Pneumonia in the child

definition

Pneumonia, which is also known as pneumonia refers to inflammation of various parts of the lungs. It is the most common respiratory disease in children and can be triggered by various pathogens such as bacteria or viruses. It should be noted that the symptoms in children can be very non-specific. Since pneumonia can even lead to death under certain circumstances, a (pediatric) doctor should be consulted promptly and promptly. Pneumonia can be diagnosed by listening with a stethoscope, an X-ray or with the help of a blood test / blood culture by cultivating pathogens.

Also read our topic: Pneumonia in the baby

causes

Pneumonia is an infectious disease. This means that the disease is caused by germs that attack the lungs. This can be bacteria as well as viruses or fungi.
The most common pathogens that cause pneumonia in children are pneumococci. Other common bacteria that primarily affect school children are mycoplasma and chlamydia.
Common viruses that cause pneumonia in children are RS viruses, rhinoviruses, and parainfluenza viruses.
If bacteria are the cause of pneumonia, it is called typical pneumonia, while atypical pneumonia is often caused by viruses. Pneumonia is often caused by different germs together.
Hospital-acquired pneumonia (nosocomial pneumonia) is caused by different bacteria than community-acquired pneumonia, as it is rare here. This includes, for example, the Pseudomonas germ. This is particularly dangerous for children with immune deficiencies or diseases that affect the lungs, such as cystic fibrosis.
Risk factors for a child to develop pneumonia include serious previous diseases of the heart or lungs, as well as diseases in which the immune system is weakened.

For more information, see:

• Causes of Pneumonia
• Here's how you can prevent pneumonia - vaccination against pneumococci

diagnosis

Diagnosing pneumonia can sometimes be tricky. Many symptoms are not particularly specific, especially in children, so that pneumonia can also go undetected.
When examining the lungs with a stethoscope, so-called rattling noises can be heard, which indicate that the lungs are occupied. However, this finding is very unspecific and is often missing.
In children, signs may be seen that suggest breathing is difficult. This includes the wings of the nose (movement of the nostrils while breathing) or great effort when breathing in. When inspecting (looking at) the upper body, retractions on the ribs may be seen.
During a blood test, inflammatory values ​​such as ESR (blood sedimentation rate), CRP (C-reactive protein) and procalcitonin can be increased. Blood cultures (to cultivate pathogens) can be taken or an examination of the sputum can be carried out to detect the presence of germs. The color of the sputum can be yellowish to green in the case of bacterial infestation. Ultimately, a chest x-ray can show that the lungs are infiltrated. This can be seen in the X-ray image as so-called shadowing. Taking an X-ray is not part of routine diagnostics, but it is necessary in some cases. An X-ray examination is mandatory for children under 5 years of age or a fever above 39 ° C without a certain cause.

Read more on the topic:

• Blood tests for pneumonia
• Diagnosis of pneumonia
• X-ray examination of the child

Symptoms

Pneumonia symptoms can vary widely in children.
Typical pneumonia usually starts suddenly with a strong feeling of illness. It can lead to a high fever and an increased breathing rate, which is typical for pneumonia in children. The cough is productive, which means that the children cough up greenish sputum. Breathing pain that makes it difficult to breathe is also typical.
Atypical pneumonia shows a slightly different course and is not that rare in children. It is often caused by mycoplasma. Usually the beginning is very insidious and pneumonia can easily be overlooked. The disease begins with headache and body aches. A slight fever can accompany it, but it can also be absent entirely. Difficulty breathing and dry cough without sputum are typical. However, since the beginning is very gradual and the symptoms of atypical pneumonia can be very unspecific, especially in children, it can be mistaken for a cold.

For more information, see:

• Symptoms of pneumonia
• Pneumonia pain

Pneumonia with and without fever

Fever is a symptom that is typical of pneumonia. However, it does not have to be there. There is also pneumonia that causes little or no increase in body temperature.
In general, typical pneumonia causes a high fever and an equally strong feeling of illness. In children, the fever can also rise to over 39.0 ° C. However, this does not necessarily have to be the case.

Atypical pneumonia show rather mild to no fever. However, it must be noted that the classification and cause allocation is not that easy. One cannot infer the germ that caused the pneumonia from the symptoms alone. Fever as a symptom is also too unspecific for the causes to be narrowed down. Reasons that children do not have a rise in fever can, for example, be serious previous illnesses such as cystic fibrosis or other immune defects.

Read more on the subject here: Pneumonia without a fever

Pneumonia with and without a cough

Not every pneumonia in the child has to be accompanied by a cough. Usually, while the cough is a symptom of pneumonia, it can also be absent.

Especially with atypical pneumonia in childhood, the cough can be completely absent. Most often, RS viruses are the cause of atypical pneumonia. The course of atypical pneumonia is also generally less symptomatic in children than the course of typical pneumonia. However, the boundaries are fluid, so that no strict distinction is possible based on symptoms alone.

A pronounced cough with sputum, on the other hand, suggests a bacterial cause. Most often, pneumococci are the cause of pneumonia. However, other germs can also be the cause. Of the Sputum can be green to yellowish. A dry cough is also possible. This means that the cough does not cough up sputum.

For more information, see: Pneumonia without a cough

treatment

The treatment of pneumonia in children depends, among other things, on which germ is the cause. The severity of the pneumonia is also included in the therapy. Treatment is possible on an outpatient as well as inpatient basis. When the child needs to be admitted to hospital depends on the severity of the disease and the general condition of the child.
Mild pneumonia can be treated on an outpatient basis. A hospital stay is not necessary here. Therapy consists of drug treatment with antibiotics. The drugs of first choice are aminopenicillins (e.g. amoxicillin), but other antibiotics are also approved for treatment. Treatment of pneumonia that can be treated on an outpatient basis is usually over after 7 days.

Moderate to severe pneumonia is treated as an inpatient in the hospital. For this purpose, the patients receive a combination of different antibiotics through an access in the vein. The antibiotic therapy is stopped 2 to 3 days after defever. Children who develop pneumonia in hospital are always treated as inpatients. The therapy includes special combinations of antibiotics that are effective against the germs that can be found in the hospital.
Treating pneumonia in children also includes important supportive measures that promote healing. Coughing up the secretion and breathing well are important for the lungs to heal well. Therefore, physical therapy, if available, is very desirable. Oxygen can also be administered via a nasogastric tube if the oxygen saturation (the oxygen content in the blood) is too low, for example in the case of severe pneumonia that requires hospitalization. A high fluid intake is very important as this helps the secretion to dissolve well.

The active ingredient ibuprofen is usually used to lower fever and relieve pain in children. Pain relief is especially important as chest pain makes it difficult for affected children to breathe. However, good breath work is necessary for healing.

Find out more about the topic here: Antibiotics for pneumonia.

Treatment with an antibiotic

Antibiotics probably do most important therapeutic measure if you have pneumonia. They fight the pathogens that cause pneumonia. Different antibiotics are used depending on whether it is pneumonia that a child has in the hospital or outside of the hospital, on an outpatient basis.
An outpatient treatable pneumonia is usually with Amoxicillin treated. The antibiotic too Azithromycin is often used in children because it is very effective and has comparatively few side effects.
In inpatient treatment, the antibiotics are given through an access in the vein. Then mostly come Combinations of different antibiotics used to be able to fight all germs as far as possible and to prevent germs from becoming resistant.

A possible combination for moderate or severe pneumonia would be amoxicillin, Clavulanic acid and azithromycin.
If you are allergic to these antibiotics you can use other active ingredients such as Cephalosporins, other Macrolides or Fluoroquinolones can be used. These are also antibiotics.

Homeopathy as therapy

Pneumonia is a serious condition and, if inadequately treated, can even be fatal for the child. thats why absolutely inadvisable to apply homeopathic methods. There are no effective homeopathic remedies that can cure pneumonia in children.

Duration of pneumonia

The duration of pneumonia in children often varies. Not every course is the same. How long pneumonia lasts depends, among other things, on how serious this is. Besides, the General condition of the child is an important factoraffecting the duration of pneumonia. With previous illnesses, immune deficiencies or with chronic diseases such as cystic fibrosis or the like, pneumonia often takes weeks to heal.
A mild pneumonia with a good general condition The child usually lasts under good therapy 7 to 14 days.

Moderate to severe pneumonia can also show longer courses. Also so-called Recurrencesrelapses are possible if a child has an immune deficiency or previous illnesses or if the therapy did not work well. In rare cases, children can be affected up to several weeks suffer from the symptoms.
Longer courses are also possible for pneumonia that was acquired in hospital. Since the pathogens involved are already resistant to some antibiotics (see also: Antibiotic resistance) therapy can be difficult. The general condition of the child also plays a decisive role here. Children who are already seriously ill in hospital are often more difficult to treat than healthy children.

For more information, see: How long does pneumonia last?

When should you go to the hospital?

Moderate to severe pneumonia is treated in the hospital. But when does a child have to go to the clinic? It is not always very clear when a child needs to go to hospital and when not. However, there are a few reasons that speak for admission to the clinic.

Each prolonged fever in children for whom there is no apparent reason should be evaluated clinically. Furthermore is a very poor general conditionFor example, if you have severe previous illnesses, this is a reason to go to the clinic with pneumonia. At Limitations of Consciousness children should also be hospitalized.
Another important value is the oxygen content in the arterial blood (Oxygen saturation). Values ​​below 94% are questionable and should be clarified. With a restriction of the circulation and one Drop in blood pressure an inpatient stay is also necessary. Also a extreme increase in respiratory rate is a reason for hospitalization.

But what exactly does this mean for the parents of the affected child? When should they go to a clinic? It is difficult to make general recommendations at this point, but there are a few points to consider.
Should the child mentally absent or clouded consciousness work, the general condition deteriorates significantly or the symptoms do not improve with outpatient therapy, it is recommended to go to an emergency room. Even with one unstable circulatory situation, for example one Faint, or Dizzy spells you should go to a clinic with your child.

How contagious is pneumonia in children?

Pneumonia is an infectious disease. This means that they are caused by pathogens such as viruses and bacteria. Children with pneumonia are of course able to infect others with the germs. Through coughing and sneezing, the pathogens are transmitted via a so-called droplet infection.

Some pathogens are more contagious than others, so it is not possible to precisely limit how contagious pneumonia is in children. This also depends on various factors, such as the frequency of coughing, the time in contact with the sick child and your own general condition. In the symptomatic phase, however, infection is quite possible, therefore very old people or people with severe previous illnesses should avoid contact with the sick child.

For more information, see: How contagious is pneumonia?