Paediatrics
Pneumonia in Children
بچوں میں نمونیا
Lung infection and a major killer of children under 5 in Pakistan. Early recognition by fast breathing and prompt antibiotics save lives.
- ICD-10
- J18
- Source
- General reference written by the assistant (not from the OPD book); needs clinical review
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Cough
- Fast breathing (≥50/min for age 2–11 months; ≥40/min for 1–5 years)
- Fever
- Chest indrawing (lower chest wall pulls in)
- Poor feeding
Red flags Refer urgently if any are present
- Unable to drink or breastfeed
- Persistent vomiting
- Convulsions, lethargy or unconsciousness
- Stridor in a calm child
- Severe malnutrition
- Oxygen saturation under 90%
- Chest indrawing in an infant under 2 months
Diagnosis
- Clinical diagnosis by respiratory rate and chest indrawing (WHO / IMCI)
- Pulse oximetry where available
- Chest X-ray not needed routinely for community cases
- Blood culture and X-ray for severe hospitalised cases
Treatment
Step 1 of 4
Classify (IMCI)
- Count breaths for a full minute while the child is calm
- Look for chest indrawing and general danger signs
- Cough or cold, no pneumonia: no antibiotic, supportive care
- Pneumonia: fast breathing and/or chest indrawing
- Severe pneumonia or very severe disease: any danger sign, oxygen saturation under 90%, or age under 2 months
Step 2 of 4
Pneumonia: oral treatment at home
- Oral amoxicillin dispersible tablets for 3–5 days
- Fever: paracetamol
- Continue breastfeeding and fluids; keep the nose clear
- Review after 2 days: if breathing is not improving or danger signs appear, refer
- Do not use cough syrups or antihistamines
Prescription
AmoxicillinPenicillin antibiotic
Dose40–50 mg/kg/dose twice daily (about 80–90 mg/kg/day)
Brands Amoxil, Dispermox
3–5 days
Per current national ARI protocol
Caution: Penicillin allergy
Paracetamol (Acetaminophen)Analgesic / antipyretic
Dose10–15 mg/kg every 6 h
Brands Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)
As needed
Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease
Step 3 of 4
Severe pneumonia: admit
- Give oxygen for oxygen saturation under 90% or respiratory distress
- First dose of antibiotic before transfer
- Parenteral therapy in hospital; switch to oral when improving
- Treat dehydration, fever and hypoglycaemia; feed by nasogastric tube if unable to swallow
Prescription
Ceftriaxone3rd-generation cephalosporin
Dose50–100 mg/kg once daily IV/IM
Brands Rocephin, Dayline, Oxidil
Until improved, then oral amoxicillin to complete 5–7 days
Resistance is widespread in Salmonella Typhi in Sindh and Punjab; use culture guidance.
Step 4 of 4
Recovery and prevention
- Follow up in 2 weeks
- Check immunisation: pneumococcal conjugate, Hib (pentavalent) and measles vaccines
- Counsel on indoor smoke from cooking fuel and exclusive breastfeeding
Prevention
- Pneumococcal conjugate vaccine (PCV) and pentavalent (Hib) vaccines under EPI
- Exclusive breastfeeding to 6 months
- Reduce smoke exposure; good nutrition
Guideline sources
- WHO Pocket book of hospital care for children
- WHO IMCI chart booklet
- National ARI Control Programme Pakistan