WHO / IMNCI Classification of Pneumonia in Children (2 months–5 years)
Fast Breathing Cutoffs (WHO)
| Age | Fast Breathing (breaths/min) |
|---|---|
| <2 months | ≥ 60/min |
| 2–12 months | ≥ 50/min |
| 1–5 years | ≥ 40/min |
Must count breaths for a full 1 minute with the child calm.
IMNCI Three-Category Classification
| Category | Defining Signs | Treatment |
|---|---|---|
| No Pneumonia (Cough/Cold) | No fast breathing; no chest indrawing; no danger signs | Home care; safe cough remedy; paracetamol for fever |
| Pneumonia | Fast breathing ± lower chest indrawing; normal SpO₂; feeding well; no danger signs | Home care; oral amoxicillin 40 mg/kg/dose BD × 5 days; follow-up in 2 days |
| Severe Pneumonia / Very Severe Disease | Lower chest indrawing + any danger sign | Inpatient; IM/IV benzylpenicillin or ampicillin + gentamicin |
General Danger Signs (Any = Severe / Very Severe)
- Unable to drink or breastfeed
- Vomiting everything
- Convulsions
- Lethargic or unconscious
- Stridor in a calm child
- Central cyanosis
WHO Criteria for Severe Pneumonia (Ghai / older WHO)
Severe pneumonia indicated by:
- Severe chest indrawing
- Evidence of hypoxia (SpO₂ <92%)
- Danger signs (lethargy, cyanosis, poor feeding, seizures)
Management: IV penicillin or ampicillin + gentamicin for ≥5 days; IV ceftriaxone as second-line.
Neonates / Young Infants (<2 months) — Severity Criteria
Any of the following = Possible Serious Bacterial Infection (PSBI):
- Fever ≥38°C
- Hypothermia (<35.5°C)
- Fast breathing (≥60/min)
- Severe chest indrawing
- Grunting
- Nasal flaring
- Bulging fontanelle
- Seizures
- Lethargic / unconscious / less than normal movements
- Not feeding / breastfeeding poorly
- Apneic spells
- Distended abdomen
- Central cyanosis
- Altered sensorium
Action: Give first dose IM ampicillin + gentamicin → Refer URGENTLY
Ambulatory vs Inpatient Decision (Summary)
Fast breathing only (no danger signs, SpO₂ normal, feeding well)
→ OUTPATIENT: oral amoxicillin × 5 days
Chest indrawing + normal SpO₂ + no danger signs
→ OUTPATIENT (per revised WHO 2014) or INPATIENT based on clinical judgment
Chest indrawing + hypoxia OR danger signs
→ INPATIENT: IV antibiotics + oxygen + supportive care
Antibiotic for Outpatient Pneumonia (WHO / IMNCI)
Amoxicillin — first choice for non-severe CAP
- Dose: 40 mg/kg/dose TWICE daily (BD)
- Duration: 5 days
- Alternative if amoxicillin unavailable: Cotrimoxazole
Antibiotic for Inpatient / Severe Pneumonia (WHO / IMNCI)
First line: IV/IM Benzylpenicillin (or Ampicillin) + Gentamicin
| Drug | Dose |
|---|---|
| Benzylpenicillin | 50,000 IU/kg/dose IV q6h |
| Ampicillin | 100 mg/kg/day IV divided |
| Gentamicin | 5 mg/kg/day IM/IV once daily |
Second line: IV Ceftriaxone 50–75 mg/kg/day
Follow-Up Protocol (IMNCI)
- Pneumonia: Follow up in 2 days
- At 2-day review, if:
- Breathing slower + less fever + eating better → complete 5-day course
- Same or worse → refer to hospital
- Chest indrawing or danger sign develops → IM chloramphenicol + urgent referral