Although common in pediatric practice, the word pneumonia strikes fear into the hearts of many parents.
What is Pneumonia?
Pneumonia simply means an infection of actual lung tissue; it differs from bronchitis, rhinitis and pharyngitis, infections of the lower airways, nose, and throat, respectively. The incidence ranges from 5-40 cases per 1000 children, most common amongst those less than five years old.
Pneumonia can occur anytime but is frequently seen during winter when certain organisms are common, and environmental conditions are more convenient for spreading. It can be caused by viruses or bacteria, and rarely, other agents.
What are the Causes and Symptoms?
In newborns, we worry about exposure to unwanted organisms while exiting the birth canal. Beyond the first six to eight weeks of life, viruses are the usual cause in infants.
From later in infancy until school age, viruses still are most common but certain bacteria emerge. For school-aged children, “walking pneumonia” becomes more common and is caused by different organisms.
Symptoms can vary significantly based upon age and cause. The most significant are fever and cough. Alone, those symptoms are similar to the common cold. But when they last for more than 48 hours or are accompanied by rapid breathing, limited response to antipyretics (fever reducing drugs), wheezing or grunting, then medical attention is prudent. Rapid onset of symptoms and a child in a weakened state are also reasons to suspect pneumonia.
What is the Treatment?
In most cases, pneumonia is not life threatening, can be treated with antibiotics by mouth, and poses little risk to others at home.
It is often difficult to isolate what causes pneumonia. Thus, we generally treat suspected pneumonia, despite many viral cases that resolve spontaneously.
Yet, in small subsets of cases, pneumonia from any cause can produce complications including fluid collections, abscesses or destruction of lung tissue. When assessment suggests that complications are likely, or the child has increased risk—from asthma, cardiac or sickle cell diseases, or is in early infancy—hospitalization is warranted.
Fortunately, such is not the case with most healthy children. Having pneumonia once does not predict that the child is likely to get it again, but children who experience multiple confirmed episodes of pneumonia may need further diagnostics by their physician.
How Can I Prevent My Child from Having It?
Parents cannot completely prevent the chance for pneumonia, but they can assure children are appropriately immunized against some of the most concerning causes (pneumococcus, influenza, and varicella). Ask your doctor or pediatric nurse practitioner about these vaccines
By William Lawrence, Jr., M.D. – Dr. Lawrence is the Wake County Medical Director of Duke Primary Care and also serves as a clinician in the Healthy Lifestyles Program. He is a board-certified general pediatrician who completed his residency training at Children’s Medical Center in Washington, D.C.