IMNCI ALL COLOR CODES

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IMNCI color codes classification pink yellow green all conditions

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https://nhmmizoram.org/upload/IMNCI%20Participants%20Module%…

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https://moh.gov.bt/wp-content/uploads/2026/01/Final-B5_IMNCI…

Finding Sources

Here is the complete IMNCI color-coding system - covering both age groups (young infants 0-2 months and children 2 months to 5 years):

IMNCI Color Code Classification System

IMNCI uses 3 colors to classify illness severity and guide management. The color determines the action, not just the diagnosis.

🔴 PINK - Urgent Referral (Severe/Life-Threatening)

Pink = Refer to hospital URGENTLY after giving pre-referral treatment.

Children 2 months to 5 years:

Problem Area	Pink Classification
General Danger Signs / Cough	Severe Pneumonia or Very Severe Disease
Diarrhea	Severe Dehydration
Diarrhea	Severe Persistent Diarrhea
Dysentery	Severe Dysentery (if referred back from hospital)
Fever (Malaria risk area)	Severe Febrile Disease (with danger signs or stiff neck)
Fever (No malaria risk)	Severe Febrile Disease
Measles	Severe Complicated Measles (danger signs or clouding of cornea)
Ear	Mastoiditis
Malnutrition	Severe Acute Malnutrition (MUAC < 11.5 cm / visible severe wasting / edema)
Anemia	Severe Anemia (severe palmar pallor)

Young Infants (0-2 months):

Problem Area	Pink Classification
Bacterial Infection	Possible Serious Bacterial Infection (PSBI)
Jaundice	Severe Jaundice
Diarrhea	Severe Dehydration

🟡 YELLOW - Treat at Facility / Outpatient Treatment

Yellow = Treat with medicines at outpatient level; give oral drugs + counsel caregiver.

Children 2 months to 5 years:

Problem Area	Yellow Classification
Cough / Breathing	Pneumonia (fast breathing, no chest indrawing, no danger signs)
Diarrhea	Some Dehydration
Diarrhea	Persistent Diarrhea (14+ days, no dehydration)
Dysentery	Dysentery
Fever (Malaria risk)	Malaria (positive RDT, no danger signs)
Fever (No malaria risk)	Fever (no danger signs, no stiff neck)
Fever (Malaria risk)	Fever: No Malaria (negative RDT but fever present)
Measles	Measles with Eye or Mouth Complications
Ear	Acute Ear Infection
Ear	Chronic Ear Infection
Malnutrition	Moderate Acute Malnutrition (MUAC 11.5-12.5 cm)
Anemia	Anemia (some palmar pallor)
Feeding/Weight	Low Weight for Age
Feeding/Weight	Feeding Problem
HIV	Symptomatic HIV Infection
TB	Possible TB

Young Infants (0-2 months):

Problem Area	Yellow Classification
Bacterial Infection	Local Bacterial Infection (skin/eye/navel infection)
Jaundice	Jaundice (jaundice present but not severe)
Diarrhea	Some Dehydration
Feeding	Feeding Problem or Low Weight

🟢 GREEN - Home Management (No Medicines Needed)

Green = Counsel mother on home care only; no medications required.

Children 2 months to 5 years:

Problem Area	Green Classification
Cough / Breathing	No Pneumonia: Cough or Cold
Diarrhea	No Dehydration
Fever (Malaria risk)	Malaria Unlikely (negative RDT, low risk)
Fever (No malaria risk)	Fever (managed at home if no danger signs - per local protocol)
Measles	Measles (uncomplicated - no eye/mouth complications)
Ear	No Ear Problem
Malnutrition	No Acute Malnutrition (MUAC ≥ 12.5 cm, no edema)
Feeding/Weight	Normal Weight / No Feeding Problem

Young Infants (0-2 months):

Problem Area	Green Classification
Bacterial Infection	Infection Unlikely (no signs of bacterial infection)
Jaundice	No Jaundice
Diarrhea	No Dehydration
Feeding	No Feeding Problem

Summary Memory Aid

Color	Action	Severity
🔴 Pink	Refer urgently to hospital (with pre-referral Rx)	Severe / Life-threatening
🟡 Yellow	Treat with oral medicines at outpatient level	Moderate
🟢 Green	Home care, counsel mother, no medicines	Mild / Normal

Key Points to Remember

General Danger Signs (any one = Pink): Cannot drink/breastfeed, vomits everything, lethargic/unconscious, convulsions
A child can have multiple classifications simultaneously (e.g., Pneumonia + Some Dehydration)
The most severe classification drives the referral decision
MUAC tape uses red (<11.5 cm), yellow (11.5-12.5 cm), green (>12.5 cm) - note these colors are for the MUAC tape only, not the IMNCI chart colors
Young infant classifications use the same 3-color system but different conditions (PSBI vs. Severe Pneumonia, etc.)
Pre-referral treatments for pink cases include: first dose of appropriate antibiotic, vitamin A (for measles), ORS, treating hypoglycemia, keeping warm

With all medication

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IMNCI all classifications medications doses treatment pink yellow green complete

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https://jknhm.jk.gov.in/zip/IMNCI%20%20Students'%20Handbook.…

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IMNCI drug doses amoxicillin cotrimoxazole ORS zinc antimalarial vitamin A pre-referral treatment India 2023

Diarrhoea color coding

Here is the complete IMNCI Diarrhoea Color Coding with all classifications, signs, and medications:

IMNCI - Diarrhoea Classification (2 months to 5 years)

🔴 PINK - Severe Dehydration

Signs (TWO or more of):

Lethargic or unconscious
Sunken eyes
Not able to drink / drinks poorly
Skin pinch goes back very slowly (>2 seconds)

Treatment:

Drug/Action	Details
ORS Plan C	Give IV fluids immediately (Ringer's Lactate or Normal Saline)
IV Fluids - Age < 12 months	30 ml/kg in 1 hour FAST, then 70 ml/kg in 5 hours
IV Fluids - Age ≥ 12 months	30 ml/kg in 30 min FAST, then 70 ml/kg in 2.5 hours
If IV not possible	ORS by NGT - 20 ml/kg/hour for 6 hours
Zinc	20 mg/day x 14 days (10 mg/day if < 6 months)
Reassess every 1-2 hours	If not improving, give IV faster
Refer	After initiating IV/ORS, refer urgently to hospital

🔴 PINK - Severe Persistent Diarrhoea

Signs:

Diarrhoea ≥ 14 days duration
With dehydration (any sign)

Treatment:

Drug/Action	Details
Treat dehydration first	As per severity (Plan B or C)
Zinc	20 mg/day x 14 days
Refer	To hospital for nutritional assessment and management
No routine antibiotics	Unless specific infection identified

🟡 YELLOW - Some Dehydration

Signs (TWO or more of):

Restless / irritable
Sunken eyes
Drinks eagerly / thirsty
Skin pinch goes back slowly (1-2 seconds)

Treatment (ORS Plan B):

Drug/Action	Details
ORS Plan B	Give 75 ml/kg ORS over 4 hours in clinic
ORS amount	Age 2m-4m: 200-400 ml; 4m-12m: 400-600 ml; 1-2yr: 600-800 ml; 2-5yr: 800-1200 ml
Zinc	< 6 months: 10 mg/day x 14 days
Zinc	≥ 6 months: 20 mg/day x 14 days
Continue breastfeeding	Throughout rehydration
Reassess after 4 hours	Reclassify and select treatment plan
Return if worsening	Cannot drink, blood in stool, high fever

🟡 YELLOW - Persistent Diarrhoea

Signs:

Diarrhoea ≥ 14 days duration
No dehydration

Treatment:

Drug/Action	Details
Zinc	20 mg/day x 14 days
Feeding advice	Avoid lactose (give yoghurt), small frequent feeds
Refer	For nutritional counseling and follow-up in 5 days
No routine antibiotics	Unless bloody stool

🟡 YELLOW - Dysentery

Signs:

Blood in stool (visible)

Treatment:

Drug/Action	Details
Ciprofloxacin	15 mg/kg/dose twice daily x 3 days (1st line)
OR Cotrimoxazole	4 mg/kg TMP twice daily x 5 days (if Ciprofloxacin not available)
Zinc	20 mg/day x 14 days
ORS	Continue for any dehydration
Follow up in 2 days	If not improving, refer
Metronidazole	If amoebic dysentery suspected: 10 mg/kg TDS x 5 days

🟢 GREEN - No Dehydration

Signs:

Not enough signs to classify as some or severe dehydration
Alert, drinking normally, no sunken eyes
Skin pinch goes back immediately

Treatment (ORS Plan A - Home):

Drug/Action	Details
ORS Plan A	Give extra fluids at home after each loose stool
< 2 years:	50-100 ml ORS after each stool
≥ 2 years:	100-200 ml ORS after each stool
Zinc	20 mg/day x 14 days (10 mg/day if < 6 months)
Continue feeding	Continue breastfeeding and normal food
When to return	Cannot drink, blood in stool, worsens, fever develops

Quick Memory Table

Color	Classification	Key Sign	ORS Plan	Zinc	Action
🔴 Pink	Severe Dehydration	Lethargic + very slow skin pinch	Plan C (IV)	14 days	Refer urgently
🔴 Pink	Severe Persistent Diarrhoea	≥ 14 days + dehydration	Plan B/C	14 days	Refer
🟡 Yellow	Some Dehydration	Restless + slow skin pinch	Plan B (ORS 4h)	14 days	Treat at clinic
🟡 Yellow	Persistent Diarrhoea	≥ 14 days, no dehydration	Plan A	14 days	Advise + follow up
🟡 Yellow	Dysentery	Blood in stool	Plan A/B	14 days	Ciprofloxacin 3 days
🟢 Green	No Dehydration	Alert, drinks normally	Plan A (home)	14 days	Counsel at home

Key Rules to Remember

Zinc is given in ALL diarrhoea classifications regardless of color - it reduces duration and severity
ORS Plan A = Home treatment after each stool
ORS Plan B = 75 ml/kg over 4 hours at clinic
ORS Plan C = IV Ringer's Lactate (urgent)
Antibiotics only for dysentery - not routine watery diarrhoea
Persistent diarrhoea = ≥ 14 days; severe if with dehydration (Pink), non-severe if no dehydration (Yellow)
Skin pinch test: Very slow (>2 sec) = severe; Slow (1-2 sec) = some; Immediate = no dehydration

With symptoms table

Here is the complete IMNCI Diarrhoea color coding with a full symptoms assessment table:

IMNCI Diarrhoea - Complete Symptoms + Classification + Treatment Table

STEP 1: ASSESS - Ask & Look for Signs

First ask: "Does the child have diarrhoea?" If YES, ask:

How long? (≥14 days = persistent)
Is there blood in the stool? (= dysentery)

STEP 2: CLASSIFY DEHYDRATION - Signs Table

Clinical Sign	No Dehydration 🟢	Some Dehydration 🟡	Severe Dehydration 🔴
General condition	Well, alert	Restless, irritable	Lethargic or unconscious
Eyes	Normal	Sunken	Very sunken and dry
Tears	Present	Absent	Absent
Mouth & tongue	Moist	Dry	Very dry
Thirst / Drinking	Drinks normally, not thirsty	Thirsty, drinks eagerly	Drinks poorly or not able to drink
Skin pinch	Goes back immediately	Goes back slowly (< 2 sec)	Goes back very slowly (≥ 2 sec)
Pulse	Normal	Rapid, weak	Very rapid, weak or absent
Urine output	Normal	Reduced	Minimal / none (dry nappies)
Fontanelle (infants)	Normal/flat	Slightly sunken	Very sunken
Breathing	Normal	Normal to slightly fast	Deep, acidotic breathing
How many signs needed	Not enough for Some/Severe	2 or more of above	2 or more of above

STEP 3: FULL CLASSIFICATION TABLE

A. DEHYDRATION CLASSIFICATION

Feature	🟢 GREEN	🟡 YELLOW	🔴 PINK
Classification	No Dehydration	Some Dehydration	Severe Dehydration
General condition	Alert, well	Restless / irritable	Lethargic / unconscious
Eyes	Normal	Sunken	Very sunken
Drinking	Normal	Drinks eagerly (thirsty)	Cannot drink / drinks poorly
Skin pinch	Returns immediately	Returns slowly	Returns very slowly (≥2 sec)
ORS Plan	Plan A (home)	Plan B (75 ml/kg/4h)	Plan C (IV Ringer's Lactate)
Zinc dose	10 mg (< 6 mo) / 20 mg (≥ 6 mo) daily x 14 days	Same	Same
Antibiotic	None	None	None (unless dysentery)
Where treated	Home	OPD / Clinic	Hospital (refer urgently)
Follow up	Return if worsens	Reassess after 4 hours	Reassess every 1-2 hours

B. DURATION-BASED CLASSIFICATION (if diarrhoea ≥ 14 days)

Feature	🟡 YELLOW	🔴 PINK
Classification	Persistent Diarrhoea	Severe Persistent Diarrhoea
Duration	≥ 14 days	≥ 14 days
Dehydration	No dehydration	With dehydration (any sign)
General condition	Child may look reasonably well	Unwell, signs of dehydration present
Weight	May have low weight for age	Weight loss / wasting likely
ORS	Plan A at home	Plan B or C depending on severity
Zinc	20 mg/day x 14 days	20 mg/day x 14 days
Diet advice	Avoid lactose; give yoghurt, rice-based foods	Manage dehydration first
Antibiotic	Only if specific infection	Only if specific infection
Action	Advise mother; follow up in 5 days	Refer to hospital

C. BLOOD IN STOOL CLASSIFICATION

Feature	🟡 YELLOW
Classification	Dysentery
Key sign	Blood visible in stool
Stool character	Loose/watery with blood and mucus
Abdominal pain	May be present
Fever	Often present
Organism	Usually Shigella spp.
1st line antibiotic	Ciprofloxacin 15 mg/kg/dose BD x 3 days
2nd line (if unavailable)	Cotrimoxazole 4 mg TMP/kg/dose BD x 5 days
Amoebic dysentery	Metronidazole 10 mg/kg TDS x 5 days
Zinc	20 mg/day x 14 days
ORS	Plan A or B depending on hydration
Follow up	In 2 days - if not improving, refer
Refer if	Severe, not improving, or danger signs develop

STEP 4: TREATMENT DETAIL BY COLOR

🟢 GREEN - No Dehydration (Plan A at Home)

Treatment	Details
ORS after each stool	< 2 yrs: 50-100 ml; ≥ 2 yrs: 100-200 ml
Zinc	< 6 months: 10 mg/day x 14 days; ≥ 6 months: 20 mg/day x 14 days
Continue feeding	Continue breastfeeding + age-appropriate foods
Fluids to offer	ORS, clean water, rice water, dal water, coconut water
Avoid	Sugary drinks, carbonated drinks
Return immediately if	Cannot drink, blood in stool, vomiting everything, high fever, very sick

🟡 YELLOW - Some Dehydration (Plan B at Clinic)

Treatment	Details
ORS Plan B	75 ml/kg over 4 hours at health facility
ORS volume by age	2-4 mo: 200-400 ml; 4-12 mo: 400-600 ml; 1-2 yr: 600-800 ml; 2-5 yr: 800-1200 ml
If vomiting	Wait 10 min, then give slowly (5 ml every 2-3 min by spoon)
Zinc	20 mg/day x 14 days (10 mg if < 6 months)
Breastfeeding	Continue throughout rehydration
Reassess after 4 hours	Reclassify → if improved → Plan A; if worse → Plan C
Food	Start age-appropriate foods after rehydration

🔴 PINK - Severe Dehydration (Plan C - Urgent)

Treatment	Details
IV Ringer's Lactate (preferred)	Or Normal Saline if Ringer's not available
< 12 months	30 ml/kg over 1 hour, then 70 ml/kg over 5 hours
≥ 12 months	30 ml/kg over 30 minutes, then 70 ml/kg over 2.5 hours
If IV not possible	ORS via NGT: 20 ml/kg/hour x 6 hours
Zinc	20 mg/day x 14 days (start when able to drink)
Reassess every 1-2 hours	If not improving, increase IV rate
When improving	Switch to ORS Plan B as soon as child can drink
Refer	Urgently to hospital after starting IV
Antibiotic	Only if signs of severe systemic infection alongside

MASTER SUMMARY TABLE

	🟢 No Dehydration	🟡 Some Dehydration	🟡 Persistent Diarrhoea	🟡 Dysentery	🔴 Severe Dehydration	🔴 Severe Persistent Diarrhoea
Duration	Any	Any	≥ 14 days	Any	Any	≥ 14 days
Blood in stool	No	No	No	Yes	No	No
Dehydration	None	Some	None	Any	Severe	Present
Key signs	Alert, normal pinch	Restless, slow pinch	Diarrhoea ≥ 14d	Blood in stool	Lethargic, very slow pinch	≥14d + dehydration
ORS Plan	A (home)	B (75 ml/kg/4h)	A	A or B	C (IV)	B or C
Zinc	14 days	14 days	14 days	14 days	14 days	14 days
Antibiotic	None	None	None	Ciprofloxacin BD x 3d	None	None
Where	Home	Clinic (OPD)	Home + follow up	OPD	Hospital	Refer
Follow up	If worsens	After 4 hours	5 days	2 days	Every 1-2 hours	At hospital

Critical Points

Zinc reduces duration, severity, and recurrence - give in ALL diarrhoea cases
Antibiotics NOT routine - only for dysentery (blood in stool)
2 signs needed to classify Some Dehydration or Severe Dehydration
Skin pinch is the single most reliable clinical sign
Persistent diarrhoea = ≥ 14 days; if with dehydration = PINK (refer); if without = YELLOW (treat at home)
ORS should never be withheld even while arranging referral
Never give anti-motility drugs (loperamide) in children

Fast breathing child age wise

Here are the IMNCI Fast Breathing Cutoffs by Age - one of the most commonly tested topics:

IMNCI - Fast Breathing Age-Wise Thresholds

The 4 Age Groups & Cutoffs

Age Group	Fast Breathing = RR ≥
Birth to < 2 months	60 breaths/min
2 months to < 12 months	50 breaths/min
12 months to < 5 years	40 breaths/min
5 years and above	30 breaths/min

Memory Trick

"60 - 50 - 40 - 30" going down with age OR: "6, 5, 4, 3" × 10

Age	Cutoff	Easy Recall
< 2 months	60	60 = 6oungest (youngest)
2-12 months	50	50 = 5 fingers on one hand
1-5 years	40	40 = 4ur years (4 years)
> 5 years	30	30 = 3 drops down

How to Count Correctly (IMNCI Rule)

Rule	Detail
Child must be calm	Count only when child is NOT crying
Count for full 60 seconds	Do not halve a 30-second count
Use a watch with seconds	Estimate is not acceptable
Count again if fast	If first count is fast, count a second time to confirm
Chest must be exposed	Watch chest rise and fall

Fast Breathing in IMNCI Classification Context

Children 2 months to 5 years (Cough/Difficult Breathing):

Signs Present	Classification	Color
Any general danger sign OR chest indrawing OR stridor	Severe Pneumonia / Very Severe Disease	🔴 PINK
Fast breathing only (no danger signs, no chest indrawing)	Pneumonia	🟡 YELLOW
No fast breathing, no chest indrawing, no danger signs	No Pneumonia: Cough or Cold	🟢 GREEN

Young Infants < 2 months (counted as part of PSBI assessment):

Signs Present	Classification	Color
RR ≥ 60/min OR severe chest indrawing OR any danger sign	Possible Serious Bacterial Infection (PSBI)	🔴 PINK
RR 60 used as the threshold	No PSBI if no other signs	🟢 GREEN

Treatment by Classification (Cough & Breathing)

Color	Classification	Key Treatment
🔴 Pink	Severe Pneumonia / Very Severe Disease	Pre-referral: 1st dose Amoxicillin or Ampicillin + Gentamicin IM; Oxygen; Refer urgently
🟡 Yellow	Pneumonia	Amoxicillin 40 mg/kg/dose BD x 5 days orally; Follow up in 2 days
🟢 Green	No Pneumonia: Cough or Cold	Soothe throat (warm honey/liquid); No antibiotic; Return if worse; Follow up in 5 days if not improving

Amoxicillin Dose for Pneumonia (Yellow) - Age/Weight Based

Weight	Amoxicillin 250 mg tablet	Amoxicillin syrup 125 mg/5 ml
3 - < 6 kg	¼ tablet BD	2.5 ml BD
6 - < 10 kg	½ tablet BD	5 ml BD
10 - < 15 kg	1 tablet BD	10 ml BD
15 - < 20 kg	1½ tablet BD	15 ml BD
20 - < 29 kg	2 tablets BD	20 ml BD

Duration: 5 days for all pneumonia cases

Important Distinctions

Feature	Fast Breathing	Chest Indrawing
Definition	RR above cutoff for age	Lower chest wall draws IN on inspiration
Significance	Pneumonia (Yellow)	Severe Pneumonia (Pink)
Visible	Counted by watch	Seen by eye - lower chest only
Note	In young infants < 2 months, mild chest indrawing is normal - only severe indrawing counts

Quick Exam Table

Q: Child is 3 months old, RR = 52/min	→ Fast breathing?	YES (cutoff is 50) → Pneumonia 🟡
Q: Child is 18 months old, RR = 42/min	→ Fast breathing?	YES (cutoff is 40) → Pneumonia 🟡
Q: Child is 6 months old, RR = 48/min	→ Fast breathing?	NO (cutoff is 50) → Not fast
Q: Neonate 10 days old, RR = 58/min	→ Fast breathing?	NO (cutoff is 60) → Not fast
Q: Child 3 years, RR = 44/min + chest indrawing	→ Classification?	Severe Pneumonia 🔴 PINK

Nutration color coding

Here is the complete IMNCI Nutrition Color Coding with all assessment signs, classifications, and treatments:

IMNCI - Nutrition & Anaemia Color Coding

ASSESSMENT TOOLS USED

Tool	What it measures	Normal
MUAC tape	Mid-Upper Arm Circumference (children ≥ 6 months)	≥ 12.5 cm
Weight for Age chart	Plotted on growth chart	Within -2 SD (normal)
Visible severe wasting	Look at child - ribs prominent, loose skin	Absent = normal
Bilateral pitting oedema	Press both feet for 3 seconds	No pitting = normal
Palmar pallor	Look at palm colour	Pink = normal

MUAC TAPE COLOR CODES

Note: MUAC tape has its own colors (Red/Yellow/Green) - different from IMNCI chart colors

MUAC Tape Color	MUAC Reading	Meaning	IMNCI Classification
🔴 Red	< 11.5 cm	Severe Acute Malnutrition	🔴 PINK
🟡 Yellow	11.5 - 12.4 cm	Moderate Acute Malnutrition	🟡 YELLOW
🟢 Green	≥ 12.5 cm	Normal / No Acute Malnutrition	🟢 GREEN

NUTRITION CLASSIFICATION TABLE

A. ACUTE MALNUTRITION

Feature	🔴 PINK	🟡 YELLOW	🟢 GREEN
Classification	Severe Acute Malnutrition (SAM)	Moderate Acute Malnutrition (MAM)	No Acute Malnutrition
MUAC	< 11.5 cm	11.5 - 12.4 cm	≥ 12.5 cm
Visible severe wasting	Present (skin hangs loose, ribs prominent)	May be mild wasting	Absent
Bilateral pitting oedema	Present (nutritional)	Absent	Absent
Weight for Height	< -3 SD	-3 SD to -2 SD	> -2 SD
Child's appearance	Marasmus / Kwashiorkor signs	Thin but no severe wasting	Normal appearance

B. WEIGHT FOR AGE (Low Weight)

Feature	🟡 YELLOW	🟢 GREEN
Classification	Low Weight for Age	Not Low Weight
Weight for Age	Below -2 SD on growth chart	At or above -2 SD
MUAC	May be borderline	Normal
Signs	Thin, may look pale	Normal growth
Note	Different from SAM - chronic undernutrition	Normal

FULL SYMPTOMS + SIGNS TABLE

Clinical Sign	🔴 SAM (Pink)	🟡 MAM (Yellow)	🟢 Normal (Green)
MUAC	< 11.5 cm	11.5 - 12.4 cm	≥ 12.5 cm
Bilateral oedema	May be present (Kwashiorkor)	Absent	Absent
Visible wasting	Severe (ribs, loose skin, buttocks wasted)	Mild	None
Hair changes	Depigmented, sparse, easily pluckable	Mild changes	Normal
Skin changes	Flaky, hyperpigmented patches	Mild	Normal
Face	"Old man face" (Marasmus) / Moon face (Kwashiorkor)	Normal to slightly thin	Normal
Abdomen	Distended (Kwashiorkor) or Scaphoid (Marasmus)	Normal	Normal
Activity	Apathetic, miserable	Active	Active
Appetite	Poor (Kwashiorkor) / Hungry (Marasmus)	Normal	Good
Weight for Height	< -3 SD	-3 SD to -2 SD	> -2 SD

ANAEMIA CLASSIFICATION TABLE

Feature	🔴 PINK	🟡 YELLOW	🟢 GREEN
Classification	Severe Anaemia	Anaemia	No Anaemia
Palmar pallor	Severe palmar pallor	Some palmar pallor	No palmar pallor
Conjunctiva	Very pale / white	Mildly pale	Pink
Haemoglobin (guide)	Hb < 7 g/dl	Hb 7-10 g/dl	Hb > 10 g/dl
Symptoms	Breathless at rest, lethargic, weak pulse	Easily tired, mild symptoms	None

TREATMENT TABLE

🔴 PINK - SAM (Severe Acute Malnutrition)

Treatment	Details
Refer urgently	To hospital / NRC (Nutrition Rehabilitation Centre)
Pre-referral Vitamin A	< 6 months: 50,000 IU; 6-12 months: 1,00,000 IU; > 12 months: 2,00,000 IU (stat)
Prevent hypoglycaemia	Breastmilk or 10% sugar water before transfer
Keep warm	Prevent hypothermia during transport
At NRC:	F-75 then F-100 therapeutic feeds / RUTF
Amoxicillin	40 mg/kg/dose BD x 5 days (presumptive antibiotic)
Zinc	2 mg/kg/day
Folic acid	5 mg Day 1, then 1 mg/day
Multivitamins	Daily for ≥ 2 weeks
Treat infections	As per other IMNCI classifications
No iron initially	Iron given only in rehabilitation phase (not acute phase)

🔴 PINK - Severe Anaemia

Treatment	Details
Refer urgently	For blood transfusion
Packed RBC / Whole blood	10 ml/kg slowly over 3-4 hours
Iron	After transfusion, once stable
Pre-referral	Keep child calm, no unnecessary activity

🟡 YELLOW - MAM (Moderate Acute Malnutrition)

Treatment	Details
Supplementary feeding	RUTF / Supplementary food at home (if available)
Feeding counselling	Teach mother calorie-dense, frequent feeding
Vitamin A	As per immunization schedule
Zinc	20 mg/day x 14 days
Deworming	Albendazole 400 mg stat (if ≥ 12 months, not given in last 6 months)
Follow up	Every 14 days to monitor weight gain
Iron	If anaemia also present
Immunization	Check and update

🟡 YELLOW - Anaemia

Treatment	Details
Iron	3-6 mg/kg/day elemental iron in 2 divided doses x 3 months
Ferrous sulphate syrup	Most commonly used
Folic acid	5 mg/day
Vitamin C	Give with iron (improves absorption) - citrus juice
Deworming	Albendazole 400 mg stat (≥ 12 months)
Dietary advice	Green leafy vegetables, jaggery, meat, lentils
Avoid	Tea/coffee with meals (inhibits iron absorption)
Follow up	In 14 days

🟡 YELLOW - Low Weight for Age

Treatment	Details
Feeding counselling	Assess feeding, counsel on age-appropriate feeding
Vitamin A	As per schedule
Zinc	20 mg/day x 14 days
Deworming	If ≥ 12 months
Follow up	In 30 days to recheck weight
Immunization	Check and complete

🟢 GREEN - No Malnutrition / No Anaemia

Action	Details
Praise mother	Good feeding practices
Counsel on feeding	Age-appropriate foods, frequency
Vitamin A supplementation	As per national schedule
Deworming	Every 6 months after 12 months of age
Growth monitoring	Regular weight plotting
Immunization	Check and update

MASTER SUMMARY TABLE

	🔴 PINK	🟡 YELLOW	🟢 GREEN
Malnutrition	SAM (MUAC < 11.5 / oedema / severe wasting)	MAM (MUAC 11.5-12.4) / Low weight	No acute malnutrition (MUAC ≥ 12.5)
Anaemia	Severe pallor (Hb < 7)	Some pallor (Hb 7-10)	No pallor (Hb > 10)
Key drug	Vitamin A + Amoxicillin + refer	Iron + Zinc + Deworming	Counselling only
Vitamin A dose	50k / 1L / 2L IU by age	As per schedule	As per schedule
Where treated	NRC / Hospital	OPD + home	Home
Follow up	At hospital	14 days	30 days (growth monitoring)

Key Rules

MUAC measured only in children ≥ 6 months
Bilateral pitting oedema alone = SAM even if MUAC is normal
Iron NOT given in acute phase of SAM - only in rehabilitation phase
Deworming (Albendazole 400 mg) for all children ≥ 12 months, every 6 months
Vitamin A is given stat as pre-referral in SAM
RUTF (Ready-to-Use Therapeutic Food) = Plumpy'Nut - used in SAM rehabilitation
Palmar pallor is assessed by stretching the palm open - compare to examiner's palm

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