The child has chest indrawing,but no fast breathing and hence classified as severe pneumonia. 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. PNEUMONIA:- 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}