Doctors Revision

IMCI · Age: 2 months - 5 years

Cough or Cold

Classification for a child with cough or difficult breathing who does NOT have signs of pneumonia (no chest indrawing, no fast breathing) or very severe disease (no danger signs, no stridor). Usually a viral upper respiratory infection.

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Care priority and warning signs

Care priority

Routine Management / Home Care

Red flags

  • Cough lasting for 14 days or more (Assess for Tuberculosis, see page 9).
  • Development of fast breathing.
  • Development of difficult breathing / chest indrawing.
  • Development of any danger sign.
  • Recurrent wheezing (needs assessment for asthma).

Assessment

  • Ask: Does the child have cough or difficult breathing?
  • Ask: For how long?
  • Confirm absence of General Danger Signs (see IMCI_2M5Y_001).
  • Confirm absence of Stridor in a calm child.
  • Confirm absence of Chest Indrawing.
  • Confirm absence of Fast Breathing (Count breaths/min. Not fast if: Age 2-11 months: < 50 breaths/minute. Age 12 months - 5 years: < 40 breaths/minute).
  • Look/Listen: Look and listen for wheezing.

Classification

  • No signs of Pneumonia or Very Severe Disease -> COUGH OR COLD

Key features

  • Absence of signs of pneumonia (chest indrawing, fast breathing) and very severe disease (danger signs, stridor).
  • This is a diagnosis of exclusion after ruling out more severe respiratory conditions.
  • Management focuses on symptom relief and home care advice.
  • Antibiotics are NOT indicated unless a specific bacterial complication develops (e.g., acute otitis media).

Management

Non-pharmacological management

  • Soothe the throat and relieve the cough with a safe remedy: Encourage breastfeeding. Offer warm drinks like tea with lemon. If child is >1 year old, honey may be given. Avoid harmful remedies (Kabuti, Kisa kya muzadde, codeine, piriton, promethazine).
  • Advise mother to continue feeding and encourage fluid intake.
  • Clear blocked nose if it interferes with feeding (e.g., saline drops).

Pharmacological treatment

  • If wheezing is present (or was present and disappeared after a trial of bronchodilator): Give inhaled rapid-acting bronchodilator (Salbutamol 100mcg/puff) 2 puffs via spacer, 3 times daily for 5 days.

Follow-up

  • Follow-up in 5 days ONLY IF the child is not improving.
  • If coughing for 14 days or more at any visit, assess for TB (History of contact, poor weight gain, persistent fever. Check for GeneXpert/smear if available. See page 9).
  • If wheezing is recurrent, refer for asthma assessment.

Counselling points

  • Reassure the mother that the child has a cold and antibiotics are not needed.
  • Teach how to soothe the throat and relieve cough using safe home remedies.
  • If Salbutamol prescribed for wheezing: Teach correct use of inhaler and spacer (as in Pneumonia counselling).
  • Advise to continue feeding and offer extra fluids.
  • Advise mother WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes fast, child not able to drink or breastfeed, child becomes sicker.
  • Advise on follow-up in 5 days only if no improvement, or sooner if symptoms worsen.
  • Advise to return if cough persists for more than 14 days.

Differential diagnosis

  • Pneumonia (early or mild)
  • Asthma/Wheezing (can occur with viral colds)
  • Allergic rhinitis
  • Bronchiolitis (if wheezing, mainly <2 yrs)
  • Tuberculosis (especially if cough > 14 days)
  • Pertussis (paroxysmal cough)

Complications

  • Acute Otitis Media
  • Sinusitis
  • Persistent cough
  • Exacerbation of underlying asthma (if present)

Prevention

  • Frequent handwashing for caregiver and child.
  • Avoiding close contact with people who have colds.
  • Avoiding exposure to tobacco smoke.
  • Good nutrition.
  • Exclusive breastfeeding for the first 6 months.

References

IMCI Chart Booklet - Page 2, Page 9, Page 17, Page 18, Page 30

For learning and professional reference. Use current local guidance and clinical judgement.

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