As per history, the child has fever, cough and was unable to drink. The history points to very severe disease. classification of pneumonia. Fast breathing is present when the respiratory rate is : 1. 60 breaths/min or more in child < 2 months of age. 2. 50 breaths/min or more in child aged 2-12 months. 3. 40 breaths/min or mote in child 12 months - 5 yrs. VERY SEVERE DISEASE:- 1. Not able to drink 2. Convulsions, abnormally sleepy/ difficult to wake. 3. Stridor in calm child 4. Severe malnutrition Treatment- Refer urgently to hospital. Give first fose of antibiotics. Treat fever and wheeze , if present. If cerebral malaria possible, give antimalarial. SEVERE PNEUMONIA Most impoant sign to consider when deciding if the child has pneumonia are the RR and chest indrawing. A child with chest indrawing may not have fast breathing if the child becomes exhausted. Then the breathing slows down. Un such cases chest indrawing may be the only sign in a child with severe pneumonia. Other signs: 1. Nasal flare 2. Grunting 3. Cyanosis 4. Wheezing Treatment:- Refer urgently to hospital. Give first dose antibiotics. Treat fever and wheeze if present. PMEUMONIA:- 1. Fast breathing 2. No chest indrawing Treatment:- Advice mother to give home care. Give an antibiotic. Treat fever and wheeze if present. Advice mother to return eith child in 2 days for reassessment, or earlier if child gets worse. No pneumonia:- 1. Simple cough or cold. Treatment:- Assess and treat ear problems or sore throat. Assess and treat other problems. Advice mother to give home care. Treat fever and wheeze if present. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.170}