Pay particular attention to:
- duration in days
- paroxysms with whoops or vomiting or central cyanosis
- exposure to someone with TB (or chronic cough) in the family
- history of choking or sudden onset of symptoms
- known or possible HIV infection
- vaccination history: BCG, diphtheria, pertussis, tetanus (DPT); measles; Haemophilus influenzae type b and pneumococcus
- personal or family history of asthma.
The symptoms and signs listed below are a guide for the clinician to reach a diagnosis. Not all children will show every symptom or sign.
- central cyanosis
- apnoea, gasping, grunting, nasal flaring, audible wheeze, stridor
- head nodding (a movement of the head synchronous with inspiration indicating severe respiratory distress)
- severe palmar pallor
- respiratory rate (count during 1 min when the child is calm)
- < 2 months, > 60 breaths
- 2 - 11 months, > 50 breaths
- 1 - 5 years, > 40 breaths
- lower chest wall indrawing
- hyperinflated chest
- apex beat displaced or trachea shifted from midline
- raised jugular venous pressure
- on auscultation, coarse crackles, no air entry or bronchial breath sounds or wheeze
- abnormal heart rhythm on auscultation
- percussion signs of pleural effusion (stony dullness) or pneumothorax (hyper-resonance)
Note: Lower chest wall indrawing is when the lower chest wall goes in when the child breaths in; if only the soft tissue between the ribs or above the clavicle goes in when the child breathes, this is not lower chest wall indrawing.
- abdominal masses (e.g. lymphadenopathy)
- enlarged liver and spleen
- pulse oximetry to detect hypoxia and as a guide to when to start or stop oxygen therapy
- full blood count
- chest X-ray only for children with severe pneumonia or pneumonia that does not respond to treatment or complications or unclear diagnosis or associated with HIV.