Overview: Pneumonia in Children
What Is Pneumonia?
Pneumonia is an infection of the lungs that is most often caused by viruses or bacteria. This infection leads to inflammation in the lungs, causing the tiny air sacs (or, alveoli) that are usually filled up with air to fill up with pus and other liquid instead. This can cause many different symptoms including, fever, cough, chest pain, and increased work of breathing (difficulty/labored breathing).
Pneumonia is more common in children younger than 5 years old, and it can range from mild to serious and potentially life-threatening. It is more common during respiratory season (fall, winter, and early spring) when children spend more time indoors and within close proximity to others.
Pneumonia may be considered lobar or bronchial:
Lobar pneumonia—Affecting one or more sections (or lobes) of the lung
Bronchial pneumonia (bronchopneumonia)—Affecting patches throughout both lungs
What Causes Pneumonia?
Pneumonia occurs when germs, such as viruses and bacteria, enter the lungs, infecting them. This can happen when germs living in the nose, sinuses, or mouth (such as those present during an upper respiratory infection [URI] from the common cold, influenza [flu], or COVID-19) spread to the lungs. This can also happen if your child breathes some of these germs directly into the lungs, or if they aspirate (breathe in) food or liquids.
While most cases of pneumonia in children result from a viral upper respiratory infection traveling to the lungs, it is also possible for the viral infection to irritate the airway or weaken the child’s immune system—this can make it easier for bacteria to grow in the lungs. This bacterial pneumonia is considered a second infection in addition to the original one and is referred to as a secondary bacterial infection.
What Are the Different Types of Pneumonia?
The most common pneumonias result from viral or bacterial infections:
Bacterial Pneumonia
Bacterial pneumonia is caused by many different kinds of bacteria, most commonly by Streptococcus pneumoniae (the bacteria responsible for pneumococcal disease). Other pneumonia-causing bacteria include group B Streptococcus (most common in newborns), Staphylococcus aureus, and Group A Streptococcus (most common in children over age 5).
Bacterial pneumonia typically happens suddenly with the following symptoms:
Productive cough (cough that produces mucus)
Chest pain (associated with coughing)
Vomiting or diarrhea
Decrease in/loss of appetite
Fatigue (tiredness)
Fever (temperature of 100.4℉ (38℃) and higher)
Viral Pneumonia
Viral pneumonia is caused by many different kinds of viruses, most commonly by influenza viruses (the flu) or respiratory syncytial virus (RSV; most commonly in children younger than 5 years old). Other pneumonia-causing viruses include parainfluenza virus and adenovirus.
While early symptoms of viral pneumonia are the same as bacterial pneumonia, the respiratory (breathing) symptoms happen slowly. You may notice your child wheezing, and their cough may get worse. Viral pneumonias may put your child at greater risk of developing bacterial pneumonia.
Mycoplasma Pneumonia (Walking Pneumonia)
Mycoplasma pneumonia is caused by the organism Mycoplasma pneumoniae. M. pneumoniae typically causes mild respiratory infections, but it can also progress to a mild type of pneumonia. This is considered an atypical pneumonia as the signs and symptoms present differently than the other types of pneumonia—with mycoplasma pneumonia, symptoms tend to be less severe, allowing the child to remain active (thus coining the term “walking pneumonia”). Mycoplasma pneumonia can affect all age groups, however, according to the Centers for Disease Control and Prevention (CDC), cases of mycoplasma pneumonia have recently been on the rise in the United States, especially in young children.
Symptoms of mycoplasma typically do not start with a cold. Symptoms may include:
Fever and cough (usually the first symptoms to develop)
Cough is persistent, lasting three to four weeks
Severe cough that may be productive (cough that produces mucus)
Other types of pneumonia are less common and may result from the inhaling of food, liquid, gases, dust, or fungi.
What Are the Signs and Symptoms of Pneumonia in Children?
All types of pneumonia share the following symptoms (each child may experience these differently):
Fever
Chills
Chest pain (associated with coughing)
Abdominal pain
Decrease in appetite
Increased work of breathing (difficulty/labored breathing)
a. Breathing fast or hard
b. Retractions (when the skin in the neck or between or below the ribs “sucks in” with each breath
c. Nasal flaring (when the nostrils widen with each breath) and head bobbing with breathing
d. Wheezing (a high-pitched whistling sound heard when exhaling [breathing out])
e. Turning blue around the lips or nail beds (caused by decreased oxygen in the bloodstream)
Vomiting
Headache
Malaise (generally not feeling well)
Fussiness
Since the signs and symptoms of pneumonia may resemble those of other conditions, you should always consult your child’s pediatrician for diagnosis, particularly if respiratory symptoms last longer than seven to 10 days or if they return and worsen after getting better.
How Is Pneumonia Diagnosed in a Child?
Your child’s primary care provider (PCP) can often diagnose pneumonia after obtaining your child’s full health history and performing a physical exam. The following tests may be ordered to confirm the diagnosis:
Chest X-ray: Produces images of internal tissues, bones, and organs
Blood tests: Blood count to check for evidence of infection; Arterial blood gas to check if enough oxygen is getting into the blood from the lungs
Blood culture and sputum culture: Diagnostic tests to determine what germ is causing the pneumonia
Pulse oximetry: Uses a small device with a sensor taped to the finger (like a Band-Aid); Painlessly measures the amount of oxygen in the blood
Chest CT (computed tomography) scan: Produces images of the structures in the chest
Bronchoscopy: A procedure used to look inside the airways of the lungs (in rare cases)
Pleural fluid culture: A sample of fluid from the pleural space (space between the outside lining of the lungs and chest wall) is tested to determine the bacteria that is causing the pneumonia
How Is Pneumonia Treated in a Child?
Treatment for bacterial and mycoplasma pneumonia may include antibiotics taken by mouth which can usually be done at home. The antibiotic prescribed depends on which bacteria or organism is believed to have caused the pneumonia. It is important to complete the full course of antibiotics at the recommended dose. Your child may feel better after just a few days, however, do not stop the antibiotic early—even if they are feeling better—as the infection could return.
Treatment for viral pneumonia is typically supportive, and antibiotics are not prescribed. Antibiotics do not work against viral infections; they are used to fight against infections caused by bacteria. A child with viral pneumonia caused by the influenza virus or COVID-19 may receive an antiviral medicine if it is early in the illness.
Additional supportive treatment at home may include:
Ensure they get proper rest
Encourage plenty of fluids such as breastmilk or formula for infants and water, electrolyte drinks (like Pedialyte, Enfalyte, or store brands), soup broth, popsicles, or flavored gelatin for older children
Cool mist humidifiers to moisten air and help clear nasal passages—Use distilled water; Place near your child but keep out of their reach; Clean humidifier often according to the manufacturer to prevent mold or mineral buildup
Over-the-counter pain relievers and fever reducers such as acetaminophen and ibuprofen—Do not give ibuprofen if your child is under 6 months old or if your child is dehydrated; Do not give your child aspirin or other salicylates as it has been linked to a serious, potentially life-threatening disease called Reye syndrome that affects the liver and brain
Medications for cough—Should only be given if recommended by your child’s pediatrician as coughing helps the body get rid of mucus in the lungs; Do not give to infants and children under 4 years of age because of the risk of dangerous side effects; Studies have also shown that many cough and cold medications do not work in children younger than 6 years old; It is also important to remember that many of these over-the-counter (OTC) products contain acetaminophen (Tylenol or generic form), therefore, you must be careful not to give along with acetaminophen (Tylenol or generic form) or your child could get a double dose, or overdose
Chest percussion—Tap child’s back and chest gently a few times a day; This helps to loosen up mucus in the lungs, making it easier to cough up
Deep breathing—Encourage your child to take a couple of deep breaths two to three times every hour to help open up their lungs
Usually, most children with pneumonia will recover fully at home with these treatment measures. However, some children may require treatment in the hospital if the pneumonia is causing severe breathing problems, a lasting high fever, vomiting and unable to take their medication, or if the infection may have spread to the bloodstream. According to the American Academy of Pediatrics (AAP), you should contact your child’s PCP if your child has any of the following signs or symptoms during treatment:
Fever lasting more than a few days despite the use of antibiotics
Fever that goes away and then returns after a few days
Trouble breathing
Increased lethargy (tiredness)
Signs of infection somewhere else in the body (red, swollen joints, back pain, neck stiffness vomiting, or other new signs or symptoms)
Treatment in the hospital may include:
Intravenous (IV) or oral antibiotics
Intravenous (IV) fluids if your child is unable to drink well
Oxygen therapy
Breathing treatments (nebulizers) to help open the airways
Frequent suctioning of the nose and mouth to help get rid of thick mucus
What Is the Prognosis (Outlook) for a Child with Pneumonia?
Most children with pneumonia improve within seven to 10 days with treatment. Walking pneumonia may take longer to recover completely, up to four to six weeks. Children with severe pneumonia or complications may need treatment for two to three weeks. Children at risk for severe pneumonia include those that have/are:
Immunocompromised (with a weakened immune system from other conditions, such as cancer)
Chronic (ongoing) health conditions (such as asthma or cystic fibrosis)
Other problems with their lungs or airway
Younger than one year old and are around secondhand tobacco smoke
Is Pneumonia Contagious?
Pneumonia itself is not contagious, however, the respiratory viruses, bacteria, and other organisms that can lead to pneumonia are. When these pneumonia-causing germs are in a person’s mouth or nose, they can spread the germs and illness either through the air when they cough or sneeze or through touch:
Air—When an infected person coughs or sneezes, virus/bacteria particles (droplets) can travel up to 12 feet in the air and can stay suspended in the air for varying amounts of time. If your child breathes in this air, the virus or bacteria can stick to their nasal membrane, infecting them.
Touch—If your child directly touches an infected person or a contaminated object then touches their eyes, nose, or mouth, the virus or bacteria can enter the body. Children often touch their face as well as other people and objects (like shared toys), making viruses and bacteria easy to spread in young kids.
How Can I Help Prevent My Child from Getting Pneumonia?
Vaccines
Pneumococcal pneumonia can be prevented with a vaccine called pneumococcal conjugate that protects against Streptococcus pneumoniae (the bacteria responsible for pneumococcal disease). The AAP recommends that all children receive this series of shots starting at 2 months of age.
The AAP also recommends another vaccine, called pneumococcal polysaccharide, for older children (ages 2 through 5 years old) who have a high risk of developing pneumococcal infection. These include children with:
Sickle cell anemia
Heart disease
Lung disease
Kidney failure
Damaged or no spleen
Organ transplant
HIV (human immunodeficiency virus) infection
Weakened immune system (immunocompromised) from medications or other conditions
Staying up to date on all vaccines—including those that are yearly (like the flu vaccine)—is also important as pneumonia can occur after illnesses such as the flu, COVID-19, and pertussis (whooping cough).
Other Prevention Strategies
You can also help prevent your child from getting pneumonia by avoiding contact with others who are sick. Also, encourage proper handwashing techniques both with soap and water and with hand sanitizer (containing at least 60% alcohol), and teach your child not to touch their nose, mouth, or eyes until their hands are properly washed. Additionally, children can be taught how to cough or sneeze into a tissue or their elbow (not their hands) and to not share towels, drinking glasses, or eating utensils. Toys and common play areas should be cleaned and sanitized regularly. Children should also avoid secondhand smoke, as this can increase your child’s risk of getting sick.
Key Points to Remember
Pneumonia is an infection of the lungs that most commonly results from a viral or bacterial infection. Symptoms may include fever, cough, chest pain, and increased work of breathing (difficulty/labored breathing), and more. While most children can fully recover at home with comfort care and medications, some kids with severe cases may require treatment in the hospital. Bacterial pneumonia may require treatment with antibiotics, however, it is important to remember that antibiotics will not work to treat cases of viral pneumonia as antibiotics do not kill viruses. Luckily, certain types of pneumonia can be prevented with vaccines, so it is important for your child to stay up to date on their immunization schedule—if you are unsure, you should talk to your child’s pediatrician about what vaccines they may need. Remember to teach your child proper handwashing techniques and good coughing/sneezing etiquette so as not to spread the illnesses that may cause pneumonia. Together, we can help keep our kids safe and healthy with these key prevention strategies in mind!
