Every pneumonia algorithm in use rests on a respiratory rate threshold, and the rate is the measurement most often taken badly. A fifteen-second count multiplied by four amplifies every irregularity in a small child's breathing by a factor of four. A crying child breathes fast because they are crying.
So settle the child on the caregiver's lap, expose the chest or abdomen, and count for a full sixty seconds. If the child cries partway through, start again. Then look — chest indrawing is a visual sign, seen on the lower chest wall during inspiration, and it is missed when the shirt stays on.
The thresholds are worth having to hand rather than looked up: 50 or more per minute from 2 to 11 months, 40 or more from 12 to 59 months. Everything the algorithm does next depends on which side of that line the number falls, and on a count that was actually taken properly.
- Count for a full minute with the child calm and the chest exposed.
- Recount if the child cries or feeds during the count.
- Use 50/minute from 2–11 months and 40/minute from 12–59 months as the thresholds.
- Look for lower chest wall indrawing during inspiration as a separate step, not as an impression.
- Check for danger signs — inability to drink, persistent vomiting, convulsions, lethargy, stridor at rest — before deciding on outpatient management.
Why it matters
The classification that decides whether a child goes home rests on a measurement routinely taken in fifteen seconds.
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