Cough or Breathing Difficulty in a Child

Persistent cough

Commonly

  • chronic rhinorrhoea

  • postnasal drip

  • asthma

  • cigarette smoke

  • habit

Uncommon

Predispositions

  • poor social circumstances

  • passive smoking

Assessing

History

  • Age child

  • cough?

  • how long?

  • (2 months to 5 years) Is child able to drink? (without vomiting back again)

  • (<2 months) Is child feeding well? (> ½ normal amount)

  • Fever? (duration)

  • Convulsions?

Examination

  • Breaths in one minute

    • < 2months - 60+

      • repeat count if this fast as infants breathing may be irregular

    • 2-12 months - 50+

    • 12 months - 5 years - 40+

  • chest indrawing

  • stridor

  • wheeze

  • abnormally sleepy / difficulty in waking

  • fever / hypothermia

  • severe malnutrition

Classifying illness

  • very severe disease

  • severe pneumonia

  • pneumonia

  • no pneumonia - cough or cold

2 months to 5 years

Very severe disease

  • not able to drink

  • convulsions

  • abnormally sleepy / difficult to wake

  • stridor when calm

  • severe malnutrition

Severe pneumonia

  • chest indrawing

Pneumonia

  • No chest indrawing

  • Fast breathing

Cough or cold

  • No chest indrawing

  • No fast breathing

Less than 2 months

Very severe disease

  • stopped feeding well

  • convulsions

  • abnormally sleepy / difficult to wake

  • stridor when calm

  • wheezing

  • fever

  • low body temperature

Severe pneumonia

  • severe chest indrawing

  • fast breathing

Cough or cold

  • No severe chest indrawing

  • No fast breathing

 

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