Fast breathing is the threshold that decides antibiotics in a child with cough, and it is the measurement most often taken badly. A 15-second count multiplied by four magnifies every error by four, and a child who is crying, being examined, or febrile at the moment of counting will breathe faster than their true rate.
The sequence that works: settle the child on the parent's lap first, expose or lightly rest a hand on the abdomen, and count for a full sixty seconds. Recount if the child cries during the count. If the child is febrile, note the temperature alongside the rate, because the rate falls as the fever does and a borderline count taken at 39 degrees may not be fast breathing at all.
The age thresholds are the ones that matter: 50 or more per minute in an infant aged 2 to 11 months, 40 or more in a child of 12 to 59 months. And a normal rate does not close the assessment - chest indrawing, grunting, inability to feed, lethargy and central cyanosis are what separate a child who can go home on oral antibiotics from one who cannot.
- Count for a full minute with the child settled, and recount if they cry
- Record the temperature with the rate; reassess the rate once fever is treated
- Use 50 per minute at 2 to 11 months and 40 per minute at 12 to 59 months
- Look for indrawing, grunting, feeding failure and lethargy before deciding disposition
- Write the actual number in the notes, not fast or normal - the next clinician needs the trend
Why it matters
The antibiotic decision in childhood pneumonia rests on a number that a hurried or badly timed count will get wrong.
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