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Pneumonia

Pediatric Basics

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Updated November 13, 2011

Updated November 13, 2011
Pneumonia is an infection of the lungs and in children, pneumonia is often caused by viral infections, including RSV, the parainfluenza virus, adenovirus, and the flu.

In addition to viruses, pneumonia can also be caused by bacteria, including S. pneumoniae, H. influenzae type b, group A streptococcus, and M. tuberculosis (TB). Walking pneumonia is caused by the Mycoplasma pneumoniae bacteria. Although it is usually a milder form of pneumonia than other bacterial forms of pneumonia, the symptoms can be bothersome, lingering for a month or more.

Less commonly, a child's pneumonia can be caused by fungi, parasites, and rickettsiae.

Pneumonia Symptoms

After having symptoms of a mild upper respiratory tract infection, such as a runny nose and mild cough, children who develop pneumonia may have a sudden worsening and develop other symptoms, including:
  • worsening cough
  • fever
  • increased respiratory rate (tachypnea)
  • retractions (labored breathing)
  • wheezing (usually a sign of viral pneumonia)
  • cyanosis
  • decreased breath sounds
  • crackles
  • chest pain
  • abdominal pain
  • vomiting
  • nasal flaring

Diagnosis of Pneumonia

Most cases of pneumonia are diagnosed clinically, meaning that your Pediatrician makes the diagnosis after examining your child based on your child's symptoms and after a physical exam.

When necessary, a chest xray and blood culture are also done. Other testing might including a complete blood count (CBC) and C-reactive protein (CRP). A pulse ox test to check your child's oxygen level is also sometimes done if your Pediatrician thinks that he has pneumonia, especially if he is having a lot of trouble breathing.

Testing for RSV, flu, and other viral causes of pneumonia can also be helpful when the tests are available. Sputum cultures are not as helpful in children as they are in adults, because they are hard to obtain.

Pneumonia Treatments

Antibiotics are the usual treatment when a child is suspected of having bacterial pneumonia. Treatments for other types of pneumonia will depend on the cause, although there is usually no specific treatment for most viral causes of pneumonia.

What You Need To Know

  • Pneumonia is diagnosed in about 4 percent of children in the US each year, with the highest rates in children under age 12 months old.

  • Children who get pneumonia more than once in a single year may have a problem with their immune system.

  • Most children with pneumonia can be treated at home, although some do need to be admitted to the hospital for IV antibiotics, IV fluids, oxygen therapy, or for additional help with their breathing.

  • Children with pneumonia can develop a pleural effusion or empyema, which sometimes need to be drained.

  • Fever can sometimes be the only symptom of pneumonia in children.

  • The World Health Organization defines tachypnea as a respiratory rate of more than 50 breaths per minute for infants two to twelve months of age, more than 40 breaths per minute for children one to five years of age, and more than 30 breaths per minute for children over age five.

  • Just because your child has a cough and a fever, that doesn't mean that he has pneumonia. Without other respiratory signs, such as rapid breathing, it is more likely that his symptoms are caused by an upper respiratory tract infection, although you should discuss it with your Pediatrician if you think that they might be caused by pneumonia.

And remember that there are vaccines that can prevent many types of pneumonia, including the Pneumovax vaccine, Prevnar 13, Hib, DTaP, Varivax, MMR, and the flu vaccine.



Sources

Pediatric pneumonia Lichenstein R - Emerg Med Clin North Am - 01-MAY-2003; 21(2): 437-51

Pneumonia in hospitalized children Sandora TJ - Pediatr Clin North Am - 01-AUG-2005; 52(4): 1059-81, viii

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