Steps in assessing cough

STEP 1: Ask for general danger signs.

STEP 2: Ask the mother whether the child has a cough or any difficulty of breathing.

• If the mother says, the child does not have a cough or difficult breathing. If the child does not have a cough or difficulty breathing, you should go on to ask about the next main symptom, which is diarrhoea.
  
• If the mother answers "yes" to your questions whether the child has a cough or difficulty breathing, you should ask her the next question.
  

STEP 3: Ask for how long has the child had a cough or difficult breathing.

• Duration of a cough is considered for the chronicity of respiratory infections. A child who has had a cough or difficult breathing for more than 21 days has a chronic cough.
  
• This may be a sign of tuberculosis, asthma, whooping cough or another respiratory problem.
  

STEP 4: Count the number of breaths in one minute.

• Since breathing rate varies with age, count and compares with the cut-off point for fast breathing in children.Young infants usually breathe faster than older infants and young children.
  

Breathing Cut-Off Points

STEP 5: Look for chest in-drawing.

In a child age two months up to five years, if chest in-drawing is clearly visible and present all the time during an examination, it is a sign of severe pneumonia or very severe disease (see fig. 4.2. below, which illustrates chest in-drawing). Unlike in the young infant, mild chest in-drawing is not normal in older infants and children.

STEPS 6: Listen for stridor.

• Stridor happens when there is a swelling of the larynx, trachea or epiglottis. This swelling interferes with air entering the lungs. It can be life-threatening when the swelling causes the child's airway to be blocked. A child who has stridor when calm has a dangerous condition.
  
• Listen for stridor when the child breathes in. Put your ear near the child's mouth because stridor can be difficult to hear. Be sure to listen for stridor when the child is calm.