Children's Hospital Colorado

Pneumonia in Children

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What is pneumonia?

Pneumonia is an infection of the lungs that can be caused by viruses, bacteria, fungi and parasites. Pneumonia is a secondary illness that develops because the viral or bacterial illness was there first.

Often pneumonia begins after a cold, with symptoms beginning after 2 or 3 days of a cold or sore throat.

The length of time between exposure and feeling sick from pneumonia, called the incubation time, varies depending on the type of virus or bacteria causing the infection. For instance, if a child develops pneumonia from a cold caused by respiratory syncytial virus (RSV), it takes 4 to 6 days for symptoms to appear; for the flu virus, symptoms start after 18 to 72 hours.

Pneumonia caused by bacterial infections can last 1 to 2 weeks with appropriate antibiotics. In general, symptoms should improve about a week after starting antibiotics. Because there are no medications to treat viral infections, symptoms from viral pneumonia may last longer.

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 abnormally fast
  • Has a bluish or gray color to the fingernails or lips
  • Has a fever of 102ºF (38.9ºC), or above 100.4ºF (38ºC) in infants under 6 months of age

What causes pneumonia?

Most cases of pneumonia are caused by common viruses that cause cold, flu and other respiratory infections such as adenovirus, rhinovirus, influenza (flu), respiratory syncytial virus (RSV) and parainfluenza virus.

The viruses and bacteria that cause pneumonia are contagious and are spread by sneezing, coughing or contact with contaminated surfaces like shared drinking glasses or utensils, used tissues or even doorknobs and faucets. However, a person who becomes infected by someone with pneumonia will not necessarily develop pneumonia themselves.

Who gets pneumonia?

Anyone can get pneumonia, but some kids are at higher risk than others. Children who are more likely to get pneumonia include:

  • Children with chronic illnesses, such as heart or lung disorders
  • Children with asthma
  • Infants born prematurely
  • Children with a compromised immune system, such as those who are HIV positive

What are the signs and symptoms of pneumonia?

Symptoms vary depending on the age of the child and the cause of the pneumonia, but common ones include:

  • Cough
  • Fever 
  • Rapid breathing (in some cases, this is the only symptom)
  • Breathing with grunting or wheezing sounds
  • Labored breathing that causes nasal flaring and makes the rib muscles draw in (muscles under the ribcage or between ribs suck inward with each breath)
  • Chest pain
  • Abdominal pain
  • Vomiting
  • Decreased 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

Someone with pneumonia in the lower part of the lungs near the abdomen might have fever and abdominal pain or vomiting but little or no breathing problems.

Kids with bacterial pneumonia usually get sick fairly quickly and will develop a high fever and rapid breathing very quickly.

Kids with viral pneumonia may have symptoms that appear more gradually and may be less severe. Wheezing is more common in viral pneumonia.

What tests are used to diagnose pneumonia?

Your child's doctor may order a chest X-ray to diagnose pneumonia. The cause of some types of pneumonia can be determined by culturing the bacteria taken from the mucus an ill child produces from coughing. This helps doctors determine what types of treatments will work best. Some viral pneumonias can be diagnosed by testing nasal secretions.

How do providers at Children's Hospital Colorado make a diagnosis?

Doctors usually make a pneumonia diagnosis after asking about your child's symptoms and examining your child. The doctor also might order a chest X-ray, blood tests, tests for viruses in nasal secretions or bacterial cultures of mucus produced by coughing in some cases.

How is pneumonia treated?

In most cases, children with bacterial pneumonia are given oral antibiotics and are able to stay home to rest and recover. 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.

Pneumonia due to flu virus can be treated with anti-viral medications within the first 2 or 3 days of symptoms. For other viruses that cause pneumonia, there are no medications. In these cases, supportive measures like keeping your child hydrated, controlling any fever, and treating wheezing or oxygen need are used until the body can overcome the infection by itself.

If your doctor prescribed antibiotics, give the medicine on schedule for as long as directed. This will help your child recover faster and will decrease the chance that infection will spread to other household members. For wheezing, a doctor might recommend using a nebulizer or inhaler.

Ask your doctor before you use non-prescribed medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which may not be helpful in pneumonia. Over-the-counter cough and cold medications are not recommended for 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 102ºF (38.9ºC) in an older infant or child or above 100.4ºF (38ºC) in an infant under 6 months of age. Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that the lungs are not getting enough oxygen.

Children may be hospitalized for treatment if they have pneumonia if:

  • They need supplemental oxygen
  • They have lung infections that may have spread to the bloodstream
  • They have chronic illnesses that affect the immune system
  • They are vomiting so much that they cannot take medicine by mouth or are dehydrated

How can pneumonia be prevented?

Some types of pneumonia can be prevented by vaccines. The American Academy of Pediatrics recommends that infants and children receive routine immunizations against Streptococcus pneumoniae and Haemophilus influenza, which are the two most common bacterial causes of pneumonia. Children should be vaccinated against pertussis, also called whooping cough, beginning at 2 months of age. 

Yearly influenza virus vaccines are also recommended for the prevention of pneumonia. Children with chronic respiratory diseases may also receive an additional immunization against Streptococcus pneumoniae in order to further prevent pneumonia. Antiviral medication is now available, and can be used to treat some types of viral pneumonia or to make symptoms less severe.

Why choose Children's Colorado for your child's pneumonia?

Children's Colorado Breathing Institute's mission is to provide comprehensive clinical care and consultation for children with common and complex breathing problems. Our experts and facilities are prepared to diagnose and treat children with pneumonia. Our multidisciplinary approach means we will communicate about treatments with your child's primary care physician and any other specialists your child may need.

As a regional care center, the Breathing Institute provides professional education and advancement of knowledge through research. Our doctors are responsible for discoveries in pulmonary medicine, including the first use of inhaled nitric oxide (iNO) to treat a premature infant with respiratory failure.

The latest in diagnostic testing is available for both infants and older children, and an experienced staff of pediatric specialists to include physicians, nurses, dietitians, social workers and respiratory therapists allows families to benefit from the team approach to treating breathing disorders. Our collaborative approach to breathing and lung care incorporates and encourages family involvement.

  • Healthy Children provides more in depth information for parents about pneumonia from the American Academy of Pediatrics.
  • Medline Plus offers easy-to-understand information about causes and treatments for kids with pneumonia.

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