This document provides guidance on assessing and managing children under 5 years of age presenting with cough or difficult breathing. It outlines the IMNCI case management strategy which evaluates all problems, provides a classification, and offers treatment algorithms. General danger signs indicate severe disease and mean the child needs referral. Respiratory rate, chest indrawing, stridor, and wheeze are assessed. Potential causes like pneumonia, bronchiolitis, and asthma are considered. Investigations may include CBC, CRP, and chest X-ray. Severe pneumonia requires referral while mild cases can be treated with antibiotics, paracetamol, or salbutamol. Prevention emphasizes vaccination, breastfeeding, handwashing, and controlling pollution.
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Practical approach to child cough and breathing
1. A practical approach to the child with
Cough and Difficult Breathing
Prof. Imran Iqbal
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
4. Benefits of
IMNCI Case Management Strategy
• Evaluates all the problems the child is having
• Simple guidelines to find relevant symptoms and signs
• Gives a Classification (provisional diagnosis)
• Practical algorithms for decision-making
• Helps in deciding clinical management
• Saves time of Health Care Provider and patient
• Can be practiced by clinical assistants and paramedics
• Can be practiced in remote areas with inadequate facilities
5. Step 1
General Danger Signs
General Danger Signs indicate severe disease
Presence of any one of the General Danger Signs
means that the child needs to be
referred / admitted to the emergency
6. Check for General Danger Signs
• Unable to drink or breastfeed
• Vomiting everything
• Lethargic or unconscious
• Convulsions
• General Danger Signs indicate severity of illness
• Not diagnostic but suggests acuity of situation
11. Assess for Cough or Difficult Breathing
• ASK: Does the child have Cough or Difficult Breathing ?
• IF YES
• ASK: for how long ?
• Look, Listen, Feel:
Count the breaths in one minute (Respiratory Rate)
Look for Chest Indrawing (subcostal recessions)
Look and listen for Stridor (harsh inspiratory sound)
Look and listen for Wheeze (musical expiratory sound)
Other signs:
o ……. Chest Auscultation
o ……. Pulse Oximetry
12. Respiratory Rate
• Age average/normal Fast breathing
• Less than
2 months 50 60 or more
• 2-12 months 40 50 or more
• 1- 5 years 30 40 or more
20. Assess for Cough or Difficult Breathing
• ASK: Does the child have Cough or Difficult Breathing ?
• IF YES
• ASK: for how long ?
• Look, Listen, Feel:
Count the breaths in one minute (Respiratory Rate)
Look for Chest Indrawing (subcostal recessions)
Look and listen for Stridor (harsh inspiratory sound)
Look and listen for Wheeze (musical expiratory sound)
Other signs:
o ……. Chest Auscultation
o ……. Pulse Oximetry
21.
22.
23.
24.
25.
26. Investigations
• Admitted / serious patients may need investigations
• CBC
• CRP
• X – ray Chest
• Blood Culture
27. Chest X - ray
Bronchopneumonia Lobar Pneumonia
32. Prevention of Acute Respiratory Infection
• Vaccination –
Penta (DPT, Hib, Hep B),
Pneumococcal, Measles,
Influenza
• Breastfeeding, Nutrition
• Avoid contact with diseased patients
• Hand washing
• Control smoking, air pollution
33. 30-Jun-20 Prepared By: Medical and Compliance 33
Prevention:Vaccination
Age Vaccine
At Birth BCG and OPV-0
6 Week Penta-I, Pneumo-I and OPV-I
10 Week Penta-II, Pneumo-II and OPV-II
14 Week Penta-III, Pneumo-III, IPV and OPV-III
9 Months Measles-I
15 Months Measles-II
http://epi.gov.pk/?page_id=139
EPI: Expanded Program on Immunzation (Pakistan)