Cough or difficult breathing: the essentials
Participant handout · WHO IMCI, children 2 months to 5 years · gpreasoning.uk/global
Reasoning GP
Global Primary Care
General danger signs: check first
- Not able to drink or breastfeed
- Vomits everything
- Convulsions in this illness, or convulsing now
- Lethargic or unconscious
Look and listen
- Child calm; count breaths for a full minute.
- Look for lower chest wall indrawing.
- Listen for stridor and wheeze.
- Pulse oximeter: refer if below 90%.
Fast breathing
| Age | Fast is |
|---|
| 2 to 12 months | 50 or more per minute |
| 12 months to 5 years | 40 or more per minute |
Classify
| Signs | Classify and act |
|---|
| Danger sign or stridor | Severe: first-dose antibiotic, refer urgently |
| Chest indrawing or fast breathing | Pneumonia: amoxicillin, review in 3 days |
| Neither | Cough or cold: safe remedy, review in 5 days if not better |
Amoxicillin (dispersible 250 mg), twice daily
| Age (weight) | Tablets |
|---|
| 2 to 12 months (4 to under 10 kg) | 1 |
| 12 months to 3 years (10 to under 14 kg) | 2 |
| 3 to 5 years (14 to 19 kg) | 3 |
5 days (3 days for fast breathing alone if your national chart says so). HIV-exposed child with chest indrawing: first dose and refer.
Breath-count practice sheet
- Child 1: ____ per minute. Fast? Yes / No
- Child 2: ____ per minute. Fast? Yes / No
- Child 3: ____ per minute. Fast? Yes / No
- Child 4: ____ per minute. Fast? Yes / No
Say it simply
Give this medicine twice a day until it is finished. Bring your child back in 3 days, or straight away if they cannot drink, get sicker, get a fever, or breathe fast or with difficulty.
Sources
World Health Organization. Integrated Management of Childhood Illness (IMCI) chart booklet. 2014. World Health Organization. Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries. 2014. World Health Organization. Guideline on management of pneumonia and diarrhoea in children up to 10 years of age. 2024.Adapted from WHO guidance; not endorsed by WHO. This page paraphrases and adapts the WHO publications listed under Sources, which are licensed CC BY-NC-SA 3.0 IGO; the adapted text is shared under the same licence for non-commercial education. Reasoning GP is not affiliated with WHO or any other organisation named here. Use it alongside your national guidelines, essential medicines list and formulary, and your clinical judgement. Doses are given only where they come from a WHO source; otherwise follow your national guideline or formulary.