Signs of pneumonia in infants under 2 months

A very young baby may not show the same clear cough or fever seen in an older child. Watch for grunting, nostril flaring, the skin pulling in between or below the ribs, bluish or grey lips, unusual limpness, or tiring during feeds. Cough, chills, phlegm or fever may occur, but their absence does not rule out pneumonia. Infection can worsen quickly in this age group.

Treat breathing changes or a clear change in feeding as a reason for immediate medical assessment. Keep the baby comfortably warm, hold them upright while awake, and offer usual feeds only if they are alert and breathing comfortably. Do not give cough medicine or leftover antibiotics. Note the last feed, wet nappy, temperature and when the breathing change began for the clinician.

Call emergency services now for blue or grey colour, severe breathing effort, repeated pauses, collapse, a baby who is difficult to wake, or choking with feeds. A baby under 2 months with a fever, low temperature, poor feeding, fewer wet nappies or unusual sleepiness needs urgent assessment. Do not wait for a cough to appear or for symptoms to become severe.

Could this be Pneumonia, another infection or a breathing problem? Does the baby need oxygen, observation or tests? How should I monitor feeds, breathing and wet nappies at home?