Imci Forms Guide
Imci Forms Guide
Ask: What are the child's problems? Initial Visit? Follow-up Visit? 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 ... days. Advise mother when to return immediately. Give any immunization and
feeding advice needed today.