Signs and Symptoms:
Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, including viruses, bacteria, and parasites.

Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). When this happens, symptoms of pneumonia begin after 2 or 3 days of a cold or sore throat.

Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Some common symptoms include:

• fever
• chills
• cough
• unusually rapid breathing
• breathing with grunting or wheezing sounds
• labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath)
• vomiting
• chest pain
• abdominal pain
• decreased activity
• loss of appetite (in older children) or poor feeding (in infants)
• in extreme cases, bluish or gray color of the lips and fingernails

Sometimes a child's only symptom is rapid breathing. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing problems at all, but there may be fever and abdominal pain or vomiting.

When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia.

Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older children and adolescents, pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia.

In infants, pneumonia due to Chlamydia may cause conjunctivitis (redness of the eyes) with only mild illness and no fever. When pneumonia is due to pertussis (whooping cough), the child may have long coughing spells, turn blue from lack of air, or make a classic "whoop" sound when trying to take a breath.

Description:
Pneumonia is a lung infection that can be caused by different types of germs, including bacteria, viruses, fungi, and parasites. Although different types of pneumonia tend to affect children in different age groups, pneumonia is most commonly caused by viruses. Some viruses that cause pneumonia are adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (the virus that causes croup).

Incubation:
The incubation period for pneumonia varies, depending on the type of virus or bacteria causing the infection. Some common incubation periods are: respiratory syncytial virus, 4 to 6 days; influenza, 18 to 72 hours.

Duration:
With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely.

Contagiousness:
The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person.

Prevention:
There are vaccines to prevent infections by viruses or bacteria that cause some types of pneumonia.

Children usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. (The pertussis immunization is the "P" part of the routine DTaP injection.) Vaccines are now also given against the pneumococcus organism (PCV), a common cause of bacterial pneumonia.

Children with chronic illnesses, who are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. The flu vaccine is recommended for children with chronic illnesses such as chronic heart or lung disorders or asthma.

Because they are at higher risk for serious complications, infants who were born prematurely may be given treatments that temporarily protect against RSV, which can lead to pneumonia in younger children.

Doctors may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in children who have been exposed to someone with certain types of pneumonia, such as pertussis. Children with HIV infection may also receive prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii.

Antiviral medication is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe.

In addition, regular tuberculosis screening is performed yearly in some high-risk areas because early detection will prevent active tuberculosis infection including pneumonia.

In general, pneumonia is not contagious, but the upper respiratory viruses that lead to it are, so it is best to keep your child away from anyone who has an upper respiratory tract infection. If someone in your home has a respiratory infection or throat infection, keep his or her drinking glass and eating utensils separate from those of other family members, and wash your hands frequently, especially if you are handling used tissues or dirty handkerchiefs.

When to Call Your Child's Doctor:
Call your child's doctor immediately if your child has any of the signs and symptoms of pneumonia, but especially if your child is having trouble breathing or is breathing abnormally fast, if your child has a bluish or gray color to her fingernails or lips, or if your child has a fever of 102 degrees Fahrenheit (38.9 degrees Celsius) or above 100.4 degrees Fahrenheit (38 degrees Celsius) in infants under 6 months of age.

Professional Treatment: Doctors usually make the diagnosis of pneumonia after a physical examination of your child. The doctor may possibly use a chest X-ray, blood tests, and (sometimes) bacterial cultures of mucus produced by coughing when making a diagnosis. In most cases, pneumonia can be treated with oral antibiotics given to your child at home. The type of antibiotic used depends on the type of pneumonia. Children may be hospitalized for treatment if their pneumonia is caused by pertussis or other bacterial pneumonia that are causing high fevers and respiratory distress. If supplemental oxygen is needed or if they have lung infections that may have spread into the bloodstream, they may also be hospitalized. Children may be also be hospitalized if they have chronic illnesses that affect the immune system, if they are vomiting so much that they cannot take medicine by mouth, or if they have recurrent episodes of pneumonia. Home Treatment: If your child's doctor has prescribed antibiotics for your child's bacterial pneumonia, give the medicine on schedule for as long as the doctor directs. This will help your child recover faster and will decrease the chance that infection will spread to other household members. Don't force your child to eat if she's not feeling well, but encourage your child to drink fluids, especially if she has a fever. Ask your child's doctor before you use a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which may not be helpful in some types of pneumonia. If your child has chest pain, try a heating pad or warm compress on the chest area. Take your child's temperature at least once each morning and each evening, and call your child's doctor if it goes above 102 degrees Fahrenheit (38.9 degrees Celsius) or above 100.4 degrees Fahrenheit (38 degrees Celsius) in infants under 6 months of age. Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that your child's lungs are not getting enough oxygen.

Updated and reviewed by: Kim Rutherford, MD
Date reviewed: July 2001
Originally reviewed by: Joel Klein, MD