Management of Pneumonia and Diarrhoea in Children Up to 10 Years of Age
Publication Date: December 31, 2024
Last Updated: January 13, 2025
Summary of Recommendations
Treatment of children 2–59 months of age with pneumonia
In children 2–59 months of age with only fast breathing (no chest indrawing, no general danger signs), WHO recommends the use of oral amoxicillin for three or five days. (S, M )
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In children 2–59 months of age with chest indrawing (with or without fast breathing) and no general danger signs WHO recommends the use of oral amoxicillin for five days in the outpatient setting rather than injectable antibiotics in the inpatient setting. (S, M )
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In children 2–59 months of age with chest indrawing (with or without fast breathing) and no general danger signs in settings with functional community health worker programmes, WHO suggests the use of community-based care (use of oral amoxicillin for five days with follow-up visits) rather than of standard care (first dose of antibiotic [oral amoxicillin] given by community health worker and referral to a facility for further management). (C, L )
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Diagnosis of children 2–59 months of age with pneumonia
In children 2–59 months of age presenting with cough and/or difficult breathing, WHO makes no recommendation about the use of lung ultrasound to diagnose pneumonia. (Knowledge Gap) (U, U)
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In children 2–59 months of age presenting with cough and/or difficult breathing, WHO makes no recommendation about the use of digital auscultation or cough sound algorithms as an add-on test to diagnose pneumonia. (Knowledge gap). (U, U)
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Management of children 2–59 months of age with pneumonia and risk factors for mortality
In settings where pulse oximetry is not available, in children 2–59 months of age diagnosed with pneumonia (fast breathing or chest indrawing without general danger signs), WHO suggests evaluation of respiratory distress using a combination of signs and symptomsa to detect hypoxaemia. (C, VL )
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In children 2–59 months of age with pneumonia (fast breathing and/or chest indrawing without general danger signs) having high risk factors for mortality, WHO makes no recommendation on the effectiveness of enhanced care. (Knowledge gap). (U, U)
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Management of pneumonia in children 5–9 years of age
In children 5–9 years of age presenting at first-level health care facilities, WHO makes no recommendation on a standardized clinical assessment of community acquired pneumonia. (Knowledge gap). (U, U)
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In children 5–9 years of age with suspected pneumonia, WHO makes no recommendation about which antibiotic has the highest effectiveness in improving clinical outcomes. (Knowledge gap). (U, U)
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Treatment of diarrhoea in children up to 10 years of age
In children up to 10 years of age with acute watery diarrhoea (regardless of etiology), WHO suggests against the use of antibiotics. (C, L )
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In children up to 10 years of age with persistent diarrhoea (regardless of etiology), WHO makes no recommendation on the use of antibiotics. (Knowledge gap). (U, U)
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In children up to 10 years of age with diarrhoea and blood in the stools, WHO recommends treatment with antibiotics rather than no antibiotics. (Moderate/Low evidence) (S, M )
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In children up to 10 years of age with acute watery diarrhoea, WHO recommends adjunctive treatment with oral zinc. (S, M )
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In children up to 10 years of age with persistent diarrhoea, WHO recommends adjunctive treatment with oral zinc. (S, M )
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In children up to 10 years of age with acute watery or persistent diarrhoea, WHO suggests a 5 mg daily dose of oral zinc for up to 14 days. (C, L )
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In children up to 10 years of age with acute watery diarrhoea, WHO suggests against the use of probiotics. (C, L )
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In children up to 10 years of age with persistent diarrhoea, WHO makes no recommendation for the use of probiotics. (Knowledge gap). (U, U)
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In children up to 10 years of age with acute watery diarrhoea and dehydration, WHO recommends the use of low-osmolarity oral rehydration solution. (S, M )
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Management of diarrhoea in children up to 10 years of age with risk factors for mortality
In children up to 10 years of age with acute watery diarrhoea having risk factors for mortality, WHO makes no recommendation about enhanced care compared to the usual care. (Knowledge gap). (U, U)
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The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Management of Pneumonia and Diarrhoea in Children Up to 10 Years of Age
Authoring Organization
World Health Organization
Publication Month/Year
December 31, 2024
Last Updated Month/Year
January 13, 2025
Country of Publication
Global
Document Objectives
Pneumonia and diarrhoea account for 23% of under-five mortality and were responsible for an estimated 1.17 million deaths in children under five globally. Furthermore, pneumonia and diarrhoea were responsible for 18% of mortality in children 5–9 years of age, resulting in an estimated 86 000 preventable deaths globally in 2021. Existing World Health Organization (WHO) guidance on the clinical management of pneumonia and diarrhoea has mainly focused on children less than 5 years of age. WHO had not developed clinical guidance on the management of these conditions in children 5–9 years of age, which is a gap being addressed in response to calls from national policy- and decision-makers. The goal of the guideline is to develop, update and consolidate recommendations on the management of pneumonia and diarrhoea in order to inform, revise or update the development of clinical protocols for the management of pneumonia and diarrhoea in children up to 10 years of age. This guideline aims to help WHO Member States and their partners make evidence-informed decisions on the appropriate actions in their efforts to address common childhood illnesses, including pneumonia and diarrhoea. The main changes from previous recommendations involve giving greater scope for pneumonia treatment at the community level, using a specific set of signs and symptoms to diagnose hypoxaemia when pulse oximetry is not available, and a new dose for zinc supplementation. The recommendations are intended for a wide audience involved in the management of pneumonia and diarrhoea in children.
Inclusion Criteria
Male, Female, Child, Infant
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Management
Diseases/Conditions (MeSH)
D011014 - Pneumonia, D003967 - Diarrhea
Keywords
pneumonia, diarrhea, Diarrhoea
Source Citation
Guideline on management of pneumonia and diarrhoea in children up to 10 years of age. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.