Child Pneumonia: Fast Breathing Signs Parents Must Know

What does it mean?

Pneumonia is an infection of the lungs — the tiny air sacs fill with fluid or pus, making it hard for the child to breathe and get oxygen. It is the single largest infectious cause of death in children under five worldwide. The tragedy is that most pneumonia deaths are preventable: the warning signs can be spotted at home, treatment with antibiotics (when a doctor prescribes them) is cheap and effective, and vaccines prevent many cases entirely.

Common causes

• 1Fast breathing is the key sign.
  WHO's IMCI guidelines define fast breathing by age — count breaths for one full minute while the child is calm: Under 2 months: 60 or more breaths per minute 2 months to 12 months: 50 or more breaths per minute 12 months to 5 years: 40 or more breaths per minute (PLOS ONE, citing WHO IMCI)
• 2Chest indrawing means pneumonia.
  If the lower chest wall pulls in with each breath (instead of expanding out), the child has pneumonia and needs antibiotics from a doctor (WHO IMCI pneumonia classification).
• 3Danger signs mean severe pneumonia — go to hospital urgently:
  any general danger sign (unable to drink/breastfeed, vomits everything, convulsions, lethargic or unconscious) or stridor (harsh noise breathing in) in a calm child (WHO IMCI).
• 4Fever can raise breathing rate
  but WHO advises: count the breaths anyway and do not wait for the fever to settle (IMCI training material).
• 5Vaccines prevent pneumonia.
  Pakistan's EPI protects against the two biggest bacterial causes: pneumococcal vaccine (PCV) at 6, 10, and 14 weeks, and Hib inside the pentavalent vaccine at 6, 10, and 14 weeks (Pakistan EPI schedule). Measles vaccine also prevents measles-related pneumonia.
• 6Indoor smoke is a major risk factor.
  Cooking smoke from wood/dung stoves (chulha), cigarette smoke, and polluted air damage children's lungs and raise pneumonia risk — keep children away from smoke.
• 7Antibiotics work — but only the right ones, on prescription.
  WHO IMCI recommends oral amoxicillin for non-severe pneumonia in children 2 months–5 years, prescribed by a health worker (IMCI chart). Cough syrups and self-chosen antibiotics do not treat pneumonia and can delay real treatment.

When to worry

Prevention & practical tips

• ✓Learn to count breaths. Place your hand lightly on the child's chest, watch for one full minute while the child is calm (not crying or feeding), and count each breath. Compare with the age thresholds above.
• ✓Look at the chest. Watch the lower chest: if the skin pulls inward between/under the ribs with each breath, that is chest indrawing — see a doctor the same day.
• ✓Listen. A harsh, high-pitched noise when breathing in (stridor) in a calm child is a danger sign — go to hospital.
• ✓Complete all EPI vaccines on time — PCV, pentavalent (Hib), and measles. Check your child's vaccination card today.
• ✓Keep the air clean. No smoking inside the home; keep children away from chulha smoke; ventilate cooking areas.
• ✓Continue feeding and fluids during illness, and keep the child warm — but do not wrap a feverish, struggling child in heavy blankets.
• ✓Follow up. A child started on pneumonia treatment should be reassessed — if not improving, return to the doctor promptly.

FAQs

References

• PLOS ONE, citing WHO IMCI: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214086
• WHO IMCI pneumonia classification: https://www.ncbi.nlm.nih.gov/books/NBK143752/