How can I tell if my child's cough is pneumonia and not just a cold?

Question

Coughs and colds are common in children as the weather turns cold. Parents often ask which signs mean a cough has turned into pneumonia and needs a doctor.

DoctorOS Team · Answer

Most coughs clear up on their own within 3 to 4 weeks (NHS). The two signs that point to pneumonia (nimoniya) are fast breathing and the lower chest sucking in with each breath. If you see either, take your child to a doctor straight away.

How to check your child's breathing

Count the breaths for one full minute while your child is calm or asleep, by watching the chest or tummy rise.
WHO's guidelines for health workers count breathing as fast at 50 or more breaths a minute for babies aged 2 to 11 months, and 40 or more for children aged 1 to 5 years.
Look at the bottom of the ribcage. If it sucks in when your child breathes in (what many parents call pasli chalna), that is chest indrawing, one of the two signs WHO uses to diagnose pneumonia.

Other signs of pneumonia

A high temperature (tez bukhar), a cough that may bring up yellow, green or brown phlegm (balgham), chest pain, tiredness and irritability (HSE).

What helps at home

Give plenty of fluids, and breastfeed or bottle-feed more often (HSE).
For fever or pain, children's paracetamol can help. Follow the dose on the pack for your child's age. Avoid ibuprofen if dengue is possible, because WHO warns it can increase bleeding in dengue, and never give ibuprofen to a baby under 3 months (HSE).
Do not give cough medicine to a child under 6 unless a doctor advises it (HSE), and do not give honey to a baby under 1 year (NHS).
Keep the home smoke-free (HSE). WHO lists cutting indoor air pollution as one way to prevent pneumonia.

Treatment and prevention

Doctors usually treat pneumonia in children with antibiotics. Most children can take them by mouth at home, and only severe cases need hospital (WHO). Vaccines against Hib, pneumococcus, measles and whooping cough are the most effective prevention (WHO), so check that your child's EPI vaccines are up to date.

When to see a doctor

See a child specialist the same day for fast breathing, chest indrawing or a high fever, or whenever you think your child has pneumonia (HSE). Also see a doctor if a cough lasts more than 3 weeks (NHS).

Emergency signs

Go to the nearest emergency department, or call Rescue 1122 or Edhi 115, if your child:

is struggling to breathe or breathing very fast
has blue lips or tongue
cannot drink or breastfeed, or vomits everything
has a fit (convulsion), or is unusually sleepy and hard to wake
makes a harsh, noisy sound when breathing in while calm (stridor)
is a baby under 12 weeks old with any fever (CDC)

A very sick young baby may stop feeding, feel cold, become unconscious or have fits (WHO).

Sources

General health information from the DoctorOS Team, not a diagnosis. For advice about your own situation, see a doctor.