Pneumonia

What Is Pneumonia?

Pneumonia is an infection of the lungs. The air sacs in the lungs (called alveoli) fill up with pus and other fluid. This makes it hard for oxygen to reach the bloodstream.

Someone with pneumonia may have a fever, cough, or trouble breathing.

What Are the Signs & Symptoms of Pneumonia?

Symptoms vary depending on a person's age and what caused the pneumonia, but can include:

• very fast breathing (in some cases, this is the only symptom)
• breathing with grunting or wheezing sounds
• working hard to breathe; this can include flaring of the nostrils, belly breathing, or movement of the muscles between the ribs
• fever
• cough
• stuffy nose
• shaking chills
• vomiting
• chest pain
• belly pain (because a child is coughing and working hard to breathe)
• less 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

If the pneumonia is in the lower part of the lungs near the abdomen, a person might have a fever and belly pain or vomiting with no breathing problems.

What Causes Pneumonia?

Pneumonia is caused by a variety of germs (viruses, bacteria, fungi, and parasites). Most cases, though, are caused by viruses. These include adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (which also can cause croup).

Often, pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat), with symptoms starting after 2 or 3 days of a cold or sore throat. It then moves to the lungs. Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.

Kids with pneumonia caused by bacteria usually become sick fairly quickly, starting with a sudden high fever and unusually fast breathing.

Kids with pneumonia caused by viruses probably will have symptoms that appear more gradually and are less severe, though wheezing can be more common.

Some symptoms give important clues about which germ is causing the pneumonia. For example:

• In older kids and teens, pneumonia due to Mycoplasma (also called walking pneumonia) is very common. It causes a sore throat, headache, and rash in addition to the usual symptoms of pneumonia.
• In babies, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever.
• When pneumonia is due to whooping cough (pertussis), a child may have long coughing spells, turn blue from lack of air, or make the classic "whoop" sound when trying to take a breath. Fortunately, the pertussis vaccine can help protect kids against whooping cough.

The length of time between exposure to the germ and when someone starts feeling sick varies, depending on which germ caused the pneumonia (for instance, 4 to 6 days for RSV, but just 18 to 72 hours for the flu).

How Is Pneumonia Diagnosed?

Doctors usually make a pneumonia diagnosis after an exam. They'll check a child's appearance, breathing pattern, and vital signs, and listen to the lungs for abnormal sounds. They might order a chest X-ray or blood tests, but neither are necessary to make the diagnosis.

How Is Pneumonia Treated?

In most cases, pneumonia is caused by a virus that does not require antibiotics. Pneumonia caused by bacteria is treated with antibiotics taken by mouth at home. The type of antibiotic used depends on the type of bacteria thought to have caused the pneumonia.

Antiviral medicine is now available too, but is reserved for the flu when found early in the course of illness.

Children might need treatment in a hospital if the pneumonia causes a lasting high fever, breathing problems, or if they:

• need oxygen therapy
• have a lung infection that may have spread to the bloodstream
• have a chronic illness that affects the immune system
• are vomiting so much that they cannot take medicine by mouth
• keep getting pneumonia
• might have whooping cough

Hospital treatment can include intravenous (IV) antibiotics (given into a vein) and respiratory therapy (breathing treatments). More severe cases might be treated in the intensive care unit (ICU).

How Can I Help My Child?

Anyone with pneumonia needs to get plenty of rest and drink lots of fluids while the body works to fight the infection.

If your child has bacterial pneumonia and the doctor prescribed antibiotics, give the medicine on schedule for as long as directed. This will help your child recover faster and help prevent the infection from spreading to others in the family. For wheezing, the doctor might recommend using a nebulizer or an inhaler.

Ask the doctor before you use a medicine to treat your child's cough. Cough suppressants stop the lungs from clearing mucus, which isn't helpful for pneumonia. Over-the-counter cough and cold medicines are not recommended for any kids under 6 years old.

Take your child's temperature at least once each morning and each evening. Call the doctor if it goes above 102°F (38.9°C) in an older infant or child, or above 100.4°F (38°C) in a baby under 6 months old.

Check your child's lips and fingernails to make sure they are rosy and pink. Call your doctor if they are bluish or gray, which is a sign that the lungs are not getting enough oxygen.

How Long Does Pneumonia Last?

With treatment, most types of bacterial pneumonia are cured in 1–2 weeks. Walking pneumonia and viral pneumonia may take 4–6 weeks to go away completely.

Is Pneumonia Contagious?

In general, pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are. When these germs are in fluid from the mouth or nose of someone who's infected, that person can spread the illness through coughs and sneezes.

Sharing drinking glasses and eating utensils, and touching the used tissues or handkerchiefs of an infected person also can spread pneumonia. So it's best to keep kids away from anyone with symptoms (stuffy or runny nose, sore throat, cough, etc.) of a respiratory infection.

Can Pneumonia Be Prevented?

Some types of pneumonia can be prevented by vaccines. Kids usually get routine immunizations against Haemophilus influenzae pneumococcus and whooping cough beginning at 2 months of age.

The flu vaccine is recommended for all healthy kids ages 6 months through 19 years, but especially for kids with chronic illnesses such as heart or lung disorders or asthma.

Because they're at higher risk for serious complications, babies born early may get treatments that temporarily protect against RSV because it can lead to pneumonia in younger kids.

Doctors may give antibiotics to prevent pneumonia in kids who have been exposed to someone with certain types of pneumonia, such as whooping cough. Those with HIV infection might get antibiotics to prevent pneumonia caused by Pneumocystis jirovecii.

If someone in your home has a respiratory infection or throat infection, keep their drinking glasses and eating utensils separate from those of other family members, and wash your hands often, especially if you're handling used tissues or dirty handkerchiefs.

When Should I Call the Doctor?

Call your doctor right away if your child has any of the signs of pneumonia, but especially if he or she:

• has trouble breathing or is breathing too fast
• has a bluish or gray color to the fingernails or lips
• has a fever of 102°F (38.9°C), or above 100.4°F (38°C) in babies younger than 6 months old