Pneumonia

Pneumonia is a general term for lung infections that can be caused by a variety of germs (viruses, bacteria, fungi, and parasites). Most cases, though, are caused by viruses, including adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), human metapneumovirus, and parainfluenza virus (which causes croup).

Often, pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat), with symptoms starting after 2 or 3 days of a cold or sore throat. It then moves to the lungs. Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.

Signs and Symptoms

Symptoms vary depending on a child’s age and what caused the pneumonia, but can include:

• fever
• shaking chills
• cough
• stuffy nose
• very fast breathing (in some cases, this is the only symptom)
• breathing with grunting or wheezing sounds
• working hard to breathe; this can include flaring of the nostrils, belly breathing, or movement of the muscles between the ribs
• vomiting
• chest pain
• abdominal pain, which often happens because a child is coughing and working hard to breathe
• less activity
• loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration
• in extreme cases, bluish or gray color of the lips and fingernails

If the pneumonia is in the lower part of the lungs near the abdomen, a child might have a fever and abdominal pain or vomiting but no breathing problems.

Kids with pneumonia caused by bacteria usually become sick fairly quickly, starting with a sudden high fever and unusually fast breathing.

Kids with pneumonia caused by viruses probably will have symptoms that appear more gradually and are less severe, though wheezing can be more common.

Some symptoms give important clues about which germ is causing the pneumonia. For example, in older kids and teens, pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat, headache, and rash in addition to the usual symptoms of pneumonia.

In babies, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. When pneumonia is due to whooping cough (pertussis), a child may have long coughing spells, turn blue from lack of air, or make the classic “whoop” sound when trying to take a breath.

Start of Symptoms

The length of time between exposure to the germ and when someone starts feeling sick varies, depending on which virus or bacteria is causing the pneumonia (for instance, 4 to 6 days for RSV, but just 18 to 72 hours for the flu).

Duration

With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks, although walking pneumonia may take 4 to 6 weeks to go away completely. Viral pneumonia may last longer.

Contagiousness

The viruses and bacteria that cause pneumonia are contagious. They’re usually found in fluid from the mouth or nose of someone who’s infected, so that person can spread the illness by coughing or sneezing. Sharing drinking glasses and eating utensils, and touching the used tissues or handkerchiefs of an infected person also can spread pneumonia.

Prevention

Some types of pneumonia can be prevented by vaccines. Kids usually get routine immunizations against Haemophilus influenzae and whooping cough (pertussis) beginning at 2 months of age. Vaccines are now also given against the pneumococcus, a common cause of bacterial pneumonia.

Children with chronic illnesses can be at special risk for certain types of pneumonia, so they might need additional vaccines or protective immune medication. (“Chronic” means an ongoing illness or one that goes away and keeps coming back.) The flu vaccine is recommended for all healthy kids ages 6 months through 19 years, but especially for kids with chronic illnesses such as heart or lung disorders or asthma.

Because they’re at higher risk for serious complications, babies born prematurely may get treatments that temporarily protect against RSV because it can lead to pneumonia in younger kids.

Doctors may give antibiotics to prevent pneumonia in kids who have been exposed to someone with certain types of pneumonia, such as pertussis. Those with HIV infection might be given antibiotics to prevent pneumonia caused by Pneumocystis jirovecii.

Antiviral medicine is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe.

In general, pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are. So it’s best to keep kids away from anyone with symptoms (stuffy or runny nose, sore throat, cough, etc.) of a respiratory infection.

If someone in your home has a respiratory infection or throat infection, keep his or her drinking glasses and eating utensils separate from those of other family members, and wash your hands often, especially if you are handling used tissues or dirty handkerchiefs.

When to Call the Doctor

Call your doctor immediately if your child has any of the signs and symptoms of pneumonia, but especially if he or she:

• is having trouble breathing or is breathing too fast
• has a bluish or gray color to the fingernails or lips
• has a fever of 102°F (38.9°C), or above 100.4°F (38°C) in babies younger than 6 months old

Professional Treatment

Doctors usually make a pneumonia diagnosis after a physical examination. They’ll check a child’s appearance, breathing pattern, and vital signs, and listen to the lungs for abnormal sounds. They might order a chest X-ray, blood tests, and (sometimes) bacterial cultures of mucus produced by coughing.

In most cases, pneumonia is treated with antibiotics taken by mouth at home. The type of antibiotic used depends on the type of pneumonia. In some cases, other members of the household might be treated with medication to prevent illness.

Children might be treated in a hospital if the pneumonia is caused by whooping cough, if another kind of bacterial pneumonia is causing a high fever and breathing problems, or if they:

• need oxygen therapy
• have a lung infection that may have spread to the bloodstream
• have a chronic illness that affects the immune system
• are vomiting so much that they cannot take medicine by mouth
• have frequent episodes of pneumonia

Hospital treatment can include intravenous (IV) antibiotics (given through a needle into a vein) and respiratory therapy (breathing treatments). More severe cases might be treated in the intensive care unit (ICU).

Home Care

Anyone with pneumonia needs to get plenty of rest and drink lots of fluids while the body works to fight the infection.

If your child has bacterial pneumonia and the doctor has prescribed antibiotics, give the medicine on schedule for as long as directed. This will help your child recover faster and help prevent the infection from spreading to other household members. For wheezing, the doctor might recommend using a nebulizer or an inhaler.

Ask the doctor before you use a medicine to treat your child’s cough because cough suppressants stop the lungs from clearing mucus, which isn’t helpful in some types of pneumonia. Over-the-counter cough and cold medications are not recommended for any kids under 6 years old.

Take your child’s temperature at least once each morning and each evening, and call the doctor if it goes above 102°F (38.9°C) in an older infant or child, or above 100.4°F (38°C) in a baby under 6 months of age.

Check your child’s lips and fingernails to make sure they are rosy and pink. Call your doctor if they are bluish or gray, which is a sign that the lungs are not getting enough oxygen.