Pneumonia

Pneumonia can affect one or both lungs. It is nearly always due to an infection, caused by either bacteria or viruses, and can make a child very unwell.

In young children, it’s most commonly caused by a viral infection. Viruses that can cause pneumonia include:

• Adenoviruses
• Rhinovirus
• Influenza virus
• Respiratory syncytial virus
• Parainfluenza virus (which causes croup).

These viruses don’t respond to antibiotics but a child’s immune system can usually fight them off.

The second most common cause of pneumonia is bacterial infection. A particular bacterium – streptococcus pneumoniae – is most often to blame.

These bacteria are present in the noses and throats of many healthy people without causing a problem. But young children, whose immune systems are not yet fully developed, are more susceptible to infection than older children and adults.

Pneumonia is not a very infectious disease, even within families. The viruses and bacteria that cause pneumonia can spread through:

• Coughs and sneezes from an infected person
• Touch contact with an infected person, infected sheets or tissues

Pneumonia is most common in younger children and often starts after a cold, cough or sore throat. In fact, the early symptoms of the condition are very similar to those seen in colds.

The symptoms vary depending on the age of the child and also the precise cause of the infection. In general, the key symptoms for children are a temperature over 38.5°C and rapid breathing, or difficulty in breathing.

Other common symptoms include:

• Cough
• Laboured breathing that makes the muscles under a child’s rib cage draw inwards
• Vomiting
• Chest pain
• Abdominal pain
• Decreased activity
• Loss of appetite (older children) or poor feeding (infants)
• In extreme cases, bluish or grey lips and fingernails

Not every child with pneumonia will have much of a cough – sometimes the only symptoms are high temperature and rapid breathing.

If the pneumonia is in the lower part of the lungs near the abdomen, breathing might not be affected but a child might have fever, abdominal pain or vomiting.

A doctor will examine the child and may organise a chest x-ray, blood tests and, sometimes, bacterial cultures of mucus the child produces when coughing to identify the organism concerned.

In most cases, pneumonia can be treated with oral antibiotics given to the child at home. The type of antibiotic used depends on the type of pneumonia. Sometimes, if a child does not begin to get better after 48 hours of treatment at home, hospital treatment may be needed.

This might involve putting antibiotics directly into the bloodstream, and supplementary oxygen to aid breathing.

There are some steps people can take to help the child feel more comfortable at home.

If the child has been prescribed antibiotics, make sure the medicine is taken at the right time and that the child completes the course. This will help them recover more quickly, and will reduce the possibility of the infection spreading to other members of the family.

If the child has a fever, offer paracetamol syrup to reduce their temperature. Make sure they drink plenty of fluids, but don’t worry if they are eating less than usual – they will catch up when they recover.

Children can find coughing distressing and this is often worse at night. A productive cough produces mucus and you should encourage the child to cough up phlegm and spit it out. If the child is too young to be able to do this, try laying them across your lap and patting the back during coughing fits. Raising the head of the child's cot at night may help – you could do this by slipping a pillow or a rolled up blanket underneath the mattress.

If the child has chest pain, try a heating pad or warm compress on the chest area.

Check the child’s lips and nails to make sure that they are pink, not bluish or grey, which is a sign that the lungs are not getting enough oxygen.

If the child is having difficulty in breathing, for example if they have trouble finishing sentences, it’s a sign they may need more intensive treatment in hospital.

Occasionally pneumonia can get worse even when children are getting the right treatment at home. Call your GP for advice if this happens, even if the child has been seen within the previous 24 to 48 hours.

Fortunately, pneumonia is becoming less common thanks to the introduction of the pneumococcal vaccine for babies in 2006, which offers protection against one of the most common causes of bacterial pneumonia. This is offered at two months, four months and 13 months.

In the USA, the vaccine has been part of the routine immunisation programme since 2000. Since its introduction there, there has been a 94 per cent reduction in serious disease in children under five years of age.

It has been used in the UK since 2001 for children with conditions which put them at higher risk of infection (such as heart disease), and in September 2006 it became part of the UK routine immunisation schedule.

Serious side effects from the vaccine are rare. In a few children it may cause a mild fever and soreness at the site of injection.

Despite vaccinations being available, there are still around 700 reported cases of pneumonia in the under-fives in the UK every year. The disease claims the lives of around 40 children in England and Wales each year.

So it’s worth being aware of the signs and symptoms of pneumonia, and knowing when to call for medical help.

With treatment, most types of bacterial pneumonia clear up within one to two weeks. Viral pneumonia may last longer.

Talk to the child’s doctor or health visitor.