IMNCI Approach to Childhood Illness
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Direct answer
IMNCI — the Integrated Management of Neonatal and Childhood Illness, the Indian adaptation of the WHO-UNICEF strategy — trains the nurse or ANM to assess every sick young infant and child through standard charts, classify by colour and act: pink means urgent referral with pre-referral treatment, yellow means specific treatment at the facility, and green means home management with counselling. Assessment begins with general danger signs — unable to drink or breastfeed, vomits everything, convulsions, lethargy or unconsciousness — any one of which sends the child to the urgent pathway before the symptom-by-symptom review. Fast breathing thresholds for pneumonia are 60 or more per minute below 2 months, 50 or more from 2 to 12 months, and 40 or more from 12 to 59 months.
What you must remember
- Age bands: young infant 0 to 2 months, child 2 months to 5 years — different charts, different cutoffs, different drug doses.
- Four general danger signs: not able to drink or breastfeed, vomits everything, convulsions in this illness, lethargy or unconsciousness; any danger sign equals urgent referral regardless of other findings.
- Diarrhoea is classified by skin pinch, sunken eyes and behaviour: none; some (restless, thirsty, pinch under 2 seconds); severe (lethargic, drinking poorly, pinch 2 seconds or more) — plus dysentery and persistent diarrhoea classes.
- Zinc is given for 14 days — 20 mg daily for children over 6 months, 10 mg for younger infants — alongside continued feeding and fluids.
- Fever assessment considers malaria risk with stiff-neck and measles checks; fever beyond 7 days needs referral.
- Malnutrition screening: visible severe wasting, palmar pallor and oedema of both feet; the feeding assessment reviews breastfeeding attachment and complementary foods.
- Every mother is counselled on when to return immediately — any danger sign or worsening — with follow-up scheduled for yellow classifications.
- Pre-referral treatment: first antibiotic dose, first antimalarial, paracetamol, ORS sips, warmth for young infants (skin-to-skin), and a written referral note.
Where students slip
The fast breathing thresholds are quoted without their age bands, which is where the marks live; examiners deliberately set a 3-month-old with a rate of 55 and watch candidates call it normal against the wrong threshold. Danger signs are recalled incompletely, and "crying" or "poor weight gain" get invented as danger signs. The ORS volume (75 mL per kg over 4 hours) and zinc duration (14 days) are the two numbers most often wrong, and the colour logic is reversed — pink is the urgent tier, green the mildest. Finally, students stop at classification and forget pre-referral treatment, which the strategy treats as inseparable from referral.
Frequently asked questions
What are the general danger signs in IMNCI?
Inability to drink or breastfeed, vomiting everything, convulsions during this illness, and lethargy or unconsciousness — any one warrants the urgent pathway.
What is the fast breathing threshold for a three-month-old infant?
At least 50 breaths per minute for infants aged 2 to 12 months; below 2 months the cutoff is 60, and from 12 to 59 months it is 40.
What do the colours pink, yellow and green signify?
Pink classifies severe disease needing urgent referral with pre-referral treatment, yellow needs specific treatment at the facility, and green means home management with counselling.
How much ORS is given under treatment plan B?
75 mL per kg over 4 hours, with reassessment thereafter and continued breastfeeding and feeding throughout.
What does severe dehydration management (plan C) involve?
Rapid intravenous Ringer's lactate 100 mL per kg — 30 mL per kg fast, the remainder slower — with urgent referral where infusion cannot be established.