From the Guidelines
Red flags of pneumonia in children include rapid or difficult breathing, chest retractions, nasal flaring, grunting, bluish discoloration of lips or face (cyanosis), persistent high fever, decreased activity or lethargy, poor feeding in infants, and worsening cough with production of colored sputum, as these symptoms indicate respiratory distress and potential severe pneumonia complications. According to the most recent and highest quality study 1, severe pneumonia diagnosis involves a combination of respiratory symptoms, clinical signs, and severity, and general danger signs such as inability to drink, vomiting everything, convulsions, lethargy or unconsciousness, severe malnutrition, or stridor in a calm child should be used to identify severe cases of pneumonia. The study also recommends using hypoxaemia as a clinical sign, marker of disease severity, or ancillary test, and defining hypoxaemia as a SpO measurement of less than 93%.
Some key points to consider when evaluating a child for pneumonia include:
- Respiratory rate: tachypnea is a nonspecific clinical sign, but may represent a marker for respiratory distress and/or hypoxemia 1
- Oxygen saturation: a pulse oximetric SpO2 measurement of <90% at the initial visit has been documented to be predictive of failure of outpatient oral amoxicillin treatment 1
- Clinical signs: chest retractions, nasal flaring, grunting, and cyanosis are all indicators of increased severity of pneumonia 1
- Age: children under 5 years old, particularly infants, are at higher risk for severe pneumonia complications 1
- Comorbid conditions: the presence of significant comorbid conditions is also a risk factor for the development of pneumonia and may require hospitalization 1
It is essential to seek immediate medical attention if a child shows any of these warning signs, especially if they occur together or worsen over time, as early treatment with appropriate antibiotics for bacterial pneumonia or supportive care for viral pneumonia can prevent complications and speed recovery.
From the Research
Red Flags of Pneumonia in Children
The following are red flags of pneumonia in children:
- Central cyanosis 2, 3, 4
- Inability to drink or breastfeed 2, 5, 3, 4
- Severe chest indrawing 2, 3, 4
- Tachypnea (rapid breathing) 6, 5, 3, 4
- Grunting with every breath (in young infants) 3, 4
- Head nodding 5, 3, 4
- Lethargy or unconsciousness 2, 4
- Vomiting everything 2
- Convulsions 2
- Nasal flaring 4
- Chest retractions 4
- Auscultatory signs (abnormal lung sounds) 4
Clinical Signs of Hypoxaemia
Clinical signs of hypoxaemia in children with pneumonia include:
- Tachypnea (rapid breathing) 5, 3, 4
- Head nodding 5, 3
- Inability to drink or breastfeed 5, 3
- Central cyanosis 3, 4
- Grunting with every breath (in young infants) 3, 4
- Nasal flaring 4
- Chest retractions 4
- Auscultatory signs (abnormal lung sounds) 4
Prediction of Hypoxaemia
The World Health Organization (WHO) model for predicting hypoxaemia in children with pneumonia includes:
- Central cyanosis
- Inability to drink
- Severe chest indrawing
- Respiratory rate >70 breaths/min
- Grunting with every breath (in young infants)
- Head nodding 3