1. IMNCI
Nebiyu A.

2. Introduction
• Since the 1970s, the estimated annual
number of deaths among children less
than 5 years old has decreased by almost
a third.
• This reduction, however, has been very
uneven. And in some countries rates of
childhood mortality are increasing.
• Every minute 20 children under 5 years of
age die, leading to 10.6 million deaths
each year.
• Altogether more than 10 million children
die each year in developing countries
before they reach their fifth birthday

3. contd..
The majority of these deaths are caused by
conditions that are either preventable or
treatable, Seven in ten of these deaths are due
to:
• acute respiratory infections (mostly pneumonia)
• diarrhea
• measles
• malaria
• malnutrition
• and often to a combination of these conditions

4. contd..

5. In Ethiopia
Each year an estimated 472,000 children under
the age of five die in Ethiopia, placing Ethiopia
sixth in the world in terms of absolute number of
under-5 deaths.
The proportions of attributable causes of under-5
mortality have been estimated as follows:
• pneumonia 28%
• neonatal complications 25%
• malaria 20%
• diarrhea 20%
• measles 4%
• AIDS 1% and
• other 2%

7. • In some countries, three in four episodes of
childhood illness are caused by one of these five
conditions
• At this level, in most developing countries,
diagnostic supports such as radiology and
laboratory services are minimal or non-existent;
and drugs and equipment are scarce.
• Limited supplies and equipment
• combined with an irregular flow of patients,
leave health care providers at first-level facilities
with few opportunities to practice complicated
clinical procedures

8. • Providing quality care to sick children in these
conditions is a serious challenge.
• In response to this challenge, WHO and UNICEF
developed a strategy known as Integrated
Management of Childhood Illness (IMCI).
• Although the major stimulus for IMCI came from the
needs of curative care,
• The strategy combines improved management of
childhood illness with aspects of nutrition,
immunization, and other important disease prevention
and health promotion elements.
• The objectives are to reduce deaths and the frequency
and severity of illness and disability and to contribute to
improved growth and development.

9. • Since 2006, the newly adapted version has
incorporated care and management of newborns
below the age of 7 days of life and its name has
been changed to IMNCI, Integrated
Management of Newborn and Childhood Illness.
• Currently, HIV/AIDS is a major public health
problem in many African countries especially in
the Sub-Saharan Region.
• Thus, HIV/AIDS is adapted into the
Ethiopian IMNCI algorithm taking into
consideration the increasing magnitude of
childhood HIV/AIDS in the country

10. • It is a case management process for a
first-level facility such as a clinic, a health
centre or an outpatient department of a
hospital

11. The strategy includes three main
components
• Improvements in the case-management
skills of health staff through the provision
of locally adapted guidelines on IMNCI
and through activities to promote their use
• Improvements in the health system
required for effective management of
childhood illness
• Improvements in family and community
practices

12. • The clinical guidelines
– They promote evidence-based assessment and
management, using a syndromic approach that
supports the rational, effective and affordable use of
drugs.
– They include methods for assessing signs that
indicate severe disease;
– assessing a child's nutrition, immunization, and
feeding;
– teaching parents how to care for a child at home;
– counseling parents to solve feeding problems; and
advising parents about when to return to a health
facility

13. – The guidelines also include recommendations
for checking the parents' understanding of the
advice given and for showing them how to
administer the first dose of treatment.

14. Principles of integrated case
management
• All U5s first checked for signs of severe illness
– General Danger Signs
– Signs of Very Severe Disease
• All children assessed for main symptoms, Malnutrition
and anemia, HIV, immunizations, de-worming, and other
problems
• Limited number of clinical signs used
• Color-coded Classification system for easy triaging
• Limited number of Essential drugs needed
• Emphasis on Counseling & active participation of care-
givers on - Home care & Feeding and fluids
- When to return (immediately or for F/up)
• Well-defined Follow-up care

15. Steps in integrated case
management
1. ASSESS - Good communication skills
- Focused assessment
2. CLASSIFY – using a combination of
signs
3. IDENTIFY TREATMENT & TREAT
eg. Pre-referral Rx, first dose of oral
drugs, advice
4. COUNSEL
5. FOLLOW-UP
urgent pre-referral
treatment and referral,
or
specific medical
treatment and advice,
or
simple advice on
home management

16. IMNCI Case MaNageMeNt
steps
Sick Children
(age 2 months up to 5 years)

17. IMNCI Case MaNageMeNt
steps
Age 2 months up to 5 years
General Danger Signs
Main Symptoms
Cough or Difficult Breathing
Diarrhoea
Fever
Ear Problems
Nutritional Status
HIV/AIDS
Immunization Status
Other Problems

18. General Danger Signs
DANGER
SIGNS
CONVULSIONS
INABILITY TO DRINK
OR BREASTFEED
VOMITING
LETHARGY
UNCONSCIOUSNESS

19. Cough or difficult breathing
Ask:
– Cough, or
– Difficult breathing
(ask or look)
Look, listen, feel:
– General Danger Signs
– Breathing Rate
– Chest In-drawing
– Stridor
If the child is: The child has fast breathing if you
count:
2 months up to 12 months:
12 months up to 5 years:
50 breaths per minute or more
40 breaths per minute or more.

20. Classification of cough/difficult breathing
SIGNS CLASSIFY AS TREATMENT
(Urgent pre-referral treatments are in bold print)
• Any general danger
sign or
•Chest indrawing or
•Stridor in calm child
SEVERE
PNEUMONIA
OR VERY
SEVERE DISEASE
Give first dose of Cotrimoxazole*
Refer URGENTLY to hospital**
•Fast breathing PNEUMONIA Give Cotrimoxazole for 5 days
Soothe the throat and relieve the cough with a safe
remedy
Advise mother when to return immediately
Follow-up in 2 days
•No signs of
pneumonia or very
severe disease
NO
PNEUMONIA
COUGH
OR COLD
If coughing more than 21 days, refer for
assessment
Soothe the throat and relieve the cough with a
safe remedy
Advise mother when to return immediately.
Follow-up in 5 days if not improving

21. Assessment of Diarrhea
• Ask: - Duration?
- Blood in the stool?
• Look, Listen, Feel
• Sensorium (lethargic OR restless)
• Sunken Eyes (ask caretaker as well)
• Drinking (poorly OR eagerly)
• Skin Pinch (very slowly OR slowly OR immediately)

22. Classification of dehydration
Two of the following
signs:
Lethargic or
unconscious
Sunken eyes
Not able to drink or
drinking poorly
Skin pinch goes back
very slowly
SEVERE
DEHYDRATION
If child has no other severe classification:
- Give fluid for severe dehydration (Plan C).
OR
If child also has another severe classification:
Refer URGENTLY to hospital with mother giving frequent sips of
ORS on the way. Advise the mother to continue breastfeeding.
If child is 2 years or older, and there is cholera in your area, give
antibiotic for cholera
Two of the following
signs:
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back
slowly
SOME
DEHYDRATION
Give fluid, Zinc supplements and food for some dehydration (Plan B)
If Child also has a severe classification:
- Refer URGENTLY to hospital with mother giving frequent sips of
ORS on the way.
Advise the mother to continue breastfeeding.
Advise mother when to return immediately.
Follow-up in 5 days if not improving
If confirmed/suspected symptomatic HIV, follow-up in 2 days if not
improving
Not enough signs to
classify as some or
severe dehydration
NO
DEHYDRATION
Give fluid, Zinc supplements and food to treat diarrhoea at home (Plan A)
Advise mother when to return immediately.
Follow-up in 5 days if not improving.
If confirmed/suspected symptomatic HIV, follow-up in 2 days if not
improving

23. Persistent diarrhea and Dysentery
 Dehydration present SEVERE
PERSISTENT
DIARRHOEA
Treat dehydration before referral unless
the child has another severe
classification.
Give Vitamin A.
Refer to hospital.
 No dehydration PERSISTENT
DIARRHOEA
Advise the mother on feeding a child who
has PERSISTENT DIARRHOEA.
Give Vitamin A, therapeutic dose.
Advise mother when to return immediately.
Follow-up in 5 days.
 Blood in the stool DYSENTRY  Treat for 5 days with Cotrimoxazole.
 Advise mother when to return immediately.
 Follow-up in 2 days.

24. Fever
• Fever associated with malaria, is the main focus of
IMNCI Guidelines
• Important to determine the malaria risk based on
altitude, season & travel history
– In high risk areas, all children with febrile diseases
assumed to have malaria
– In low risk areas, only children with no other
diagnoses should be considered to have malaria
– In no risk areas, anti-malarials should not be used

25. Assessment of Fever
• ASK
– For how long has the child had fever?
– If more than 7 days, has fever been present
every day?
– Has the child had measles within the last 3
months?
• LOOK AND FEEL:
– Look or feel for stiff neck
– Look or feel for bulging fontanels (< 1year old)
– Look for runny nose
– Look for signs of MEASLES
• Generalized rash and one of these: cough,
runny nose, or red eyes

26. Any general dangers sign or
Stiff neck or
Bulging fontanels
VERY SEVERE
FEBRILE DISEASE
•Give Quinine for severe malaria (first dose).
•Give first does of Chloamphenicol.
•Treat the child to prevent low blood sugar.
•Give one dose of Paracetamol in clinic for high fever (38.50
C or above).
•Refer URGENTLY to hospital.
Positive blood film/RDT or
If blood film/RDT not available
Fever (by history or feels hot or temperature
37.50
C or above).
MALARIA Treat with Coartem
Give one dose of Paracetamol in clinic for high fever (38.50
C or above).
Advise mother when to return immediately.
Follow-up in 2 days if fever persists.
If fever is present every day for more than 7 days, refer for assessment.
Any general danger sign or
Stiff neck or
Bulging fontanels
VERY SEVERE
FEBRILE
DISEASE
•Give Quinine for severe malaria (first dose)
•Give first dose of Chloamphenicol
•Treat the child to prevent low blood sugar.
•Give one dose of Paracetamol in clinic for high fever (38.50
C or above)
•Refer URGENTLY to hospital
•Positive blood film/RDT or
•If blood film/RDT not available
•NO runny nose and
•NO measles and
•NO other causes of fever.
MALARIA Treat with Coartem.
Give one dose of Paracetamol in clinic for high fever (38.50
C or above)
Advise mother when to return immediately.
Follow-up in 2 days if fever persists.
If fever is present every day for more than 7 days, refer for assessment.
Blood film/RDT negative or
If blood film/RDT not available:
Runny nose PRESENT or
Measles PRESENT or
Other causes of fever PRESENT
FEVER
MALARIA
UNLIKELY
Give one dose Paracetamol in clinic for high fever (38.50
C or above)
Treat other obvious causes of fever
Advise mother when to return immediately
Follow-up in 2 days if fever persists.
If fever is present every day for more than 7 days, refer for assessment.
Any general danger sign or
Stiff neck or
Bulging fontanels
VERY SEVERE
FEBRILE
DISEASE
Give first dose of Chloamphenicol.
Treat child to prevent low blood sugar
Give one dose of Paracetamol for high fever (38.50
C or above)
Refer URGENTLY to hospital
Any fever FEVER
(NO MALARIA)
Give one dose of Paracetamol for high fever
(38.50
C or above)
Treat other obvious causes of fever
Follow-up in 2 days if fever persists
If fever is present every day for more than 7 days, refer for assessment
No Malaria
Risk
Low Malaria
Risk
High Malaria
Risk
Classify
FEVER

27. MEASLES
• If the child has measles now or within
the last 3 months:
–Look for mouth ulcers
• Are they deep and extensive?
–Look for pus draining from the eye.
–Look for clouding of the cornea.

28. Classification of measles
Any general danger
sign or
Clouding of cornea or
Deep or extensive
mouth ulcers
SEVERE
COMPLICATED
MEASLES
 Give Vitamin A, first dose
 Give first dose of Chloramphenicol
 If clouding of the cornea or pus draining from
the eye, apply Tetracycline eye ointment.
 Refer URGENTLY to hospital
Pus draining from the
eye, or
Mouth ulcers
MEASLES
WITH
EYE OR MOUTH
COMPLICATIONS
 Give Vitamin A, therapeutic dose
 If pus draining from the eye, treat eye
infection with Tetracycline eye ointment.
 If mouth ulcers, treat with gentian violet
 Advise mother when to return immediately
 Follow-up in 2 days
•Measles now or
within the last 3
months
MEASLES
 Give Vitamin A, therapeutic dose
 Advise mother when to return immediately

29. Assessm. & classification of Ear
problem
IF YES, ASK:
• Is there ear pain?
• Is there ear discharge?
- If yes, for how long?
LOOK AND FEEL:
• Look for pus draining from the ear
• Feel for tender swelling behind the
ear
 Tender swelling behind the ear MASTOIDITIS Give first dose of Cotrimoxazole
Give first dose of Paracetamol for pain
Refer URGENTLY to hospital
 Pus is seen draining from the ear and
discharge is reported for less than 14
days or
 Ear pain
ACUTE EAR
INFECTION
Give Cotrimoxazole for 5 days
Give Paracetamol for pain
Dry the ear by wicking
Follow-up in 5 days
 Pus seen draining from the ear and
discharge is reported for 14 days or more
CHRONIC EAR
INFECTION
Dry the ear by wicking
Treat with Topical Quinolone ear drops for 2 weeks
Follow-up in 5 days
 No ear pain and
 No pus seen draining from the ear
NO EAR
INFECTION
No additional treatment

30. Nutritional Status & Anemia
MALNUTRITION
 For all children
Look for edema of both feet & Determine weight for age
 For children up to six months - Look for visible severe wasting
 For children aged 6 months or more( Lt/Ht 65-110 cm)
- Determine if MUAC is less than 11.0 cm
 Assess appetite (if MUAC < 11.0 cm or edema of both feet & no
medical complications)
ANAEMIA - Look for palmar pallor, is it;
- Severe palmar pallor?
- Some palmar pallor?

31. • If age up to 6 months
- and visible severe wasting or
- edema of both feet
• If age 6 months and above &
- MUAC < 11 cm (Lt 65 - 110cm), or
edema of both feet
- and fail appetite test, or
has pneumonia/persistent
diarrhea/dysentery/measles...
SEVERE
COMPLICATED
MALNUTRITION
 Treat the child to prevent low blood sugar
 Give first dose of Vitamin A for all except for those with edema or
those who received a dose in the past 6 months
 Refer URGENTLY to hospital
• If age 6 months or above and
- MUAC < 11 cm (Lt = 65 -
110cm), or edema of both
feet
And
- pass appetite test, and
- no medical complications
SEVERE
UNCOMPLICATED
MALNUTRITION
 Refer to the Outpatient Treatment Program (OTP)
When OTP is not available, manage as follows:-
 Give RUTF (see page 70) and counsel the mother on how to feed a child
with RUTF, if available, or else refer to hospital
 Give first dose of Vitamin A (as above)
 Give amoxicillin for 7 days
 Give single dose of 5mg folic acid for those with anemia
 Give Mebendazole (if child aged one year or above),
 Advise the mother when to return immediately
 Follow-up in 7 days
• Very low weight for age
VERY LOW
WEIGHT
 Assess the child’s feeding and counsel the mother on feeding according to
the FOOD box on the COUNSEL THE MOTHER chart
- If feeding problem, follow-up in 5 days
 Advise mother when to return immediately.
 Follow-up in 30 days.
• Not very low weight for age and no
other signs
NOT VERY
LOW WEIGHT
 If child is less than 2 years old, assess the child’s feeding and counsel the
mother on feeding according to the FOOD box on the COUNSEL THE
MOTHER chart.
- If feeding problem, follow-up in 5 days
 Advise mother when to return immediately

32. Classification of Anemia
 Severe palmar pallor SEVERE
ANAEMIA
 Refer URGENTLY to hospital
 Some palmar pallor ANAEMIA  Assess the child’s feeding and counsel the
mother on feeding according to the FOOD box
on the COUNSEL THE MOTHER chart.
 Give iron
 Give oral antimalarial if high malaria risk.
 Give Mebendazole or Albendazole if child is 12
months or older and has not had a dose in the
previous 6 months.
 Advise mother when to return immediately.
 Follow-up in 14 days.
 No palmar pallor NO ANAEMIA  No additional treatment

33. Assessment for HIV infection
Check for HIV infection:
 If the mother or child has a positive HIV test or
 If the child has one or more of the following classifications now:
• Pneumonia or severe pneumonia
• Persistent diarrhoea or severe persistent diarrhoea
• Acute ear infection with discharge, or chronic ear infection
• Very low weight or severe malnutrition
NOTE OR ASK:
• Is the mother known to have a positive HIV test?
• Is the child known to have a positive HIV test?
• Does the child have PNEUMONIA or SEVERE
PNEUMONIA / VERY SEVERE DISEASE now?
• Does the child have PERSISTENT / SEVERE PERSISTENT
DIARRHOEA now?
• Does the child have EAR DISCHARGE now?
• Does the child have VERY LOW WEIGHT / SEVERE
MALNUTRITION?
LOOK AND FEEL:
• Oral thrush
• Bilateral Parotid
enlargement for 14 days or
more
• Enlarged lymph node in two
or more sites: neck, axilla,
or groin

34. Classification of HIV infection
Positive HIV antibody test in a child 18 months and
above, OR, Positive PCR test at any age AND
Two or more of the following HIV - related conditions:
 Pneumonia/Severe Pneumonia
Persistent diarrhoea/severe persistent diarrhoea
Ear discharge
Very low weight/Severe Malnutrition
Oral thrush
Enlarged palpable lymph nodes in two or more sites
Bilateral parotid enlargement for 14 days or more
CONFIRMED
SYMPTOMATIC
HIV
INFECTION
Give Cotrimoxazole Prophylaxis
Treat HIV-related conditions if present (eg., thrush)
Give multivitamin supplements
Assess the child's’ feeding and counsel as necessary
Counsel the mother about her own HIV status and
arrange counselling and testing if necessary
Advise the mother on home care
Refer for ARV
Positive HIV antibody test in a child 18 months and
above, OR, Positive PCR test at any age
AND
Less than two HIV- related conditions
CONFIRMED
HIV
INFECTION
Give Cotrimoxazole prophylaxis
Treat HIV-related conditions if present (eg., thrush)
Give multivitamin supplements
Assess child’s feeding and counsel as necessary
Advise the mother on home care
Counsel the mother about her own HIV status and arrange
counselling and testing if necessary
Refer for ARV
Positive HIV antibody test in a child under 18
months, OR, No HIV test result in a child
AND
 Two or more HIV-related conditions
SUSPECTED
SYMPTOMATIC
HIV
INFECTION
Give Cotrimoxazole prophylaxis
Treat HIV-related conditions if present (eg., thrush)
Give multivitamin supplements
Assess the child's’ feeding and counsel as necessary
Advise on benefits of HIV test and refer for VCT ( mother &child)
Advise the mother on home care
Follow up in 14 days
Positive HIV antibody test in a child under 18 months,
OR
Mother HIV Positive
POSSIBLE
HIV INFECTION
or
(HIV EXPOSED)
Give appropriate feeding advice
Treat HIV-related conditions if present (eg., thrush)
Give Cotrimoxazole Prophylaxis and test for HIV at 18 months (If
child still breastfed repeat HIV testing 3 months after stopping BF)
Assess child’s feeding and counsel as necessary
Follow-up in 14 days
Negative HIV test in mother or child AND not enough
signs to classify as suspected symptomatic HIV infn.
HIV INFECTION
UNLIKELY
Treat, counsel and follow-up existing infections
 Advise the mother about feeding and about her own health

35. Young Infants
(Birth up to 2 months)
IMNCI Case
MaNageMeNt steps

36. IMNCI assessment steps, age birth
up to 2 months
Young Infants
Birth Asphyxia
Prematurity and low birth weight
Possible serious bacterial infection & jaundice
Diarrhea
HIV Infection
Feeding Problem or Low Weight
Immunization Status
Assess other problems

37. Newborn care during first week (0-6
days)
• Essential Newborn Care at birth
– Drying/covering & Assm of breathing/color
– early skin-skin contact and BF
– Cord & eye Care; Vitamin K
• Assm & Management of Birth Asphyxia
• Assm & Management of Prematurity and LBW
– Feeding & Temperature Mx (Kangaroo Mother
Care)

38. CHECK FOR POSSIBLE BACTERIAL INFECTION AND JAUNDICE
LOOK, LISTEN, FEEL:
 Count RR and look for severe chest indrawing.
 Look and listen for grunting
 Look for feel for bulging fontanelle
 See if the infant is not feeding ;or is convulsing now
 Measure temperature (or feel for fever or low body
temp.)
 Look at the umbilicus & for skin pustules.
 Look at the young infant’s movements - Are they
less than normal?
 Look for Jaundice:
Are the palms and soles yellow?
Are skin on the face or eyes yellow?
ASK
 Has the infant had convulsions?
 Is the infant not feeding ?

39. Classification of Possible serious bacterial infection
SIGNS CLASSIFY AS IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print)
• Not feeding well or
• Convulsions/convulsing now or
• Fast breathing (60 breaths per minute or
more) or
• Severe chest indrawing or
• Grunting or
• Fever (37.5°C* or above or feels hot) or
• Low body temperature (less than
35.5°C* or feels cold) or
• Movement only when stimulated or no
movement even when stimulated.
POSSIBLE
SERIOUS
BACTERIAL
INFECTION
Or
VERY SEVERE
DISEASE
 Give first dose of intramuscular Ampicillin and
Gentamycin
 Treat to prevent low blood sugar
 Warm the young infant by skin-to-skin contact if
temperature is less than 36.5°C (or feels cold to
touch) while arranging referral
 Advise mother how to keep the young infant
warm on the way to the hospital
 Refer URGENTLY to hospital
• Red umbilicus or draining pus or
• Skin pustules
LOCAL
BACTERIAL
INFECTION
 Give Cotrimoxazole or Amoxycillin for 5 days
 Teach the mother to treat local infections at home
 Advise mother when to return immediately
 Follow-up in 2 days

40. Contd..
SIGNS CLASSIFY AS IDENTIFY TREATMENT
(Urgent pre-referral treatments are in bold print)
• Palms and/or soles yellow OR
• Age < 24 hrs OR
• Age 14 days or more
SEVERE
JAUNDICE
 Treat to prevent low blood sugar
 Warm the young infant by skin-to-skin
contact if temperature is less than 36.5°C
(or feels cold to touch) while arranging
referral
 Advise mother how to keep the young
infant warm on the way to the hospital
 Refer URGENTLY to hospital
• Only skin or eyes yellow
JAUNDICE
 Advise mother to give home care for the
young infant
 Advise mother when to return immediately
 Follow-up in 2 days

41. Diarrhea in Young infants
• Relatively rare compared to the older child
• Assessment, classification & management
the same to the sick child except
–The sign thirst not used in young infant
–All Bloody and persistent diarrheas
are referred to hospital for management

42. HIV Infection in Young InfantsHIV Infection in Young Infants
Signs Classify Treatment
• Positive PCR
test in the
young infant
CONFIRMED
HIV
INFECTION
• Give Cotrimoxazole Prophylaxis from 6 weeks of age
• Refer for ARV
• Assess feeding and counsel as necessary
• Advise the mother on home care
• Follow-up in 14 days
• Mother HIV
positive, OR
• Child has
positive HIV
antibody test
POSSIBLE
HIV
INFECTION
(HIV EXPOSED)
• Assess feeding and counsel as necessary
• Give Cotrimoxazole Prophylaxis from 6 weeks of age
• Confirm HIV status as soon as possible using PCR
• Follow-up in 14 days
• Negative HIV
test in mother or
child
HIV
INFECTION
UNLIKELY
• Treat, counsel and follow-up existing infections
• Advise the mother about feeding and about her own
health

43. Check for Feeding Problem or Low weight
SIGN CLASSIFY AS TREATMENT
If any of the following signs:
• Not well positioned or
• Not well attached to breast or
• Not suckling effectively or
• Less than 8 breastfeeds in 24 hours or
• Switching the breast frequently or
• Not increasing frequency of
breastfeeding during illness or
• Receives other foods or drinks or
• The mother not breastfeeding at all or
• Low weight for age or
• Thrush (ulcers or white patches in
mouth)
FEEDING
PROBLEM
OR
LOW WEIGHT
 Advise the mother to breastfeed as often and for as long
as the infant wants, day and night
• If not well attached or not suckling effectively, teach
correct positioning and attachment
• If breastfeeding less than 8 times in 24 hours, advise to
increase frequency of feeding
• Empty one breast completely before switching to the
other
• Increase frequency of feeding during and after illness
 If receiving other foods or drinks, counsel mother about
breastfeeding more, reducing other foods or drinks, and
using a cup
 If not breastfeeding at all:
- Refer for breastfeeding counseling and possible
relactation
- Advise about correctly preparing breastmilk substitutes
and using a cup
 If thrush, teach the mother to treat thrush at home
 Advise mother to give home care for the young infant
 Follow-up any feeding problem or thrush in 2 days
 Follow-up low weight for age in 14 days
Not low weight for age and no other signs of
inadequate feeding
NO FEEDING
PROBLEM
 Advise mother to give home care for the young infant
 Praise the mother for feeding the infant well

45. THANK
YOU