Pneumonia: Diagnosis and Treatment

Kids are pretty good at fighting colds. They suffer through the symptoms with limited language ability to communicate symptoms and minimal over the counter symptom management solutions. Sometimes, though, they get secondary infections because they just can’t kick a cold. Pneumonia is one of those things.


The pneumonia itself is not contagious. Just like you can’t catch an ear infection, you can’t catch someone else’s pneumonia. You can, however, catch the virus that came before the pneumonia.


Typically, coughing and the gag reflex protect the lungs in kids with a head cold. Sometimes, the germs and mucus find their way down into the lungs. It’s dark, warm, and moist, which is the perfect breeding ground for infection. So, those germs set up camp and cause inflammation in the lungs. The body recognizes that something is not right, and tells the immune system to get rid of it. Unfortunately, though, the way the immune system gets rid of germs also allows fluid to get in the lungs.


Everyone knows the lungs are meant for air not fluid. So, when your breathing space is taken up by infection and fluid, it makes sense that pneumonia symptoms are cough, fast breathing, shortness of breath, and difficulty breathing. Some other symptoms that typically go hand-in-hand with pneumonia are fever, chest pain or painful cough, and feeding difficulties in infants.


In adults, diagnosing pneumonia without a chest x-ray is pretty easy. Adults are really good at taking deep breaths, coughing effectively, and allowing me to listen to them breathe. Kids, on the other hand, are squirmy, distracted, and usually pretty scared of a stranger with a stethoscope. The guideline for diagnosing pneumonia says yes, a clinical diagnosis is fine if that’s all you have. But, it recommends a chest x-ray to diagnose pneumonia if the exam is “unclear” or if the child may require hospitalization.


Personally, unless a kid has fever, cough, fast breathing, and “pneumonia lung sounds” (EX: crackles) that don’t go away after they cough several times I’m going to order a chest x-ray. That way I don’t prescribe an unnecessary antibiotic and cause more damage.


There is no single sign or symptom that is specific to pneumonia. Fever and cough for 3 days are red flags for me. But, you know your kids better than anyone else. Talk with your provider about any concerns you may have about your child’s illness.


For otherwise healthy kids who are able to tolerate treatment at home, Amoxicillin is the best first choice antibiotic for pneumonia. It’s the most effective and most gentle on the insides. But, unlike ear infections, pneumonia requires three times a day Amoxicillin for treatment. There are, of course, alternatives for people with allergies to Amoxicillin.


Kids with pneumonia typically have fever and some kind of chest pain or discomfort. Unfortunately, when kids don’t feel well, they are less likely to do things to take care of themselves like eat and drink well, and cough effectively. So, it’s important to treat the symptoms with anti-fever and pain medications. The cough is good. We want kids to cough to keep their airways cleared. You can soothe airway irritation with fluids and warm broths. If your child is old enough, you can even try honey, throat lozenges, and hard candy. They are inexpensive and unlikely to be harmful. Most kids start feeling better after 24-48 hours on the right antibiotic. The cough may last for several weeks after recovery, though.


KidMed has pediatric providers, nurses, x-ray and lab staff. Hopefully you don’t need us, but we’re here to help if you do!


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