Dear Neil, pneumonia in children is serious disease, incidence is less than in the past also thanks to vaccination for hemophilus and pneumococcus. Poor nutrition plays a role in mortality. From IMCI we learned to adopt RR (respiratory rate) with 3 thresholds according to child age. It is a good/reliable approach, that I adopt with confidence. However common/medical sense should also be there: a child severly dehydrated shows fast breathing (acidotic breathing), a child with high fever or severely pale (anemic) presents as well fast breathing.
Stethoscope is extremely fallacious: ten doctors/pediatricians that auscultated ten chests will report ten different opinions. As you wrote other signs like: lack of apetite, lethargy or restlessness, DOB, fever should also be considered.
In my opinion pneumonia is overdiagnosed, most children suffer of URTI (viral, no antibiotic please).
Amoxicilline is still the drug of choice.
The rest is market, profit, private health care, in Africa and in the rest of the world where medicine comes second after money (for doctors!).
Greetings from Dodoma
HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com