Chapter 2. Diagnostic approach to the sick child

The Pocket book is symptom-based in its approach, the symptoms following the sequence in the IMCI guidelines: cough, diarrhoea, and fever. 

The diagnoses also closely match the IMCI classifications, except that the expertise and investigative capacity in a hospital setting allow classifications such as ‘very severe disease’ or ‘very severe febrile disease’ to be defined more precisely, making possible such diagnoses as severe pneumonia, severe malaria, septicaemia and meningitis.

Classifications for conditions such as pneumonia and dehydration follow the same principles as in the IMCI.  Young infants (< 2 months) are considered separately (see Chapter 3), as in the IMCI approach.  Severely malnourished children are also considered separately (see Chapter 7), because they require special attention and treatment if their high mortality risk is to be reduced.

In hospital, the stages of management for any child are:

  • Emergency triage
  • Emergency treatment (if required)
  • Taking a history
  • Examination
  • Laboratory investigations (if required)
  • Making a diagnosis or a differential diagnosis
  • Treatment