Acute LRTI causing fever, cough, tachypnoea, and chest retractions; major cause of under-five mortality.
History taking
- • Cough, fever, fast breathing, refusal to feed, lethargy
- • Duration, exposure to TB, immunisation (PCV, Hib, measles)
Examination
- • Respiratory rate (WHO age cutoffs), chest indrawing, grunting, nasal flaring, SpO₂
- • Auscultation: crackles, bronchial breathing, decreased air entry
- • Hydration, danger signs
Red flags
- • SpO₂ <90%, severe respiratory distress, inability to feed
- • Cyanosis, altered sensorium, convulsions
Differential diagnosis
- • Bronchiolitis, asthma, TB, foreign body aspiration, congenital heart disease with failure
Recommended investigations
- • Clinical for outpatient; CXR if severe or atypical
- • Pulse oximetry mandatory
- • CBC, blood culture if admitted
Diagnosis
- • WHO IMCI: pneumonia (fast breathing) vs severe pneumonia (chest indrawing/danger sign)
Initial treatment / management
- • Pneumonia (outpatient): Oral amoxicillin 40 mg/kg/dose BD x 5 d (3 d in selected)
- • Severe pneumonia: admit, IV ampicillin + gentamicin (or Ceftriaxone); oxygen if SpO₂ <90%
- • Bronchodilators if wheeze
- • Supportive: hydration, antipyretic, nutrition
Prescription examples
- • Tab/Syrup Amoxicillin 40 mg/kg/dose PO BD x 5 d
- • Inj Ampicillin 50 mg/kg IV 6 hourly + Inj Gentamicin 7.5 mg/kg IV OD (severe, <5 y)
- • Oxygen via nasal prongs 1–2 L/min if hypoxic
Follow-up advice
- • Review in 48 h; if no improvement, reassess and consider admission
Patient counselling
- • Recognise fast breathing, chest indrawing, refusal to feed
- • Continue feeding, breastfeed
- • Immunisation: PCV, Hib, influenza, measles
Referral criteria
- • Severe pneumonia, hypoxia, comorbidity, treatment failure
Clinical pearls
- • Respiratory rate cutoffs (WHO): <2 mo ≥60, 2–11 mo ≥50, 1–5 y ≥40
- • Amoxicillin is first-line for non-severe CAP
- • Always check for hypoxia with pulse oximetry
References
- • WHO Pocket Book of Hospital Care for Children 2013
- • BTS Guidelines for CAP in Children 2011
Educational outpatient guide — verify against local guidelines before clinical use.
