Pneumonia

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Key points to remember about pneumonia

  • pneumonia is a chest infection - an infection of the lungs
  • pneumonia causes cough, fever and problems with breathing
  • it can be caused by viruses or bacteria
  • viral pneumonia is more common in children
  • antibiotics are prescribed for bacterial pneumonia but they do not help viral pneumonia
  • most children make a complete recovery from pneumonia

What is pneumonia?

Pneumonia is a chest infection which is an infection of the lungs. Usually only part of the lungs is involved. Lungs are the part of the body that does the breathing.

Normal lungs

See Acknowledgement for this image.

What causes pneumonia?

Viral pneumonia is caused by viruses.

Bacterial pneumonia is caused by bacteria. 

In children, especially young children, viral pneumonia is more common.

Viruses and bacteria are tiny infectious organisms. They are so small that they can only be seen under a microscope.

Pneumonia occurs when these viruses or bacteria manage to get past the body’s normal defences. The immune (infection-fighting) system tries to kill them. If the viruses or bacteria survive in the lungs, they can breed fast and cause pneumonia.

Is pneumonia catching (contagious)?

The viruses that cause viral pneumonia are catching (contagious) meaning they can spread easily between people. Most children and adults just get an upper respiratory infection ("head cold") with a runny nose. Only a few will get pneumonia. Virus infections, including viral pneumonia, are more common in winter.

Most bacterial pneumonia cannot be spread between people but some can be contagious. It is wise to limit the possible spread of infection by keeping your child with pneumonia away from other children.

What puts my child at risk of getting pneumonia?

Anyone can get pneumonia, but some children are more likely to than others. A child will be at greater risk of catching pneumonia if they:

  • are very young
  • are exposed to cigarette smoke
  • don't have immunisation or immunisations on time
  • have a long-lasting (chronic) condition that affects the lungs such as poorly controlled asthma, Bx (bronchiectasis) or cystic fibrosis 
  • are taking a medicine long-term that affects the immune (infection-fighting) system (such as steroids)
  • were a premature baby
  • have feeding problems, such as aspiration (breathing in a bit of feed). These children often cough and / or choke with feeding
  • have other long-lasting medical problems

What are the signs and symptoms of pneumonia?

Pneumonia causes cough, fever and trouble with breathing. Breathing problems include:

  • breathing faster than usual
  • noisy or rattly breathing
  • difficulty with feeding
  • making a grunting sound with breathing
  • putting a lot of extra effort into breathing

A child with pneumonia is usually very tired and looks unwell.

Viral pneumonia usually develops over days. It starts with a cold and a runny nose. Then there is a cough, and sometimes fever, before breathing problems develop.

Bacterial pneumonia usually develops faster, over a day. It causes high fever, a cough, and breathing problems. A child will be very tired and look quite unwell.

Sometimes bacterial pneumonia develops during a viral infection. If this happens, your child will usually start with an illness like a cold for a few days, and then become much sicker quite quickly.

When should I seek help?

You can look after your child at home if they:

  • are drinking and feeding well
  • do not look sick
  • are not having problems with breathing

You should see a doctor urgently if your child:

  • is under 3 months old

You should see a doctor urgently if your child of any age:

  • is breathing fast, has noisy breathing and is having to use extra effort to breathe
  • looks unwell
  • looks very pale
  • suddenly gets worse after beginning to get better from a cold

You should also see a doctor if you are worried about your child.

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your child:

  • has blue lips and tongue
  • has severe difficulty breathing
  • is becoming less responsive
  • is floppy
  • has any episodes of irregular or stopping breathing

How is pneumonia diagnosed?

Your doctor will ask questions about the illness, examine your child and listen to their chest for signs of pneumonia. Pneumonia can be hard to diagnose in very young children.

If your child looks very unwell, your doctor may refer your child to hospital. Your child may need to have blood tests. Your doctor may order a chest x-ray.

A chest x-ray gives a picture of your child’s lungs. An x-ray uses a low dose of radiation. Chest x-rays are very safe and painless. To avoid unnecessary radiation, chest x-rays are only ordered if essential.

The chest x-ray will usually show the pneumonia.

What treatments are required?

Antibiotics do not help in viral pneumonia. It is not always easy to tell if pneumonia is viral or bacterial. Doctors tend to use antibiotics when it is not clear which sort of pneumonia a child has. If your child has bacterial pneumonia, they will need antibiotics. If your child is young or sick enough to be in hospital, antibiotics are often given by a drip (into a vein).

Pneumonia affects your child’s breathing. Sometimes this makes it hard for them to get enough oxygen. Signs of not getting enough oxygen may include any of the following:

  • looking very pale
  • going blue in the tongue and lips
  • becoming very sleepy and not easy to rouse

If your child needs to be given extra oxygen in hospital, this is usually given through nasal prongs (small soft plastic tubes) that fit into your child’s nose.

A child with pneumonia may not eat well but they do need to drink fluids. If they are not drinking well enough, your child may need to be given fluids by an intravenous drip (into a vein) or by nasogastric feeding (feeding via a tube that is passed through the nose or mouth into the stomach).

A small number of children who are extremely unwell with pneumonia need more intensive hospital treatment.

How can I care for my child at home?

If your child is miserable because of pain or fever, you can give paracetamol to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose. 

Your child will need rest to help them recover from pneumonia. Encourage them to drink fluids and eat healthy small meals.

If antibiotics have been prescribed, make sure your child takes all the doses for all the days until finished.

It is wise to keep your child with pneumonia away from other children. This is to both limit the possible spread of infection and prevent your child from getting a second infection before they have fully recovered.

How long does pneumonia last?

A child usually takes a couple of weeks to fully recover. Over that time the immune (infection-fighting) system will be cleaning up the pneumonia. Coughing up phlegm (mucus or sputum) is part of the cleaning up process. The cough may last 1 or 2 weeks, or even longer.

If you are worried that the cough is getting worse again, or is not getting better after 4 weeks, you should take your child to see your doctor.

How can pneumonia be prevented?

  1. Breastfeeding your baby protects them from getting pneumonia by boosting their immune (infection fighting) system. Breastfeeding beyond 4 months of age offers the best protection.
  2. Make sure your child’s environment is smoke-free. This will help reduce the chance of your child getting pneumonia. If you want to give up smoking:
    • call the Quitline on 0800 778 778 for free
    • check out the website Quitline
    • ask your health professional
  3. Immunisation helps to prevent some serious causes of pneumonia, in particular immunisation against the following diseases:
  4. Make sure your child has a healthy balanced diet and maintains a healthy weight. Being underweight or overweight can increase your child's risk of getting pneumonia.
  5. Make sure your child keeps up with their treatment for any long-lasting (chronic) condition such as asthma.
  6. Make sure everyone in your family washes their hands regularly and thoroughly, and dries them well including (but not only) before preparing food and eating. 
  7. Keeping the house warm and well-insulated will also decrease your child's risk of developing pneumonia.

The following article, written by 3 New Zealand paediatricians, discusses the serious consequences pneumonia can have and how it can be prevented:

Experts: Pneumonia threat putting our youngsters' health at risk (New Zealand Herald: 9 November 2009)

How are infections spread?

Infection is spread in droplets through the air by sneezing and coughing. It is also spread between hands, noses and mouths.

Teach your child about the importance of catching coughs and sneezes in tissues and teach them how to put their elbow across their mouth and nose when they cough or sneeze. These actions can reduce the spread of infection.

Encourage your child to wash and dry their hands. Hand washing reduces the spread of infection and also lowers the chance of catching infections.

Keep children who are unwell and infectious with coughs and colds away from their pre-school or school. This reduces the risk of other children catching the infection. Some of these children might develop pneumonia.

Are there likely to be any complications?

Most children make a full recovery from pneumonia. They do not have any lasting effects.

A small number of children may need specialised treatment for complications. A very small number of children may get very sick.

References

Paediatric Society of New Zealand. 2005. Best practice evidence based guideline: Wheeze and chest infection in infants under 1 year. NZ Paediatric Society of New Zealand. http://www.paediatrics.org.nz/files/guidelines/Wheezeendorsed.pdf [Accessed 3/3/2014]

Acknowledgements

The image of the lungs comes from http://www.cleanair.utah.gov/pollutants/pollutionEffects.htm. Diagram labels have been added. Thank you to the State of Utah, USA, for use of this image. [Accessed 3/3/2014]

This page last reviewed 05 March 2014
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2014
Printed on 22 October 2014. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version
Content endorsed by the Paediatric Society of New Zealand