How does pneumonia develop?
The pathogen enters the lower respiratory tract, overcoming protective barriers weakened by a previous viral infection. Inflammation develops in the lung area: the alveoli are filled with fluid and cells, and the area ceases to fully saturate the blood with oxygen. The body compensates for this by breathing faster - which is why shortness of breath becomes the most reliable early sign. Inflammation can occupy a small focus, an entire lobe, or spread to both lungs. In young children, the process develops faster because respiratory reserves are smaller.
- Focal pneumonia - individual areas of inflammation
- Lobar - damage to an entire lobe of the lung
- Bilateral - lesions in both lungs
- Community-acquired - develops outside the hospital
- Aspiration - when food or liquid enters the respiratory tract
Causes and risk factors
In children of the first years of life, the leading bacterial cause is pneumococcus, and in school-age children, mycoplasma plays a significant role, which causes a lingering dry cough while feeling relatively well. Viral pneumonia is more common in the youngest children. The risk of severe disease is increased by prematurity, chronic heart and lung diseases, immunodeficiencies, nutritional deficiencies and passive smoking. Significantly reduce the risk of vaccination against pneumococcal infection, Haemophilus influenzae type b, measles and influenza.
- Pneumococcus and Haemophilus influenzae
- Mycoplasma in schoolchildren
- Respiratory viruses, including influenza and RSV
- Prematurity and chronic diseases
- Passive smoking and air pollution
- Lack of routine vaccinations
- Aspiration for swallowing disorders
Symptoms your doctor looks for
The classic picture is high fever, cough, weakness and rapid breathing, but in children the set of complaints is incomplete. In infants, pneumonia may manifest as refusal to breastfeed, wheezing, pallor, and lethargy without a significant cough. In preschoolers, sometimes the only complaint is abdominal pain. With mycoplasma pneumonia, a child may remain active but cough for weeks. Therefore, the doctor focuses on the respiratory rate by age, the participation of auxiliary muscles, saturation and auscultation data.
- Rapid breathing and shortness of breath at rest
- Persistent or recurring fever
- Cough, often wet
- Lethargy, refusal to eat and drink
- Chest or abdominal pain
- Pallor and cyanosis in severe cases
Diagnostics
The examination begins with an examination: counting the respiratory rate, measuring blood oxygen saturation, listening to the lungs. A chest x-ray confirms the diagnosis and shows the extent of the lesion and the presence of fluid in the pleural cavity. A complete blood count and C-reactive protein help distinguish bacterial from viral inflammation, although the decision about antibiotics is always based on the clinical picture. In difficult cases, additional studies are prescribed, the causative agent is determined, and in case of complications, computed tomography is performed.
- Examination with respiratory rate calculation and saturation assessment
- Chest X-ray in two projections
- Complete blood count with ESR
- C-reactive protein
- Tests for mycoplasma and viruses according to indications
- Ultrasound of the pleural cavities for suspected effusion
- Computed tomography for complications
Treatment and prevention
Bacterial pneumonia is treated with antibiotics, which are selected by the doctor based on the child’s age and the suspected pathogen; the course must be completed completely, even if after two or three days it has become noticeably better. Additionally, drinking, antipyretics if you feel unwell, and rest are important. Children in the first months of life, with severe shortness of breath, low saturation, dehydration or treatment failure, require hospitalization with oxygen support and intravenous drugs. Improvement usually occurs within 48–72 hours; if this does not happen, the tactics are reconsidered.
- Full course of antibiotics as prescribed by a doctor
- Adequate fluid intake and antipyretics if necessary
- Hospitalization of young children and in severe cases
- Oxygen support at low saturation
- Follow-up examination after 48–72 hours
- Vaccination against pneumococcus, Haemophilus influenzae, measles and influenza
- Stop smoking in the room where the child is