The sick young infant up to 2 months

WHO IMCI · reviewed October 2026 · gpreasoning.uk/global

Reasoning GP
Global Primary Care

Who / when

Any infant from birth up to 2 months (0 to 59 days) brought sick, and at postnatal home visits.
Community health workers: check for danger signs at every postnatal visit and help the family seek care.
Infants 2 months and older: use the IMCI sick child charts.

Red flags: refer now

Possible serious bacterial infection (PSBI): the 7 signs

Not feeding well, or not able to feed at all.
Convulsions.
Fast breathing: 60 or more per minute (count a full minute; repeat if high).
Severe chest indrawing.
Temperature 38 °C or above, or below 35.5 °C.
Movement only when stimulated, or no movement at all.

Critical illnessNot able to feed at all, no movement at all, or convulsions = critical illness. Give first-dose antibiotics, prevent low blood sugar, keep warm, refer urgently.

Assess

The infant must be calm. Count breaths for one minute; look for severe chest indrawing; measure axillary temperature.
Watch movement; if asleep, wake gently. Does the infant move on its own, only when stimulated, or not at all?
Look at the umbilicus (red or pus?) and skin (pustules).
Jaundice: when did it start? Are palms and soles yellow?
Diarrhoea and dehydration; feeding (observe a breastfeed), weight for age, thrush.
Mother's and infant's HIV status; immunisations.

Classify

Signs	Classify as	Action
Not able to feed at all, no movement at all, or convulsions	Critical illness	Pre-referral treatment; refer urgently
Not feeding well, moves only when stimulated, temperature 38 °C or more or below 35.5 °C, severe chest indrawing, or fast breathing at 0 to 6 days	Clinical severe infection	First-dose antibiotics; refer. If referral not possible: outpatient regimen
Fast breathing as the only sign, age 7 to 59 days	Fast breathing (pneumonia)	Oral amoxicillin for 7 days at home; no referral needed
Red or pus-draining umbilicus, or skin pustules	Local bacterial infection	Oral amoxicillin 5 days, gentian violet; review in 2 days
Jaundice under 24 hours of age, or yellow palms and soles	Severe jaundice	Prevent low blood sugar; refer urgently
None of these	Severe disease or local infection unlikely	Home care

Treat

Before referral

First dose of IM ampicillin 50 mg/kg and gentamicin (5 mg/kg in the first week of life; 7.5 mg/kg after). Use 10 mg/mL gentamicin; avoid undiluted 40 mg/mL.
Prevent low blood sugar: breastfeed; or 10 mL/kg (20 to 50 mL) expressed breast milk or sugar water by cup or nasogastric tube.
Keep warm: skin-to-skin contact on the way, or well covered with a hat.

When the family cannot accept or reach referral

Clinical severe infection: oral amoxicillin 50 mg/kg per dose twice daily for at least 7 days plus IM gentamicin once daily for 7 days (5 to 7.5 mg/kg; low birthweight 3 to 4 mg/kg). If 7 days of injections are not possible: gentamicin for 2 days with the 7 days of amoxicillin; a check on day 4 is essential.
Fast breathing alone, 0 to 6 days: refer; if not possible, oral amoxicillin 50 mg/kg twice daily for at least 7 days.
Critical illness: keep trying to refer. If impossible, ampicillin plus gentamicin for at least 10 days by a trained worker.

Follow-up

Outpatient severe infection: the infant is seen daily for the injections; close follow-up is essential, with a careful check on day 4. Refer at once if any critical illness sign appears or the infant is not improving.
Fast breathing alone: arrange close follow-up; refer if worse or any other PSBI sign appears.
Local infection: review after 2 days; pus or redness the same or worse: refer.
Jaundice: review in 1 day; feeding problem: 2 days; low weight for age: 14 days.

Counsel

Breastfeed only, often, day and night. Keep the infant warm; skin-to-skin contact helps.
Give every dose of amoxicillin until finished.
Return at once if the baby is breastfeeding poorly, less active, sicker, has a fever or feels cold, breathes fast or with difficulty, or the palms and soles turn yellow.

Your baby has a serious infection and needs hospital care today. If you truly cannot go, we will give injections here every day and you must come back each day, or straight away if she stops feeding or moving well.

When to refer

Urgently: critical illness; clinical severe infection; fast breathing in the first week of life; severe jaundice; severe dehydration.
Outpatient-treated infant who develops a critical sign, or is not better by day 4.
Jaundice still present after 2 weeks of age, or appearing after 14 days.
Not able to attach or feed, or losing weight despite counselling.

Sources

World Health Organization. WHO recommendations for management of serious bacterial infections in infants aged 0–59 days. 2024. World Health Organization. Guideline: managing possible serious bacterial infection in young infants when referral is not feasible. 2015. World Health Organization. Integrated Management of Childhood Illness (IMCI) chart booklet. 2014.

Adapted from WHO guidance; not endorsed by WHO. This page paraphrases and adapts the WHO publications listed under Sources, which are licensed CC BY-NC-SA 3.0 IGO; the adapted text is shared under the same licence for non-commercial education. Reasoning GP is not affiliated with WHO or any other organisation named here. Use it alongside your national guidelines, essential medicines list and formulary, and your clinical judgement. Doses are given only where they come from a WHO source; otherwise follow your national guideline or formulary.