IMCI training video:Exercise C - How to assess a child with cough and difficult breathing

Summary

This script offers a comprehensive guide for assessing children with cough or difficult breathing, focusing on identifying pneumonia among common respiratory issues. It emphasizes the importance of determining the duration of coughing, recognizing fast breathing rates relative to the child's age, and observing for signs like chest indrawing and stridor. The script also provides practical steps for counting breaths and checking for breathing difficulties, ensuring early detection of severe respiratory infections.

Takeaways

• 🔍 Initial assessment of a child should include checking for general danger signs and inquiring about the presence of a cough or difficulty breathing.
• 🤒 A child with a cough might be suffering from pneumonia or another severe acute respiratory infection, necessitating further assessment.
• 🕒 The duration of the child's cough is critical, as a chronic cough lasting over 30 days could indicate tuberculosis, asthma, or whooping cough.
• 🏃‍♂️ Fast breathing is a key indicator of pneumonia; it's essential to count the child's breaths per minute to determine if it's rapid.
• 👶 Age-specific cutoff rates for fast breathing are crucial: 50 breaths per minute for children aged 2 months to 12 months, and 40 breaths per minute for those aged 12 months to 5 years.
• 👁️‍🗨️ Observing the child's breathing movement on the chest or abdomen is necessary, and the child should be calm during this observation.
• 👶 For a 7-month-old child, 90 breaths per minute indicate fast breathing, which is a sign of potential pneumonia.
• 🫁 Chest indrawing is a significant sign that occurs when the effort to breathe in is much greater than normal, and it should be assessed when the child is breathing in.
• 👂 Listening for stridor, a harsh noise made during inhalation, is important for identifying potential life-threatening airway obstructions.
• 🚫 Stridor is only significant if it is present consistently and is definitely visible; it should not be confused with noises heard when the child is upset or feeding.

Q & A

What is the first main symptom to ask about when assessing a child's respiratory condition?

The first main symptom to inquire about is whether the child has a cough or is experiencing difficulty breathing.

Why is it important to determine the duration of a child's cough?

Knowing the duration of a child's cough is crucial as a chronic cough lasting more than 30 days may indicate tuberculosis, asthma, or whooping cough.

What is the significance of assessing fast breathing in a child with a cough?

Fast breathing is a sign of pneumonia. It indicates that the child's lungs have become stiff, making it harder to breathe and causing an increase in the breathing rate as the body tries to compensate for lung stiffness and low oxygen levels.

How can one determine if a child's breathing rate is fast?

Fast breathing is determined by counting the number of breaths the child takes in one minute and comparing it with age-specific cutoff rates.

What are the cutoff rates for fast breathing in children aged two months up to 12 months?

For children aged two months up to 12 months, fast breathing is present if 50 breaths per minute or more are counted.

What are the cutoff rates for fast breathing in children aged 12 months up to five years?

For children aged 12 months up to five years, fast breathing is indicated if 40 breaths per minute or more are counted.

Why is it necessary to observe a child's breathing when they are calm?

Observing a child's breathing when they are calm ensures that the assessment is accurate and not influenced by temporary factors such as crying or agitation, which can alter the breathing pattern.

What is chest indrawing and why is it significant in assessing a child's respiratory condition?

Chest indrawing occurs when the effort required to breathe in is much greater than normal, causing an inward movement of the lower chest wall. It is significant because it indicates severe respiratory distress and may be present in conditions like pneumonia.

How can one identify chest indrawing in a child?

Chest indrawing can be identified by observing the inward movement of the lower chest wall when the child breathes in, which is more pronounced than the normal outward movement of the upper chest and abdomen.

What is stridor and how can it be detected?

Stridor is a harsh noise made when a child is breathing in, which can indicate a life-threatening airway obstruction. It can be detected by listening closely to the child's breathing, especially by placing the ear near the child's mouth.

Why is it important to observe a child for stridor when they are calm?

Observing a child for stridor when they are calm helps to ensure that the noise is not a temporary response to crying or upset but a consistent sign of respiratory distress.