This post is also available in: Svenska
Pneumonia is an infection in the lungs that can be bacterial or viral. Children with pneumonia often have a cough and fever as well as stomach aches, tiredness, lethargy or paleness.
Is it pneumonia or the common cold?
The cold is the most common infection in children. It is a viral infection of the upper respiratory tract and often manifests as fever for a few days, some sniffing and sneezing, and a cough that can last for 2-3 weeks.
If your child is alert between fever peaks and does not have any breathing difficulties, then wait 3-4 days to see if your child’s immune system can fight off the infection themselves. In the vast majority of cases, children’s immune system 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 the flu season, influenza is the most common cause of fevers lasting more than 3 days. At the same time, children will also have a cough. So, if it is flu season, the child is alert, and does not have any breathing difficulties, you can wait another couple of days to see if it passes.
If your child gradually becomes more tired during the days, the fever persists, 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.
Vaccines against pneumonia is the only effective way to prevent the common cold from developing to pneumonia.
How do you know if it’s pneumonia?
A medical examination is required to safely diagnose pneumonia. The doctor examines your 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.
Usually a medical examination is enough to make a diagnosis, but sometimes the doctor will order a chest X-ray. This happens occasionally but is not required.
Bacterial or viral pneumonia?
A qualified medical assessment is required to assess whether the pneumonia is bacterial or viral. It’s similar to putting together a puzzle. We consider 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 for example 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 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 Amoxil (amoxicillin) or 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 program in Sweden since 2009. However, there are many pneumococcal types that the vaccine does not help against, which can also cause pneumonia.
If Amoxil or Penicillin VK does not reduce the fever or cough within 3-4 days, then it may be another type of bacteriacausing 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, so plenty of rest, warmth, fluid and perhaps paracetamol.
There are also viruses (eg. influenza , chickenpox and measles viruses) that can cause more severe pneumonia. This can lead to respiratory distress and consequently hospitalization. Measles is very rare in Sweden thanks to our vaccination program. But influenza and chickenpox cause more severe pneumonia in children every year.
If your child has a cough and fever that does not pass within 3-4 days, it could be pneumonia. Pneumonia can be suspected if your child has a cough, fever and breathing problems. The diagnosis for pneumonia is made by doctors and antibiotics are required if it’s bacterial pneumonia.