WHO FHIR Implementation Guide (IG): Integrated Management of Childhood Illness (IMCI) in emergencies
0.1.0 - release International flag

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/feature/update-canonical and changes regularly. See the Directory of published versions
Built from commit 1051de42.   Branch: feature/update-canonical.

Questionnaire: Ccc.B18-21.Signs.2m.m

Branch:

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. Ccc.B18-21.Signs.2m.mQuestionnairehttps://smart.who.int/ccc/Questionnaire/Ccc.b18-21.signs.2m.m#0.1.0
... Fevernull0..1booleaniconiconiconiconValue Set:
.... Fever-helpThe client is reported to have or has had fever0..1displayValue Set:
.... Fever-instructionhelp0..1displayiconiconValue Set:
... zscorenull0..1decimaliconiconValue Set:
... AgeInMonthsAge in Month0..1integericoniconValue Set:
... AgeInDaysnull0..1integericoniconValue Set:
... Ccc.B20S1.DE01Diarrhoea0..1booleaniconiconiconiconValue Set:
... Ccc.A.DE31Biological Mother Vital Status0..1choiceiconiconValue Set:
Options: 3 options
... Ccc.B21S1.DE01Breastfed0..1booleaniconiconiconiconValue Set:
... Ccc.B18S1.DE02Difficulty with Feeding0..1choiceiconiconValue Set:
Options: 3 options
... YI_sever_but_dheyYI severe classification other than severe dehydration0..1booleaniconiconiconiconValue Set:
... YI_severYI severe classification0..1booleaniconiconiconiconValue Set:
... Ccc.B7.DE03Convulsion(s) in this Illness0..1booleaniconiconiconiconValue Set:
... Ccc.B22.RespiratoryRatenull0..1groupValue Set:
.... Ccc.B22.DE01Respiratory Rate (breaths per minute)1..1quantityValue Set:
..... Ccc.B22.DE01-help<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 infection0..1displayValue Set:
.... Ccc.B22.DE02null0..*choiceValue Set:
Options: 1 option
.... secondnull0..1groupValue Set:
..... Ccc.B22.DE04Respiratory Rate Second Count (breaths per minute)0..1quantityValue Set:
...... Ccc.B22.DE04-help<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 infection0..1displayValue Set:
..... Ccc.B22.DE05null0..*choiceValue Set:
Options: 1 option
.... Ccc.B22.DE07Fast Breathing0..1booleaniconiconiconiconValue Set:
..... Ccc.B22.DE07-helpThe 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 infection0..1displayValue Set:
... Ccc.B18S2.DE07Severe Chest Indrawing1..1booleaniconiconValue Set:
.... Ccc.B18S2.DE07-helpThe young infant must be calm while you assess for severe chest indrawing.  Lift the young infant’s shirt. </p> <p>Look for chest indrawing when the young infant breathes in. Lower chest wall indrawing is the inward movement of the bony structure of the chest wall <br /> when the child breathes in. Look at the lower chest wall (lower ribs). The child has chest indrawing if the lower chest wall goes IN when the child breathes IN.<br /> In normal breathing, the whole chest wall (upper and lower) and the abdomen move <span class="caps">OUT</span> when the child breathes IN. </p> <p>Mild chest indrawing is normal in a young infant because the chest wall is soft. Severe chest indrawing is very deep and easy to see.0..1displayValue Set:
... Ccc.B18S2.DE08Movements1..1choiceValue Set:
Options: 3 options
.... Ccc.B18S2.DE08-helpLook at the young infant’s movements. Does the young infant move on his/her own? Does the infant move only when stimulated but then stops? Does the infant not move at all?<br /> Young infants often sleep most of the time, and this is not a sign of illness. It is not necessary for the infant to be awake if he/she is moving spontaneously. <br /> If a young infant is not moving spontaneously and does not wake up during the assessment, ask the mother to wake him. An awake young infant will normally move his arms or legs or turn his head several times in a  minute if you watch him closely. If the infant is awake but has no spontaneous movements, gently stimulate the young infant. Stimulation  is a gentle, painless touching of the baby with enough pressure that would evoke movements, sound making and eye opening. The presence of any movement such as a grimace of the face, eye-opening or movement of a limb will qualify &#8220;Movement only when stimulated but then stops&#8221;.  An infant who cannot be woken up even after stimulation is considered to have the sign &#8220;Does not move even with stimulation. &#8220; 0..1displayValue Set:
... Ccc.B18S2.DE12Umbilicus Red or Pus Draining1..1booleaniconiconValue Set:
.... Ccc.B18S2.DE12-help&#8220;The umbilical cord usually separates one week after birth and the wound heals within 15 days. Redness of the end of the umbilicus or pus draining from the umbilicus are signs of umbilical infection.&#8221; 0..1displayValue Set:
... Ccc.B18S2.DE13Skin Pustules1..1booleaniconiconValue Set:
.... Ccc.B18S2.DE13-helpExamine the skin on the entire body. Skin pustules are red spots or blisters which contain pus.0..1displayValue Set:
... Ccc.B19S2.DE01Yellow Skin1..1booleaniconiconValue Set:
.... Ccc.B19S2.DE01-helpJaundice is a yellow discoloration of skin and mucus membranes. It is important to look for jaundice in natural light. To look for jaundice, press the infant’s skin over the forehead with your fingers to blanch, remove your fingers and look for yellow discolouration. If there is yellow discoloration, the infant has jaundice0..1displayValue Set:
... Ccc.B19S2.DE02Yellow Palms or Yellow Soles1..1booleaniconiconValue Set:
.... Ccc.B19S2.DE02-helpJaundice is a yellow discoloration of skin and mucus membranes. Jaundice in the palms of hands or soles of feet is a sign of Severe Jaundice.  It is important to look for jaundice in natural light. To assess for severe jaundice, press the infant&#8217;s skin in the palm of there hand and then in the sole of their feet with your fingers to blanch, remove your finders and look for yellow dicoulouration in the palm or the sole. If there is yellow discoloration of the palm or sole, the infant has severe jaundice.0..1displayValue Set:
... Ccc.B19S2.DE04When did the Jaundice first appear?0..1choiceValue Set:
Options: 3 options
.... Ccc.B19S2.DE04-helpAsk the caregiver when the baby&#8217;s skin first turned yellowish. If the caregiver didn&#8217;t notice the yellow discolouration or can&#8217;t remember when it started, select &#8220;don&#8217;t know&#8221;. <br /> Jaundice that appears in less than 24 hours after birth is always due to an underlying disease. These babies should be referred urgently. <br /> Many normal babies, particularly small babies, may have jaundice during the first week of life. This jaundice usually appears on the third or fourth day of life and is mild and disappears before the age of two to  three weeks. It does not need any treatment.0..1displayValue Set:
... Ccc.B11S2.DE01Sunken Eyes1..1booleaniconiconValue Set:
.... Ccc.B11S2.DE01-helpThe eyes of a dehydrated infant may look sunken. In a low-weight infant, the eyes may always look sunken, even if the young infant is not dehydrated. Even though the sign “sunken eyes” is less reliable in a low-weight infant, it can still be used to classify the young infant‘s dehydration. </p> <p>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 you confirm.0..1displayValue Set:
... Ccc.B11S2.DE02Skin pinch of Abdomen1..1choiceValue Set:
Options: 3 options
.... Ccc.B11S2.DE02-helpLocate the area on the infant’s abdomen halfway between the umbilicus and the side of the abdomen. To do the skin pinch, use your thumb and first finger. Do not use your fingertips because this will cause pain. Place <br /> your hand so that when you pinch the skin, the fold of skin will be in a line up and down the child’s body and not across the child’s <br /> body. Firmly pick up all of the layers of skin and the tissue under them. Pinch the skin for <br /> one second and then release it. When you release the skin, look to see if the skin pinch <br /> goes back:</p> <p>• very slowly (longer than 2 seconds)<br /> • slowly<br /> • immediately<br /> If the skin stays up for even a brief time after you release it, decide that the skin pinch goes back slowly0..1displayValue Set:
... Ccc.B11S2.DE06Restless and Irritable1..1booleaniconiconValue Set:
.... Ccc.B11S2.DE06-helpLook at the young infant&#8217;s general condition Is the infant restles and irritable? <br /> An infant has teh sign &#8220;restless and irritable&#8221; if the infant is restless and irritable all the time or every time he is touched and handled. If an infant is calm when breastfeeding but again <br /> restless and irritable when he stops breastfeeding, he has the sign “restless and irritable”. A healthy infant will be consoled when put on the breast.0..1displayValue Set:
... Ccc.B21S2.DE01Weight Status0..1stringiconiconValue Set:
.... Ccc.B21S2.DE01-helpWeight status is calculated based on the young infant&#8217;s weight for age Z-score, which is determined from a standardized chart for weight -for-age for the infant&#8217;s sex. <br /> A young infant is low weight for age if the z-score is below -2. <br /> A young infant who is less than 7 days old and weighs less than 2 kg is considered very low weight.<br /> Some young infants who are low weight for age were born with low birth weight. Some did not gain weight well after birth.0..1displayValue Set:
... Ccc.B21S2.DE05Breastfed how many times in 24 hours?1..1integerValue Set:
.... Ccc.B21S2.DE05-helpAsk the caregiver how many times in 24 hours (one day and one night) they usually breastfeed the young infant. The recommendation is that the young infant be breastfed as often and for as long as the <br /> infant wants, day and night. This should be 8 or more times in 24 hours.0..1displayValue Set:
... Ccc.B21S2.DE06Sufficient feeds0..1integericoniconValue Set:
... Ccc.B21S2.DE08Young Infant receives food or fluids other than breast milk1..1booleaniconiconValue Set:
.... Ccc.B21S2.DE08-helpFind out if the young infant is receiving any other foods or drinks such as other milk, juice, tea, thin porridge, dilute cereal, or even water. Ask how often he receives it and the amount. You need to know if the infant is mostly breastfed, or mostly fed on other foods0..1displayValue Set:
... Ccc.B21S2.DE09What milk is being given as a replacement feed?1..*choiceValue Set:
Options: 2 options
.... Ccc.B21S2.DE09-helpAsk the mother questions to determine what replacement milk or milks are used. It may be a breastmilk replacement, animal milk or some other fluid or some combination. Determine if this type of replacement feed is appropriate or not appropriate in your setting.0..1displayValue Set:
... Ccc.B21S2.DE12How many replacement feeds during the day and night (24 hours)?1..1integerValue Set:
.... Ccc.B21S2.DE12-helpA young infant up to one month of age should be fed 8 times and a young infant between 1 <br /> and 2 months of age should be fed 7 times in 24 hours.0..1displayValue Set:
... Ccc.B21S2.DE13Sufficient replacement feeds (in 24 hours)1..1booleaniconiconiconiconValue Set:
... Ccc.B21S2.DE15How much milk is given at each feed (ml)?1..1quantityValue Set:
.... Ccc.B21S2.DE15-helpA young infant up to one month of age should be given approximately 60 ml per feed, 8 times per day, and a young infant between 1 and 2 months of age approximately 90 ml at each feed, 7 times per day. It is helpful to have common bottles or cups available so that a mother can show you the amount that she gives.0..1displayValue Set:
... Ccc.B21S2.DE16Sufficient replacement feeds1..1booleaniconiconiconiconValue Set:
... Ccc.B21S2.DE18How is the milk prepared?1..1choiceValue Set:
Options: 2 options
.... Ccc.B21S2.DE18-helpLet mother demonstrate or explain how a feed is prepared and how she gives it to the infant. Determine if the breastmilk substitute is being prepared correctly and hygienically.0..1displayValue Set:
... Ccc.B21S2.DE21How is the milk given?1..1choiceValue Set:
Options: 2 options
... Ccc.B21S2.DE24How are the feeding utensils cleaned?1..1choiceValue Set:
Options: 2 options
.... Ccc.B21S2.DE24-helpAsk the caregiver how they clear the feeding utensils. Determine if this is a safe and hygienic cleaning method.0..1displayValue Set:
... Ccc.B21S2.DE27Do you give any breastmilk at all?1..1choiceValue Set:
Options: 2 options
... Ccc.B21S2.DE30Ulcers or White Patches in Mouth1..1booleaniconiconValue Set:
.... Ccc.B21S2.DE30-helpLook inside the mouth at the tongue and inside of the cheek. Thrush looks like milk curds on the inside of the cheek, or a thick white coating of the tongue. Try to wipe the white off. The white patches of thrush will remain.0..1displayValue Set:
... Ccc.B21S2.DE31null0..*choiceValue Set:
Options: 1 option
... Respiratory Rate profilenull0..1quantityiconiconValue Set:
... force-collectionnull0..1booleaniconiconiconiconValue Set:
... Respiratory Rate Second Count Profilenull0..1quantityiconiconValue Set:
... Fast Breathing profilenull0..1booleaniconiconiconiconValue Set:
... timestampnull0..1dateTimeiconiconValue Set:

doco Documentation for this format

Options Sets

Answer options for Ccc.A.DE31

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE46 ("Dead")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE34 ("Alive")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE33 ("Unknown")

Answer options for Ccc.B18S1.DE02

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE03 ("Not Able to Feed At All")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE04 ("Not Feeding Well")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE05 ("Feeding Well")

Answer options for Ccc.B22.DE02

  • null#Ccc.B22.DE02 ("Unable to perform Respiratory Rate at this time")

Answer options for Ccc.B22.DE05

  • null#Ccc.B22.DE05 ("Respiratory Rate Second Count Not Possible")

Answer options for Ccc.B18S2.DE08

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE11 ("Moves on his or her own or moves spontaneously or without stimulation")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE10 ("Movement only when stimulated but then stops")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE09 ("No movement at all")

Answer options for Ccc.B19S2.DE04

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE05 ("Within less than 24 hours of birth")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE06 ("24 hours or more after birth")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE07 ("Unknown when Jaundice first appeared")

Answer options for Ccc.B11S2.DE02

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE03 ("Skin Pinch goes back very slowly (More than 2 seconds)")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE04 ("Skin Pinch goes back slowly (2 seconds or fewer, but not immediately)")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE05 ("Skin Pinch goes back Normally (immediately)")

Answer options for Ccc.B21S2.DE09

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE11 ("Inappropriate replacement milk")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE10 ("Appropriate replacement milk")

Answer options for Ccc.B21S2.DE18

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE19 ("Correct and hygienic feed preparation")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE20 ("Incorrect or unhygienic feed preparation")

Answer options for Ccc.B21S2.DE21

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE22 ("Cup")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE23 ("Bottle")

Answer options for Ccc.B21S2.DE24

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE26 ("Feeding utensils not cleaned hygienically")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE25 ("Feeding utensils cleaned hygienically")

Answer options for Ccc.B21S2.DE27

  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE28 ("Breastmilk also given")
  • https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE29 ("No Breastmilk at all")

Answer options for Ccc.B21S2.DE31

  • null#Ccc.B21S2.DE31 ("Unable to check if Ulcers or White Patches in Mouth")