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Pneumonia is an infection in the lungs. It can be bacterial or viral. Children with pneumonia often have a cough and fever as well as stomach aches, be tired, lethargic or pale.
Pneumonia or a cold?
A cold is the most common infection in children. It is a viral infection of the upper respiratory tract. Often children have a fever for a few days; some sniffing and sneezing; and a cough that can sit for 2-3 weeks.
If the child is alert between the fever peaks and does not have any breathing difficulties, then just wait 3-4 days to see if the child can fight off the infection themselves. In the vast majority of cases, children do.
Fevers that don’t go away
If the fever does not pass on the 4th day, it may be time to seek medical care. During flu season, influenza is the most common cause of this. Children who have a fever for more than 3 days, also experience coughs. If it is flu season, the child is alert and does not have any breathing difficulties, you can wait another couple of days and see if it passes.
Read more about the flu in children here.
If the child gradually becomes more tired during the days; the fever increases; and the cough becomes the dominant symptom, then it is definitely time to suspect pneumonia.
Pneumonia is often a complication of the common cold
Often the lining of the lungs have been compromised by the viral infection. This makes it easier for viruses and bacteria to wander down and cause pneumonia. However, pneumonia can also come about without a previous cold.
There is nothing you can do to prevent a cold from developing into pneumonia, except to vaccinate against pneumococcus.
How do you know if it’s pneumonia?
It takes a medical examination to safely diagnose pneumonia. The doctor examines the child by listening to their chest with the stethoscope. Sometimes, but far from always, a part of the lung is silent, as it is clogged with mucus and bacteria or viruses. In combination with a fever and cough, it is a sufficiently sure sign of pneumonia.
Sometimes chest X-rays are needed to make a diagnosis. However, if the examination is clear already without x-rays, doctors can often refrain its use.
Bacterial or viral?
A qualified medical assessment is also required to assess whether the pneumonia is bacterial or viral. It’s similar to putting together a puzzle. We need to look into: the child’s symptoms; the results of the examination and possible X-rays; combine that with what we know about the state of infection in the community; and the child’s vaccination status. Often the puzzle might need another piece, a blood test, or so-called CRP test.
In severe pneumonia, where the child needs to be hospitalized, we often take a blood culture and look for bacteria in the blood. We also often take samples of viruses and certain bacteria in the pharynx.
It is extremely important that the persons interpreting these test results, are aware of how common it is for healthy children to carry several viruses and bacteria in the pharynx. The sample results are therefore only pieces of the puzzle, not the determining factor.
If your doctor determines that pneumonia is likely to be bacterial, antibiotic treatment is required. Unlike most tonsillitis and otitis, bacterial pneumonia are potentially dangerous, and antibiotics are always recommended. (The hard part, as I said, is to assess whether it is bacterial or not).
In Sweden, one of the penicillins Amimox/Amoxil (amoxycillin) or Kåvepenin/Penicillin VK (phenoxymethylpenicillin) is given. They help against the most common pneumonia bacteria, pneumococcus. Vaccines against certain types of pneumococcus (the most aggressive) have also been included in the vaccination programme in Sweden since 2009. However, there are many pneumococcal types that the vaccine does not help against, which can also cause pneumonia.
If Amimox/Amoxil (amoxicillin) or Kåvepenin/Penicillin VK (phenoxymethylpenicillin) does not reduce the fever or cough within 3-4 days, then it may be some other bacteria that is causing the pneumonia. There is a group of bacteria-causing pneumonia (eg. mycoplasma) that requires treatment with another type of antibiotic eg. Ery-Max (erythromycin). In this case, your doctor should make the switch.
Pneumonia caused by viruses cannot be treated with antibiotics. In most cases, the common cold and flu viruses cause fairly mild pneumonia. They are best treated like the cold eg. plenty of rest, warmth, fluid and perhaps aspirin.
There are also viruses (eg. influenza viruses, chickenpox viruses and measles viruses) that can cause more severe pneumonia. This can lead to respiratory distress and thus hospitalization. Measles is very rare in Sweden thanks to our vaccination programme. But influenza and chickenpox can cause more severe pneumonia in children every year.
… there is reason to suspect pneumonia if your child has a cough and fever that does not pass within 3-4 days. In addition, pneumonia can be suspected if your child has a cough, fever and breathing problems. The diagnosis is made by doctors and antibiotics are required if it’s bacterial pneumonia.
Influenza in children – symptoms and treatment
Sore throat and a cold in children
Pneumococcal vaccine for children – effects & side effects