On this page
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