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Pneumonia in Children

What is pneumonia?

Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid.

  • Lobar pneumonia. This affects one or more sections (lobes) of the lungs.

  • Bronchial pneumonia (or bronchopneumonia). This affects patches throughout both lungs.

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What are the different types of pneumonia?

The main types of pneumonia are:

  • Bacterial pneumonia. This is caused by various bacteria. The streptococcus pneumoniae is the most common bacterium that causes bacterial pneumonia.

    Many other bacteria may cause bacterial pneumonia including:

    • Group B streptococcus

    • Staphylococcus aureus

    • Group A streptococcus

    Bacterial pneumonia may have a quick onset and the following symptoms may occur:

    • Productive cough

    • Pain in the chest

    • Vomiting or diarrhea

    • Decrease in appetite

    • Fatigue

    • Fever

  • Viral pneumonia. This is caused by various viruses, including the following:

    • Respiratory syncytial virus, or RSV (most commonly seen in children under age 5)

    • Parainfluenza virus

    • Influenza virus

    • Adenovirus

    Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. However, with viral pneumonia, the respiratory involvement happens slowly. Wheezing may occur and the cough may worsen.

    Viral pneumonias may make a child susceptible to bacterial pneumonia.

  • Mycoplasma pneumonia. This presents somewhat different symptoms and physical signs than other types of pneumonia. They generally cause a mild, widespread pneumonia that affects all age groups, but it's most prevalent in children older than 5.

    Symptoms usually do not start with a cold, and may include the following:

    • Fever and cough are the first to develop

    • Cough that is persistent and may last 3 to 4 weeks

    • A severe cough that may produce some mucus

    Other less common pneumonias may be caused by the inhaling of food, liquid, gases or dust, or by fungi.

What are the symptoms of pneumonia?

In addition to the symptoms listed above, all pneumonias share the following symptoms. However, each child may experience symptoms differently. Symptoms may include:

  • Fever

  • Chest or stomach pain

  • Decrease in appetite

  • Chills

  • Breathing fast or hard

  • Vomiting

  • Headache

  • Not feeling well

  • Fussiness

The symptoms of pneumonia may look like other problems or medical conditions. Always consult your child's health care provider for a diagnosis.

How is pneumonia diagnosed?

Diagnosis is usually made based on the season and the extent of the illness. Based on these factors, your health care provider may diagnose simply on a thorough history and physical exam, but may include the following tests to confirm the diagnosis:

  • Chest X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Blood tests. Blood count for evidence of infection; arterial blood gas to analyze the amount of carbon dioxide and oxygen in the blood.

  • Sputum culture. A diagnostic test done on the material that is coughed up from the lungs and into the mouth. A sputum culture is often done to determine if an infection is present. This test is not routinely done because it is hard to obtain sputum samples in children.

  • Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a bandage) is taped 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. A test that takes images of the structures in the chest, very rarely done.

  • Bronchoscopy. A procedure used to look inside the airways of the lungs, very rarely done.

  • Pleural fluid culture. A culture of fluid sample taken from the pleural space (space between the lungs and chest wall) to identify the bacteria that cause pneumonia

Treatment for pneumonia

Treatment may include antibiotics for bacterial and mycoplasma pneumonia. There is no clearly effective treatment for viral pneumonia, which usually resolves on its own.

Other treatment may include:

  • Appropriate diet

  • Increased fluid intake

  • Cool mist humidifier in the child's room

  • Acetaminophen (for fever and discomfort)

  • Medication for cough

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

  • Intravenous (IV) or oral antibiotics for bacterial infection

  • Intravenous (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 secretions)

  • Breathing treatments, as ordered by your child's health care provider