Pediatrics
IMNCI Guidelines
IMNCI for MBBS pediatrics: five components, pink-yellow-green colour codes, danger signs and respiratory rate cut-offs for young infants and children, mapped to NMC codes PE16.1 to PE16.3.
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IMNCI Guidelines
IMNCI for MBBS pediatrics: five components, pink-yellow-green colour codes, danger signs and respiratory rate cut-offs for young infants and children, mapped to NMC codes PE16.1 to PE16.3.
This chapter covers the Integrated Management of Neonatal and Childhood Illnesses, including its components, colour-coded risk stratification and the assessment of the young infant and the child aged 2 months to 5 years. It emphasises danger signs, respiratory rate cut-offs and referral thresholds.
High-yield: IMNCI Guidelines
- IMNCI stands for Integrated Management of Neonatal and Childhood Illnesses and covers two age groups: young infants up to 2 months and children 2 months to 5 years.
- The five components of IMNCI are Assess, Classify, Treat, Counsel and Follow-up.
- The three IMNCI colour codes are pink for urgent referral, yellow for specific outpatient treatment and green for home care with counselling.
- In children 2 months to 5 years the general danger signs are inability to drink or breastfeed, vomiting everything, convulsions, and being lethargic or unconscious.
- The fast-breathing cut-off is a respiratory rate of 50 per minute or more for 2 to 12 months and 40 per minute or more for 1 to 5 years.
- Pneumonia (yellow) is fast breathing or lower chest wall indrawing without a general danger sign and with oxygen saturation of 90 percent or more.
- Severe pneumonia (pink) is any general danger sign, stridor in a calm child, or oxygen saturation below 90 percent.
- In the young infant, danger signs of possible serious bacterial infection include not feeding well, convulsions, a respiratory rate of 60 per minute or more, severe chest indrawing, fever or hypothermia and lethargy.
- In the young infant, severe jaundice is indicated by yellow palms and soles, onset within 24 hours, or age 14 days or more.
- A young infant weighing less than 1800 grams is classified pink and needs urgent referral.
- IMNCI integrates the assessment of feeding, immunisation status and other problems at every sick-child visit.
- IMNCI risk stratification uses the colour codes to decide between urgent referral, outpatient treatment and home care.
- IMNCI counselling includes advising the mother on home fluids, feeding during illness, and when to return immediately.
- IMNCI is an evidence-based, integrated approach designed for use by frontline health workers to reduce under-five mortality.
IMNCI colour codes and cut-offs
- **Pink:** Urgent referral (danger signs, severe classifications).
- **Yellow:** Specific outpatient treatment (for example, pneumonia).
- **Green:** Home care with counselling.
- **Fast breathing:** RR >= 50/min at 2 to 12 months; >= 40/min at 1 to 5 years; >= 60/min in young infants.
NMC competencies in this chapter
- **PE16.1:** Components of IMNCI and method of risk stratification
- **PE16.2:** Assessment of children below 2 months using IMNCI guidelines
- **PE16.3:** Assessment of children 2 months to 5 years using IMNCI guidelines and risk stratification
Frequently Asked Questions
What are the five components of IMNCI?
The five components of the Integrated Management of Neonatal and Childhood Illnesses are Assess, Classify, Treat, Counsel and Follow-up, applied to young infants up to 2 months and children 2 months to 5 years.
What do the IMNCI colour codes mean?
Pink means urgent referral for severe illness, yellow means specific outpatient treatment such as for pneumonia, and green means home care with counselling. These colours drive the risk-stratified management decision.
What are the fast-breathing cut-offs in IMNCI?
Fast breathing is a respiratory rate of 50 per minute or more for infants 2 to 12 months and 40 per minute or more for children 1 to 5 years, while in young infants below 2 months the cut-off is 60 per minute or more.
What are the general danger signs in a child 2 months to 5 years?
The general danger signs are inability to drink or breastfeed, vomiting everything, a history of convulsions, and being lethargic or unconscious. Any of these classifies the child as pink for urgent referral.
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