Pneumonia in children: fast breathing and danger signs to know

Coughs and colds are very common in young children, and most get better on their own. Pneumonia is different. It is an infection of the lungs that can become serious quickly, especially in babies and children under five. Knowing a few simple signs, above all fast breathing and chest indrawing, can help you get your child to a doctor in time.

What is pneumonia?

Pneumonia is an infection that affects the lungs. Inside the lungs are tiny air sacs called alveoli, which normally fill with air when we breathe in. In pneumonia, these sacs fill with pus and fluid. This makes breathing hard and lowers the amount of oxygen the body gets.

Pneumonia can be caused by viruses, bacteria or fungi. A study by icddr,b and partners, published in 2021, looked at young children in hospital with severe pneumonia at one rural site (Matlab) and one urban site (Dhaka) in Bangladesh. It found that most of their pneumonia was caused by viruses, especially respiratory syncytial virus (RSV). RSV is a common virus that can infect the lungs of babies and young children.

How common and how serious is it?

The World Health Organization (WHO) calls pneumonia the single largest infectious cause of death in children worldwide. According to WHO’s pneumonia fact sheet, it killed about 740,000 children under five in 2019. That was 14% of all deaths in that age group.

UNICEF has described pneumonia as a leading killer of young children in Bangladesh. WHO says pneumonia can be prevented with vaccines, good nutrition and cleaner air at home, and that pneumonia caused by bacteria can be treated with antibiotics.

Common symptoms

Your child may have:

a cough
fever (high temperature)
difficult or fast breathing
a wheezing (whistling) sound when breathing, which is more common when a virus is the cause
in very sick babies, being unable to feed or drink

A cough and fever alone do not mean pneumonia. In a child under five with cough or breathing difficulty, health workers look for fast breathing or lower chest indrawing.

How to check for fast breathing

Health workers in Bangladesh and around the world use WHO’s age-based limits to decide whether a child is breathing too fast. You can count your child’s breaths at home too:

Wait until your child is calm or asleep. Crying, feeding or moving makes the count wrong.
Lift or loosen clothing so you can see the chest or tummy rise and fall.
Count each rise of the chest as one breath, for a full 60 seconds using a phone timer.
Compare your count with the table below.

Child’s age	Fast breathing is
Under 2 months	60 breaths a minute or more
2 months up to 12 months	50 breaths a minute or more
12 months up to 5 years	40 breaths a minute or more

If your child has a cough or breathing difficulty and is breathing at or above these rates, take them to a doctor or health facility the same day. Your count is a warning sign, not a diagnosis. The doctor will examine your child properly.

What is chest indrawing?

Normally the chest moves out when a child breathes in. In lower chest indrawing, the lower part of the chest wall sucks in each time the child breathes in. It shows the child is working very hard to breathe. A child with chest indrawing needs to be seen by a doctor urgently.

Warning signs: go to a hospital emergency now

Take your child to the nearest hospital emergency department immediately if they have cough, fever or breathing difficulty together with any of these signs:

not able to drink or breastfeed
vomits everything they eat or drink
has had a convulsion (fit), or is having one now
is unusually sleepy, floppy, hard to wake, or unconscious
struggling to breathe, gasping, or chest indrawing
a harsh, high-pitched noise when breathing in while calm (called stridor)
blue, grey or very pale lips, tongue or skin
a young baby who feels unusually cold to touch, as well as one with fever

The first four are what WHO calls general danger signs. Any child with one of them has a serious problem, whatever the cause. Do not wait to see if it gets better overnight.

Babies under 2 months are especially at risk. If a newborn is ill and is feeding poorly, breathing fast, has a fever or feels cold, a doctor should check them without delay.

Which children are at higher risk?

Most healthy children can fight off the infection. According to WHO, the risk is higher in children who:

are undernourished, especially if they were not exclusively breastfed as infants
have other illnesses, such as measles or HIV
live with indoor smoke from cooking or heating with fuels such as wood or dung
live in crowded homes
have parents who smoke

How is pneumonia diagnosed and treated?

A doctor will ask about the illness, count your child’s breathing, look at the chest and listen with a stethoscope. They may measure the oxygen level with a small clip on the finger or toe (a pulse oximeter), and sometimes order a chest X-ray or blood tests.

Pneumonia caused by bacteria is treated with antibiotics. WHO says most cases need antibiotics taken by mouth, often prescribed at a health centre, and that hospital care is recommended only for severe cases. In hospital, children may also get help with breathing, such as oxygen, and with feeding. The doctor decides whether antibiotics are needed, which one and for how long.

Some practical points:

Give any medicine exactly as the doctor prescribed. If you have questions or worries about the medicine, ask the doctor.
Do not use leftover antibiotics or buy them from a pharmacy without a prescription. Using them wrongly helps germs become resistant.
Keep breastfeeding and offer fluids and food often, in small amounts.
Go back for the follow-up visit the doctor asks for. Return immediately if your child gets worse or shows any warning sign.

Preventing pneumonia

WHO says vaccination is the most effective way to prevent pneumonia in children. Key vaccines protect against pneumococcus, Hib (Haemophilus influenzae type b), measles and whooping cough (pertussis). Since 2015, Bangladesh has given the pneumococcal conjugate vaccine (PCV) through its national immunisation programme, the EPI. Make sure your child gets every dose on time at your nearest EPI centre or health facility, and keep the vaccination card safe.

Other steps that help:

Breastfeed only (no water, formula or other food) for the first 6 months, then keep breastfeeding alongside good food.
Keep children away from cooking smoke and tobacco smoke. Cook in a well-ventilated area if you can.
Practise good hygiene at home, such as washing hands with soap, especially in crowded homes.

Which doctor should you see?

Emergency: if your child has any warning sign above, go straight to the emergency department of the nearest hospital. Do not wait for a specialist appointment.
Paediatrician (child specialist): the right doctor for most children with cough, fever and fast breathing. If you need help quickly, a general doctor (MBBS) at a community clinic or Upazila Health Complex can assess your child and refer them if needed.
Neonatologist (newborn specialist): for sick babies in their first month, often in a hospital newborn unit.
Paediatric pulmonologist (child lung specialist): for children who get pneumonia again and again, have long-lasting breathing problems, or are not getting better with treatment. You usually see one after a paediatrician refers you.

If you are unsure what to do, you can call the government health call centre Shastho Batayon on 16263. DGHS says doctors answer calls 24 hours a day. A phone call does not replace seeing a doctor when your child has danger signs.

Key points

Cough or difficult breathing plus fast breathing or chest indrawing may mean pneumonia. See a doctor the same day.
Count breaths for a full minute while your child is calm.
Not being able to drink, vomiting everything, fits and being very sleepy are emergencies.
Vaccines, breastfeeding and a smoke-free home help prevent pneumonia.

This article is for general information and does not replace advice from a doctor who has examined your child.

Find a doctor

Browse Child Diseases doctors in Bangladesh on ratings.com.bd, with chamber addresses, visiting hours and appointment numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above and checked automatically against them; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.