By Carrie Madormo, RN, MPH 

 Medically reviewed by John Carew, MD

Pneumonia in kids is an infection that causes inflammation in the air sacs in the lungs. These air sacs fill with fluid or pus, leading to a productive cough, fever, and chest soreness.

Pneumonia is often caused by an upper respiratory infection, such as the flu, that spreads to the lungs. Pneumonia in babies and kids can also be caused by a bacterial infection.1 

A pneumonia infection can range from mild to very serious. Most children today recover easily with appropriate treatment.2 

Westend61 / Getty Images

Causes

Pneumonia in kids is usually caused by a bacterial infection or a virus. In rare cases, kids can also experience pneumonia due to food, liquids, gas, dust, or fungi. 

Bacterial Pneumonia

Bacterial pneumonia is caused by a bacterial infection in the lungs. The most common types of bacteria that can lead to pneumonia in kids include:2

• Streptococcus pneumoniae, which can cause pneumococcal disease

• Group B streptococcus, a common cause of severe infections in newborns

• Staphylococcus aureus, which can cause heart valve and bone infections

• Group A streptococcus, which can also lead to strep throat

Viral Pneumonia

Viral pneumonia usually starts out as an upper respiratory infection, which then spreads to the lungs and causes pneumonia. Respiratory viruses that have the potential to cause pneumonia include:

• Respiratory syncytial virus (RSV), the most common cause of bronchiolitis and pneumonia in children younger than 1

• Influenza viruses

• Adenovirus, which causes cold-like symptoms

It is possible for viral pneumonia to turn into bacterial pneumonia. 

Pneumonia itself is not an infection your child can “catch.” Pneumonia describes the inflammation happening in the lungs. When your child comes in contact with someone who has pneumonia, they are being exposed to the virus or bacterium that led to pneumonia, but they will not not necessarily develop it themselves.

Risk Factors

Certain underlying conditions can put your child at higher risk of experiencing pneumonia. Chronic diseases that affect the lungs like cystic fibrosis or asthma make your child more at risk of pneumonia. Children with a history of cancer or immunosuppression are also at higher risk.

If your child was born with reduced lung function or abnormal airways, they may be more likely to experience pneumonia, and children who have been exposed to secondhand smoke are at higher risk as well.

All children are more likely to be diagnosed with pneumonia during the months in late fall, winter, and early spring. This is because infections are more easily spread when children spend more time indoors together at school or daycare.2

Symptoms

Pneumonia is generally characterized by a deep, productive cough. Your child will most likely cough up mucus. Babies and toddlers often gag and vomit up the mucus that they have swallowed.

Other common signs of pneumonia in kids include:2

• Fever

• Chest soreness

• Fatigue

• Decreased appetite

• Chills

• Headache

• Malaise

In bacterial pneumonia, these symptoms seem to come on quite suddenly, while the symptoms are more gradual and slowly worsen over time in viral pneumonia.1

You will most likely notice that your baby or toddler is extremely fussy. This is due to a combination of factors, including the discomfort of the cough and chest soreness, as well as fatigue and not feeling well.

A baby with pneumonia often appears pale and limp. They will most likely cry more than usual as well.2

School-age and older kids will be able to tell you that they don’t feel good. They will probably feel tired and worn out, without energy to eat very much. 

Because pneumonia affects your child’s lungs, you may notice a change in their breathing. It’s important to keep a close eye on any wheezing or shortness of breath, and seek medical care if you are concerned.

Babies and toddlers may exhibit fast, labored breathing. When a young child is working harder to breathe, you may notice that their nostrils are flaring or that the muscles around their lungs or clavicle seem to be drawing inward. 

Call your healthcare provider right away if your child develops signs of labored breathing such as rapid, shallow breaths, nostrils flaring, or chest muscles pulling in.

Call your practitioner if your child becomes very lethargic or weak, as well as if you suspect they are becoming dehydrated. 

If your child’s lips or nails appear blue, this means that they are not able to adequately oxygenate their bodies. Seek emergency care immediately if they develop a blue tint or high fever.2

Diagnosis

Your healthcare provider will likely check your child’s pulse oximetry. This involves placing a small, painless sensor on one of their fingernails to determine the amount of oxygen in their blood. This helps your practitioner determine how well your child’s lungs are functioning.

Your medical professional may also recommend obtaining a sputum culture while in the office. This involves taking a sample of the mucus that your child coughs up and sending it to the lab to determine what kind of infection your child has. 

After your initial pediatrician visit, your healthcare provider will likely order a chest X-ray for your child. An X-ray can show if there is fluid and inflammation in your child’s lungs. A chest CT scan may also be ordered.

Taking your child for an X-ray or CT scan is nerve-racking for both you and your child. Ask about what to expect and if you can be present with your child during the test.

Other diagnostic tests your healthcare provider may consider include blood tests, bronchoscopy, and pleural fluid culture.3 A pleural fluid culture involves removing fluid from your child’s chest and is usually only considered when a bacterial cause is suspected.1

What Is Walking Pneumonia?

Walking pneumonia refers to a mild case of pneumonia that does not keep a child in bed. The symptoms often resemble a cold and are usually mild enough that they do not slow your child down. Walking pneumonia is usually diagnosed with a history and physical exam, and does not require a chest X-ray unless your child’s symptoms worsen. 

Treatment

Treatment for pneumonia in kids depends on a variety of factors. Your healthcare provider will consider your child’s age, overall health, severity of disease, and cause of the infection.4 

Treatment for bacterial pneumonia involves antibiotics, while viral pneumonia often resolves on its own. If your pediatrician prescribes an antibiotic for your child, be sure to administer the entire prescription as directed. It can be tempting to stop the medication once your child begins feeling better, but this can potentially lead to antibiotic resistance and is not recommended. 

Home remedies to try include drinking plenty of clear fluids like water or broth, using a cool-mist humidifier, and trying a saline nasal spray or drops. 

If your child were to develop severe breathing problems, they would be admitted to the hospital for additional monitoring and treatment. The treatment options may include intravenous (IV) antibiotics, IV fluids, oxygen therapy, and nebulizer treatments.5

It is not unusual for infants and toddlers to be admitted to the hospital for monitoring because they can develop breathing problems very quickly. School-aged children and teenagers are more likely to be cared for at home unless they develop shortness of breath.

Should I Give My Child Cough Suppressants?

While the cough is uncomfortable, it is also useful. Coughing helps break up the fluid and mucus in your child’s lungs and clear them out of their body. The American Academy of Pediatrics recommends against cough suppressants containing codeine or dextromethorphan in infants and children.2 Talk with your healthcare provider about how to keep your child as comfortable as possible without preventing their body from fighting the infection.

Prevention

Protecting your child from infection is not always possible. Fortunately, there is a safe and effective way to protect your child against many types of bacterial pneumonia. 

According to the American Academy of Pediatrics, all children should receive the pneumococcal conjugate vaccine series that protects against pneumococcal infections. The vaccine schedule includes doses at the following ages:2

• 2 months

• 4 months

• 6 months

• 12 to 15 months

If your child has not started this vaccine series yet, there are catch-up schedules that will allow them to become fully vaccinated. Talk with your pediatrician about the right schedule for your child. There is an additional pneumococcal vaccine meant for older children who are at high risk for developing pneumonia due to an underlying condition. 

While there is no vaccine for viral pneumonia, the best way to prevent it is by preventing upper respiratory infections as best as you can. This means frequent handwashing for kids, as well as covering their sneezes and coughs with their sleeve. Making sure your child gets the flu shot each year will also lower their risk of catching a virus that could lead to pneumonia. 

Complications

Pneumonia symptoms can range from mild cold-like symptoms to serious breathing difficulties. One common complication of pneumonia is dehydration, and many older kids experience a decreased appetite during pneumonia. Your child may also feel too worn out to have the energy to eat and drink. Babies often exhibit poor feeding as well.

To help prevent dehydration, offer your child small snacks and drinks frequently. Popsicles provide hydration and may soothe a sore throat. For babies, nursing or a bottle may provide some comfort, so offer feedings often. If your baby or child is refusing to eat or drink, call your pediatrician. 

Rarely, bacterial pneumonia can lead to a bacterial infection in the blood. This is a serious complication and requires treatment with IV antibiotics right away. If your child develops a high fever or signs of another infection in the body, see your healthcare provider immediately. 

Sources

Children’s Hospital of Philadelphia. Pneumonia in children. 

American Academy of Pediatrics. Pneumonia.

Katz SE, Williams DJ. Pediatric community-acquired pneumonia in the United States: changing epidemiology, diagnostic and therapeutic challenges, and areas for future research. Infect Dis Clin North Am. 2018;32(1):47-63. doi:10.1016/j.idc.2017.11.002

Messinger AI, Kupfer O, Hurst A, Parker S. Management of pediatric community-acquired bacterial pneumonia. Pediatr Rev. 2017;38(9):394-409. doi:10.1542/pir.2016-0183

Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76. doi:10.1093/cid/cir531

By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.