Pneumonia in the child


Pneumonia, also known as pneumonia, is the inflammation of various parts of the lung. It is the most common respiratory disease in children and can be caused by various pathogens such as bacteria or viruses. It should be noted that the symptoms in children can be very unspecific. Since pneumonia may even lead to death, a (pediatrician) doctor should be consulted in a timely and timely manner. Pneumonia can be diagnosed by listening to the stethoscope, an X-ray, or using a blood test / blood culture by cultivating pathogens.


Pneumonia is an infectious disease. This means that the disease is caused by germs that affect the lungs. These can be bacteria as well as viruses or fungi.
The most common pathogens that cause pneumonia in children are pneumococci. Other common bacteria, especially those affecting schoolchildren, are mycoplasma and chlamydia.
Common viruses that cause pneumonia in children are RS viruses, rhinoviruses and parainfluenza viruses.
If bacteria are the cause of pneumonia, it is called typical pneumonia, while atypical pneumonia is often caused by viruses. Often, pneumonia is also caused by different germs together.
In the hospital acquired pneumonia (nosocomial pneumonia) are caused by other bacteria than community-acquired pneumonia, as they are rare here. These include, for example, the germ Pseudomonas. This is a danger, especially for children with immunodeficiencies or diseases that affect the lungs, such as cystic fibrosis.
Risk factors for a child to get pneumonia, in addition to severe pre-existing diseases of the heart or lungs, are also diseases in which the immune system is weakened.

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Under certain circumstances, an X-ray image may be necessary to secure the diagnosis.

The diagnosis of pneumonia can not be that easy at times. Many symptoms are not particularly specific in children, so pneumonia may go undetected.
When examining the lungs with the stethoscope so-called rattling noises can be heard, indicating that the lungs are occupied. However, this finding is very unspecific and often missing.
In children, you may see signs that indicate that breathing is difficult. These include the nostrils (movement of the nostrils when breathing) or great efforts during inhalation. When inspecting (looking at) the upper body, there can be recesses on the ribs.
Inflammation scores such as the blood sedimentation rate (CRG), CRP (C-reactive protein) and procalcitonin may be elevated in a blood test. To detect the germs, blood cultures (for the cultivation of pathogens) can be removed or an examination of the sputum can be carried out. The color of sputum may be yellowish to green in case of bacterial infection. Finally, an X-ray of the chest can show that the lungs are covered with infiltrates. This can be seen in the X-ray image as so-called shading. The preparation of an X-ray image does not belong to the routine diagnostics, but is necessary in some cases. In children under 5 years or a fever over 39 ° C without a confirmed cause, an X-ray examination is obligatory (mandatory).

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The symptoms of pneumonia can be very different in the child.
A typical pneumonia usually starts suddenly with a strong feeling of illness. It can lead to high fever and an increased respiratory rate, which is typical for pneumonia in children. The cough is productive, meaning that the children cough up greenish expectoration. Breathing pain that complicates breathing is also typical.
An atypical pneumonia shows a slightly different course and is not so rare in children. It is often caused by mycoplasma. Most of the onset is very insidious and pneumonia can easily be overlooked. The disease begins with headache and body aches. Slight fever may accompany, but it may be completely absent. Shortness of breath and dry cough without sputum are typical. Since the onset, however, is very insidious and the symptoms of atypical pneumonia can be very unspecific, especially in children, a confusion with a cold is possible.

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Pneumonia with and without fever

Fever is a symptom that is typical of pneumonia. However, it does not necessarily exist. There are also pneumonia with only slight or no increase in body temperature.
In general, typical fever is characterized by a high fever and an equally strong malaise. In children, the fever can also rise to over 39.0 ° C. But that does not necessarily have to be the case.

Atypical pneumonia shows mild to no fever. However, one has to keep in mind that the division and attribution of causes is not so easy. It is not possible to conclude by the symptoms alone that has caused the pneumonia. Also, the fever as a symptom is too unspecific, as that causes could be limited. Reasons why children do not have a rise in fever, for example, severe pre-existing conditions such as cystic fibrosis or other immune deficiencies.

Pneumonia with and without cough

Not every pneumonia in a child has to be accompanied by a cough. Although coughing is usually a symptom of pneumonia, it may be absent.

Especially with atypical pneumonia in childhood, the cough may be completely absent. In most cases, RS viruses are the cause of atypical pneumonia. The course of atypical pneumonia is also more symptomatic overall in children than the course of typical pneumonia. The boundaries, however, are fluid, so that no strict distinction is possible solely on the basis of the symptoms.

A pronounced cough with sputum, however, rather speaks for a bacterial cause. Most pneumococci are the cause of pneumonia. However, other germs can also be the cause. The ejection can be green to yellowish. Even a dry cough is possible. This means that no expectoration is coughed off by the coughing.

For more information, see: Pneumonia without cough


For pain relief and to reduce fever, there are juices with ibuprofen for children.

The treatment of pneumonia in children depends, among other things, on which germ is the cause. Furthermore, the severity of pneumonia is included in the therapy. Treatment is possible both outpatient and inpatient. When a hospitalization of the child is necessary, depends on the severity of the disease and the general condition of the child.
A mild pneumonia can be treated on an outpatient basis. A hospital stay is not necessary here. The therapy consists of a drug treatment with antibiotics. The drugs of first choice are aminopenicillins (eg amoxicillin), but other antibiotics are also approved for treatment. The treatment of community-treatable pneumonia is usually completed after 7 days.

Moderate to severe pneumonia is hospitalized in hospital. In addition, patients receive a combination of different antibiotics via an access in the vein. Antibiotic treatment is stopped 2 to 3 days after the child is exhausted. Children who get pneumonia in the hospital are always hospitalized. The therapy includes special combinations of antibiotics effective against the germs found in the hospital.
The treatment of child pneumonia also includes important supportive measures that promote healing. The coughing up of the secretion and good breathing are important for the lung to heal well. Therefore, physiotherapy, if available, is highly desirable. Furthermore, oxygen can be administered via a nasogastric tube if oxygen saturation (blood oxygen content) is too low, such as severe pneumonia that requires hospitalization. High fluid intake is very important as it helps to clear the secretion well.

To reduce the fever and pain relief in children, the active ingredient Ibuprofen is usually used. Pain relief is particularly important because chest pain hampers the breathing of the affected children. However, good work of breathing is necessary for healing.

Treatment with an antibiotic

Antibiotics are probably the most important treatment for pneumonia. They fight the pathogens that cause pneumonia. Depending on whether it is pneumonia, the child has received in the hospital or outside a hospital, outpatient, various antibiotics are used.
Outpatient pneumonia is usually treated with amoxycillin. Also, the antibiotic azithromycin is often used in children because it is very effective and has relatively few side effects.
In inpatient treatment, the antibiotics are given via an access in the vein. In most cases combinations of different antibiotics are used in order to be able to combat as many germs as possible and to prevent germs becoming resistant.

A possible combination of moderate or severe pneumonia would be, for example, amoxicillin, clavulanic acid and azithromycin.
Allergies to these antibiotics may be due to other drugs such as cephalosporins, other macrolides or fluoroquinolones. These are also antibiotics.

Homeopathy as a therapy

Pneumonia is a serious condition and can even be fatal to the child if therapy is inadequate. Therefore, it is absolutely not recommended to use homeopathic methods. There are no effective homeopathic remedies that could cure pneumonia in the child.

Duration of pneumonia

The duration of pneumonia in the child often varies. Not every course is the same. How long a pneumonia takes depends, among other things, on how severe it is. In addition, the general condition of the child is an important factor influencing the duration of pneumonia. In pre-existing conditions, immunodeficiencies or in chronic diseases such as cystic fibrosis or the like, pneumonia often lasts for weeks until it heals.
A mild pneumonia in a good general condition of the child usually takes 7 to 14 days under good therapy.

Moderate to severe pneumonia can also show longer courses. Even so-called relapses, which are disease relapses, are possible if a child has not struck an immune deficiency or previous illnesses or the therapy well. In rare cases, affected children may suffer from the symptoms for up to several weeks.
Lung infections acquired at the hospital may also be prolonged. Since they can be pathogens that are already resistant to some antibiotics ( see also: antibiotic resistance), the therapy can be difficult. The general condition of the child also plays a decisive role here. Children who are already seriously ill in the hospital are often more difficult to treat than healthy children.

For more information, see: How long does pneumonia last?

When should you go to the hospital?

Moderate to severe pneumonia is treated in hospital. But when does a child have to go to the clinic? It is not always clear when a child has to go to the hospital and when not. However, there are a few reasons that are more likely to be considered for hospitalization.

Any prolonged fever in children for which there is no apparent cause should be clinically clarified. Furthermore, a very poor general condition, for example, in severe pre-existing diseases, a reason to go to the hospital with pneumonia. If consciousness is limited, children should also go to the hospital.
Another important value is the oxygen content in the arterial blood (oxygen saturation). Values ​​below 94% are questionable and should be clarified. With a restriction of the circulation and a fall in blood pressure a stationary stay is also necessary. An extreme increase in the respiratory rate is also a reason for hospitalization.

But what exactly does that mean for the parents of the affected child? When should they go to a clinic? General recommendations are hard to pronounce here, but there are some points to keep in mind.
If the child is mentally distracted or clouded by conscience, the general condition worsens severely or the symptoms do not improve under an ambulant therapy, it is recommended to visit an emergency room. Even with an unstable circulatory situation, such as a fainting, or dizziness you should visit a clinic with his child.

How contagious is pneumonia in the child?

Pneumonia is an infectious disease. This means that they are caused by pathogens such as viruses and bacteria. Children with pneumonia are, of course, able to infect others with the germs. By coughing and sneezing, the pathogens transmit via a so-called droplet infection.

Some pathogens are more contagious than others, so it's not clear how contagious a child's pneumonia is. This is also dependent on several factors, such as the frequency of coughing, the time of contact with the sick child and their own general condition. In the symptomatic phase, however, infection is well possible, so very old people or people with severe pre-existing conditions should avoid contact with the sick child.

For more information, see: How contagious is pneumonia?

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