[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › The child with cough or difficult breathing: fast breathing, chest indrawing, home care and when to return # The child with cough or difficult breathing: fast breathing, chest indrawing, home care and when to return - Safe practice Count breaths for a full minute, look for chest indrawing, then teach the family home care and the signs to come back at once. Updated Nov 13, 2026 ## Key points - Fast breathing: 60 or more per minute under 2 months; 50 or more at 2–11 months; 40 or more at 12 months to 5 years. - Count for a full minute with the child calm; crying or feeding changes the count. - Chest indrawing: the lower chest wall goes in when the child breathes in, instead of expanding. - Any danger sign, chest indrawing or a saturation below 92% (below 90% above 2,500 m altitude): severe pneumonia, urgent referral. - Home care for cough or cold: clean the nose with saline, small frequent feeds, plenty of fluids, no over-wrapping. - Return at once if breathing becomes fast or difficult, the child cannot drink or breastfeed, vomits everything, gets worse or develops fever. ## What it is Cough or difficult breathing is one of the main symptoms in AIEPI. The nurse counts the breathing rate in a calm child for a full minute, looks for chest indrawing, listens for stridor and wheeze and, where available, measures oxygen saturation. These few signs separate the child who can be cared for at home from the child with pneumonia or severe pneumonia. Most children only have a cough or cold; for them, the nurse's main work is teaching the family how to care at home, how to prevent new episodes and when to come back. ## What it requires - A calm child, chest and abdomen visible, a watch with a second hand and, where available, a pulse oximeter. - Knowing the age of the child: the fast-breathing threshold depends on age. - The AIEPI chart for cough or difficult breathing and the recording form. ## Components - Ask: for how long has the child had cough? If there is wheeze, is it the first episode or recurrent? Was there a previous cold, apnoea or prematurity? - Look and listen: breathing rate in one minute, chest indrawing, stridor, wheeze, saturation. - Classify with the chart, then treat or refer, counsel and arrange follow-up. ## How it is applied (and why) - Check the general danger signs first — any one makes the illness very severe whatever the breathing shows. - Calm the child on the carer's lap and uncover the chest — crying, feeding or fever change the count and hide signs. - Count breaths for a full minute, watching one spot on the chest or abdomen — a short count misses irregular breathing. - Under 2 months, repeat any count of 60 or more — young infants breathe irregularly and a single count can mislead. - Look at the lower chest while the child breathes in — chest indrawing means the lungs are stiff and the work of breathing is high. - Listen for stridor in the calm child and for wheeze — stridor at rest signals airway obstruction that needs urgent care. - Measure saturation in room air if an oximeter is available — low saturation is severe even without other signs. - Teach home care: nose cleaning with saline, small frequent feeds, fluids, no over-wrapping, no smoke at home — it eases breathing and feeding. - Teach the signs to return at once and give the follow-up date — the family is the child's monitor between visits. ## In nursing practice - Pneumonia (fast breathing, no danger sign or indrawing): treatment as prescribed, home care, return signs and a follow-up visit two days later. - Cough or cold: no antibiotic; home care, return signs, and a follow-up visit after five days if the child does not improve. - Cough for more than 21 days: assess with the chart for tuberculosis. - Prevention to teach: avoid smokers and people with colds, hand washing, covering coughs and sneezes with a tissue or the elbow, daily ventilation and complete vaccination. - A sick child should stay home from day care until 24 hours after symptoms improve. ## Common mistakes - Counting breaths for 15 or 30 seconds and multiplying. - Counting while the child cries or feeds. - Looking for indrawing between the ribs only, instead of the lower chest wall. - Telling the family 'come back if worse' without naming fast breathing and difficult breathing as reasons to return. - Forgetting the follow-up visit that the classification requires. ## Test yourself Think of the answer, then tap the question to see it. ## From what respiratory rate does a child aged 2 to 11 months have fast breathing? 50 breaths or more per minute, counted for a full minute in a calm child. ## What does chest indrawing look like? The lower chest wall goes in when the child breathes in, instead of moving out as in a healthy child. ## Which oxygen saturation in room air classifies severe pneumonia in AIEPI? Below 92%, or below 90% if the child lives above 2,500 m of altitude. ## What home care does AIEPI teach for a child with cough or cold? Nose cleaning with saline, small and frequent feeds, plenty of fluids and not over-wrapping the child. ## After how many days of cough should tuberculosis be considered with the chart? When the cough has lasted more than 21 days. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/nursing/the-child-with-cough-or-difficult-breathing-fast-breathing-chest-indrawing-home/) ## Elsewhere in DurgiPedia - [Vital signs in children: how they change with age](https://durgical.com/en/clinical-exam/vital-signs-in-children-how-they-change-with-age/) ## Connections ## Related 2 - [AIEPI: the integrated strategy for childhood illness in Colombia and the nurse's role](https://durgical.com/en/nursing/aiepi-the-integrated-strategy-for-childhood-illness-in-colombia-and-the-nurse-s/) - [Nursing the infant with bronchiolitis: nasal suction, feeding, oxygen and when to escalate](https://durgical.com/en/nursing/nursing-the-infant-with-bronchiolitis-nasal-suction-feeding-oxygen-and-when-to-e/) ## Related conditions 6 - [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/) - [Acute otitis media](https://durgical.com/en/conditions/acute-otitis-media/) - [Streptococcal pharyngitis](https://durgical.com/en/conditions/streptococcal-pharyngitis/) - [Croup (laryngotracheobronchitis)](https://durgical.com/en/conditions/croup/) - [Acute epiglottitis](https://durgical.com/en/conditions/acute-epiglottitis/) - [Pertussis (whooping cough)](https://durgical.com/en/conditions/pertussis/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/cuadro-procedimientos-atencion-integrada-enfermedades-prevalentes-infancia.pdf) (Ministerio de Salud y Protección Social de Colombia, 2016); [AIEPI: Guía del facilitador clínico](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/guia-facilitador-atencion-integrada-enfermedades.pdf) (Ministerio de Salud y Protección Social de Colombia / Organización Panamericana de la Salud, 2012); [Pneumonia in children (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/pneumonia) (World Health Organization, 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/the-child-with-cough-or-difficult-breathing-fast-breathing-chest-indrawing-home/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-child-with-cough-or-difficult-breathing-fast-breathing-chest-indrawing-home/