Integrated Management of Childhood Illness (IMCI) is a WHO–UNICEF strategy, adopted by the Department of Health, to reduce death, illness, and disability and to promote growth and development in children under 5 years. Instead of treating one complaint, the health worker assesses the whole child — danger signs, main symptoms, nutrition, immunization, feeding, and other problems — using a standard chart booklet.

Three components

1. Improving the case management skills of health workers (IMCI training and chart booklets)
2. Improving health systems (drugs, supplies, supervision, referral)
3. Improving family and community practices (feeding, care seeking, home care)

Two age groups

• Sick young infant: birth up to 2 months
• Sick child: 2 months up to 5 years

Case management process: Assess → Classify → Identify treatment → Treat → Counsel the mother → Follow up. IMCI classifies illness by severity rather than making an exact diagnosis; a child can have more than one classification.

Color-coded triage

The details below follow the WHO 2014 generic IMCI chart booklet; the DOH-adapted Philippine chart booklet in use at the facility is the reference for local drugs and doses.

General danger signs (sick child 2 months up to 5 years) — check first in every sick child:

• Not able to drink or breastfeed
• Vomits everything
• Has had convulsions (during this illness)
• Lethargic or unconscious
• Convulsing now

Any general danger sign = urgent attention: complete the assessment quickly, give pre-referral treatment, and refer without delay.

Cough or difficult breathing — count breaths for a full minute in a calm child; look for chest indrawing; listen for stridor and wheeze.

If a pulse oximeter is available, refer when SpO₂ is below 90%.

Diarrhea — dehydration

• Plan A (home): extra fluid (ORS, soup, clean water), zinc, continued feeding and breastfeeding, and when to return.
• Plan B (clinic): ORS about 75 mL/kg over 4 hours, then reassess and choose A, B, or C.
• Plan C: IV Ringer's lactate (or normal saline) 100 mL/kg — infants under 12 months: 30 mL/kg in 1 hour, then 70 mL/kg in 5 hours; children 12 months and older: 30 mL/kg in 30 minutes, then 70 mL/kg in 2½ hours. Reassess often; give ORS (about 5 mL/kg/hour) as soon as the child can drink.
• Zinc (2 months up to 5 years): 10 mg daily (half a 20-mg tablet) for ages 2 up to 6 months, 20 mg daily for 6 months and older, for 14 days (WHO 2024 conditionally suggests a lower 5 mg daily dose; the IMCI chart still uses 10/20 mg — follow the local booklet).
• Persistent diarrhea (14 days or more): with dehydration = severe persistent diarrhea (pink, refer); without = persistent diarrhea (yellow, feeding advice, multivitamins and minerals including zinc for 14 days, follow up in 5 days).
• Dysentery (blood in the stool): yellow — oral antibiotic (ciprofloxacin in the WHO booklet) for 3 days, follow up in 3 days.

Fever — any general danger sign or stiff neck = very severe febrile disease (pink). Malaria is classified according to local malaria risk; measles now or in the last 3 months is checked for complications (mouth ulcers, eye pus, clouding of the cornea).

Dengue (Philippine chart booklet). The DOH-adapted booklet also assesses every febrile child for dengue. Warning signs include bleeding (nose, gums, blood in stool or vomitus), skin petechiae, cold clammy extremities with slow capillary refill, and persistent abdominal pain or vomiting; these point to severe dengue (pink): give ORS or fluids if the child can drink, give paracetamol only (no aspirin or NSAIDs), and refer urgently. Use the current DOH booklet for the exact criteria and the lower-severity dengue classification.

Other checks: palmar pallor — severe pallor = severe anemia (pink), some pallor = anemia (yellow: iron, deworming if due); ear problems — tender swelling behind the ear = mastoiditis (pink), ear pain or discharge under 14 days = acute ear infection (yellow: amoxicillin).

Acute malnutrition (look for bilateral pitting edema of the feet; measure MUAC in children 6 months or older; weight-for-length/height z-score)

Every sick child also has immunization status checked (and missing doses given), vitamin A and deworming status reviewed, and feeding assessed.

Sick young infant (birth up to 2 months) — very severe disease (pink) if any of: not feeding well, convulsions, fast breathing (60 or more), severe chest indrawing, fever (37.5 °C [99.5 °F] or above), low temperature (below 35.5 °C [95.9 °F]), or movement only when stimulated or no movement. Give the first dose of IM antibiotics, prevent low blood sugar, keep warm (skin-to-skin), and refer urgently. Local bacterial infection (yellow): umbilicus red or draining pus, or skin pustules — oral antibiotic and home treatment, follow up in 2 days. The young infant is also assessed for jaundice, diarrhea, feeding problems, and low weight.

Pre-referral treatment (pink classifications)

• First dose of the appropriate antibiotic (IM ampicillin and gentamicin for young infants)
• Prevent low blood sugar: breastfeed, or give expressed milk or sugar water by mouth or nasogastric tube
• Diazepam for a child convulsing now (per chart dose)
• Keep the child warm; ORS sips on the way if dehydrated and able to drink
• Write a referral note; explain the need to the mother and help arrange transport

Counseling the mother or caregiver

• Teach her to give oral drugs at home: show the dose, have her give the first dose, check understanding, give the full course.
• Feeding: continue breastfeeding; give more fluids and food during illness and extra food after.
• Return immediately if the child is not able to drink or breastfeed, becomes sicker, or develops fever; with cough — fast or difficult breathing; with diarrhea — blood in the stool or drinking poorly.
• Follow-up visits: pneumonia and dysentery in 3 days; persistent diarrhea and uncomplicated acute malnutrition as scheduled by the booklet.

Drug safety points

• Amoxicillin: ask about penicillin allergy; watch for rash and diarrhea; teach to finish the course.
• Ciprofloxacin (dysentery): short courses in children are recommended by WHO; do not give with milk products or antacids at the same time, as absorption falls.
• Diazepam: watch breathing after a dose; repeat only as the chart allows.
• ORS: use the correct volume of clean water; incorrect dilution risks sodium problems.

• Apply the IMCI chart consistently: check danger signs first, then each main symptom, nutrition, and immunization.
• Prioritize pink classifications for pre-referral treatment and urgent referral.
• Treat yellow classifications, counsel families, and schedule follow-up.
• Give missing vaccines, vitamin A, and deworming during the visit (missed opportunities are a major cause of low coverage).
• Train and supervise BHWs in community IMCI practices (early care seeking, home fluids, breastfeeding).
• Keep records (IMCI recording forms, FHSIS) and report.

• Nurses and midwives use IMCI within their training and DOH protocols; prescriptions follow the chart booklet and facility standing orders.
• Delaying referral of a pink case is a serious breach of standard of care — if referral is not possible, follow the booklet's guidance for continued treatment and document why.
• Informed decision: explain the reason for referral; if the family refuses, document the explanation and the refusal, and give the best available care.
• Justice: every child gets the same systematic assessment regardless of social status.
• Confidentiality of child and family information (Data Privacy Act, RA 10173).
• Child protection: unexplained injuries or severe neglect-related malnutrition require reporting under child protection policies.

Case 1. A 14-month-old has cough for 3 days, breathing 46/min, no chest indrawing, no danger signs.

• Action: classify pneumonia (yellow; fast breathing is 40 or more at this age). Give oral amoxicillin, teach home care and return signs, follow up in 3 days.
• Why: fast breathing without danger signs or stridor.

Case 2. A 9-month-old with diarrhea is restless, has sunken eyes, drinks eagerly, and the skin pinch goes back slowly.

• Action: some dehydration — Plan B: ORS 75 mL/kg over 4 hours in the clinic, plus zinc 20 mg daily for 14 days, continue breastfeeding.
• Why: two or more yellow signs.

Case 3. A 3-year-old with fever cannot drink and is lethargic.

• Action: general danger signs → pink. Pre-referral treatment (first dose of antibiotic per chart, prevent hypoglycemia) and urgent referral.
• Why: any danger sign needs urgent referral.

Case 4. A 3-week-old infant has a temperature of 35.2 °C (95.4 °F) and is feeding poorly.

• Action: very severe disease — first dose of IM antibiotics, prevent low blood sugar, skin-to-skin warming, urgent referral.
• Why: hypothermia and poor feeding are signs of possible serious bacterial infection.

• Counting breaths in a crying child or for less than a full minute.
• Using the wrong cutoff: 60 (under 2 months), 50 (2 up to 12 months), 40 (12 months up to 5 years).
• Treating the main complaint and skipping danger signs, nutrition, and immunization.
• Delaying referral to complete non-urgent treatment.
• Stopping breastfeeding or food during diarrhea.
• Confusing "very slowly" (over 2 seconds, severe) with "slowly" (some dehydration).
• Forgetting zinc or giving it for only a few days — the course is 14 days.
• Assuming the green classification needs no teaching — mothers still need return signs.

• IMCI covers children under 5: young infant (up to 2 months) and child (2 months up to 5 years).
• Assess → classify → treat → counsel → follow up.
• Pink = urgent referral; yellow = specific treatment; green = home care.
• General danger signs: not able to drink or breastfeed, vomits everything, convulsions, lethargic or unconscious, convulsing now.
• Fast breathing: 60 / 50 / 40.
• Chest indrawing or fast breathing = pneumonia (oral amoxicillin); danger sign or stridor = severe.
• Plan A home; Plan B ORS 75 mL/kg over 4 hours; Plan C IV 100 mL/kg.
• Zinc for 14 days (10 mg under 6 months, 20 mg from 6 months).
• MUAC below 115 mm or bilateral edema = severe acute malnutrition; 115 up to 125 mm = moderate.
• Young infant very severe disease: poor feeding, convulsions, RR 60 or more, severe chest indrawing, fever 37.5 °C or above, temperature below 35.5 °C, reduced movement.
• Pre-referral: first antibiotic dose, prevent hypoglycemia, keep warm.
• Philippine booklet: fever with bleeding, petechiae, cold clammy extremities, or persistent abdominal pain/vomiting = severe dengue (pink); paracetamol only, no aspirin.