Hesperian Health Guides

2. Difficulty breathing and cough

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HealthWiki > Helping Children Live with HIV > Chapter 12: Common health problems > Difficulty breathing and cough

Coughs are usually caused by simple colds. But any cough that lasts more than 2 days may be a sign of illness. And for children with HIV, this may be serious. While you care for the cough at home, watch for other signs of illness in case more treatment is needed. If the child has a fever, other problems with breathing, or coughs up yellow or green mucus, check for signs of pneumonia or tuberculosis (TB). These are both very common and dangerous for children with HIV, and need quick treatment.

Breathing problems to watch for

Breathing fast is an important sign of pneumonia and other lung infections.

When is breathing too fast?

A baby under 2 months old: more than 60 breaths a minute.

A child from 2 months to 12 months old: more than 50 breaths a minute.

A child from 12 months to 5 years old: more than 40 breaths a minute.

All children breathe fast when they are crying. Try to calm the child. When she is not crying, rest a hand on her belly to feel it rise and fall. Watch and feel how many breaths she takes each minute.

It can be difficult to measure a minute and also count breaths. If possible, have one person look at a clock or watch and say when to start and stop counting (when the minute changes) and another person count the child’s breaths.

Also watch for these signs:

illustration of a baby.
Cyanosis (change in skin color). In people with light skin, a dark blue-ish color on skin and lips. In people with dark skin, a gray or ash color around the mouth and in the whites of the eyes
Grunting noises
Neck muscles pull in with each breath
Nose flaring. The sides of the nose may open wide as he tries to breathe.
Chest in-drawing (sucking chest). The skin on chest visibly sucks in with each breath
How to treat coughs at home
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  • Make the child comfortable in a sitting or halfway sitting position. This will help the child breathe more easily.
  • At night, put something underneath the child’s sleeping mat to lift her head, or put boards or a brick under the legs at the head of her bed, so she sleeps at an angle rather than lying flat. This helps lessen coughing at night.
  • Stay close or have someone stay with the child until she feels better — having trouble breathing can be very scary, and being scared can make it harder to breathe.
  • Give plenty of fluids to drink and food to eat. Help your child understand that drinking fluids and eating healthy foods will help her feel better.
  • Nurse babies often, to provide comfort as well as nourishment. If the child does not get better in a week or so, or the cough becomes worse, or she also has a fever, see a health worker to check for pneumonia or TB.

Pneumonia (lung infection)

Pneumonia is a lung infection, and a very serious and common health problem for children with HIV. It can quickly worsen and lead to death.

Signs of pneumonia
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  • Breathing fast, the most important sign of pneumonia.
  • Difficulty breathing, including nose flaring or the skin on the chest pulling in when the child breathes. The child may make grunting noises when breathing.
  • Fever
  • Cough
  • Yellow or green mucus comes up when the child coughs.
  • No interest in food and not wanting to eat.

Children will probably not have all of these signs unless the pneumonia is already very serious. If a child has any 2 or 3 signs, treat for pneumonia.

Treatment for pneumonia

If you think a child has pneumonia, treat with an antibiotic right away


Amoxicillin: Give 22 to 25 mg for each kg, 2 times a day, for 5 days. Or dose by age:
Under 1 year old: give 250 mg (one 250 mg tablet) ground up in a little breast milk, 2 times a day, for 5 days.
1 to 3 years old: give 500 mg (2 tablets of 250 mg), 2 times a day, for 5 days.

Cotrimoxazole may also work against other causes of pneumonia that amoxicillin cannot cure by itself, if the child has not been taking cotrimoxazole regularly.


Cotrimoxozole (trimethoprim + sulfamethoxazole): Give 3 mg trimethoprim and 15 mg sulfamethoxazole for each kg, 2 to 4 times a day, for 21 days. Or dose by age, using a single-strength 480 mg tablet (80 mg trimethoprim and 400 mg sulfamethoxazole):
6 weeks to 12 months: give ¼ tablet (20 mg trimethoprim and 100 mg sulfamethoxazole), 2 to 4 times a day for 21 days.
1 to 3 years: give ½ tablet (40 mg trimethoprim and 200 mg sulfamethoxazole), 2 to 4 times a day, for 21 days.
4 years to 7 years: give 1 tablet (80 mg trimethoprim and 400 mg sulfamethoxazole), 2 to 4 times a day, for 21 days.
Note: If the child already takes cotrimoxazole, he should simply continue taking it. Do not give the child an extra dose or increase the dose.

The child should start to get better within 2 days. If she does not, there may be another cause, such as tuberculosis, malaria, asthma, or a worm infection that has spread to her lungs. Be sure to have her tested for TB. If the child’s health worsens, if she has serious trouble breathing, loses consciousness, or has a seizure, she needs medical help quickly

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Tuberculosis or “TB” is a lung disease that causes weight loss, cough, and other serious health problems. Having HIV makes it easier for a child to get TB, and TB sickens children more quickly than adults. Any child who does not gain weight or grow well should be tested for both TB and HIV. TB passes easily from person to person through the air, and babies with HIV get TB most easily. Treating TB is very important for a baby or child with HIV. Adults must be treated as well, both for their own health and so they will not reinfect a treated child.

a health worker talking to a woman and a child.
This baby weighs the same as last month. I would like to test her for TB. OK?
Signs of tuberculosis
  • Others in the child’s household have TB
  • Fever for more than a few days
  • Cough lasting more than 2 or 3 weeks (but not all children with TB have a cough)
  • Tiredness, weakness, not as playful
  • Pain in the chest or pain when breathing or coughing
  • Not wanting to eat, babies do not gain weight and older children lose weight
  • Blood in sputum, night sweats, swollen glands
Treatment for tuberculosis
  • Seek medical help. Any child with signs of TB needs to be tested for TB, pneumonia, and HIV. Any child with HIV who gets TB should be treated first for TB, and after 2 to 8 weeks, start taking ART medicines.
  • TB medicine takes a long time to work completely, and needs to be taken daily for the full course of treatment, often 6 to 12 months, even if the child seems well. A health clinic will provide the combination of medicines needed (usually isoniazid, rifampicin, pyrazinamide, and ethambutol), often at no cost, as well as advice on how to take them.
  • See How to treat coughs at home for ways to make a child with a cough more comfortable.
  • Children with TB also need extra food to get well.
Prevention of tuberculosis

TB spreads easily from one person to another when they live or sleep in the same room. Until a person with TB is on medication that keeps his TB under control, children should sleep separately from them. Everyone who has TB should be treated so they do not infect others.

Prevention medicine to protect children from TB

Children with HIV who are more than 12 months old, who live in an area where there is a lot of TB but who have no signs of TB, and do not live with someone who has TB, can take the TB medicine called isoniazid, or a combination of isoniazid and rifampicin, to prevent them from catching TB. They must take the medicine each day for 6 months.


Isoniazid: Give 10 mg for each kg, one time a day, for 6 months. Or dose by age:
Under 1 year old: give one 100 mg tablet, every day, for 6 months.
1 to 3 years old: give 150 mg (1½ 100 mg tablets), every day, for 6 months.
Prevention of pneumonia and TB

Children with HIV get pneumonia and tuberculosis more easily than other children. Try to get your child on ART (see Chapter 11) or cotrimoxazole. These medicines are the best way to prevent pneumonia and many other infections in children with HIV.

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Everyone breathes easier when children get enough healthy food every day.
  • Anything that irritates the lungs makes it easier for children to get a lung infection. Smoke weakens the lungs and makes both pneumonia and TB more common.
  • A stove with a chimney, or good ventilation, will pull smoke out of the house and protect the lungs of the girls and women who do the cooking, and others nearby. People who smoke should always smoke outside, away from children.
  • Malnutrition makes children too weak to fight pneumonia or TB. To help prevent serious illnesses, feed children with HIV more food and more nutritious food. See Chapter 10.
  • The vaccine that can prevent pneumonia is safe for children with HIV. Ask a health worker if it is available in your area.

Colds and flu

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A runny nose, sore throat, or cough will usually go away without medicines. Rest, plenty of fluids, and enough food will help the child get better on his own. Antibiotics are useless for a cold. But a cold sometimes leads to ear or throat infections which do need treatment.

This page was updated:27 Nov 2019