Pediatric Pneumonia

Pneumonia is an inflammation in one or both of the lungs that is almost always caused by a viral or bacterial infection. 1 The inflammation interferes with the body’s ability to deliver oxygen and remove carbon dioxide from the blood. 2 A person is more likely to get pneumonia as a child, known as pediatric pneumonia, than they are as an adult.

Symptoms of pediatric pneumonia depend on the cause of the infection and several other factors, including the age and general health of the child. Rapid breathing, a high temperature and coughing are three of the most common signs of the condition. 1 2

Pneumonia in newborns and very young children is more likely to be caused by a viral, rather than a bacterial infection. 3 Potential viral causes for pneumonia include respiratory syncytial virus or influenza infection. Bacterial infections become more common in school-aged children and young adolescents. The most common bacterial cause for pneumonia is a type of bacterium known as streptococcus pneumoniae, but there are several other bacterial infections that can also cause pneumonia. ref3 4

Diagnosis is generally based on a physical exam and several other tests, which may include blood tests and an X-ray. 1

The prognosis for pediatric pneumonia is generally good. A bacterial infection can often be treated with antibiotics, such as amoxicillin. Viral pneumonia usually resolves on its own without the need for medication. 1 2 3 However, parents and guardians should be vigilant, as the condition is often hard to spot in children. Most deaths from pediatric pneumonia occur due to underlying health conditions, such as heart disease. ref1

Vaccination against bacterial infection is the best way of preventing the spread of pediatric pneumonia. 1 Children aged over six months old may also benefit from the influenza vaccine.

Symptoms of pediatric pneumonia depend on a number of factors, particularly the age of the affected child, and whether the cause of the infection is bacterial or viral. 5

Newborns and babies under a month old are the only age group that rarely cough as a direct consequence of pneumonia. The most common symptoms are irritability and not feeding properly. A child of this age may also display: 5 6

• Abnormally fast breathing
• Shortness of breath
• Grunting sounds

Once a baby is over a month old, then the most noticeable symptom of pneumonia is likely to be coughing. All of the symptoms that affect newborns will possibly be present too, although grunting becomes less common as the baby grows older. Other pneumonia symptoms observed in babies of this age include: 5 6

• Congestion, the feeling that the chest is full or clogged
• Wheezing or heavy breathing
• Fever, particularly during pneumonia caused by bacterial infection

Fever and cough are the most common symptoms for children over a year old. Other typical symptoms include: 5 6

• Abnormally rapid breathing
• Congestion
• Vomiting, particularly following coughing

Fever and coughing remain the most common signs of pneumonia in children of school age. They might also complain of the following symptoms: 5

• Chest pain
• Tiredness
• Vague stomach pain

Other possible symptoms of pneumonia at this age include:

• Vomiting
• Diarrhea
• Sore throat
• Ear ache

If you are worried that your child, or a child that you know, may be showing signs of pediatric pneumonia or another condition, you can get a free symptom assessment by downloading the Ada app.

Pneumonia is an inflammation of the air sacs, also known as the alveoli, in the lungs, usually caused by infection that causes them to fill with fluid or pus. 7

This inflammation interferes with the lungs’ ability to breathe and properly supply oxygen to the body, causing many of the symptoms described above.

Pneumonia is almost always caused by bacteria or a virus. In children below school age, viral infection is the most common cause. School-aged children and young adolescents are more likely to develop a bacterial infection. 4

Viral infections that can cause pediatric pneumonia include: 3 4

• Respiratory syncytial virus (RSV), which is the most common viral cause
• Influenza
• Parainfluenza virus, which also causes croup

And less commonly:

• Rhinovirus
• Adenovirus
• Human Metapneumovirus
• Enterovirus
• Coronavirus
• Herpes simplex virus

The most common bacterial cause of pediatric pneumonia is Streptococcus pneumoniae bacteria. This bacterium is often carried underneath the nose of healthy people without causing any harm, but can develop into pneumonia if the bacterium spreads to those with vulnerable immune systems, such as children and the elderly. 3 4

Another possible bacterial cause is Mycoplasma pneumoniae, which usually causes a milder form of the condition known as walking pneumonia or atypical pneumonia. Walking pneumonia is sometimes confused with the common cold and does not usually require bed rest. However, in some cases, symptoms following infection with Mycoplasma pneumoniae will be as severe as those caused by other types of bacteria. 4 8

A few other types of bacteria can cause pneumonia in children, including group B streptococcus and staphylococcus aureus.

In rare cases, there can be another cause for a child developing pneumonia. These include other potential infectious causes, such as:

• Aspiration pneumonia, which is when food, saliva or stomach acid enters the lungs
• Inhaling fungi, such as from soil

There are also non-infectious causes, such as inhaling harmful substances and chemicals.

Read more about the different types of pneumonia »

The first step in a diagnosis of pediatric pneumonia is usually a physical exam, where a doctor assesses the child’s symptoms. Their temperature will typically be taken and the doctor will listen to their chest with a stethoscope. 3 9

A particular challenge is finding out whether the pneumonia is bacterial or viral in origin. A doctor may ask questions about recent travel history and check their vaccination history.

A chest X-ray is sometimes used to confirm the diagnosis or to look for any complications that pneumonia may have caused around the lungs. In recent years, there has been promising progress in the use of ultrasound, a scan that uses sound waves to produce an image of the inside of the body, to diagnose pneumonia. Ultrasound may replace X-ray testing at some point in the future. 9

Other potential tests include: 7 9 10

• A blood test can help determine whether an infection is present, the extent of its spread and possibly the cause
• A sputum test, which is when a sample of spit or phlegm is laboratory-tested. This might confirm if a certain type of bacterium is causing the pneumonia
• A pulse oximetry, which is a test to measure oxygen levels in the blood
• A bronchoscopy, which is when a tube with a camera and light attached to the end is guided into the lungs so a doctor can look inside. This is rare and generally only used in complicated pneumonia cases

Treatment of pediatric pneumonia depends on the child’s age and health, as well as the cause of the infection. In most cases, particularly with school-age children, pneumonia can be treated or managed at home. Children with bacterial infections will generally be given antibiotics, whereas viral infections usually resolve themselves without the need for additional medication.

Sometimes a child may need to be hospitalized for treatment. The decision whether to hospitalize is typically based on factors such as: 7 11 10

• The child’s breathing ability
• The age of the child
• The risk of complications due to the type of pneumonia or any underlying health conditions the child may have
• The level of oxygen in the blood
• The presence of any unusual symptoms, such as altered mental states

Hospitalization will usually involve giving the affected child supplemental oxygen, monitoring their condition and treatment with antibiotics. Any complications may also need to be addressed.

Children being treated at home for bacterial pneumonia infections will generally be prescribed an antibiotic drug called amoxicillin, which can come in tablet or liquid form. If this is unsuccessful, then a doctor may recommend alternative antibiotics. 11 12

Macrolide antibiotics, such as azithromycin, may be recommended if it is thought the child is affected by atypical pneumonia. 12

The antibiotics used in hospital will generally vary from those recommended for use at home. A doctor will base the antibiotic treatment on several factors, such as whether a child has been immunized. In hospital, the antibiotics may be delivered directly into the bloodstream using an intravenous drip. 11 12

Antibiotics are not a useful treatment for children with viral infections. However, if the pneumonia has been caused by an influenza infection, antiviral therapy may be used to fight the spread of the disease.

A child’s fever symptoms might be helped with acetaminophen whether they are in the hospital or being treated at home. 3

If a doctor decides a child should be treated at home, their caregiver should take the following steps:

• Keep them hydrated by offering plenty of fluids.
• If a child’s cough is producing mucus, encourage spitting the phlegm out to clear the airwaves. 3 If the child is too young to understand, then an adult should lay the infant across their lap and pat their back when coughing fits occur
• Relieve chest pain with a heated pad or warm compress on the chest area

If a child’s lips or nails are bluish or grey then this may indicate that they are not getting enough oxygen. This is a sign that medical professionals should be contacted.

The vast majority of children affected by pneumonia recover without any long-term difficulties. However, there are some potential complications, including: 7 13

Pleural effusion, which is a buildup of fluid between the layers of the pleura, the membrane that covers the lung. It is also known as water on the lungs. This liquid can sometimes become infected and cause a more dangerous condition known as empyema. Empyema can be treated by draining the excess liquid out of the body.

Lung abscesses, which are pus-filled cavities that can appear in the lungs. These can often be treated with antibiotics.

Sepsis, occurs when an infection passes into the bloodstream causing the body to respond in a dangerous way. In the most serious cases, sepsis can potentially lead to multiple organ failure

Pneumothorax, the medical term for a collapsed lung. This is when air enters the space around a person’s lungs, which can impact upon the lungs ability to stay inflated.

There are two vaccines that the Centers for Disease Control and Prevention (CDC) recommends in the U.S. to protect against Streptococcus pneumoniae bacteria, the most common cause of bacterial pneumonia. 14 It can also cause a number of other conditions, including bronchitis and meningitis. Conditions caused by infection with Streptococcus pneumoniae bacteria are known as pneumococcal disease.

The PCV13 vaccine is recommended for all children under the age of two. It protects against 13 of the most common strains of pneumococcal bacteria. The first shot should be given at two months old, the next two at four months and six months old. A final booster shot should be administered when the child is between 12 and 15 months old. For children older than this age, a single shot is usually all that is needed.

The PPSV23 vaccine is recommended for children older than two, who have certain medical conditions, such as leukemia or chronic cardiovascular disease. PPSV23 protects against 23 types of pneumococcal bacteria. Children with these medical conditions will generally need two doses of PPSV23.

Side effects are rare. Allergic reactions to the vaccine are thought to occur only in one in a million cases. Nevertheless, a doctor should be told if a person has had an allergic reaction to any other vaccine. Taking a vaccine should usually be delayed if the child feels ill, but a doctor will be able to advise on this.

The introduction of a vaccine against Streptococcus pneumoniae in the U.S. has coincided with a significant decline in pneumococcal disease in children under the age of five. 3

One of the potential viral causes of pneumonia is influenza infection, also known as the flu. The influenza vaccination cannot stop all children from getting the flu, but it is the best means of defending against infection.

The CDC recommends that all children aged over six months should get a flu vaccine shot once a year before the end of October. A new vaccination is needed every year, because the specific influenza viruses that are spreading through the population change as time passes.

Babies younger than six months old are too young to be vaccinated. The best way to ensure that they are protected against the flu is to make sure everyone around them is vaccinated.

Q: Pediatric bronchitis vs pneumonia: what is the difference?
A: Bronchitis is the infection and subsequent inflammation of the bronchial tubes, which carry air to and from the lungs. Pneumonia describes inflammation of the alveoli, tiny air sacs inside the lungs. Under certain conditions, bronchitis can develop into pneumonia. 7

The two conditions cause very similar symptoms and may be difficult to tell apart. However, a child suspected to have either bronchitis or pneumonia should be taken to see a doctor, who will be able to help with a diagnosis. You can also get a free symptom assessment by downloading the Ada app.

Read more about Acute Bronchitis »

Q: Is pediatric pneumonia contagious?
A: The bacteria and viruses that usually cause pneumonia can spread from person to person. The best way to prevent a child developing the condition is to make sure they are properly vaccinated.

It is also beneficial to practice good hygiene, such as regularly washing the hands and covering coughs and sneezes.

Q: When should a child go to hospital for pneumonia?
A: A doctor will usually make a call on whether a child needs hospitalization based on a number of factors, including how well the child can breathe and how old they are.

Read more about hospitalization and other types of pneumonia treatment »

• Childhood lung infection
• Pneumonia, children
• Pneumonia, infants