Childhood Pneumonia

Pneumonia is an infection that causes inflammation and fluid to build up in the lungs. It can make it harder for your child to breathe and get enough oxygen.

Pneumonia can affect children of any age. Some children have mild symptoms that improve with treatment at home, while others can become seriously ill and need care in the hospital. Young children, babies, and children with existing medical conditions are at greater risk for complications.

At UVA Health Children's, our pediatric specialists provide comprehensive care for children with pneumonia, from diagnosis and treatment to advanced respiratory support for children with severe infections.

Symptoms of Childhood Pneumonia

Pneumonia symptoms can vary depending on your child's age, the cause of the infection and how severe it is. Common symptoms include:

• Cough, with or without mucus
• Fever and chills
• Fast or difficult breathing
• Wheezing or noisy breathing
• Chest pain, especially when coughing or taking a deep breath
• Low energy or unusual sleepiness
• Irritability
• Loss of appetite
• Vomiting
• Headache
• Abdominal pain

Babies and young children may not be able to describe how they feel. Instead, you may notice that your child is breathing faster than usual, refusing to eat or drink, having fewer wet diapers or seeming unusually tired or irritable.

When to Seek Emergency Care

Pneumonia can sometimes cause a child's oxygen level to drop or make breathing dangerously difficult. Some of the signs you may notice:

• Your child is struggling to breathe or breathing very rapidly
• The skin around their ribs is pulling inward when they inhale
• They have bluish, gray, or pale skin around the lips or fingernails
• They're hard to wake or unresponsive
• They cannot drink or keep fluids down

What Causes Pneumonia in Children?

Pneumonia can be caused by viruses, bacteria and, less commonly, fungi or other microorganisms.

Viral pneumonia is the most common type in young children. Viruses that can cause pneumonia include:

• Respiratory syncytial virus (RSV)
• Influenza (flu)
• COVID-19
• Common cold viruses and other respiratory viruses

Bacterial pneumonia can occur on its own or develop after a viral respiratory infection. Streptococcus pneumoniae is one of the most common bacteria associated with pneumonia in children.

Sometimes pneumonia develops when food, liquid or another substance is accidentally inhaled into the lungs. This is called aspiration pneumonia.

Diagnosing Pneumonia in Children

Your child's doctor will ask about their symptoms and medical history and listen to their lungs. Depending on your child's symptoms, additional tests may be needed.

These may include:

• Pulse oximetry: A small sensor placed on your child's finger or toe measures the amount of oxygen in their blood.
• Chest X-ray: An X-ray can show inflammation or other changes in the lungs.
• Lung ultrasound: Ultrasound can sometimes help doctors identify pneumonia or complications without exposing your child to radiation.
• Blood tests: These may help identify signs of infection or determine how seriously your child is affected.
• Respiratory tests: A sample from your child's nose or throat may be tested for viruses or other germs.
• Mucus or sputum tests: In some cases, testing mucus from the lungs can help identify the cause of infection.

Not every child needs every test. Your child's care team will determine which tests are appropriate based on their symptoms and overall health.

Treating Childhood Pneumonia

Pneumonia treatment depends on what caused the infection and how sick your child is.

Viral pneumonia often improves with rest, fluids and treatment of symptoms. Some viral infections, such as influenza, may be treated with antiviral medication.

Bacterial pneumonia is treated with antibiotics. Your child's doctor will choose an antibiotic based on your child's age, symptoms and suspected or confirmed cause of the infection.

For pneumonia that can be treated at home, your child's doctor may recommend:

• Plenty of rest
• Drinking fluids to prevent dehydration
• A cool-mist humidifier
• Medicine to reduce fever or discomfort, when appropriate for your child's age
• Monitoring your child's breathing and symptoms

Never give cough or cold medicine to a young child unless your child's doctor recommends it.

Hospital Treatment for Severe Pneumonia

Children with severe pneumonia may need to stay in the hospital for closer monitoring and treatment. Hospital care may include:

• Supplemental oxygen
• Breathing treatments
• Noninvasive breathing support, such as high-flow oxygen or other respiratory support
• A ventilator for children who cannot breathe adequately on their own
• Fluids or nutrition through an IV or feeding tube
• Antibiotics or other medicines through an IV
• Treatment for complications of pneumonia
• Close monitoring of breathing, heart rate, and oxygen levels

Our pediatric specialists are experienced in caring for children who need advanced respiratory support and treatment for complicated infections.

Pneumonia Complications

Most children recover from pneumonia without long-term problems. However, severe pneumonia can sometimes cause complications, including:

• Low oxygen levels
• Dehydration
• Fluid around the lungs (pleural effusion)
• An infection around the lungs (empyema)
• Lung abscess
• Respiratory failure
• Infection that spreads to the bloodstream

Children with complications may need additional treatment or a longer hospital stay.

Who Is at Higher Risk?

Pneumonia can be more serious for some children, particularly those who have conditions that affect their lungs or immune system.

Children at increased risk for severe pneumonia may have:

• Chronic lung or respiratory conditions
• Congenital heart defects
• A weakened immune system
• Genetic or neuromuscular conditions
• Problems that make swallowing or clearing mucus difficult
• Other complex medical conditions

Environmental exposures can also increase the risk of respiratory infections. Secondhand smoke and other sources of air pollution can make children's lungs more vulnerable to infection.

Preventing Pneumonia

You cannot prevent every case of pneumonia, but vaccines and healthy habits can reduce your child's risk.

Vaccines can protect against several infections that can cause pneumonia, including pneumococcal disease, influenza, and COVID-19. Keeping your child's routine vaccinations up to date is one of the most effective ways to help prevent serious respiratory infections.

Other ways to reduce your child's risk include:

• Washing hands frequently with soap and water
• Avoiding close contact with people who are sick when possible
• Teaching children to cover coughs and sneezes
• Keeping your child away from cigarette smoke and vaping
• Cleaning frequently touched surfaces when someone in the household is sick
• Encouraging healthy eating, adequate sleep, and good hydration

If your child develops symptoms of pneumonia, early evaluation can help determine whether they need treatment at home or more advanced medical care.