Pneumonia In Children

Words by Dr Prashant Rijal

A one year old boy from Kathmandu, presented at GIH with a history of cough, fever, difficulty in breathing for two days. His physical examination revealed a very severe chest wall in drawing and head nodding, high grade fever and low oxygen level. Chest X ray showed pneumonia.

Hence, he was immediately admitted to PICU with severe pneumonia and discharged in a normal condition. A 9 months old baby was brought to GIH with complaints of cough, fever, difficulty in breathing, vomiting and diarrhea from thelast 5 days. The parents had come to GIH after failed treatment at another hospital.

His physical examination showed temperature 102°F with fast breathing and chest X-ray revealed pneumonia. Hence, he was admitted and treated in the hospital. Cases as such are fairly common in kids and pneumonia the lung infection is generally more common in children below 5 years of age.

In this article we talk about the causes of pneumonia in children, its transmission, the symptoms, diagnosis, treatment and prevention of the disease.

Overview

The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. It can be mild or serious. Pneumonia is the single largest infectious cause of death in

children worldwide. As per WHO data Pneumonia killed 7,40,180  children under the age of 5 in 2019, accounting for 14% of all deaths of children under 5 years old but 22% of all deaths in children aged 1 to 5 years. Pneumonia affects children and families everywhere, but deaths are highest in southern Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and it can be treated with low-cost, low-tech medication and care.

What causes pneumonia in a child?

Pneumonia is most often caused by bacteria or viruses. Some of these bacteria and viruses can be spread by direct contact with a person who is already infected with them. Common bacteria and viruses that may cause pneumonia are: Streptococcus pneumonia Mycoplasma pneumonia.

This often causes a mild form of the illness called walking pneumonia. Mycobacterium Tuberculosis Group B streptococcus Staphylococcus aureus Respiratory syncytial virus (RSV). This is most often seen in children younger than 5 years old. Parainfluenza virus Influenza virus Adenovirus Corona Virus Pneumonia may sometimes be caused by fungi too.

Transmission

Pneumonia can be spread in several ways. The viruses and bacteria that are commonly found in a child’s nose or throat can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.

Is my child at risk for pneumonia?

While most healthy children can fight the infection with their natural defenses, children whose immune systems are compromised are at higher risk of developing pneumonia. A child is more likely to get pneumonia if he or she has:

Weak immune system, due to malnutrition or undernourishment, especially in infants who are not exclusively breastfed Low birth weight and premature babies Ongoing (chronic) health problem, such as asthma or cystic fibrosis Unvaccinated children Problems with the lungs or airways Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child’s risk of contracting pneumonia.

The following environmental factors also increase a child’s susceptibility to pneumonia: –

• Indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
• Living in crowded homes
• Parental smoking

In addition, children younger than 1 year old are at risk if they are around secondhand tobacco smoke. This is especially true if their mother smokes.

What are the symptoms of pneumonia in a child?

Symptoms of pneumonia may be a bit different for each child. They may also depend on what is causing the pneumonia. Cases of bacterial pneumonia tend to happen suddenly with these symptoms: Cough that produces mucus Fever Fast or hard breathing Chest indrawing Chest pain (older children) Vomiting or diarrhea Loss of appetite Tiredness (fatigue) Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. But with viral pneumonia, the breathing problems happen slowly.

Your child may wheeze and the cough may get worse. Viral pneumonia may make a child more at risk for bacterial pneumonia. Pneumonia killed 7,40,180 children under the age of 5 in 2019, making it the single largest infectious cause of death in children worldwide.

In addition to the symptoms listed above, your child may have: Chills Headache Fussiness The symptoms of pneumonia may look like other health problems.

Make sure your child sees his or her healthcare provider for a diagnosis. How is pneumonia diagnosed in a child? To diagnose pneumonia, a detailed health history and physical exam is required. He or she may include these tests to confirm the diagnosis: Chest X-ray: Chest X-ray helps to see the lungs, heart and blood vessels. It helps to diagnose pneumonia and determine the extent and location of the infection.

Blood tests. A white blood cell count looks for signs of an infection. Occasionally, an arterial blood gas test looks at the amount of carbon dioxide and oxygen in the blood. Sputum culture. In older children, this test is done on the mucus (sputum) that is coughed up from the lungs and into the mouth. It can help to find out an infection. It’s not routinely done because it is hard to get sputum samples from children. Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. Chest CT scan. This test takes images of the structures in the chest. It is very rarely done. Bronchoscopy. This procedure is used to look inside the airways of the lungs. It is very rarely done. Pleural fluid culture.

This test takes a sample of fluid from the space between the lungs and chest wall (pleural space). Fluid may collect in that area because of pneumonia. This fluid may be infected with the same bacteria of the lung. Or the fluid may just be caused by the inflammation in the lung. Children can be protected from pneumonia; it can be prevented with simple interventions and treated with low-cost, low-tech medication and care. How is pneumonia treated in a child? Treatment may include antibiotics for bacterial pneumonia.

No good treatment is available for most viral pneumonias. They often get better on their own. Flu-related pneumonia may be treated with an antiviral medicine. Other treatments can ease symptoms. They may include: Plenty of rest Getting more fluids Paracetamol for fever and discomfort Some children may be treated in the hospital if they are having breathing problems. While in the hospital, treatment may include: Antibiotics by IV (intravenous) or by mouth (oral) for bacterial infection IV fluids if the child is unable to drink well Oxygen therapy Frequent suctioning child’s nose and mouth to help get rid of thick mucus Breathing treatments, as ordered by child’s healthcare provider

What are possible complications of pneumonia in a child?

Pneumonia can be a life threatening illness. Pneumonia is a lung infection that can lead to a variety of health complications including pleural effusion, lung abscess, organ and respiratory failure, and sepsis, especially if left untreated.

How can pneumonia be prevented?

Breastfeeding during infancy Good and adequate nutrition Limited exposure to air pollution Vaccination against Hib, pneumococcus, measles and whooping cough (pertussis) also make sure, child is up-to-date on all vaccines, including the yearly flu shot. Maintain good hygiene. Teach your child to cover their nose and mouth when coughing or sneezing. The child should also wash their hands often.

These measures can help to prevent other infections, too. .

Key points about pneumonia in children

Pneumonia is an infection in the lungs. It can be mild or serious. The illness can be caused by bacteria, viruses, and fungi. Some common symptoms include fever, cough, fast or difficulty in breathing, tiredness (fatigue), and chest pain. Treatment depends on the cause of the pneumonia. Some types of pneumonia can be prevented with a vaccine. Proper hand washing and hygiene can help a lot