WHO FHIR Implementation Guide (IG): Integrated Management of Childhood Illness (IMCI) in emergencies
0.1.0 - release
WHO FHIR Implementation Guide (IG): Integrated Management of Childhood Illness (IMCI) in emergencies, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-emcare/tree/220/merge and changes regularly. See the Directory of published versions
Built from commit 2185a543. Branch: feature/rename.
Profile: SDCBaseQuestionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints![]() |
|---|---|---|---|---|---|
![]() | Questionnaire | https://smart.who.int/ccc/Questionnaire/Ccc.b10-16.signs.2m.p#0.1.0 | |||
![]() ![]() | null | 0..1 | boolean | Value Set: | |
![]() ![]() | Age | 0..1 | integer | Value Set: | |
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![]() ![]() | null | 0..1 | choice | Value Set: | |
![]() ![]() | null | 0..1 | boolean | Value Set: | |
![]() ![]() | null | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Respiratory Rate (breaths per minute) | 1..1 | quantity | Value Set: | |
![]() ![]() ![]() ![]() | <b>Count the number of breaths the child takes per minute</b> to determine if fast breathing is present.<br /> It is <b>very important that the child is calm</b> and still. If the child is moving or crying, you will not be able to get an accurate count of breaths. <br /> <b>To count the breaths per minute,</b> use a watch with a second hand or a digital watch. Look for the breathing movement anywhere on the child’s chest or abdomen. <br /> The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b></p> <ul> <li>Under 2 months: More than 60 breaths per minute*</li> <li>2 to 11 months: More than 50 breaths per minute</li> <li>12 to 59 months: More than 40 breaths per minute</li> </ul> <p>*In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display | Value Set: | |
![]() ![]() ![]() | null | 0..* | choice | Value Set: Options: 1 option | |
![]() ![]() ![]() | null | 0..1 | group | Value Set: | |
![]() ![]() ![]() ![]() | Respiratory Rate Second Count (breaths per minute) | 0..1 | quantity | Value Set: | |
![]() ![]() ![]() ![]() ![]() | <b>Count the number of breaths the child takes per minute</b> to determine if fast breathing is present.<br /> It is <b>very important that the child is calm</b> and still. If the child is moving or crying, you will not be able to get an accurate count of breaths. <br /> <b>To count the breaths per minute,</b> use a watch with a second hand or a digital watch. Look for the breathing movement anywhere on the child’s chest or abdomen. <br /> The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b></p> <ul> <li>Under 2 months: More than 60 breaths per minute*</li> <li>2 to 11 months: More than 50 breaths per minute</li> <li>12 to 59 months: More than 40 breaths per minute</li> </ul> <p>*In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display | Value Set: | |
![]() ![]() ![]() ![]() | null | 0..* | choice | Value Set: Options: 1 option | |
![]() ![]() ![]() | Fast Breathing | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() ![]() | The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b> * Under 2 months: More than 60 breaths per minute* * 2 to 11 months: More than 50 breaths per minute * 12 to 59 months: More than 40 breaths per minute *In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display | Value Set: | |
![]() ![]() | Chest Indrawing | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b><span class="caps">NORMAL</span>:</b> When child breaths <b>IN,</b> chest wall moves <b><span class="caps">OUT</span></b><br /> <b><span class="caps">CHEST</span> <span class="caps">INDRAWING</span>:</b> When child breaths <b>IN,</b> chest wall moves <b>IN</b></p> <p>Chest indrawing occurs when the child needs to make a greater effort than normal to breathe in. <b>You will look for chest indrawing when the child breathes IN.</b></p> <p>In normal breathing, the whole chest wall (upper and lower) and the abdomen move <span class="caps">OUT</span> when the child breathes IN. <b>The child has chest indrawing if the lower chest wall (lower ribs) goes IN when the child breathes IN.</b> | 0..1 | display | Value Set: | |
![]() ![]() | Stridor in a calm child | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b>Stridor is a harsh noise made when a child breathes IN.</b><br /> Put your ear near the child’s mouth because stridor can be difficult to hear. Sometimes you will hear a wet noise if the child’s nose is blocked. Clear the nose, and listen again.</p> <p><b>Be sure to look and listen for stridor when the child is calm.</b><br /> A child who is not very ill may have stridor only when he is crying or upset. However, a child who is calm and also has stridor has a dangerous situation. | 0..1 | display | Value Set: | |
![]() ![]() | Wheezing | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b>Wheeze is a high-pitched whistling or musical sound heard at the end of the breathing <span class="caps">OUT</span>.</b> The child’s small air passages narrow to cause wheezing.<br /> <b>To hear wheezing,</b> put your ear near to the child’s mouth when the child is calm. Look at the child’s breathing while you listen to check that the sound mainly occurs when the child breathes out | 0..1 | display | Value Set: | |
![]() ![]() | Recurrent Wheeze | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Recurrent wheezing can be a sign of asthma, tuberculosis or other important health problems which require further assessment | 0..1 | display | Value Set: | |
![]() ![]() | null | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Oxygen Saturation | 0..1 | quantity | Value Set: | |
![]() ![]() ![]() ![]() | If pulse oximeter is available, determine oxygen saturation (SpO2). <br /> After turning on, position the appropriate probe based on the child’s size. If using on a finger or toe, make sure the area is clean and without nail varnish. <b>Ensure that a good (even) pulse signal (waveform) is displayed before taking the reading.</b> If uncertain that the probe is working, check by testing on your own finger. <br /> <b>Normal oxygen saturation at sea level is 95 – 100%. Oxygen should be given if saturation drops to less than 90%,</b> and may be needed for children with severe illness if SpO2 less than 94%. Different cut-offs may be used at high altitude. | 0..1 | display | Value Set: | |
![]() ![]() ![]() | Oxygen Saturation < 90 % | 0..1 | display | Value Set: | |
![]() ![]() ![]() ![]() | Check that the value you have entered is correct. Children with oxygen saturation less than 90% need oxygen if available and urgent referral. | 0..1 | display | Value Set: | |
![]() ![]() ![]() | null | 0..* | choice | Value Set: Options: 1 option | |
![]() ![]() | Sunken eyes | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b>The eyes of a child who is dehydrated may look sunken.</b> Decide if you think the eyes are sunken. Then ask the mother if she thinks her child’s eyes look unusual. Her opinion can help<br /> you confirm.<br /> NOTE: In a severely malnourished child who is wasted, the eyes may always look sunken, even if the child is not dehydrated. Still use the sign to classify dehydration. | 0..1 | display | Value Set: | |
![]() ![]() | Skin pinch of Abdomen | 1..1 | choice | Value Set: Options: 3 options | |
![]() ![]() ![]() | To assess dehydration using the skin pinch<br /> 1. <b><span class="caps">ASK</span></b> the mother to place the child on the examining table so that the child is flat on his back with his arms at his sides (not over his head) and his legs straight. Or, ask the mother to hold the child so he is lying flat on her lap.<br /> 2. <b><span class="caps">USE</span> <span class="caps">YOUR</span> <span class="caps">THUMB</span> <span class="caps">AND</span> <span class="caps">FIRST</span> <span class="caps">FINGER</span></b> to locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. Do not use your fingertips because this will cause pain. The fold of the skin should be in a line up and down the child’s body.<br /> 3. <b><span class="caps">PICK</span> UP</b> all the layers of skin and the tissue underneath them.<br /> 4. <b><span class="caps">HOLD</span></b> the pinch for one second. Then release it.<br /> 5.. <b><span class="caps">LOOK</span></b> to see if the skin pinch goes back <b>very slowly</b> (more than 2 seconds), <b>slowly,</b> (less than 2 seconds, but not immediately), or <b>immediately.</b> If the skin stays up for even a brief time after you release it, decide that the skin pinch goes back slowly. | 0..1 | display | Value Set: | |
![]() ![]() | Restless and Irritable | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | A child is classified as restless and irritable if s/he is restless and irritable all the time or every time s/he is touched and handled. If an infant or child is calm when breastfeeding but again restless and irritable when he stops breastfeeding, s/he has the sign restless and irritable. Many children are upset just because they are in the clinic. Usually these children can be consoled and calmed, and do not have this sign. | 0..1 | display | Value Set: | |
![]() ![]() | Throat problem | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | Look to see if the child has a throat problem. <br /> - Red (congested) throat indicates inflammation and may be sign of infection<br /> - Exudate may be seen as white / yellow mucus on the tonsils or throat<br /> - A membrane is a thick grey coating on the throat is a sign of diptheria, requiring urgent referral | 0..1 | display | Value Set: | |
![]() ![]() | Specify Throat problem | 1..1 | choice | Value Set: Options: 4 options | |
![]() ![]() ![]() | Look to see if the child has a throat problem. <br /> - Red (congested) throat indicates inflammation and may be sign of infection<br /> - Exudate may be seen as white / yellow mucus on the tonsils or throat<br /> - A membrane is a thick grey coating on the throat is a sign of diptheria, requiring urgent referral | 0..1 | display | Value Set: | |
![]() ![]() | Enlarged lymph nodes on front of neck | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | Lymph nodes can be considered enlarged if 1cm or more in diameter (about the width of the tip of an adult index finger) | 0..1 | display | Value Set: | |
![]() ![]() | Ability to swallow | 1..1 | choice | Value Set: Options: 3 options | |
![]() ![]() | Tender swelling behind the ear | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b>If both tenderness and swelling are present, the child may have mastoiditis, a deep infection in the mastoid bone.</b> Feel behind both ears. Compare them and decide if there is tender swelling of the mastoid bone. In infants, the swelling may be above the ear. Do not confuse this swelling of the bone with swollen lymph nodes. | 0..1 | display | Value Set: | |
![]() ![]() | Pus Seen Draining from the Ear | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | Look inside the child’s ear to see if pus is draining. That is a sign of infection, even if the child is not feeling any pain. Draining pus is a sign of infection | 0..1 | display | Value Set: | |
![]() ![]() | Pus Seen Draining from the Ear for how long? | 1..1 | choice | Value Set: Options: 2 options | |
![]() ![]() | Stiff neck | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | <b>A stiff neck may be a sign of meningitis, cerebral malaria or another very severe febrile disease. It requires urgent treatment with injectable antibiotics and referral to a hospital.</b><br /> <b><span class="caps">WATCH</span> <span class="caps">THE</span> <span class="caps">CHILD</span>:</b> While you talk with the caregiver during the assessment, look to see if the child moves and bends his or her neck easily when looking around. If the child is moving and bending his or her neck, the child does not have a stiff neck.<br /> <b><span class="caps">TEST</span> <span class="caps">THE</span> <span class="caps">CHILD</span>:</b> If you did not see any movement, or if you are not sure, draw the child’s attention to his or her umbilicus or toes. For example, you can shine a flashlight on the toes or umbilicus or tickle the toes to encourage the child to look down. Look to see if the child can bend his or her neck when looking down at his or her umbilicus or toe<br /> <b><span class="caps">FEEL</span> <span class="caps">FOR</span> <span class="caps">STIFF</span> <span class="caps">NECK</span>:</b> If you still have not seen the child bend his or her neck himself, ask the caregiver to help you lay the child on his or her back. Lean over the child, gently support the child’s back and shoulders with one hand. With the other hand, hold the child’s head. Then carefully bend the head forward towards the child’s chest. If the neck bends easily, the child does not have stiff neck. If the neck feels stiff and there is resistance to bending, the child has a stiff neck. Often a child with a stiff neck will cry when you try to bend the neck. | 0..1 | display | Value Set: | |
![]() ![]() | Runny nose | 1..1 | boolean | Value Set: | |
![]() ![]() | Red eyes | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | The child has “red eyes” if there is redness in the white part of the eye. In a healthy eye, the white part of the eye is clearly white and not discoloured. | 0..1 | display | Value Set: | |
![]() ![]() | Pus Draining from Eye | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | Pus draining from the eye is a sign of conjunctivitis. Conjunctivitis is an infection of the conjunctiva, the inside surface of the eyelid and the white part of the eye.<br /> <b>If you do not see pus draining from the eye, look for pus on the conjunctiva or on the eyelids.</b> Often the pus forms a crust when the child is sleeping and seals the eye shut. You can gently open the eye, making sure that your hands are clean.<br /> Wash your hands after examining the eye of any child with pus draining from the eye. | 0..1 | display | Value Set: | |
![]() ![]() | Clouding of the Cornea | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | The cornea is usually clear. When clouding of the cornea is present, the cornea <b>may appear clouded or hazy.</b> The cornea may look the way a glass of water looks when you add a small amount of milk. <b>The clouding may occur in one or both eyes.</b><br /> A child with corneal clouding may keep his or her eyes tightly shut when exposed to light. The light may cause irritation and pain to the child’s eyes. To check the child’s eye, wait for the child to open his or her eye. Or gently pull down the lower eyelid to look for clouding.<br /> <b>Corneal clouding is a dangerous condition.</b> It may be the result of vitamin A deficiency that has been made worse by measles. If the corneal clouding is not treated, the cornea can ulcerate and cause blindness. A child with clouding of the cornea needs urgent treatment with vitamin A. | 0..1 | display | Value Set: | |
![]() ![]() | Is Clouding of the Cornea a new problem | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | If there is clouding of the cornea, ask the caregiver how long the cloudinghas been present. If the caregiver is certain that clouding has been there for some time, ask if the clouding has already been assessed and treated at the hospital. If it has, you do not need to refer this child again for corneal clouding. | 0..1 | display | Value Set: | |
![]() ![]() | Has Clouding of the Cornea previously been treated | 0..1 | boolean | Value Set: | |
![]() ![]() | Generalised or Localised Skin Problem | 1..* | choice | Value Set: Options: 3 options | |
![]() ![]() | Measles Rash | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | In measles, <b>a rash begins behind the ears and on the neck. It spreads to the face.</b> During the next day, the rash spreads to the rest of the body, arms and legs. After 4 to 5 days, the rash starts to fade and the skin may peel.</p> <p>Some children with severe infection may have more rash spread over more of the body. The rash becomes more discoloured (dark brown or blackish), and there is more peeling of the skin. A measles rash does not have vesicles (blisters) or pustules. The rash does not itch.</p> <p>Do not confuse measles with other common childhood rashes such as chicken pox, scabies, or heat rash. Chicken pox rash is a generalized rash with vesicles. Scabies occurs on the hands, feet, ankles, elbows, buttocks and axilla (underarm). It also itches. Heat rash can be a generalized rash with small bumps and vesicles, which itch. A child with heat rash is not sick. | 0..1 | display | Value Set: | |
![]() ![]() | Measles within the last 3 months | 1..1 | boolean | Value Set: | |
![]() ![]() ![]() | Ask the caregiver or check the child’s health record to see if they have had measles in the last 3 months. If the caregiver is not sure, explain the symptoms (a generalised rash all over the body, starting from behind the ears and on the neck, spreading to the face, then the body, arms and legs, accompanied by runny nose, red eyes or cough). | 0..1 | display | Value Set: | |
![]() ![]() | Blisters, Sores or Pustules | 1..1 | boolean | Value Set: | |
![]() ![]() | Type of Skin Problem | 0..* | choice | Value Set: Options: 13 options | |
![]() ![]() | Scalp Infection (tinea capitis) | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Scalp lesions may result in loss of hair | 0..1 | display | Value Set: | |
![]() ![]() | Severe rash | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Severe rash indicates that the child needs referral due to risk of complications. | 0..1 | display | Value Set: | |
![]() ![]() | Disseminated Herpes Zoster | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Disseminated herpes zoster means that the rash is affecting more than one area of the body | 0..1 | display | Value Set: | |
![]() ![]() | Eye Involvement | 0..1 | boolean | Value Set: | |
![]() ![]() | Skin Infection extends to Muscle | 0..1 | boolean | Value Set: | |
![]() ![]() | Extensive impetigo lesions | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Impetigo can be considered as extensive if it is greater than 4cm in diameter | 0..1 | display | Value Set: | |
![]() ![]() | Extensive molluscum lesions | 0..1 | boolean | Value Set: | |
![]() ![]() ![]() | Molluscum Contagiosum – Skin coloured pearly white papules with central umbilication. Most commonly seen on face and trunk in children. | 0..1 | display | Value Set: | |
![]() ![]() | Molluscum lesions close to the eye | 0..1 | boolean | Value Set: | |
![]() ![]() | Extensive warts | 0..1 | boolean | Value Set: | |
![]() ![]() | Severe Seborrhoeic Dermatitis | 0..1 | boolean | Value Set: | |
![]() ![]() | Secondary bacterial infection of eczema | 0..1 | boolean | Value Set: | |
![]() ![]() | Severe acute moist or weeping eczema | 0..1 | boolean | Value Set: | |
![]() ![]() | Secondary herpes infection of eczema (eczema herpeticum) | 0..1 | boolean | Value Set: | |
![]() ![]() | Oral sores or Mouth Ulcers | 1..1 | choice | Value Set: Options: 4 options | |
![]() ![]() ![]() | Ulcers are painful open sores on the inside of the mouth and lips or the tongue. They may be red or have white coating. | 0..1 | display | Value Set: | |
![]() ![]() | Add a Skin or Mouth or Eye Problem | 0..* | choice | Value Set: Options: 4 options | |
![]() ![]() | Palmar Pallor | 1..1 | choice | Value Set: Options: 3 options | |
![]() ![]() ![]() | <span class="caps">LOOK</span> at the skin of the child’s palm. Hold the child’s palm open by grasping it gently from the side. Do not stretch the fingers backwards. This may cause pallor by blocking the blood supply. Compare the colour of the child’s palm with your own palm and with the palms of other children. The child has some palmar pallor if the skin of the child’s palm is pale. The child has severe palmar pallor if the skin of the palm is very pale or so pale that it looks white. | 0..1 | display | Value Set: | |
![]() ![]() | Mucous membrane pallor | 1..1 | choice | Value Set: Options: 3 options | |
![]() ![]() | null | 0..1 | quantity | Value Set: | |
![]() ![]() | null | 0..1 | boolean | Value Set: | |
![]() ![]() | null | 0..1 | quantity | Value Set: | |
![]() ![]() | null | 0..1 | boolean | Value Set: | |
![]() ![]() | null | 0..1 | dateTime | Value Set: | |
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