Pneumonia is an infection of the lungs, the "lower" part of our breathing system (respiratory tract). Air enters our body through the nose and mouth (the "upper" respiratory tract), travels through smaller and smaller tubes, into tiny sacs (alveoli) in the lungs where oxygen, from the air that we breathed in, enters the blood. Carbon dioxide is exchanged at the same time and then breathed out. Germs normally are taken out of the respiratory tract, trapped in the mucus of the nose and sinuses, and cleared away from the lungs with coughing. Sometimes, when these areas are not working well (for example, with a cold) germs get deeper into the lungs and cause an infection. As a result, mucus and fluid fill the air sacs, causing trouble breathing, more coughing and fever.
Although the term "pneumonia" refers to an infection of the lung caused by viruses, bacteria and other germs, it most commonly is used for bacterial pneumonia. Other terms, such as bronchiolitis or bronchitis, tend to be used more for viral pneumonias.
Pneumonia can occur at any age and at any time of year, but most commonly is seen in younger children during the winter months.
Symptoms of pneumonia may include:
- Fever, often high, sometimes with shaking chills
- Fast breathing (tachypnea)
- Having a hard time breathing
- Breathing with wheezing or grunting sounds
- Chest pain, especially with deep breaths
- Belly pain
- Vomiting or diarrhea
- Increased sleepiness (lethargy)
- Decreased activity
- Decreased appetite or poor feeding
To know if there is pneumonia, the doctor will:
- Check your child's temperature, since pneumonia often causes fever.
- Watch your child's breathing. This includes:
- Counting how many times your child is breathing per minute (respiratory rate). Pneumonia often causes fast breathing.
- Checking if your child is using the muscles in his neck, chest or belly to help him breathe (retracting), making grunting noises, or flaring his nostrils. These can be signs of difficult or labored breathing.
- Examine your child’s lungs carefully by listening to your child's breathing with a stethoscope. Pneumonia can cause harsh sounds or sometimes, wheezing in the lung.
- Consider further testing.
- A chest X-ray may help to find a pneumonia that is not heard clearly with a stethoscope. It also is done to see how involved the lung infection may be.
- If available, a special device called a pulse oximeter is used to check the oxygen level of the blood. This painless test measures the oxygen using a light that is placed on your child’s finger or toe.
- Blood tests to look for signs of infection may be done if your child is young or looks very sick.
If your child does have pneumonia, the doctor will:
- Prescribe an antibiotic. Bacterial pneumonia is treated with antibiotics taken by mouth. Which antibiotic and how long to treat depend on the type of pneumonia and the age of the child. If your child is very young, looks sick, or is vomiting and cannot hold down any fluids, the antibiotics are best given directly into the bloodstream or muscle using a needle.
- Discuss whether any other medicines are necessary. Sometimes pneumonia causes wheezing in the lungs and medicines used for asthma may be helpful.
- Recommend ways to ease the pain.
- Discuss the things you should watch for at home.
- Tell you when your child should be seen again. The doctor usually will want to see your child within a few days, or at least hear from you by phone, to make sure that the infection is getting better.
Be sure your child takes the antibiotic by mouth exactly as directed.
- Check with your pharmacist to see whether the antibiotic should be taken on an empty stomach or with food.
- Finish all of the antibiotic, even as your child starts feeling better.
Be sure your child drinks lots of liquids to prevent dehydration.
Some over-the-counter medications may be helpful.
- For pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
These over-the-counter medicines usually are not helpful:
- Expectorants (for example, guaifenesin) are supposed to loosen up mucus and make it easier to be coughed out. Unfortunately, they have not been shown to be helpful for children with coughs caused by colds or pneumonia.
Certain over-the-counter medications should not be used unless directed by your doctor:
- Do not use cough suppressants, such as dextromethorphan or codeine (available only by prescription), unless directed by your doctor. Coughing is the body's way of clearing mucus from the lungs and helping get rid of the infection. Stopping the cough actually could make the infection worse. If your child is exhausted because he is coughing so much that he cannot sleep, your doctor may recommend trying a cough medicine for a short period. However, cough suppressants can have serious side effects, and are no better at quieting children's coughs than plain cherry syrup.
- Vitamin A supplements do not help and may even worsen pneumonia in children, except in rare cases. Furthermore, taking too much vitamin A can be dangerous.
- Never give your child aspirin or any products containing aspirin because it has been associated with Reye's syndrome, a serious illness that affects the liver and brain.
- Prop up your child with extra pillows while sleeping and sitting, but never put pillows in the crib with an infant.
- If your child has chest pain, try holding a warm compress or heating pad on the area.
- Use a cool mist vaporizer (a humidifier) in your child's room, but make sure to clean it every few days according to the manufacturer's instructions.
- Do not smoke around your child because it will make symptoms worse.
- Is getting worse instead of better.
- Is having more trouble breathing.
- Develops blueness around the lips or on the fingernails or toenails at any time.
- Is not drinking and has not made any urine in six to eight hours.
- Seems too sleepy or tired (lethargic) at those times when you would expect him to be more awake and active.
- Continues to have fever or difficulty breathing two to three days after having seen a doctor.
Prevent other episodes of pneumonia by:
- Teaching your child to always wash his hands regularly and well.
- Teaching your child to cover his mouth and nose when he coughs or sneezes, and to wash his hands right after.
- Using disposable tissues to wipe or blow noses (use once and then throw them away).
- Making sure your child gets all of the recommended immunizations, which help to prevent some types of pneumonia. For example, the pneumococcal vaccine (PCV7 or Prevnar) helps prevent pneumonia caused by the Streptococcus pneumoniae bacteria, while the pertussis (whooping cough) vaccine (DTaP or Tdap) prevents a potentially severe cough and breathing problem, especially in very young children. The influenza, measles and chicken pox vaccines prevent viral illnesses that can cause infections in the lungs and be complicated by bacterial pneumonia.
Check with your school or day care regarding specific policies about returning after illness. Although most cases of pneumonia are not contagious (spread from person to person), the cold that often comes before the pneumonia is contagious. However, keeping children with respiratory symptoms out of school or day care may not decrease the spread of infection and therefore, children with colds or pneumonia usually can go back to school or day care as soon as they have no fever for 24 hours and feel well enough to be there. Children with certain types of pneumonia, such as that caused by pertussis, must stay home for longer periods.
If your child needs to take a dose of medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or day care and leave the other at home. Also be sure to fill out any necessary forms, including a note from your doctor, with specific instructions for giving the medicine.