Pneumonia

What is pneumonia?

Pneumonia is an infection of the lung that causes fluid to collect in the air sacs, which are called alveoli. Symptoms include:

• laboured breathing (respiratory distress)
• rapid breathing
• occasionally painful breathing
• coughing
• fever, sometimes with chills
• abnormal patch on a chest x-ray

Most rattly breathing is not pneumonia. Your child needs to see a health care provider to confirm that she has pneumonia.

What is the cause?

About 80% of pneumonia cases are caused by viruses and 20% by bacteria. Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to occur more suddenly and cause higher fevers (often over 40°C, or 104°F). Pneumonia is usually a complication of a cold. Although colds can be passed from person to person, bacterial pneumonia is not considered contagious.

How long does it last?

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. Recovery from viral pneumonia is gradual but complete. 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, as determined by an x-ray. Recurrences of pneumonia are rare.

How is it treated?

Antibiotics

Children with bacterial pneumonia need an antibiotic. Only bacterial pneumonia is helped by antibiotics. Because it's difficult to distinguish bacterial from viral pneumonia in all cases, sometimes antibiotics are prescribed for children who have viral pneumonia.

Medicines for fever

Use acetaminophen (Tylenol) or ibuprofen (Advil) for fever (over 38.9°C, or 102°F). This can be repeated every 4 to 6 hours. These medicines can also help chest pain.

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, apple juice, or herbal tea. Children over 1 year old can sip warm chicken broth. Encourage your child to drink a lot of fluids. In addition, breathing warm moist air helps to loosen up 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 a humidifier in your child's bedroom.

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 a teenager with pneumonia that if she smokes, the cough will last weeks longer.

When should you call your child's health care provider?

Call immediately if:

• breathing becomes more laboured or difficult
• your child starts acting very sick

Call within 24 hours if:

• the fever lasts over 48 hours after your child starts taking the antibiotic
• the cough lasts over 3 weeks
• you have other questions or concerns