In pediatric pneumonia, in children with cough as the main symptom, the doctor needs to check only 2 clinical signs of the child to confirm the diagnosis of almost all pneumonia, and these are increased respiration and chest depression.
When a child has pneumonia, the lungs become solid and one of the body’s responses to solid lungs and hypoxemia (too little oxygen) is increased respiration. As the pneumonia worsens, the lungs become more solid and chest depression may occur, which is a sign of severe pneumonia.
The first step is to check for general danger signs in all children. Children with general danger signs have severe disease. Most children with general danger signs need urgent referral to the hospital.
A child has danger signs if.
1. the child is unable to drink or breastfeed.
2. the child is vomiting everything he or she eats.
3. The child is having convulsions.
4. The child is drowsy or unconscious.
Q: Can the child drink water or breast milk?
When the child is too weak to suck or swallow, the child has/can’t drink water or breast milk signs.
If the child’s mother tells you that the child cannot drink water or breast milk, ask her to tell you what happens when she gives the child something to drink. For example, can the child drink and swallow liquids?
If you are not sure about the mother’s answer, ask the mother to give the child water or breast milk at that time. Note: When the child’s nasal passages are blocked, sucking on breast milk can be difficult. If the child’s nasal passages are blocked, clear them. If the child’s nasal cavity is cleared and breastfeeding is possible, the child does not/can’t drink water or can’t take breast milk as a risk sign.
Q: Does the child vomit up everything he/she eats?
A child who spits out everything he or she eats is one who is unable to retain food, fluids or oral medications that he or she has ingested. If you are not sure about the mother’s answer, ask the mother to give the child water. See if the child is vomiting.
Q: Does the child have convulsions?
In convulsions, the child’s arms and legs straighten due to muscle contractions. The child may have loss of consciousness or be unable to respond to commands.
Ask the mother if the child has had any convulsions during this episode. Use language that the mother can understand, e.g., the mother may call the convulsions a convulsion.
Look: Is the child drowsy or comatose.
A sleepy or comatose child is one who remains drowsy and uninterested in what is going on around him when he should be awake. Typically, a sleepy child will not look at his mother or at your face when you are talking.
A comatose child is impossible to wake up. He is unresponsive when touched, shaken, or spoken to.
Ask the mother if the child seems to be sleeping abnormally or if she is unable to wake the child. Observe if the child wakes up when the mother talks or shakes the child or when you clap.
Note: If the child is sleeping and has a cough or difficulty breathing, count the child’s breaths before waking him or her. If the child has general danger signs, the child has a very serious problem that needs urgent attention (immediate evaluation and urgent treatment before referral).
If there are no general danger signs, continue with the assessment, classification and management of the cough or dyspnea.
Q: How long has the child had a cough or dyspnea?
If it has been >30 days, it has a chronic cough. It may be a sign of tuberculosis, asthma, whooping cough or other diseases.
Count the number of breaths in 1 minute to determine if there is increased respiration? This is done in a quiet state.
Any child without increased respiration is classified as having no pneumonia, a cough or a cold.
Children with increased respiration are classified as having pneumonia.
The criterion for increased respiration is determined by the age of the child, and the normal respiratory rate in children 2 to 12 months of age is higher than that in children 12 months to 5 years of age. The criteria for increased respiration were: ≥50 breaths/min for 2 to 12 months; ≥40 breaths/min for 12 months to 5 years.
Method of counting the number of breaths in 1 minute
1.Use a watch with a second hand or an electronic watch.
2.Count the number of breaths by observing the movement of the child’s chest or abdomen.
3.If the child is crying, calm the child and then count the number of breaths.
4.If you are not sure whether the number of breaths is correct, you can repeat the count once more.
Look: whether there is chest depression in the quiet state, observe whether the lower part of the chest wall is sunken in when the child inhales. If so, this indicates a chest depression. Classify him/her as having severe pneumonia.
Look and listen: for laryngeal wheezing in a quiet state. Observe if a noise is produced in the child’s larynx when he or she inhales. When there is edema in the larynx, trachea, or epiglottis, laryngeal wheezing in the quiet state can occur and can be life-threatening for the pediatrician.
Once a child develops laryngeal wheeze, classify him/her as having severe or very severe pneumonia.
Other physical examination
1, the child’s general, significance: mental depression: consider cystic fibrosis, immunodeficiency; cyanosis or pallor: exclude hypoxia.
2, barrel-shaped chest, suggesting air residual in the lungs due to chronic disease.
3, examination results: pestle finger. Significance: seen in bronchiectasis.
4.Nasal polyp, associated with allergic disease or cystic fibrosis.
5, tracheal deviation, suggesting a mediastinal mass or foreign body aspiration.
6.Examination findings: signs of specific allergic diseases, eczema, allergic dark circles, conjunctival congestion suggesting allergies, reactive respiratory diseases.
7. Findings: periorbital edema, sinus tenderness, purulent exudate from the posterior pharyngeal wall, halitosis, sinusitis.