The word pneumonia means “infection of the lung.” While such infections were extremely dangerous in past generations, today most children can recover from them easily if they receive proper medical attention.
Most cases of pneumonia follow a viral upper respiratory tract infection. Typically, the viruses that cause these infections (respiratory syncytial virus [RSV], influenza, parainfluenza, adenovirus) spread to the chest and produce pneumonia there. Pneumonia also can be caused by bacterial infections.
Some of these are spread from person to person by coughing or by direct contact with the infected person’s saliva or mucus. Also, if a viral infection has weakened a child’s immune system, bacteria may begin to grow in the lung, adding a second infection to the original one.
Children whose immune defenses or lungs are weakened by other illnesses, such as cystic fibrosis, asthma, or cancer (as well as by the chemotherapy used to treat cancer), are more likely to develop pneumonia. Children whose airways or lungs are abnormal in any other way also have a higher risk.
Because most forms of pneumonia are linked to viral or bacterial infections that spread from person to person, they’re most common during the fall, winter, and early spring, when children spend more time indoors in close contact with others. The chance that a child will develop pneumonia is not affected by how she is dressed or by air temperature.
Signs and Symptoms
Like many infections, pneumonia usually produces a fever, which in turn may cause sweating, chills, flushed skin, and general discomfort. The child also may lose her appetite and seem less energetic than normal. Babies and toddlers may seem pale and limp, and cry more than usual.
Because pneumonia can cause breathing difficulties, you may notice these other, more specific symptoms, too:
Fast, labored breathing
Increased activity of the breathing muscles below and between the ribs and above the collarbone
Flaring (widening) of the nostrils
Pain in the chest, particularly with coughing or deep breathing
Bluish tint to the lips or nails, caused by decreased oxygen in the bloodstream
Although the diagnosis of pneumonia usually can be made on the basis of the signs and symptoms, a chest X-ray sometimes is necessary to make certain and to determine the extent of lung involvement.
When pneumonia is caused by a virus, usually there is no specific treatment other than rest and the usual measures for fever control. Cough suppressants containing codeine or dextromethorphan should not be used, because coughing is necessary to clear the excessive secretions caused by the infection. Viral pneumonia usually improves after a few days, although the cough may linger for several weeks. Ordinarily, no medication is necessary.
Because it is often difficult to tell whether the pneumonia is caused by a virus or by bacteria, your pediatrician may prescribe an antibiotic. All antibiotics should be taken for the full prescribed course and at the specific dosage recommended. You may be tempted to discontinue them early, but you should not do so. Your child will feel better after just a few days, but some bacteria may remain and the infection might return unless the entire course is completed.
Your child should be checked by the pediatrician as soon as you suspect pneumonia. Check back with the doctor if your child shows any of the following warning signs that the infection is worsening or spreading.
Fever lasting more than a few days despite using antibiotics
Evidence of an infection elsewhere in the body: red, swollen joints, bone pain, neck stiffness, vomiting, or other new symptoms or signs
Your child can be vaccinated against pneumococcal infections, a bacterial cause of pneumonia. The American Academy of Pediatrics recommends that all children younger than two years old receive this immunization (called pneumococcal conjugate or PCV7). A series of doses needs to be given at two, four, six, and twelve to fifteen months of age, at the same time that children receive other childhood vaccines.
Another pneumococcal vaccine (pneumococcal polysaccharide or PPV23) also is recommended for older children (twenty-four to fifty-nine months of age) who have a high risk of developing an invasive pneumococcal infection. These include children with sickle cell anemia, heart disease, lung disease, kidney failure, damaged or no spleen, organ transplant, and HIV (human immunodeficiency virus) infection. It’s also recommended for children taking medications or who have diseases that weaken their immune system.