Checklist – IMCI

MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS

Name: _________ Age: ___________ Weight: ______kg Temperature: ______ °C

ASK: What are the infant's problems? ______ Initial visit? _________ Follow-up Visit?_____

ASSESS (Circle all signs present)   CLASSIFY TREAT

CHECK FOR POSSIBLE BACTERIAL INFECTION      

• Has the infant had convulsions? • Count the breaths in one minute.______ breaths per minute    
Repeat if elevated ______ Fast breathing?
• Look for severe chest indrawing.
• Look for nasal flaring.
• Look and listen for grunting.
• Look and feel for bulging fontanelle.
• Look for pus draining from the ear.
• Look at umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
• Fever (temperature 37.5°C or feels hot) or low body temperature (below 35.5°C or feels cool).
• Look for skin pustules. Are there many or severe pustules?
• See if young infant is lethargic or unconscious.
• Look at young infant's movements. Less than normal?

DOES THE YOUNG INFANT HAVE DIARRHOEA? Yes _____ No ______    

• For how long? _____ Days • Look at the young infant's general condition. Is the infant:    
• Is there blood in the stools? Lethargic or unconscious?
Restless or irritable?
• Look for sunken eyes.
• Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?

Slowly?

THEN CHECK FOR FEEDING PROBLEM OR LOW      

• Is there any difficulty feeding? Yes ___ No ___ • Determine weight for age. Low ___ Not Low ___    
• Is the infant breastfed? Yes ___ No ___
• If Yes, how many times in 24 hours? ____ times
• Does the infant usually receive any other foods or drinks?
Yes ___ No ___
If Yes, how often?
• What do you use to feed the child?

If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or drinks, or is low weight for age AND has no    
indications to refer urgently to hospital:
ASSESS BREASTFEEDING:      

• Has the infant breastfed in the previous hour? • If infant has not fed in the previous hour, ask the mother to put her infant to the breast. Observe    
the breastfeed for 4 minutes.
• Is the infant able to attach? To check attachment, look for:

  - Chin touching breast Yes ___ No ___    

  - Mouth wide open Yes ___ No ___    

  - Lower lip turned outward Yes ___ No ___    

  - More areola above than below the mouth Yes ___ No ___    

  no attachment at all not well attached good attachment    

  • Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?    

  not suckling at all not suckling suckling effectively    

  • Look for ulcers or white patches in the mouth (thrush).    

CHECK THE YOUNG INFANT'S IMMUNIZATION STATUS Circle immunizations needed today. Return for next  
immunization on:

(Date) Return for follow-up in: