Pediatrics Community Acquired Pneumonia

- Pneumonia is a lung infection caused by bacteria, viruses, or fungi.

- This type of pneumonia occurs in healthy children who have not recently been in the
hospital or another health care facility.
- Pneumonia that affects people in health care facilities, such as hospitals, is often caused
by germs that are harder to treat. This is called hospital-acquired pneumonia.
Causes
Viruses are the most common cause of CAP in infants and children.
Ways your child can get CAP include:
 Bacteria and viruses living in the nose, sinuses, or mouth may spread to the lungs.
 Your child may breathe some of these germs directly into the lungs.
 Your child breathes in food, liquids, or vomit from the mouth into the lungs.
Risk factors that increase a child's chance of getting CAP include:
 Being younger than 6 months of age
 Being born prematurely
 Birth defects, such as cleft palate
 Nervous system problems, such as seizures or cerebral palsy
 Heart or lung disease present at birth
 Weak immune system (this can occur due to cancer treatment or disease such as
HIV/AIDS)
 Recent surgery or trauma
Symptoms
Common symptoms of pneumonia in children include:
 Stuffed up or runny nose, headaches
 Loud cough
 Fever, which may be mild or high, with chills and sweating
 Rapid breathing, with flared nostrils and straining of the muscles between the ribs
 Wheezing
 Sharp or stabbing chest pain that gets worse when breathing deeply or coughing
 Low energy and malaise (not feeling well)
 Vomiting or loss of appetite
Children with more severe infections include:
 Blue lips and fingernails due to too little oxygen in the blood
 Confusion or very hard to arouse
Exams and Tests
The health care provider will listen to your child's chest with a stethoscope. The provider will
listen for crackles or abnormal breath sounds. Tapping on the chest wall (percussion) helps the
provider listen and feel for abnormal sounds.
If pneumonia is suspected, the provider will likely order a chest x-ray.
Other tests may include:
 Oximetry - noninvasive method to determine the level of oxygen in the blood
  Arterial blood gases to see if enough oxygen is getting into your child's blood from the
lungs
 Blood culture and sputum culture to look for the germ that may be causing the
pneumonia
 CBC to check white blood cell count
 Chest X-ray or CT scan of the chest
 Bronchoscopy -- a flexible tube with a lighted camera on the end passed down into the
lungs (in rare cases)
 Removing fluid from the space between the outside lining of the lungs and the chest wall
(in rare cases)
Treatment
The provider must first decide whether your child needs to be in the hospital.
If treated in the hospital, your child will receive:
 Fluids, electrolytes, and antibiotics through the veins or mouth
 Oxygen therapy
 Breathing treatments to help open up the airways
Your child is more likely to be admitted to the hospital if they:
 Have another serious medical problem, including long-term (chronic) health issues such
as cystic fibrosis or diabetes mellitus
 Have severe symptoms
 Are unable to eat or drink
 Are less than 3 to 6 months old
 Have pneumonia due to a harmful germ
 Have taken antibiotics at home, but isn't getting better
If your child has CAP caused by bacteria, antibiotics will be given. Antibiotics are not given for
pneumonia caused by a virus. This is because antibiotics do not kill viruses. Other medicines,
such as antivirals, may be given if your child has the flu.
Many children can be treated at home. If so, your child may need to take medicines such as
antibiotics or antivirals.
When giving antibiotics to your child:
 Make sure your child does not miss any doses.
 Make sure your child takes all the medicine as directed. Do not stop giving the medicine,
even when your child starts feeling better.
Do not give your child cough medicine or cold medicine unless your provider says it is OK.
Coughing helps the body get rid of mucus from the lungs.
Other home care measures include:
 To bring mucus up from the lungs, tap your child's chest gently a few times a day. This
can be done as your child is lying down.
 Have your child take a couple of deep breaths 2 or 3 times every hour. Deep breaths help
open up your child's lungs.
 Make sure your child drinks plenty of liquids. Ask your provider how much your child
should drink each day.
 Have your child get plenty of rest, including napping throughout the day if needed.
Outlook (Prognosis)
Most children improve in 7 to 10 days with treatment. Children who have severe pneumonia with
complications may need treatment for 2 to 3 weeks. Children at risk for severe pneumonia
include:
 Children whose immune system does not work well
 Children with lung or heart disease
Possible Complications
In some cases, more serious problems may develop, including:
 Life-threatening changes in the lungs that require a breathing machine (ventilator)
 Fluid around the lung, which can become infected
 Lung abscesses
 Bacteria in blood (bacteremia)
The provider may order another x-ray. This is to make sure that your child's lungs are clear. It
may take many weeks for the x-ray to clear up. Your child may feel better for a while before the
x-rays are clear.
When to Contact a Medical Professional
Contact your provider if your child has the following symptoms:
 Bad cough
 Difficulty breathing (wheezing, grunting, rapid breathing)
 Vomiting
 Loss of appetite
 Fever and chills
 Breathing (respiratory) symptoms that get worse
 Chest pain that gets worse when coughing or breathing in
 Signs of pneumonia and a weak immune system (such as with HIV or chemotherapy)
 Worsening symptoms after starting to get better
Prevention
Teach older children to wash their hands often:
 Before eating food
 After blowing their nose
 After going to the bathroom
 After playing with friends
 After coming in contact with people who are sick
Vaccines may help prevent some types of pneumonia. Be sure to get your child vaccinated with:
 Pneumococcal vaccine
 Flu vaccine
 Pertussis vaccine
 Hib vaccine
When infants are too young to be immunized, parents or caregivers can get themselves
immunized against vaccine-preventable pneumonia.

REFERENCES:
https://medlineplus.gov/ency/article/007690.htm