Pediatric Pneumonia

What is Pediatric Pneumonia?

Pneumonia is a significant health issue affecting children under five worldwide. It causes a lot of illness and death, particularly in this age group. Most of these deaths occur in less developed countries. However, pneumonia is a substantial health problem everywhere and treating it can be quite expensive, even in wealthier, developed countries.

What Causes Pediatric Pneumonia?

The cause of pneumonia in children can be sorted based on specific ages or specific germs. For newborn babies, they are at risk of getting pneumonia from bacteria that are found in the birth canal. This includes bacteria such as group B streptococci, Klebsiella, Escherichia coli, and Listeria monocytogenes. Other bacteria, including Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus, can be found in babies who get pneumonia a bit later after they are born.

Viruses are the main cause of pneumonia in older infants and toddlers between the age of 1 month old and 2 years old. For children between the ages of 2 and 5, respiratory viruses are still the most common cause of pneumonia, but cases related to the bacteria S. pneumoniae and H. influenzae type B are also seen frequently.

In children ranging from 5 to 13 years old, pneumonia is often caused by a bacterium called Mycoplasma pneumonia, however, S. pneumoniae is still the most common cause. Teenagers usually have the same risk for types of pneumonia as adults.

It’s important to be aware of tuberculosis (TB), especially in children who have immigrated from areas where TB is common, or have been exposed to it in some way. Children with long-term illnesses are also at risk for specific types of pneumonia. For example, in children with cystic fibrosis, pneumonia can often be caused by S. aureus and Pseudomonas aeruginosa. Those with a condition called sickle cell disease are at risk of infection from certain types of bacteria. Children who have weakened immune systems should be checked for germs such as Pneumocystis jirovecii, cytomegalovirus, and different types of fungi if no other cause is found. Children who haven’t been vaccinated are at risk for germs that could be prevented by vaccines.

Risk Factors and Frequency for Pediatric Pneumonia

Pneumonia is a major health concern globally, with about 120 million cases recorded yearly, leading to around 1.3 million deaths. Notably, a considerable 80% of pneumonia-related deaths in children occur in children under 2 years old in less developed countries.

Pneumonia is more common and severe in developing countries, particularly among young children.
In developed countries, pneumonia’s impact is still substantial, with about 2.5 million cases each year.
A significant number of these cases, between a third and a half, result in hospitalization.
The introduction of the pneumococcal vaccine has significantly reduced the risk of pneumonia in the United States.

Signs and Symptoms of Pediatric Pneumonia

Pneumonia symptoms can be nonspecific and may include coughing, fever, rapid breathing, and trouble breathing. Some young children with pneumonia might experience stomach pain. It’s important to provide the doctor with information about how long your child has been experiencing symptoms, if they’ve been exposed to people who are sick or traveled recently, their general health, any long-term illnesses they have, any past episodes of similar symptoms, any recent choking incidents, their vaccination record, and details about the mother’s health or any problems during birth if the child is newborn.

In a physical examination, doctors will watch for signs of breathing difficulties, like rapid breathing, flaring nostrils, sunken chest when breathing, or low oxygen levels. Infants with pneumonia might have difficulty feeding and could make grunting sounds or have pauses in their breathing. Doctors will listen to the lungs using a stethoscope to pick up abnormal sounds such as rales or rhonchi; this can help in diagnosing pneumonia. In developed countries, lab tests and imaging like x-rays may also support the diagnosis. However, no single physical finding can confirm pneumonia; its diagnosis is a combination of symptoms, physical findings, additional tests, and imaging.

Testing for Pediatric Pneumonia

When a child is suspected of having pneumonia, the first step is usually a quick, non-invasive test using a swab from the back of their nose. This can identify viruses like the flu, respiratory syncytial virus, and human metapneumovirus, if the test is available and suitable. By doing this first, doctors can avoid unnecessary imaging scans and avoid giving antibiotics when they’re not needed.

However, if a child appears very sick with severe symptoms, more comprehensive testing, which may include complete blood counts, electrolyte levels, and checks for kidney and liver function, are performed. Blood tests can also be done, although in standard cases they are usually not needed. While some of these tests can’t tell the difference between viral and bacterial pneumonia in kids, they can be helpful to track how the disease is progressing and potentially predict its outcome.

If a child has signs of pneumonia and has been in an area where tuberculosis is common or has been exposed to it, doctors will collect samples of sputum (mucus from the lungs) or gastric aspirates (fluid from the stomach) for testing. The usefulness of these tests might be limited because the samples are often contaminated with bacteria from the mouth, and blood cultures often come back negative. However, these tests still provide valuable information and are becoming more widely available. Test results typically take 24-48 hours to come back.

X-rays of the chest can help diagnose pneumonia, but there’s no general rule saying they should be routinely used in children. Even though X-rays can be useful in diagnosing and confirming pneumonia, they carry their own risks, which include exposure to radiation, healthcare costs, and the possibility of false negatives, leading to unnecessary antibiotic treatments. Therefore, doctors try to only use imaging techniques in specific circumstances — such as in children who appear very sick, have recurring or prolonged illnesses despite treatment, infants younger than 3 months old with fever, suspected lung problems or congenital lung malformations. It’s also justifiable for children younger than 5 years who have a fever, higher than normal white blood cell count, and no clear source of infection. Imaging can also help rule out a lung mass in children who show signs of “round pneumonia” or acute worsening of upper respiratory infections.

Treatment Options for Pediatric Pneumonia

The treatment for potential lung infections is chosen based on the type of infection suspected by your doctor. This suspicion is based on your symptoms and physical examination. In addition to medicine for the specific infection, you may receive oxygen if your oxygen levels are low, fever reducers if you have a fever, and fluids if you are dehydrated. This is especially important for certain lung inflammations and virus-caused lung infections that don’t need antibiotics.

If your doctor suspects you have bacterial pneumonia, they will usually treat you right away with antibiotics. This treatment will consider your medical history and age, as different age groups tend to get infections from different types of bacteria.

If you’re a newborn baby, your treatment will likely include a type of penicillin plus an alternative class of antibiotics called aminoglycosides or third-generation cephalosporins. However, one specific cephalosporin called ceftriaxone should not be used because it can cause an accumulation of bilirubin in the body, which can harm the brain.

If you’re an infant between 1 to 3 months old, and your doctor suspects atypical pneumonia, which is common in this age group, you would receive additional antibiotic coverage with either erythromycin or clarithromycin.

For the majority of infants and children over 3 months old, a bacteria called S. pneumoniae is the most common cause of pneumonia. High doses of amoxicillin, a type of penicillin, or other similar antibiotics are the best treatment.

In children older than 5 years old, atypical pneumonia becomes more common, and antibiotics called macrolides are usually the first choice.

Children with chronic illnesses need special care, as this may change the choice of antibiotics. For example, children with sickle cell anemia will need cefotaxime and vancomycin if they are very ill. Children with cystic fibrosis may need a mixture of two broad-spectrum antibiotics. For severe viral pneumonia, your treatment will depend on which virus is causing the infection. Acyclovir could be used for chickenpox and ribavirin for a viral lung infection for high-risk patients.

If your infection is resistant to certain antibiotics, like the MRSA bacteria, clindamycin or vancomycin may be given.

Doctors need to watch out for complications, especially for patients they’ve seen previously. It’s possible to have a viral infection that then gets complicated by a bacterial infection. People with bacterial infections that don’t improve after three days might have other issues, like a collapsed lung, abscess, or fluid buildup in the chest. Other potential serious complications from pneumonia include sepsis (overwhelming body infection), dehydration, arthritis, meningitis, and a rare but serious condition called hemolytic uremic syndrome.

Newborns and babies younger than 90 days old should be hospitalized. The same goes for children with weak immune systems or other chronic diseases like sickle cell anemia or cystic fibrosis. Children who have trouble accessing medical care, have not gotten better with outpatient treatment, or are suspected of having tuberculosis should also be hospitalized.

Hospitalization is often required for people with difficulty breathing and low oxygen levels. If there is fluid accumulation in your chest, you might also need to be admitted to the hospital. Children with severe breathing problems may need help breathing with a machine. Large amounts of fluid in the chest require removal for both diagnostic and therapeutic purposes. Early minimally invasive surgery for chest abscesses can reduce mortality, hospital stays, and potentially harmful radiation exposure from CT scans.

Parents or caregivers should receive detailed discharge instructions and act upon any worsening symptoms. It’s also important to follow up with your pediatrician after leaving the hospital.

Here are some medical conditions that could be relevant for a diagnosis:

Alveolar proteinosis
Aortic stenosis
Aseptic meningitis
Asphyxiating thoracic dystrophy
Aspiration syndromes
Asthma
Atelectasis
AV septal defect, complete
AV septal defect, unbalanced
Bacteremia
Birth trauma

What to expect with Pediatric Pneumonia

Generally, most children recover well from pneumonia, especially when it’s caused by a virus, which often gets better on its own without any treatment. Long-term serious impacts are uncommon.

However, pneumonia caused by certain bacteria like staph and varicella (the virus that causes chickenpox) can be more serious, leading to less certain outcomes in children.

Children with tuberculosis are at a high risk of their disease getting worse if not treated. Children who have weakened immune systems tend to have the worst outcomes.

Every year, about 3 million children sadly die from pneumonia, and most of these children also have other health conditions like birth defects affecting the heart, suppressed immune systems, or a chronic lung condition often seen in premature infants.

Possible Complications When Diagnosed with Pediatric Pneumonia

Empyema: A condition where pus gathers in the area between the lungs and the inner surface of the chest wall.
Pleural Effusion: A problem where there is too much fluid buildup around the lungs.
Lung Abscess: This is when a cavity filled with pus forms in the lung due to an infection.
Necrotizing Pneumonia: A severe form of pneumonia where a part of the lung becomes necrotic or dies off.
Sepsis: This life-threatening condition occurs when the body’s response to infection damages its own tissues and organs.

Frequently asked questions

Pediatric pneumonia is a significant health issue affecting children under five worldwide, causing illness and death, particularly in this age group.

Pneumonia is a major health concern globally, with about 120 million cases recorded yearly, leading to around 1.3 million deaths.

Signs and symptoms of Pediatric Pneumonia include: - Coughing - Fever - Rapid breathing - Trouble breathing - Stomach pain in some young children - Difficulty feeding in infants - Grunting sounds or pauses in breathing in infants - Breathing difficulties, such as rapid breathing, flaring nostrils, sunken chest when breathing, or low oxygen levels - Abnormal sounds in the lungs, such as rales or rhonchi, which can be detected using a stethoscope - Nonspecific symptoms that may vary from child to child It is important to provide the doctor with the following information to aid in diagnosis: - Duration of symptoms - Exposure to sick individuals or recent travel - General health of the child - Any long-term illnesses the child has - Past episodes of similar symptoms - Recent choking incidents - Vaccination record - Details about the mother's health or any problems during birth if the child is newborn In developed countries, lab tests and imaging like x-rays may also be used to support the diagnosis of pneumonia. However, it is important to note that no single physical finding can confirm pneumonia, and the diagnosis is a combination of symptoms, physical findings, additional tests, and imaging.

Pediatric pneumonia can be caused by specific germs, including bacteria and viruses. The specific cause can vary based on the age of the child.

The doctor needs to rule out the following conditions when diagnosing Pediatric Pneumonia: - Alveolar proteinosis - Aortic stenosis - Aseptic meningitis - Asphyxiating thoracic dystrophy - Aspiration syndromes - Asthma - Atelectasis - AV septal defect, complete - AV septal defect, unbalanced - Bacteremia - Birth trauma

The types of tests that may be needed for pediatric pneumonia include: - Non-invasive swab test from the back of the nose to identify viruses like the flu, respiratory syncytial virus, and human metapneumovirus - Complete blood counts, electrolyte levels, and checks for kidney and liver function - Blood tests to track the progression of the disease - Collection of samples of sputum or gastric aspirates for testing in cases where tuberculosis is suspected or the child has been exposed to it - X-rays of the chest in specific circumstances, such as when the child appears very sick, has recurring or prolonged illnesses, or is younger than 3 months old with fever - Other imaging techniques to rule out lung mass or acute worsening of upper respiratory infections It is important to note that the specific tests ordered will depend on the individual case and the judgment of the doctor.

The treatment for pediatric pneumonia depends on the age of the child and the suspected cause of the infection. For newborn babies, treatment usually involves a type of penicillin along with alternative antibiotics called aminoglycosides or third-generation cephalosporins. Infants between 1 to 3 months old with suspected atypical pneumonia may receive additional antibiotic coverage with erythromycin or clarithromycin. For most infants and children over 3 months old, the most common cause of pneumonia is a bacteria called S. pneumoniae, and high doses of amoxicillin or similar antibiotics are used. In children older than 5 years old, atypical pneumonia is more common, and macrolide antibiotics are usually the first choice. Children with chronic illnesses may require special care and may need different antibiotics based on their specific condition.

When treating pediatric pneumonia, there can be potential side effects or complications. These may include: - Accumulation of bilirubin in the body, which can harm the brain, when using the cephalosporin ceftriaxone in newborn babies. - Possible complications such as a collapsed lung, abscess, or fluid buildup in the chest for bacterial infections that don't improve after three days. - Serious complications such as sepsis, dehydration, arthritis, meningitis, and hemolytic uremic syndrome from pneumonia. - Hospitalization may be required for newborns, babies younger than 90 days old, children with weak immune systems or chronic diseases, those with difficulty breathing and low oxygen levels, and those with fluid accumulation in the chest. - Detailed discharge instructions and follow-up with a pediatrician after leaving the hospital are important for parents or caregivers.

Most children recover well from pneumonia, especially when it's caused by a virus, which often gets better on its own without any treatment. Long-term serious impacts are uncommon. However, pneumonia caused by certain bacteria like staph and varicella (the virus that causes chickenpox) can be more serious, leading to less certain outcomes in children. Children with tuberculosis are at a high risk of their disease getting worse if not treated. Children who have weakened immune systems tend to have the worst outcomes.

Pediatrician.