Paediatrics: IMCI Assessment and Newborn Danger Signs
Paediatrics in the Myanmar MMLE tests IMCI-based assessment of sick children and neonates: pneumonia, diarrhoea, malnutrition, malaria, TB, immunization, and newborn danger signs. The exam rewards age-specific vital signs, danger-sign recognition, and correct classification before treatment. A child’s age changes both the respiratory threshold and the likely pathogen.
Core rules
- Count respiratory rate for a full minute; use age thresholds: under 2 months at least 60, 2–11 months at least 50, and 1–5 years at least 40 breaths per minute.
- Chest indrawing, grunting, lethargy, convulsions, inability to feed, and central cyanosis are danger signs requiring referral.
- Diarrhoea: give oral rehydration salts and zinc, continue feeding, and treat severe dehydration with IV Ringer’s lactate per plan C.
- Neonatal jaundice: assess age, bilirubin level, and risk factors; jaundice in the first 24 hours is always pathological.
Worked example
An 18-month-old has cough for 3 days, respiratory rate 54, and lower chest indrawing, with no general danger signs. Reasoning: fast breathing plus chest indrawing classifies severe pneumonia. Give the first antibiotic dose, provide oxygen if hypoxic, and refer urgently. If there were fast breathing without indrawing, classify as pneumonia and start oral amoxicillin.
Traps
Using adult respiratory rates; treating all diarrhoea with antibiotics; missing severe acute malnutrition; failing to check glucose in a sick child; and accepting incomplete immunization without catch-up planning.