Cough and difficult breathing are among the most common symptoms in childhood and are major causes of morbidity and mortality, especially due to acute respiratory infections such as pneumonia. Early assessment, prompt diagnosis, and appropriate treatment are essential to prevent complications. The Integrated Management of Childhood Illness (IMCI) and Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines provide a systematic approach to managing children presenting with these symptoms. The first step is rapid assessment of the airway, breathing, and circulation. The healthcare provider should ensure that the airway is clear and assess respiratory effort, oxygen saturation, respiratory rate, chest movements, and the presence of cyanosis or altered consciousness. A detailed history should include the duration of cough, onset of breathing difficulty, presence of fever, wheezing, feeding difficulties, previous respiratory illnesses, immunization status, exposure to tuberculosis, and any underlying chronic diseases. Physical examination includes counting the respiratory rate for one full minute. Fast breathing is an important indicator of pneumonia. Age-specific cut-offs are used: 60 breaths or more per minute in infants less than 2 months, 50 or more in children aged 2–12 months, and 40 or more in children aged 1–5 years. The examiner should also look for chest indrawing, nasal flaring, grunting, head nodding, inability to feed, lethargy, convulsions, central cyanosis, and stridor when the child is calm. Auscultation of the chest may reveal crackles,