Pneumonia in Children

Pneumonia is an infection in the lungs. It can be mild or serious. Pneumonia is generally more common in children younger than 5 years old.

Pneumonia is most often caused by bacteria or viruses. Some of these bacteria and viruses can be spread by direct contact with a person who is already infected with them.

Common bacteria and viruses that may cause pneumonia are:

• Streptococcus pneumoniae
• Mycoplasma pneumonia. This often causes a mild form of the illness called walking pneumonia.
• Group B streptococcus
• Staphylococcus aureus
• Respiratory syncytial virus. This is most often seen in children younger than 5 years old.
• Parainfluenza virus
• Influenza virus
• Adenovirus
• COVID-19

Pneumonia may sometimes be caused by fungi, but this is unusual in healthy children.

A child is more likely to get pneumonia if they have:

• Weak immune system, such as from cancer
• Ongoing (chronic) health problem, such as asthma or cystic fibrosis
• Problems with the lungs or airways

In addition, children younger than 1 year old are at risk if they are around secondhand tobacco smoke. This is especially true if their mother smokes.

Symptoms may be a bit different for each child. They may also depend on what is causing the pneumonia. Cases of bacterial pneumonia tend to happen suddenly with these symptoms:

• Cough that produces mucus
• Chest pain associated with coughing
• Abdominal pain
• Vomiting or diarrhea
• Loss of appetite
• Tiredness (fatigue)
• Fever

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. But with viral pneumonia, the breathing problems happen slowly. Your child may wheeze, and the cough may get worse. Viral pneumonia may make a child more at risk for bacterial pneumonia.

In addition to the symptoms listed above, your child may have:

• Chills
• Fast or hard breathing
• Flaring nostrils
• Headache
• Fussiness

The symptoms of pneumonia may look like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

Your child’s healthcare provider can often diagnose pneumonia with a full health history and physical exam. They may include these tests to confirm the diagnosis:

• Chest X-ray. This test makes images of internal tissues, bones, and organs.
• Blood tests. A blood count looks for signs of an infection. An arterial blood gas test looks at the amount of carbon dioxide and oxygen in the blood.
• Sputum culture. This test is done on the mucus (sputum) that is coughed up from the lungs and into the mouth. It can find out if your child has an infection. It’s not routinely done because it is hard to get sputum samples from children.
• Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To get this measurement, the provider tapes a small sensor onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless, and the red light does not get hot.
• Chest CT scan. This test takes images of the structures in the chest. This is done only in cases of complicated pneumonia or if your child is not responding to routine treatments.
• Bronchoscopy. This procedure is used to look inside the airways of the lungs. It is very rarely done.
• Pleural fluid culture. This test takes a sample of fluid from the space between the lungs and chest wall (pleural space). Fluid may collect in that area because of the pneumonia. This is called a pleural effusion. This fluid may be infected with the same bacteria as the lung. Or the fluid may just be caused by the inflammation in the lung.

Treatment may include antibiotics for bacterial pneumonia. No good treatment is available for most viral pneumonias. They often get better on their own. Flu-related pneumonia may be treated with an antiviral medicine.

Other treatments can ease symptoms. They may include:

• Plenty of rest
• Getting more fluids
• Cool mist humidifier in your child’s room
• Acetaminophen or ibuprofen for fever and discomfort. Don't give ibuprofen to children younger than 6 months.
• Medicine for cough or wheezing

Talk with your child's healthcare provider before giving your child any over-the-counter (OTC) medicines. Some OTC medicines aren't safe for children younger than 6 years.

Some children may be treated in the hospital if they are having severe breathing problems. While in the hospital, treatment may include:

• Antibiotics by IV (intravenous) or by mouth (oral) for bacterial infection
• IV fluids if your child is unable to drink well
• Oxygen therapy
• Frequent suctioning of your child’s nose and mouth to help get rid of thick mucus
• Breathing treatments, as ordered by your child’s healthcare provider

Pneumonia can be a life-threatening illness. It may have these complications:

• Severe breathing problems
• Bacteria that enters the blood

Pneumococcal pneumonia can be prevented with a vaccine that protects against 13 types of pneumococcal pneumonia. Healthcare providers recommend that children get a series of shots beginning at age 2 months. Talk with your child’s healthcare provider about this vaccine. Another vaccine is available for children older than 2 years who are at increased risk for pneumonia. Talk with your child's healthcare provider to see if it is recommended for your child. Also make sure your child is up-to-date on all vaccines, including the COVID-19 vaccine and the yearly flu shot. Pneumonia can occur after illnesses, such as whooping cough and the flu.

You can also help your child prevent pneumonia with good hygiene. Teach your child to cover their nose and mouth when coughing or sneezing. Your child should also wash their hands often. These measures can help prevent other infections, too.

Vaccines

Your child can be vaccinated against pneumococcal pneumonia. There are two types of vaccines that can help prevent pneumococcal disease. The vaccine that is right for your child depends on their age and risk factors. Talk with your child's healthcare provider about which vaccine is best for your child and when they should get it.

Call your child’s healthcare provider if your child’s symptoms get worse. Or if they have:

• A fever for more than a few days
• Fever in babies 3 months or younger
• New symptoms, such as neck stiffness or swollen joints
• Trouble drinking enough fluids to stay well hydrated

Call 911

Call 911 right away if your child has any of these symptoms:

• Problems swallowing or they are drooling
• Trouble breathing or needing to lean forward to breathe
• Drawing in of the skin around the ribs (retractions)
• Problems opening mouth fully
• Problems speaking
• Skin, lips, or nails look blue, purple, or gray in color
• Loss of consciousness or problems waking or feeling faint or dizzy
• Shortness of breath with a fast heartbeat

• Pneumonia is an infection in the lungs. It can be mild or serious.
• The illness can be caused by bacteria, viruses, and fungi.
• Some common symptoms include fever, cough, tiredness (fatigue), and chest pain.
• Treatment depends on the cause of the pneumonia.
• Some types of pneumonia can be prevented with a vaccine. Good handwashing and hygiene can also help.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.