Paediatrics and Child Health: IMCI Thinking
What you must know
Work through the IMCI framework: assess, classify, treat, counsel and follow up. Core topics are neonatal resuscitation and thermal care, danger signs in the newborn and young infant, pneumonia classification, diarrhoea managed with the WHO Plan A, B and C approach, malnutrition assessed by MUAC and oedema, growth monitoring, the immunisation schedule, and weight-based drug dosing.
Classic traps
- Aspirin is contraindicated in febrile children because of Reye syndrome.
- Fever alone is not an indication for antibiotics; localise the infection and look for general danger signs.
- In severe acute malnutrition, give broad spectrum antibiotics, correct hypoglycaemia and hypothermia, and avoid aggressive fluid boluses; the danger is over-hydration and heart failure.
- Never use adult doses. Recalculate by weight and confirm the maximum dose.
- A newborn with poor feeding, lethargy or temperature instability may have sepsis; treat early rather than wait for cultures.
Rule of thumb
WHO dehydration: no dehydration is Plan A with extra fluids at home; some dehydration is Plan B with oral rehydration solution 75 ml/kg over four hours and reassessment; severe dehydration is Plan C with intravenous Ringer's lactate 100 ml/kg. In the newborn remember the warm chain: warm delivery room, immediate drying, skin-to-skin contact, early breastfeeding and delayed bathing.