18 month old child sign of severe pneumonia is
**Core Concept**
Severe pneumonia in children is characterized by the presence of respiratory distress, which can lead to hypoxia and multi-organ failure if not promptly treated. This condition is often associated with bacterial infections such as Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae.
**Why the Correct Answer is Right**
Severe pneumonia in children is often diagnosed based on clinical signs such as respiratory rate, work of breathing, and oxygen saturation. A respiratory rate of 50-60 breaths per minute in a child of this age group is considered abnormal and may indicate severe pneumonia. Additionally, signs of respiratory distress such as grunting, flaring of nostrils, and nasal flaring may also be present. The child may also show signs of lethargy, refusal to feed, and poor perfusion.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because while cough is a common symptom of pneumonia, it is not a specific indicator of severe pneumonia. A child with severe pneumonia may not always cough, or the cough may be absent due to respiratory muscle fatigue.
**Option B:** This option is incorrect because while fever is a common symptom of pneumonia, it is not a specific indicator of severe pneumonia. Some children with severe pneumonia may not have a fever, or the fever may be low-grade due to underlying conditions such as HIV/AIDS.
**Option C:** This option is incorrect because while tachycardia (rapid heart rate) may be present in children with pneumonia, it is not a specific indicator of severe pneumonia. Children with severe pneumonia may also have bradycardia (slow heart rate) due to hypoxia and respiratory muscle fatigue.
**Clinical Pearl / High-Yield Fact**
The World Health Organization (WHO) recommends the use of the "Danger Signs" criteria to diagnose severe pneumonia in children. These danger signs include respiratory rate > 50 breaths per minute, grunting, flaring of nostrils, nasal flaring, and refusal to feed.
**Correct Answer: D.**