Pneumonia in children: the signs that mean an emergency

Pneumonia is a lung infection. It fills the tiny air sacs in the lungs with fluid, making it hard for the child to breathe. It is one of the leading killers of children under 5 in Ethiopia — but it is easy to spot and easy to treat if you catch it early.

On this page

• The single most important sign: fast breathing
• Other danger signs
• Common cold or pneumonia — how to tell
• What to do
• Treatment
• How to prevent pneumonia

The single most important sign: fast breathing

WHO and Ethiopian MoH teach parents and health workers one number for each age:

How to count: watch the child’s tummy or chest rise for one full minute. Do not count when the child is crying, feeding, or has just been running. Count when calm or asleep.

If the child is breathing at or above the number for their age, this is pneumonia until a health worker proves otherwise.

Other danger signs

::: urgentAdvice severity=“emergency”

Emergency: go to a hospital right now if:

• The chest pulls inward with each breath (chest indrawing / lower chest wall retraction)
• The child cannot drink or breastfeed at all
• The child vomits everything
• The child has a seizure (convulsion)
• The child is unconscious, extremely drowsy, or hard to wake
• The child’s skin, tongue, or lips look grey or blue (cyanosis)
• The child grunts with each breath
• The child’s nostrils flare with each breath (nasal flaring)

Bring the child on foot only if there is no faster way. If someone can drive you, take that. :::

::: urgentAdvice severity=“urgent”

Urgent advice: go to a health post today if:

• The child has a cough with fast breathing (see numbers above)
• Fever with a bad cough for more than 2 days
• The child is more tired than usual
• The child is not eating or drinking normally :::

Common cold or pneumonia — how to tell

A common cold and pneumonia both start with a cough and runny nose. The difference is in the breathing.

Cold does not need antibiotics. Pneumonia does.

If you are unsure, go to the health post. It is always safer to be checked and told it is a cold than to wait too long.

What to do

• Count your child’s breaths for one full minute
• If breathing is fast, go to the nearest health post today — do not wait until tomorrow
• Keep breastfeeding your baby if under 6 months
• Give plenty of fluids to older children (water, ORS, breastmilk, soft foods)
• Bring down the fever with paracetamol at the correct dose (ask a health worker)
• Do NOT give any cough medicine without a health worker’s advice — most cough syrups are useless for children and some are dangerous

Treatment

The health worker will listen to the child’s chest, count breaths, and check for the danger signs above. Some health posts have oximeters that measure blood oxygen through the fingertip — this is a very useful test.

For pneumonia treated at home:

• Amoxicillin tablets (dispersible amoxicillin DT is preferred for young children) for 5 days
• Give the full course — do not stop when the child feels better after 2 days
• Return to the health post if there is no improvement after 48 hours

For severe pneumonia:

• The child will be referred to a hospital for injectable antibiotics and oxygen if needed
• Do not refuse referral if the health worker recommends it — severe pneumonia can kill within hours

Antibiotics only work against bacterial pneumonia. Some pneumonias are caused by viruses — for those, care means fluids, fever control, and monitoring for danger signs. The health worker decides which is which.

::: doList

Do

• Count breaths yourself if a child under 5 is coughing
• Take the full course of amoxicillin, even if the child looks better after 2 days
• Return in 48 hours if the child is not improving
• Give paracetamol for fever at the correct dose for the child’s weight
• Keep breastfeeding — it protects against pneumonia :::

::: dontList

Don’t

• Do not give leftover antibiotics from another illness
• Do not give cough syrup to a child under 6 without a health worker’s advice
• Do not delay because it is night — child pneumonia kills fastest overnight
• Do not use traditional herbal preparations that block the airway
• Do not smoke or cook indoors on wood/dung fires near the child while they are sick :::

How to prevent pneumonia

Vaccines prevent most severe pneumonia:

• PCV (pneumococcal) — 3 doses on the EPI schedule
• Pentavalent (includes Hib) — 3 doses on the EPI schedule
• Measles — measles suppresses immunity and causes pneumonia in survivors
• Rotavirus — reduces severity of other infections

Other prevention:

• Exclusive breastfeeding for the first 6 months
• Vitamin A supplementation every 6 months (given free at health posts)
• Keep indoor air clean — stove ventilation, avoid smoke exposure
• Handwashing before feeding
• Warm clothes for cold weather (especially highland Ethiopia)
• Treat HIV, malnutrition, and low birth weight — all raise pneumonia risk

::: factBox

The 3 things every parent should remember

1. Count breaths for one full minute if a child under 5 is coughing.
2. Chest indrawing is a hospital emergency, day or night.
3. Finish the full amoxicillin course even if the child seems better. :::

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa Last reviewed: 5 September 2026 · Next review due: 5 September 2028

Sources:

1. World Health Organization. Pneumonia in children fact sheet. November 2024.
2. Federal Ministry of Health, Ethiopia. Integrated Management of Newborn and Childhood Illness (IMNCI). 2023.
3. WHO / UNICEF. End Preventable Deaths Global Action Plan for Pneumonia and Diarrhoea. 2013.

Content adapted from WHO pneumonia guidance and Ethiopian MoH IMNCI. Reviewed for Ethiopian context by Dr. Hanna Alemayehu.

Draft notes (delete before publish)

• Word count: ~1,010
• Grade 6 reading level (deliberate — parent-focused)
• isTimeCritical: true — pneumonia can kill in hours
• Uses both urgentAdvice severities, doList, dontList, factBox
• WHO/IMNCI age-specific breath count numbers are the practical core
• Cold-vs-pneumonia table is the single most valuable diagnostic pattern for parents
• References indoor cooking smoke — a significant Ethiopian pneumonia risk factor
• Cross-references PCV, Pentavalent (Hib), Measles from the EPI article
• Dr. Hanna Alemayehu is placeholder — B2B-22