Definition

Pneumonia is a lung infection caused by bacteria, viruses, or fungi.

This article covers community-acquired pneumonia (CAP) in children. This type of pneumonia occurs in healthy children who have not recently been in the hospital or another health care facility.

Pneumonia that affects people in health care facilities, such as hospitals, is often caused by germs that are harder to treat. This is called hospital-acquired pneumonia.

Alternative Names

Bronchopneumonia - children; Community-acquired pneumonia - children; CAP - children

Causes

Viruses are the most common cause of CAP in infants and children.

Ways your child can get CAP include:

• Bacteria and viruses living in the nose, sinuses, or mouth may spread to the lungs.
• Your child may breathe some of these germs directly into the lungs.
• Your child breathes in food, liquids, or vomit from the mouth into the lungs.

Risk factors that increase a child's chance of getting CAP include:

• Being younger than 6 months of age
• Being born prematurely
• Birth defects, such as cleft palate
• Nervous system problems, such as seizures or cerebral palsy
• Heart or lung disease present at birth
• Weak immune system (this can occur due to cancer treatment or disease such as HIV/AIDS)
• Recent surgery or trauma

Symptoms

Common symptoms of pneumonia in children include:

• Stuffed up or runny nose, headaches
• Loud cough
• Fever, which may be mild or high, with chills and sweating
• Rapid breathing, with flared nostrils and straining of the muscles between the ribs
• Wheezing
• Sharp or stabbing chest pain that gets worse when breathing deeply or coughing
• Low energy and malaise (not feeling well)
• Vomiting or loss of appetite

Symptoms common in children with more severe infections include:

• Blue lips and fingernails due to too little oxygen in the blood
• Confusion or very hard to arouse

Exams and Tests

The health care provider will listen to your child's chest with a stethoscope. The provider will listen for crackles or abnormal breath sounds. Tapping on the chest wall (percussion) helps the provider listen and feel for abnormal sounds.

If pneumonia is suspected, the provider will likely order a chest x-ray.

Other tests may include:

• Oximetry - noninvasive method to determine the level of oxygen in the blood
• Arterial blood gases to see if enough oxygen is getting into your child's blood from the lungs
• Blood culture and sputum culture to look for the germ that may be causing the pneumonia
• CBC to check white blood cell count
• Chest X-ray or CT scan of the chest
• Bronchoscopy -- a flexible tube with a lighted camera on the end passed down into the lungs (in rare cases)
• Removing fluid from the space between the outside lining of the lungs and the chest wall (in rare cases)

Treatment

The provider must first decide whether your child needs to be in the hospital.

If treated in the hospital, your child will receive:

• Fluids, electrolytes, and antibiotics through the veins or mouth
• Oxygen therapy
• Breathing treatments to help open up the airways

Your child is more likely to be admitted to the hospital if they:

• Have another serious medical problem, including long-term (chronic) health issues such as cystic fibrosis or diabetes mellitus 
• Have severe symptoms
• Are unable to eat or drink
• Are less than 3 to 6 months old
• Have pneumonia due to a harmful germ
• Have taken antibiotics at home, but isn't getting better

If your child has CAP caused by bacteria, antibiotics will be given. Antibiotics are not given for pneumonia caused by a virus. This is because antibiotics do not kill viruses. Other medicines, such as antivirals, may be given if your child has the flu.

Many children can be treated at home. If so, your child may need to take medicines such as antibiotics or antivirals.

When giving antibiotics to your child:

• Make sure your child does not miss any doses.
• Make sure your child takes all the medicine as directed. Do not stop giving the medicine, even when your child starts feeling better.

Do not give your child cough medicine or cold medicine unless your provider says it is OK. Coughing helps the body get rid of mucus from the lungs.

Other home care measures include:

• To bring mucus up from the lungs, tap your child's chest gently a few times a day. This can be done as your child is lying down.
• Have your child take a couple of deep breaths 2 or 3 times every hour. Deep breaths help open up your child's lungs.
• Make sure your child drinks plenty of liquids. Ask your provider how much your child should drink each day.
• Have your child get plenty of rest, including napping throughout the day if needed.

Outlook (Prognosis)

Most children improve in 7 to 10 days with treatment. Children who have severe pneumonia with complications may need treatment for 2 to 3 weeks. Children at risk for severe pneumonia include:

• Children whose immune system does not work well
• Children with lung or heart disease

Possible Complications

In some cases, more serious problems may develop, including:

• Life-threatening changes in the lungs that require a breathing machine (ventilator)
• Fluid around the lung, which can become infected
• Lung abscesses
• Bacteria in blood (bacteremia)

The provider may order another x-ray. This is to make sure that your child's lungs are clear. It may take many weeks for the x-ray to clear up. Your child may feel better for a while before the x-rays are clear.

When to Contact a Medical Professional

Contact your provider if your child has the following symptoms:

• Bad cough
• Difficulty breathing (wheezing, grunting, rapid breathing)
• Vomiting
• Loss of appetite
• Fever and chills
• Breathing (respiratory) symptoms that get worse
• Chest pain that gets worse when coughing or breathing in
• Signs of pneumonia and a weak immune system (such as with HIV or chemotherapy)
• Worsening symptoms after starting to get better

Prevention

Teach older children to wash their hands often:

• Before eating food
• After blowing their nose
• After going to the bathroom
• After playing with friends
• After coming in contact with people who are sick

Vaccines may help prevent some types of pneumonia. Be sure to get your child vaccinated with:

• Pneumococcal vaccine
• Flu vaccine
• Pertussis vaccine
• Hib vaccine

When infants are too young to be immunized, parents or caregivers can get themselves immunized against vaccine-preventable pneumonia.

References

Bradley JS, Byington CL, Shah SS, et al. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):617-630. PMID: 21890766 pubmed.ncbi.nlm.nih.gov/21890766/.

Kelly MS, Sandora TJ. Community-acquired pneumonia. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 428.

Shah SS, Bradley JS. Pediatric community-acquired pneumonia. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 22.