Pneumonia in Children: Signs and Treatment

Pneumonia is an infection in the lungs. The word can sound frightening, but most children with pneumonia recover fully, often with care at home. What helps most is knowing the signs, especially the breathing changes that tell you a cough has become something more than a cold. This guide covers what causes pneumonia, how to spot it, how it is diagnosed and treated, and what recovery looks like.

What happens in pneumonia

Deep in the lungs are tiny air sacs where oxygen passes into the blood. In pneumonia, germs infect these sacs, and they fill with fluid and inflammation. That makes it harder for oxygen to get in, so the body breathes faster and works harder to keep up.

What causes it

• Viruses are the most common cause in young children. Many of the same viruses that cause colds, flu and RSV can spread down into the lungs.
• Bacteria can cause pneumonia on their own or after a viral illness. Bacterial pneumonia often comes on more suddenly, with a higher fever.
• Mycoplasma is a germ that tends to affect school-age children and teens. It often causes a milder illness that comes on slowly, sometimes called "walking pneumonia" because kids may not seem very sick.

Pneumonia is not usually caught directly as pneumonia. A child catches a germ through coughs, sneezes or hands, and in some children that germ causes a lung infection.

Signs and symptoms

Pneumonia often begins like a cold and then gets worse instead of better. Watch for:

• Cough, which may be dry or bring up mucus
• Fever, sometimes with chills
• Fast breathing
• Working hard to breathe
• Chest pain, especially with coughing or deep breaths
• Belly pain or vomiting, which can be the main complaint in some younger kids
• Tiredness, low energy and poor appetite
• In babies, poor feeding, fussiness or unusual sleepiness

Babies and toddlers may not have a big cough at all. Fast or hard breathing may be the clearest sign.

Checking for fast breathing

Breathing rate is one of the most helpful things a parent can check. Count breaths when your child is calm or asleep, because crying, fever and activity all speed it up. Watch the chest or belly rise and count each rise as one breath for a full 60 seconds.

Normal rates are faster in babies than in older children. As a general guide used by the World Health Organization, breathing may be too fast if it is:

• 60 or more breaths a minute in babies under 2 months
• 50 or more in babies 2 to 12 months
• 40 or more in children 1 to 5 years

Fever alone can raise the breathing rate a bit, so recheck after the fever comes down. If the count stays high, call your pediatrician.

Signs of hard breathing

• Skin pulling in between or under the ribs, or above the collarbone, with each breath
• Nostrils flaring
• A grunting sound at the end of each breath
• Head bobbing with breathing in infants
• Trouble talking in full sentences or feeding because of breathing

How pneumonia is diagnosed

Your pediatrician will ask about the illness, watch your child breathe, and listen to the lungs with a stethoscope for crackles or areas where air is not moving well. A small clip on the finger or toe measures the oxygen level in the blood. Many children are diagnosed this way without other tests. A chest X-ray, swab or blood test may be used if the diagnosis is unclear, your child is very sick, or the illness is not improving as expected.

Treatment

Bacterial pneumonia

Pneumonia that is likely caused by bacteria is treated with antibiotics. Give every dose as prescribed and finish the full course, even when your child feels better. Most children start to improve within two or three days.

Viral pneumonia

Antibiotics do not work on viruses. Viral pneumonia usually gets better with rest, fluids and time. In some cases, such as flu, your pediatrician may prescribe an antiviral medicine.

Care at home

• Offer plenty of fluids. Small, frequent sips are easier for a child who is breathing fast.
• Let your child rest. Quiet play is fine once they feel up to it.
• Acetaminophen, or ibuprofen for babies 6 months and older, can ease fever and chest pain. Ask your pediatrician or pharmacist for the right dose by weight. Never give aspirin to children.
• Do not give cough medicine unless your pediatrician recommends it. Coughing helps clear the lungs.
• Keep your child away from smoke and vaping.

Some children need care in the hospital, especially young babies or kids who have low oxygen levels, cannot keep fluids down, or are working very hard to breathe. There they may get oxygen, IV fluids or IV medicines.

Recovery

Fever usually goes away within a few days of starting treatment. Energy returns more slowly, and a cough can linger for a few weeks. Your child can usually go back to school or child care once the fever is gone and they feel well enough to take part. Your pediatrician may want a follow-up visit to check that the lungs are clearing.

Prevention

• Vaccines. Several vaccines protect against germs that can cause pneumonia, including pneumococcal disease, Hib, flu, whooping cough and measles. Keep your child up to date on the schedule your pediatrician recommends, and ask about protection against RSV for young babies.
• Handwashing and covering coughs and sneezes.
• A smoke-free home and car. Smoke exposure makes lung infections more likely.
• Managing asthma and other health conditions well.

You can learn more on MedlinePlus's pneumonia page and at HealthyChildren.org.

When to call us

Call your A thru Z Pediatrics office if your child:

• Has a cough with fever that lasts more than a few days or is getting worse instead of better
• Is breathing faster than normal when calm
• Has chest pain with coughing or breathing
• Is drinking less or peeing less than usual
• Is not improving after two or three days on antibiotics
• Is under 3 months and has a temperature of 100.4°F or higher. Call right away.

Call 911 or go to the nearest ER if your child is struggling to breathe, is grunting, has skin pulling in deeply with each breath, has blue or gray lips, face or nails, is very sleepy or hard to wake, or cannot drink at all.

For a non-urgent check, you can request a visit online.