Cough or Difficult Breathing and Wheezing (Age 2 months up to 5 years)

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Does the child have a cough or difficulty breathing?  If yes, 

Ask

• For how long?

Look, listen, feel

• Count the breaths in one minute
• Look for chest indrawing. (Child must be calm)
• Look and listen for stridor or wheeze. (Child must be calm)
• If the pulse oximeter is available then determine oxygen saturation

And if wheeze, ask

• Has the child had a wheeze before this illness?
• Does the child frequently cough at night?
• Has the child had a wheeze for more than 7 days?
• Is the child on treatment for asthma at present?

Fast Breathing

• If the child is 2 months up to 12 months, then fast breathing is 50 or more breaths per minute
• If the child is 12 months up to 5 years, then fast breathing is 40 or more breaths per minute

Classify the Cough or Difficulty Breathing

Severe Pneumonia or Very Severe Disease
Any general danger sign OR Chest indrawing OR Stridor in calm child OR Oxygen saturation less than 90% in room air	Give oxygen  If wheezing, give salbutamol by inhaler or nebuliser. Reassess after 15 minutes, and reclassify for cough or difficult breathing. If stridor: give nebulised adrenaline and prednisone  Give first dose of ceftriaxone IM  Give first dose cotrimoxazole  Test for low blood sugar, then treat or prevent  Keep child warm, and refer URGENTLY
Pneumonia
Fast breathing	If wheezing, give salbutamol by inhaler or nebuliser. Reassess after 15 minutes, and reclassify for cough or difficult breathing. Give amoxicillin for 5 days  If coughing for more than 14 days, assess for TB  Soothe the throat and relieve the cough  Advise caregiver when to return immediately  Follow-up in 2 days
Cough or Cold
No signs of pneumonia or very severe disease	If coughing for more than 14 days, assess for TB  Soothe the throat and relieve cough  Advise caregiver when to return immediately  Follow up in 5 days if not improving

Classify the Wheeze

Recurrent Wheeze
Yes to any question Has the child had a wheeze before this illness? Does the child frequently cough at night? Has the child had a wheeze for more than 7 days? Is the child on treatment for asthma at present?	Give salbutamol and prednisone if referring for a severe classification Give salbutamol via spacer for 5 days
Wheeze (First Episode)
All other children with wheeze	Give salbutamol if referring for a severe classification  Give salbutamol via spacer for 5 days  Follow-up in 5 days if still wheezing

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; Cough or Difficult Breathing ,Wheezing

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Last checked for updates: June 2023