Pneumonia is a serious respiratory condition. It is one of the leading causes of death in children and newborn. Some estimates suggest pneumonia affects close to 150 million children under 5 years of age annually. It is also one of the common reasons for hospitalisation especially in the under-developed as well as developing nations.

 

What is Pneumonia?

 

Pneumonia indicates infection and inflammation of the lung, the alveoli to be precise. Alveoli are the air sacs present within the lung tissue. Inflammation leads to collection of fluid and pus in these air sacs thereby affecting breathing. 

 

Pneumonia for clinical purposes is broadly classified into 

1.   Community acquired Pneumonia: where the cause is through germs from the living community

2.   Hospital acquired Pneumonia: where the germs causing it is from  hospital environment.

 

Today, we shall talk about community acquired pneumonia.

 

Normal Lung Physiology:

 

Lung is comprises of a respiratory tract that branches and ends in an air sac called alveolus. An alveoli is the primary site of oxygenation process. Here, oxygen is transferred to the bloodstream and carbon dioxide is expelled out. But during infection, collections in these air sacs impairs oxygenation process. And if it is not rectified early, the result is disastrous. 

 

Causes of Pneumonia:

 

The usual cause of community acquired pneumonia in children is a viral flu. Respiratory syncytial virus and influenza virus are the leading ones to cause pneumonia. Besides these two, adenovirus as well as parainfluenza virus are also known to cause pneumonia. 

 

Bacteria also cause pneumonia; commonest being Streptococcal pneumonia, a gram positive cocci. 

 

Other germs responsible for pneumonia in children are:

1.   Chlamydia pneumoniea infection in new born babies.

2.   Mycoplasma pneumoniea in older children and teens.

 

Some fungal species are also known to cause pneumonia; but they are more common in adults and immunocompromised individuals.

 

Clinical Symptoms and Signs:

 

1.  Most common symptoms of pneumonia in children is rapid breathing. Normally respiratory rate (number of breaths per minute) varies depending on the age. New born babies and infants have respiratory rate between 30 to 60 breaths per minute. Respiratory rate of toddlers under 3 years is between 24 to 40 and preschool children (ages 3  to 6) breathe between 20 to 34 breaths per minute. The rate is between 18  to 30 per minute in school age children (6 to 12 years); while in older adolescent children the rate is 12  to 16 per minute. 

Severity of pneumonia is assessed based on respiratory rate. If your child is breathing rapidly you should count the respiratory rate and Ask a doctor.

 

2. Cough with or without sputum expectoration. Mucus expectorant that is yellow or green colored and foul smelling is a feature of bacterial infection. Sometimes one may notice pink or blood colored streaks with it.

 

3. Fever - temperature can vary between moderate to high grade fever. 

 

4. A child can sometimes complain about breathlessness. Parainfluenza infection produces noisy breathing - ‘whoop’ sound with long spell of cough - whooping cough. You should Ask a pediatrician immediately if your child has a whooping noise while breathing.

 

5. Reduced feeding and activity are common accompanying features.

 

6. Irritable child

 

7. Bluish / grey discoloration of lips and fingernails suggestive of cyanosis due to breathing difficulty may also be found.

 

8. You will neck, chest and subcostal indrawing with pneumonia. It is indicates that child is finding it hard to breathe.

 

9. Pneumonia affected lung areas produce crackling sound or rales on auscultation.

Diagnosis:

 

Pneumonia is diagnosed clinically. You should consult a pediatrician if a child has rapid breathing with cough and fever. Your doctor will examine the child’s chest and hear the breath sounds and confirm diagnosis of pneumonia. A chest X-ray is often performed along with blood count to support and assess severity of pneumonia. They will also order for sputum examination to identify the nature of germs causing infection and the susceptible antibiotic. Blood gas analysis may be performed during the course of hospitalisation. If necessary, a chest CT scan and bronchoscopy is ordered in very few cases.

You can ask a pulmonologist for a second opinion during the course of hospitalisation and to assess the progress of the child.

Treatment:

 

Early hospitalisation and treatment is the priority. Post hospitalisation the following are the treatment options

1.   Fluid transfusion to improve and maintain hydration and other organ functions.

2.   Oxygenation through face masks. Serious conditions may require intubation and ventilatory support.

3.   Antibiotic therapy with broad spectrum antibiotic or susceptible antibiotic. It is administered parenterally (intravenous route) for better effectiveness.

4.   Antiviral drugs are also used when the cause is flu viruses.

5.   Other supportive treatment to control fever and breathing.

 

Your child’s physical condition, lung functions as well as other systems will be monitored. 

 

Prognosis:

 

Pneumonia will have better recovery when the right treatment is initiated at the earliest. With appropriate treatment pneumonia recovers in a few weeks. Bacterial pneumonia recovers in a couple of weeks while viral pneumonia can last for 4-6 weeks. 

 

Prevention:

 

Infection causing pneumonia usually spreads from droplet infection.  When an infected person coughs or sneezes, droplets are introduced into the surrounding nearby environment and contact with infected environment causes the spread of infection. Some infections are highly contagious while few are less contagious. Using face mask and washing your hands frequently when in close contact with infected person is an effective means of preventing spread of infection.

 

Besides these there are vaccines such as pneumococcal vaccine and influenza vaccine available in the market. They are part of recommended immunization schedule. You can Ask a Pediatrician about these vaccines.

 

Summary (Take away message).

 

1. Pneumonia is a serious infection. But it can be easily treatable when it is identified and treated early.

2. Do not ignore when your child is coughing and breathing rapidly. It could be a sign of pneumonia

3. If the child has cough, fever and rapid breathing, look for neck, chest and subcostal region. Muscle indrawing in these areas while breathing indicates that medical attention is required immediately.

4. Encourage the child to drink fluids and diet.

5. Check if your child is vaccinated with influenza and pneumococcal vaccines. If not check ask a doctor.

6. Keep your child away from infected person.

7. Use face mask and wash hands regularly when in contact with someone infected.