Pneumonia in Children

Pneumonia in children is a serious condition, especially for babies. In the U.S., it’s the top reason that children need to stay in a hospital.

Pneumonia is a lower respiratory infection, meaning it happens deep inside your lungs. It becomes dangerous when it keeps you from getting enough oxygen, or when the infection causing it spreads through your body.

Pneumonia in children is especially dangerous for two reasons:

• Immune system weakness: A baby may not survive a natural infection because their immune system can’t handle the germ responsible. That’s why healthcare providers recommend pneumonia vaccines. They help babies develop immunity without the risks that come with natural infections.
• Lung development: Your child’s lungs keep developing after birth. They won’t stop developing until your baby is at least 2 years old.

Symptoms of pneumonia in children

There are several possible pneumonia symptoms that children can show. The symptoms can also vary by age.

Common symptoms in babies include:

• Faster breathing (tachypnea)
• Increased work of breathing (retractions)
• Fever or low body temperature (hypothermia)
• Grunting
• Irritability
• Not wanting to feed or drink
• Lethargy or listlessness
• Low muscle tone (making them feel more “floppy”)
• Pauses in breathing (apnea)

In toddlers, common symptoms include any of the above and:

• Belly aches or pain
• Cough
• Painful breathing
• Wheezing (stridor)
• Vomiting

One thing to keep in mind is that babies and toddlers don’t always show well-known pneumonia symptoms, like coughing or wheezing.

In older children and teens, pneumonia usually looks a lot like it does for adults. Fever, coughing and wheezing are common.

When should I call my child’s provider or seek care?

If your child shows signs of pneumonia, call their pediatrician. They can advise you on what your child may need at the time.

If your child shows any of the danger signs of pneumonia, go to the nearest hospital or call 911 (or your local emergency services number) right away. These include:

• Seesaw breathing: This is where your child’s chest moves inward, and their belly moves outward when they take a breath.
• Head bobbing: This looks like your baby’s head bouncing upward away from their torso every time they take a breath.
• Retractions: This makes the skin between your baby’s ribs pull inward with each breath.
• Flaring: This is where your baby’s nostril openings widen noticeably when they breathe in.
• Cyanosis: This can make light skin look bluish or pale, and dark skin look gray or whitish.

Pneumonia causes in children

Pneumonia in children mainly happens for the same reason that it happens in adults: germs from other people. Viruses and bacteria are the most likely culprits, but fungi can also cause it. But the germs that cause it in children aren’t always the same ones that cause it in adults.

The germs themselves vary slightly by age. Viruses are more common in children under age 5. Sometimes, pneumonia may develop during or after a normal cold. It can also develop after a viral infection that suddenly worsens.

Pneumonia causes in children include:

• Streptococcus pneumoniae (this is the most common bacterial cause of pneumonia in children)
• Respiratory syncytial virus (RSV)
• Group B strep bacteria (usually in newborns)
• Herpes simplex virus (usually in newborns)
• Cold and flu viruses (like rhinoviruses, human metapneumovirus, adenoviruses, influenza and parainfluenza viruses)
• Coronaviruses (including strains of the virus that causes COVID-19)
• Haemophilus influenzae bacteria
• Chlamydophila bacteria

It’s common for pneumonia in children to happen because of multiple infections. And in many cases, experts aren’t able to confirm the cause at all.

Risk factors

The main risk factors for children to develop pneumonia include:

• Age: Younger children have a higher risk overall. They also have a higher risk of developing severe pneumonia.
• Vaccination status: Children who haven’t received vaccines are at a higher risk. This is especially true for children who aren’t old enough to get the vaccines.
• Preterm birth: Premature babies are especially vulnerable to pneumonia and other respiratory diseases. Being born early means their lungs aren’t as developed as they should be, which makes pneumonia more likely and more dangerous.

Complications of pneumonia in children

Pneumonia in children can be very dangerous. And it can cause both short-term and long-term complications.

Some of the complications include:

• Sepsis
• Needing to stay in a hospital
• Needing breathing support like mechanical ventilation
• Damage that affects lung development
• Follow-up infections that happen while your child’s immune system is still weak
• Higher risk of having pneumonia or other respiratory diseases in the future

How doctors diagnose pneumonia in children

Healthcare providers use several methods to diagnose pneumonia in children. Those include:

• A physical exam, especially listening to your child’s breathing with a stethoscope
• Pulse oximetry
• Lab tests for viruses and bacteria, and to check electrolytes and blood gas levels
• Imaging tests like ultrasound, X-ray or CT scan

Your child’s provider might recommend other tests, depending on your child’s symptoms. Their provider can tell you more about the tests and why they might be necessary.

How is pneumonia in children treated?

The main treatments for pneumonia in children include:

• Medications: Antibiotics are the mainstay for treating bacterial infections that cause pneumonia. Your child can get these in an IV line or in pill or liquid form. This can also include medications for other symptoms, like fever, pain and inflammation.
• Oxygen therapy: Extra oxygen means they don’t need to breathe as hard or as fast.
• Life support: Children who are very sick may need to be on a ventilator or ECMO. These treatments can help your child’s body recover.
• IV fluids and electrolytes: These can help with dehydration or electrolyte imbalances (which are common with pneumonia).

Other treatments might be necessary, depending on your child’s condition. Your child’s provider can tell you more about other treatments that may help.

What can I expect if my child has pneumonia?

Pneumonia in children is serious, but the outlook is generally good. That’s especially true with timely diagnosis and treatment.

When pneumonia is severe and/or it takes a long time to get a diagnosis and treatment, your child may need more advanced care. About 1 in 5 children with pneumonia need to stay in the hospital. Most children who need to stay in the hospital are under 2 years old.

Other things can affect the outlook for your child’s case. And recovery time for children with pneumonia varies widely. Your child’s healthcare team can tell you more about what to expect for your child, specifically.

Can pneumonia in children be prevented?

Yes, many of the infections that cause pneumonia in children are preventable.

Getting your child vaccinated can help protect them from pneumonia. There are vaccines for several of the most common causes of pneumonia in children. And these vaccinations often prevent the most dangerous conditions. Even when vaccines aren’t 100% effective, they can still limit how severe your child’s pneumonia is.

Other things you can do to protect your child include:

• Get vaccinated yourself: Vaccines are a lot like roadblocks. It’s harder for germs to make your child sick if all the routes to your child are blocked off.
• Limit exposure to others who are ill: That’s especially true for people who aren’t or can’t be vaccinated. Doing this can protect your child from long-term or permanent lung damage, or even save their life.
• Wash your hands: Hand hygiene helps everyone, especially young children.