Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION (Diagnosis must be confirmed by a physician.)

• labored breathing (respiratory distress)
• rapid breathing
• occasionally painful breathing
• coughing
• fever, sometimes with chills
• abnormal patch (infiltrate) on chest x-ray.

Note: Most rattly breathing is not pneumonia.

CAUSES

Pneumonia is an infection of the lung that causes fluid to collect in the air sacs (alveoli). About 80% of pneumonia cases are caused by viruses and 20% by bacteria.

Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to occur more suddenly and cause higher fevers (often over 104 degrees F, or 40 degrees C).

Because pneumonia is usually a complication of a cold, it is not considered contagious.

EXPECTED COURSE

Only bacterial pneumonia is helped by antibiotics. Because it's difficult to distinguish bacterial from viral pneumonia in all cases, sometimes antibiotics are prescribed for children who have viral pneumonia.

Before antibiotics were available, bacterial pneumonia was dangerous. With antibiotics it improves within 24 to 48 hours. On the other hand, viral pneumonia can continue for 2 to 4 weeks. Recovery from viral pneumonia is gradual but complete.

Most children with pneumonia can be cared for at home. Admission to the hospital for oxygen or intravenous fluids is required in less than 10% of cases. Most children admitted to the hospital are young infants or children who have extensive involvement of the lungs (as determined by an x-ray).

Recurrences of pneumonia are rare.

HOME TREATMENT

1. Antibiotics

   Children with bacterial pneumonia need an antibiotic prescribed by their physician.

2. Medicines for fever

   Use acetaminophen or ibuprofen for fever (over 102 degrees F, or 38.9 degrees C). This can be repeated every 4 to 6 hours. These medicines can also help chest pain.

3. Warm fluids for coughing spasms

   Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer your child warm lemonade, apple juice, or herbal tea. Children over 1 year old can sip warm chicken broth.

   In addition, breathing warm moist air helps to loosen up the sticky mucus that may be choking your child. You can provide warm mist by placing a warm wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

   Don't give cough suppressant medicines (such as those containing dextromethorphan) to children with pneumonia. The infectious secretions need to be coughed up.

4. Humidity

   Dry air tends to make coughs worse. Use a humidifier in your child's bedroom. The new ultrasonic humidifiers are very quiet and they kill molds and most bacteria that might be in the water.

   If possible, use distilled water instead of tap water in the humidifier. The Environmental Protection Agency reported in 1988 that tap water may contain harmful minerals (such as lead and asbestos). If these minerals are in your tap water, they will also be in the mist produced by the humidifier. Frequent inhaling of these particles may cause chronic lung problems.

5. No smoking

   Tobacco smoke aggravates coughing and makes coughs last longer. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home. Remind a teenager with pneumonia that if he or she smokes, the cough will last weeks longer.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• Breathing becomes more labored or difficult.
• Your child starts acting very sick.

CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:

• The fever lasts over 48 hours after your child starts taking the antibiotic.
• The cough lasts over 3 weeks.
• You have other questions or concerns.