In settings where pulse oximetry is not available, in children 2–59 months of age diagnosed with pneumonia (fast breathing or chest indrawing, without danger sign- not able to drink or breastfeed, or vomits everything, or has had convulsions, or is lethargic or unconscious, or stridor or hypoxaemia-), WHO suggests evaluation of respiratory distress using a combination of signs and symptoms (head nodding or nasal flaring or grunting or severe tachypnoea (respiratory rate ≥20 breaths per minute above the age-specific cutoff) to detect hypoxaemia