Every winter, hospital children's wards across Pakistan fill with small patients struggling to breathe. Pneumonia is the single largest infectious killer of children under five in Pakistan — UNICEF estimates it claims tens of thousands of young lives here every year. Yet it is both preventable and treatable, and parents who know one simple skill — counting a child's breaths — catch it early enough to save lives.
What is pneumonia?
Pneumonia is an infection of the lungs in which the tiny air sacs fill with fluid and pus, making breathing hard work and reducing oxygen. In children it is caused by bacteria (especially pneumococcus and Haemophilus influenzae type b), viruses (RSV, influenza, measles), and occasionally other organisms. It often begins as an ordinary cold or flu that travels down to the chest.
Risk is higher for babies who are not breastfed, malnourished children, unvaccinated children, and children exposed to indoor smoke — wood or coal chulhas in closed kitchens and cigarette smoke at home are proven contributors in Pakistan.
Symptoms: the skill of counting breaths
Early pneumonia looks like a cough and fever. What separates it from a simple cold is fast, difficult breathing. WHO and UNICEF, through the IMCI programme used in Pakistani clinics, teach parents and health workers to count breaths for one full minute while the child is calm or sleeping:
- Under 2 months: 60 breaths per minute or more is fast
- 2 to 12 months: 50 or more is fast
- 1 to 5 years: 40 or more is fast
Fast breathing with cough or fever means the child needs a doctor the same day.
Danger signs — go to hospital now
Go to an emergency department, or call Rescue 1122, if a child with cough or fever has:
- Chest indrawing — the skin below the ribs sucking inward with each breath
- Grunting, or nostrils flaring with breathing
- Bluish lips, tongue or fingertips
- Unable to drink or breastfeed
- Vomiting everything
- Drowsiness, floppiness, or difficulty waking
- Fits (convulsions)
- Any breathing difficulty in a baby under 2 months
These are WHO danger signs of severe pneumonia. Do not wait for morning, and do not try another home remedy first.
How doctors test for it
In most clinics, pneumonia is diagnosed by examination — breath counting, listening to the chest, and checking oxygen with a small fingertip pulse oximeter, now common in Pakistani clinics and worth every rupee for families with vulnerable children. Where needed, doctors may order a chest X-ray, CBC, and in admitted children, blood oxygen monitoring and cultures. A simple outpatient case often needs no tests at all — that is consistent with international practice.
Treatment overview
Treatment depends on severity, following WHO and IMCI guidance:
- Non-severe pneumonia — treated at home with an oral antibiotic prescribed by a doctor, fever control with paracetamol as advised, fluids and continued feeding. Amoxicillin-type antibiotics are the international first choice; the exact medicine, strength and duration must come from your doctor, and the full course must be completed even when the child bounces back in two days.
- Severe pneumonia — needs hospital admission for oxygen, injectable antibiotics and close monitoring. Oxygen is a lifesaving treatment, not a bad omen — parents sometimes fear it, but it simply supports the child while antibiotics work.
- Viral pneumonia — antibiotics do not kill viruses; doctors may still use them when bacterial infection cannot be excluded. Supportive care and oxygen are the mainstays.
Cough syrups are not recommended for young children by NHS and international paediatric guidance — they do not treat pneumonia and can cause harm. Steam from a bowl risks burns; a safer option is sitting with the child in a steamy bathroom. Desi measures like honey (only for children over 1 year) may soothe a cough, but they must never delay antibiotics for true pneumonia.
Prevention: vaccines, breastfeeding, clean air
- Vaccination — Pakistan's free EPI schedule includes the pneumococcal vaccine (PCV10), Hib vaccine (in the pentavalent injection), measles and whooping cough vaccines — together these prevent a large share of childhood pneumonia. Completing the schedule is the single strongest protection.
- Breastfeeding — exclusive breastfeeding for 6 months substantially cuts pneumonia risk, per WHO and UNICEF.
- Nutrition — a well-nourished child fights infection better; zinc and vitamin A status matter.
- Clean air — keep children away from cigarette and chulha smoke; ventilate kitchens.
- Hand washing and keeping sick family members masked around infants.
Age-specific notes
- Under 2 months: any fever, poor feeding or fast breathing is an emergency at this age — newborns can have pneumonia without cough.
- 2 months to 5 years: the highest-risk group; learn breath counting and keep vaccinations current.
- School-age children: pneumonia is less dangerous but still needs treatment; walking pneumonia with prolonged cough and mild fever occurs in this group.
- A cough lasting more than 2 weeks in any child, especially with weight loss or TB contact at home, should be checked for tuberculosis — see our TB guide.
Frequently asked questions
Bachon mein nimonia ki alamat kya hain?
Cough or fever with fast breathing — 50 or more breaths per minute in a baby of 2 to 12 months, 40 or more in a child of 1 to 5 years. Chest indrawing, refusal to feed, blue lips or drowsiness mean severe pneumonia and need hospital immediately.
Nimonia kitne din mein theek hota hai?
With the right antibiotic, most children improve within 2 to 3 days and recover fully in 1 to 2 weeks, though a mild cough may linger. If a child is not clearly better after 3 days of treatment, go back to the doctor.
Kya nimonia thand lagne se hota hai?
Cold weather alone does not cause pneumonia — germs do. Winter increases spread because families crowd indoors and viruses circulate. Warm clothes are sensible, but vaccines, breastfeeding and smoke-free air are what actually prevent pneumonia.
Is pneumonia contagious to other children?
The germs that cause pneumonia spread through coughs and sneezes, though not every exposed child develops pneumonia. Keep an ill child home, teach cough covering, wash hands, and keep infants away from anyone with a chest infection.
Bache ko pasli chalna kya hota hai?
Pasli chalna — chest indrawing, where the lower chest sinks inward with each breath — is a WHO danger sign of severe pneumonia. A child breathing this way needs emergency hospital care, not home treatment. Call Rescue 1122 or go straight to the nearest hospital.
If your child has a cough or fever and you are unsure how serious it is, our free symptom check can guide your next step in minutes. This article is general health education, not a diagnosis. Always consult a doctor about your own health.