World Pneumonia Day: count a child’s breaths for one minute, and know the signs that need a hospital

A child with a cough who breathes 50 times a minute or more before the first birthday, or 40 times or more between one and five years, should be shown to a health worker, the Union Health Ministry’s childhood pneumonia guidance says. Thursday, 12 November, is World Pneumonia Day, and winter is setting in across Andhra Pradesh and Telangana.

Pneumonia remains the biggest infectious killer of Indian children under five. The ministry’s guidance note for its SAANS campaign puts its share of under-five deaths at 16.31%, citing the Registrar General’s cause-of-death figures for 2021-23, and estimates about 3 crore episodes of respiratory infection and pneumonia among children each year. The World Health Organization counted 740,180 pneumonia deaths of under-fives worldwide in 2019, or 14% of all deaths in that age group.

What to watch for at home

Front-line workers are trained to count how many times the chest rises in one full minute, then look at the lower chest. If it sinks inward each time the child breathes in, the ministry classes that as severe pneumonia. For babies younger than two months, 60 breaths a minute or more is a warning sign by itself.

Some signs call for a hospital at once: a child who cannot feed or drink, throws up everything, has fits, is unusually drowsy or hard to wake, makes grunting sounds, or has bluish lips or hands. A cough lasting more than 14 days also needs a doctor. Under the guidance, an ASHA or ANM who finds pneumonia starts a first oral dose of amoxicillin and refers the child to a health facility. WHO lists amoxicillin dispersible tablets as the first-line drug and says only one in three children with pneumonia receives the antibiotics they need.

Three free vaccine doses

PCV, the pneumococcal conjugate vaccine, costs nothing for eligible children through the Universal Immunization Programme. Shots are due at six and 14 weeks of age, with a third dose at nine months, and the ministry wants all three finished within the first year. The doses are recorded on the Mother and Child Protection card that anganwadi and primary health centre staff use.

Smoke inside the home adds to the risk. The ministry lists cooking or heating with wood or dung, smoking indoors, burning rubbish close to the home and poor ventilation. WHO adds breast milk alone for the first six months, and handwashing with soap, as protection.

The last round of the campaign, SAANS 2025-26, opened on World Pneumonia Day in 2025 with ASHA home visits to screen children under five. A guidance note for a 2026-27 round had not been posted on the National Centre for Disease Control website by Wednesday night, 11 November.