Cough and breathing problems are the leading cause of child death from infectious disease after diarrhoea. Knowing the difference between a simple cough and pneumonia is life-saving.
Count the breathing rate for 60 full seconds when the child is calm and not crying. Normal rates: under 2 months — below 60 breaths per minute. 2 to 12 months — below 50. 1 to 5 years — below 40. Above these rates at rest is fast breathing — a key sign of pneumonia.
Look for chest in-drawing: watch the lower chest as the child breathes in. If the chest wall sucks inward with each breath (in-drawing), this indicates the child is working hard to breathe — serious respiratory illness.
Listen for sounds: stridor (high-pitched sound on breathing in) suggests upper airway obstruction. Wheeze (musical sound on breathing out) suggests asthma or bronchiolitis. Grunting with each breath in an infant is a serious danger sign.
SIMPLE COLD or COUGH: runny nose, mild fever, cough, normal breathing rate, no chest in-drawing. Manage with fluids, paracetamol for fever, and monitor.
CROUP: barking cough like a seal, stridor, often worse at night. Keep the child calm — crying worsens it. Breathing cool night air or steam inhalation helps. Go to hospital for severe stridor or breathing difficulty.
BRONCHIOLITIS (common in infants under 1): wheeze and fast breathing after a cold in a baby. Keep the baby hydrated, keep upright, monitor breathing rate. Hospital if breathing rate is high or feeding is affected.
PNEUMONIA: fast breathing, chest in-drawing, fever, and a sick-looking child. This requires antibiotic treatment and often hospital admission. Do not delay.
WHOOPING COUGH (pertussis): intense coughing fits followed by a whooping sound on breathing in, sometimes vomiting after coughing. Highly contagious. Needs medical assessment.
Breathing rate above the normal range for age at rest.
Chest in-drawing with each breath.
Blue or dusky colour around the lips or fingernails.
Grunting sound with each breath in an infant.
Child too breathless to feed or speak.
Stridor at rest — not just during crying.
Child is very drowsy or unresponsive.
Do not give cough suppressants to children under 6 — they can cause dangerous side effects.
Do not give honey to infants under 1 year.
A blue colour around the lips or fingernails is an emergency at any age.
A child who is too breathless to feed is a medical emergency.
✓ What Helps
· Paracetamol for fever by weight
· Saline nasal drops to clear blocked nose in infants — makes feeding easier
· Salbutamol inhaler with spacer for wheeze if asthma is confirmed
✗ What To Avoid
· Cough suppressants in children under 6
· Decongestant medications in children under 6
· Honey in children under 1 year
→ Ask The Pharmacist For
· Amoxicillin for confirmed pneumonia in children
· Salbutamol inhaler for wheeze — requires assessment
· Urgent medical assessment for any child with fast breathing or chest in-drawing
🏥 Get Professional Help
Go to hospital immediately for fast breathing at rest, chest in-drawing, blue lips or nails, grunting breaths in an infant, or a child too breathless to feed. See a doctor for any cough lasting more than 2 weeks or any wheeze in a child.
How do I know if my child has pneumonia or just a cold?
Count the breaths for 60 seconds when the child is calm. Fast breathing at rest, chest sucking inward with each breath, and a sick-looking child suggest pneumonia. A child with a runny nose and normal breathing rate likely has a cold.
My baby has been coughing for 2 weeks — what should I do?
A cough lasting more than 2 weeks in a child needs medical assessment. It may be whooping cough, a persistent infection, or asthma. Go to a clinic.