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Pneumonia

Pneumonia

What is pneumonia?

Pneumonia is the inflammation of the tissues of the lung, whereby inflammatory fluid collects in the alveoli. This inflammatory fluid can cause a reduction in the absorption of oxygen from inhaled air, causing respiratory distress and a reduction of oxygen in the blood.

 

What causes pneumonia in children?

Pneumonia is caused by viruses or bacteria. The most common cause, particularly in small children, is a virus.

 

How is pneumonia diagnosed?

The doctor diagnoses pneumonia by combining information from the child’s medical history, clinical examination of the child, an oxygen saturation measurement of the blood, and an x-ray. An x-ray positive for pneumonia alone is not sufficient to diagnose bacterial pneumonia. In other words, a positive x-ray can confirm that a child with a clinical image of pneumonia has pneumonia, but rarely is an x-ray alone characteristic enough to diagnose pneumonia, without taking into consideration other important factors from the child’s medical history, clinical examination and blood tests. The main criterion is the clinical picture of the child.

 

What are the symptoms and signs of pneumonia?

These vary. Usually there is a high fever, fever that persists for more than two days, difficulty in breathing, coughing, vomiting, poor mood in general and fatigue, pain in the chest or in the abdomen, and poor appetite. These symptoms present in various combinations.

 

How is pneumonia treated?

Many children with pneumonia are relatively well, hospitalisation is not necessary, and they can receive treatment at home.

Children with pneumonia need rest, and usually feel more comfortable lying on a pillow (children above the age of a year), in a more elevated position, or with the bed inclined (under the age of one).

They should also be encouraged to take fluids to remain hydrated. Breastfeeding should be continued, and babies frequently breastfeed more often. By offering favorite foods in small quantities, and at short intervals, the child is not forced to eat, and the parent should be aware, that as soon as the child feels better after a few days, his appetite will improve, and his reserves will be replenished.

Pain killers and antipyretics can help.

Cough suppressants should not be used with pneumonia; they don’t help, and should be avoided.

The child should not be exposed at all to passive smoking.

Treatment with antibiotics is prescribed only in cases of bacterial pneumonia. Improvement occurs within 24 to 48 hours after beginning the antibiotics (reduction of fever, improved mood and energy, improved breathing). Nevertheless, parents should be aware that poor appetite may persist for days, while the remaining cough may persist for weeks. Treatment with antibiotics usually lasts for 7 to 10 days, and it is very important to fully complete the duration of the treatment.

Antibiotic use is inappropriate with viral pneumonia, which is more frequent in small children. Whether they are administered or not, recovery is usually slower, there is no immediate response to antibiotics within 2 days, but there may be gradual improvement within weeks.

Only a few children need hospitalisation. Signs that pneumonia cannot be treated at home include:

  • Pneumonia in an infant of a few months of age, in a premature infant, or in a small child with chronic heart or respiratory problems.
  • The child cannot take medications orally or is vomiting.
  • There is no improvement after the administration of antibiotics, or the condition deteriorates.
  • Poor general condition, with lethargy or drowsiness.
  • The child cannot take fluids and becomes dehydrated, meaning he will need fluids intravenously.
  • The child suffers from serious respiratory distress, or low oxygen in the blood, meaning he needs an oxygen mask.
  • Fever is persistently high for many days and/or there are indications of pleural fluid or empyema (a build-up of pus in the pleural cavity).

 

Intravenous treatment with antibiotics will be necessary only for cases of pneumonia that are considered to be bacterial, and will continue until there is clinical improvement, and the child is able to take medications orally.

If the child’s response is clinically good, there is no need for repetition of blood tests or x-ray, just clinical re-examination.

 

Prevention

There are many vaccines that prevent specific causes of pneumonia, like the vaccines for hemophilus, pneumococcus, and influenza.

Teach children basic precautionary measures to limit the transmission of infectious diseases: thorough washing of the hands with water and soap, blowing of the nose, use of single use tissues that are promptly disposed, not to share objects like dishes and forks with other children, to cover their mouths when coughing or sneezing etc.

 

Is it possible that my child with a cough has pneumonia?

Coughing is a very common symptom in children. The most common causes of coughing are simple colds and viral infections of the upper respiratory system.

It is normal for small children to have on average 6 to 15 episodes of coughing or infections of the upper respiratory system a year, usually caused by viruses.

Parents should be aware that many viral infections can leave a lingering mild cough, which can last for weeks after the end of fever. Particularly in the case of common winter viral infections, such as bronchiolitis, the remaining cough can last for several weeks. Use of antibiotics is inappropriate in the case of a lingering cough after viral infections.

In some cases, coughing may be a sign of a bacterial infection in the lungs, the ears, or the throat. Recurrent episodes of coughing also occur in small children overgrowth of adenoids, with episodes of viral wheeze, and in older children with asthma attacks.

Parents should consult their paediatrician if they have any doubts. In addition, parents should be aware that sometimes, especially when symptoms relapse, persist, or deteriorate, re-examination and frequent re-evaluation by the doctor are necessary.

In general, cough medicines are not helpful. There is no scientific evidence to confirm their benefit. On the contrary, there are studies, which show that they may even cause harm, especially to small children.

Warm drinks, like chamomile tea, particularly in combination with honey, may reduce coughing during the night in children over the age of one year.

 

I have been told that my child has pneumonia. Should I be worried?

The diagnosis of “pneumonia” in small children is often misunderstood, and is frequently given without full substantiation, causing anxiety to parents, often unnecessarily. Even the word “pneumonia” can cause fear. The diagnosis is rarely exclusively based on an x-ray, or just by listening to the child’s chest, but all the parameters (general condition of the child, fever, coughing, vomiting, nutrition, breathing difficulties, chest examination, x-ray) should always be taken into account, with emphasis mainly on the symptoms and the clinical image of the child. A thorough clinical evaluation should be made, in order to avoid over-diagnosis, baptizing simple viral infections of the respiratory system, viral wheeze, bronchiolitis, or viral pneumonia as bacterial pneumonia.

Even if pneumonia is diagnosed in a small child in the community, there is a significant possibility that it is viral pneumonia, which cannot be treated with antibiotics, and antibiotics are not only unnecessary, but can also be harmful.

In other cases, a child with bacterial pneumonia, but who is generally well, (absence of high fever for many days, satisfactory nourishment and hydration, absence of significant respiratory distress (breathing difficulties) or reduction of oxygen saturation in the blood, absence of severe coughing etc.) may well be treated at home with antibiotics administered orally.

Hospitalisation is usually only required if the child does not respond to treatment within the first 48 hours. Finally, if hospitalisation is necessary, intravenous treatment with antibiotics continues only for as long as is necessary for the clinical picture of the child to improve (reduction of fever, improved breathing, general condition, nourishment etc.), and it is usually not for more than 2 to 5 days. In the case of hospitalisation however, all efforts should be made for the child and his parents to return to the familiar environment of his home as soon as possible, and once the child shows signs of recovery, administration of intravenous antibiotics should be changed to antibiotics given orally. Extended hospitalisation for weeks, until all symptoms disappear, is usually unnecessary and harmful, because it terrifies both child and parents, and leads to overuse of strong antibiotics, which may harm normal gut- flora of the child, and have side effects. It also affects the family’s mood, as well as their financial status and finances of hospitals and state insurances.

 

Stelios Papaventsis MRCPCH DCH IBCLC 2013

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