Most children who have a general danger sign also have a severe classification. They will be referred for their severe classification. In rare instances, children may have general danger signs without severe classification. The children with those severe conditions should be referred urgently. Make sure a child with any general danger sign is referred after taking the first dose of appropriate pre-referral treatment.

You must ask yourself whether a child has any severe classification or other severe problem that cannot be treated at your health facility. For example, the child may have a severe problem that is not covered on the ICCM chart, such as severe abdominal pain. If you cannot treat a severe problem, you will need to refer the child. Determine the severity of health condition for all children from birth up to 5 years age.

Newborn danger signs that require referral

The danger signs in a newborn baby are listed below. Refer a baby urgently if any of these signs is present in the newborn baby up to 7 days of age:

• Breathing ≤ 30 or ≥ 60 b/m, grunting, severe chest indrawing, blue tongue & lips, or gasping.
• Unable to suck or sucking poorly.
• Feels cold to touch or axillary temperature < 35.5 °C.
• Feels hot to touch or axillary temperature ≥ 37.5 °C.
• Red swollen eyelids and pus discharge from the eyes.
• Redness, pus or foul odour around the cord or umbilicus.
• History of convulsion (abnormal/unusual movement) or convulsing now.
• Jaundice or yellow skin — at age < 24 hours or > 2 weeks — involving soles and palms.
• Palmar pallor.

Severe problems of newborn baby and young infants

Based on the ICCM chart booklet classification, if any one of the following diagnosis is found in any infant refer him/her immediately with the appropriate pre-referral treatment and care.

• Very preterm and/or very low birth weight.
• Very severe disease.
• Local bacterial infection.
• Severe jaundice.
• Severe dehydration.
• Severe persistent diarrhoea.
• Dysentery.
• Possible HIV infection ( HIV-exposed).
• Any other severe problem.

Severe problems of children > 2 months and up to 5 years age

• Severe pneumonia or very severe disease.
• Severe dehydration.
• Severe persistent diarrhoea.
• Persistent diarrhoea.
• Dysentery.
• Very severe febrile disease.
• Severe complicated measles.
• Acute ear infection.
• Severe complicated malnutrition.
• Severe anaemia.
• Anaemia.
• Confirmed HIV infection.
• Possible HIV infection.
• Other severe problems.