The Many Phases of Pneumonia

An interview with Dr. Frank Cipriano, Sutter Pacific Medical Foundation Pediatric Hospitalist, at CPMC

Most parents have experienced the anxiety of having a sick child. He or she comes down with a cold or infection. Over the next several days, you hope for signs of improvement. When they don’t come, you worry that the illness has turned into something more serious.

Pneumonia, a lower respiratory tract infection, often begins as the flu or common cold. An upper respiratory tract infection, like a cough, sore throat, or stuffy nose, moves down into the lung tissue.

Many parents assume that if their child comes down with pneumonia, he or she would need to be hospitalized. Yet there are many different types of pneumonia, with varying levels of severity.

Viral or Bacterial?

Viruses often cause pneumonia, but bacteria can also bring it on. Treatment differs in each case, but diagnosis can be difficult since “the symptoms often overlap,” says Frank Cipriano, M.D. “However, there are features that are more common in one type of pneumonia than the other.”

Viral pneumonia often presents with cold-like symptoms, such as cough, runny nose, low-grade fever, and aches and pains. The more severe symptoms of bacterial pneumonia include lethargy, high fever, ill appearance, and difficult, labored, or quick breathing.

“Bacterial pneumonia is usually located in one area of the lung and sounds crackly when we listen to it,” Cipriano explains. “Viral pneumonia is more diffuse.”

Since pneumonia can often start innocuously, it’s important to know when your child should see the doctor. Cipriano recommends that kids be examined if they are:

• Breathing fast, using extra muscles to breathe, or having difficulty breathing.


• Suffering from a lingering cough that doesn’t improve in seven to 14 days.


• Difficult to wake up, not themselves, or exhibiting lethargy and listlessness.


• Not drinking enough to stay hydrated.


• Showing a high fever.

“Parents ask about a high fever a lot,” says Cipriano. “If your child has a high temperature but otherwise looks well, that’s less cause for alarm. If the fever is coupled with some of the above symptoms, you should bring him or her in.”

Good News and Bad News

There’s good news and bad news when it comes to dealing with each type of pneumonia.

Bacterial pneumonia tends to make children much sicker, but it’s treatable using antibiotics.

Viral pneumonia can’t be treated, unless it’s caused by influenza and caught within 48 to 72 hours. But, the illness is usually less severe. With no treatment options, hospitals care for kids by offering supportive therapies, like oxygen and vital fluids.

When they sense a child has viral pneumonia, doctors do their best to avoid antibiotics, but the lack of treatment possibilities can frustrate parents. “They often push us to use antibiotics, understandably so, since they want their child to get better, but it’s not always the right course of action,” Cipriano warns. Overprescribing can lead to bacterial resistance both globally and individually. If your child takes antibiotics unnecessarily, the medication may be less effective next time he or she gets ill.

Walking Pneumonia

Sometimes a child could have pneumonia and not seem that sick. Since he or she’s not bedridden, people often call this less serious condition “walking pneumonia.”

From a diagnostic standpoint, walking pneumonia refers to viral pneumonia or what doctors call atypical bacterial pneumonia.

“Typical bacterial pneumonia affects a focal area of one lung and tends to make people more sick,” explains Cipriano. “Atypical pneumonia presents a lot like viral pneumonia in that it’s more diffuse and tends to affect both lungs.”

Pneumonia can last several days or weeks. But the prognosis is good for most children who don’t have other underlying conditions. “We have so many methods of support, like medication and ventilators, that children with pneumonia nearly always recover,” says Cipriano.