Definition

• Labored breathing (respiratory distress)
• Rapid breathing
• Occasionally painful breathing
• Coughing
• Fever, sometimes with chills
• Abnormal patch (“infiltrate”) on chest x-ray film
• This diagnosis must be confirmed by a physician

Note: Most rattly breathing is not pneumonia.

Causes

Pneumonia is an infection of the lung that causes fluid to collect in the air sacs (alveoli). Approximately 80% of pneumonia cases are caused by viruses and 20% by bacteria. Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to have a more abrupt onset, higher fevers (often over 104°F [40°C]) and a larger infiltrate (greater lung involvement) visible on the chest z-ray film. Only bacterial pneumonia is helped by antibiotics. Because it's difficult to distinguish bacterial from viral pneumonia in all cases, antibiotics are prescribed for some children with viral pneumonia. Because pneumonia is usually a complication of a cold, it is not considered contagious.

Expected Course

Before antibiotics were available, bacterial pneumonia was dangerous. With antibiotics, it improves within 24 to 48 hours. On the other hand, viral pneumonia can continue for 2 to 4 weeks. Most children with pneumonia can be cared for at home. Admission to the hospital for oxygen or intravenous fluids is required in less than 10% of cases. Most children admitted to the hospital are young infants or children who have extensive involvement of the lungs. Recovery from viral pneumonia is gradual but complete. Recurrences of pneumonia are rare.

Home Treatment

Antibiotics. Children with bacterial pneumonia need an antibiotic.

Medicines for Fever. Use acetaminophen or ibuprofen for moderate fever (over 102°F [38.9°C]). These medicines can also help chest pains.

Warm Fluids for Coughing Spasms. Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer your child warm lemonade, warm apple juice, or herbal tea. In addition, breathing warm moist air helps to loosen the sticky mucus that may be choking your child. You can provide warm mist by placing a warm, wet washcloth loosely over your child's nose and mouth; or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns. Don't give cough suppressant medicines (such as those containing dextromethorphan) to children with pneumonia. The infectious secretions need to be coughed up.

Humidity. Dry air tends to make coughs worse. Use humidifiers in your child's bedroom. The new ultrasonic humidifiers not only have the advantage of quietness, but also kill molds and most bacteria that might be in the water.

No Smoking. Tobacco smoke aggravates coughing and makes coughs last longer. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home. Remind teenager with pneumonia, if he smokes, that the cough will last weeks longer than it normally would without smoking.

Call Your Pediatrician Immediately at the Following Signs:
• Breathing becomes more labored or difficult.
• Your child starts acting very sick.

Call Your Pediatrician Within 24 Hours of the Following Signs:
• The fever lasts over 48 hours on an antibiotic.
• The cough lasts over 3 weeks.
• You have other concerns or questions.

Adapted from Instructions for Pediatric Patients, 2nd Edition, 1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child's Health, Bantam Books, a book for parents.