Child 6 months or oldermeasure MUAC mm.
Look for palmar pallor.
Severe palmar pallor? Some palmar pallor?
If child has MUAC less than 115 mm or WFH/L less than -3 Z scores:
Is there any medical complication: General danger sign?
Any severe classification? Pneumonia with chest indrawing?
Child 6 months or older: Offer RUTF to eat. Is the child:
Not able to finish? Able to finish?
Child less than 6 months: Is there a breastfeeding problem?
CHECK FOR HIV INFECTION
Note mother's and/or child's HIV status
Mother's HIV test: NEGATIVE POSITIVE NOT DONE/KNOWN
Child's virological test: NEGATIVE POSITIVE NOT DONE
Child's serological test: NEGATIVE POSITIVE NOT DONE
If mother is HIV-positive and NO positive virological test in child:
Is the child breastfeeding now?
Was the child breastfeeding at the time of test or 6 weeks before it? If breastfeeding: Is the mother and child on ARV prophylaxis?
CHECK THE CHILD'S IMMUNIZATION STATUS (Circle immunizations needed today), Vitamin A status,
deworming status, Dental Check-up {Circle if needed today} Return for next
BCG Pentavalent 1 Pentavalent 2 Pentavalent 3 Measles1 MMR Vitamin A immunization on:
Hep B0 OPV-1 OPV-2 OPV-3 Mebendazole/Albendazole RTV-1 __________________
RTV-2 RTV-3 Dental check-up (Date)

ASSESS FEEDING if the child is less than 2 years old, has MODERATE ACUTE MALNUTRITION, ANEMIA, or is HIV exposed or FEEDING PROBLEMS
infected
Do you breastfeed your child? Yes No
If yes, how many times in 24 hours? times. Do you breastfeed during the night? Yes No Does
the child take any other foods or fluids? Yes No
If Yes, what food or fluids?
How many times per day? times. What do you use to feed the child? If
MODERATE ACUTE MALNUTRITION: How large are servings?
Does the child receive his own serving? Who feeds the child and how?
During this illness, has the child's feeding changed? Yes No If Yes, how?
ASSESS OTHER PROBLEMS: ASK ABOUT MOTHER'S OWN HEALTH
TREAT
Remember to refer any child who has a danger sign and no other severe classification

Return for follow –up in:


Advise the mother when to return immediately
Give any immunizations today:
Feeding Advice:
Care for Development Advice:

Return for follow-up in ... days. Advise mother when to return immediately. Give any immunization and
feeding advice needed today.

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