Pneumonia in children

Pneumonia in children – description

Pneumonia in children means that the lung and thoracic respiratory tracts become inflamed. Responsible for the disease is usually an infection with pathogens such as bacteria, viruses or fungi. The symptoms of pneumonia in toddlers are similar to those of adults. Those affected suffer from fever and cough and feel tired and tired. Often children also have symptoms such as chills or body aches, which are rare in adults.

Children are particularly at risk for pneumonia. Since infants in particular do not yet have their own hygiene awareness, pathogens such as bacteria or viruses are quickly transmitted from one child to another. This usually happens by coughing or sneezing (droplet infection). In particular, in community facilities such as schools, kindergartens or homes it comes quickly to mutual infection. In addition, children’s immune systems are often not as effective as those of adults. Children therefore have more frequent infections and are therefore more at risk of serious illnesses such as pneumonia.

Pneumonia in infants and children is the most common childhood respiratory disease. It is even one of the most common causes of death in childhood worldwide. Around 1.8 million children worldwide die of pneumonia every year. In Germany, the number of deaths is comparatively low, due on the one hand to good medical care and on the other hand to the possibility of vaccination against the most common pathogens.

Causes of pneumonia in children

Childhood pneumonia may occur as a result of another respiratory disease (such as asthma) or may be a complication of other diseases (for example, cystic fibrosis). Less commonly, pneumonia occurs in children without pre-existing conditions or risk factors. Often, bacteria or other pathogens (viruses, fungi) are the cause of pneumonia in children. Other causes such as respiratory irritating gases or disorders of the immune system are rarely the cause of pneumonia in children.

Bacterial pneumonia in children

As with adults, most bacteria in children are responsible for pneumonia. Baby and toddler are also susceptible to more common pathogens that older children and adults would not contract. Typical germs of pneumonia in children are pneumococcus, streptococcus agalactiae, hemophilus influenzae, and Escherichia coli. The causative agents of so-called atypical pneumonia, such as chlamydia or mycoplasma, are more likely to occur in school-age children.

Symptoms such as dyspnea, fever, and cough are more pronounced in children with bacterial pneumonia than with pneumonia caused by the virus. Often, bacterial pneumonia occurs after virus-induced pneumonia. Doctors then speak of a so-called superinfection.

Viral pneumonia in children

Viral pneumonia in infants is caused, for example, by respiratory syncytial virus (RS virus), adenovirus or influenza virus (influenza virus). Especially infants can develop severe RS virus pneumonia.

Pneumonia in children due to fungal infection

Mushroom-induced pneumonia in children is rare and more likely to occur in girls and boys with weakened immune systems and premature babies.

Infection with a sick child

If pathogens such as bacteria or viruses are responsible for childhood pneumonia, then pneumonia is potentially contagious to others. The pathogens can be transmitted to other people when coughing or sneezing (droplet infection). Especially with children, therefore, care must be taken to ensure adequate hygiene: Always carry a clean handkerchief with you and make sure that your child does not annoy or cough you yourself or anyone else. Under no circumstances should your baby or toddler be left alone for an extended period of time during their illness so that they can quickly notice any deterioration in their health.

Pneumonia in children: recognize symptoms

Detecting pneumonia in children and infants is not always easy. Especially for babies and very young children who are not yet able to speak, you must pay special attention to the following signs that distinguish pneumonia from a common cold:

• Lack of drinking and refusal to eat
• Cough, often with greenish or yellowish sputum
• Bloated stomach
• Fast and shallow breathing (Tachypnoe)
• Erect nostrils on inhalation (nasal breathing)
• High fever
• Significantly high heart rate (children generally have a higher heart rate than adults)
• Apathetic behavior

In children who are already able to speak, it is usually easier to detect pneumonia and to better assess the severity of the disease. The children complain then, like adults a bad general condition, a strong sense of illness and in addition to the just mentioned symptoms:

• Headache and body aches
• chills
• Chest pain when coughing, which partially radiate into the (right) lower abdomen

Diagnosis and treatment of pneumonia in children

The diagnosis of pneumonia in infants and children is essentially the same as that in adults. First, the Medical history (anamnesis) collected by the doctor, usually give the parents accurate information. Specific questions that provide the physician with further information in the case of suspected pneumonia in children could be, for example:

• Has your child been suffering from cough and fever for a long time?
• Is your child coughing a lot and being coughed up?
• Does your child feel tired and tired for a long time?
• Is your child eating less lately?
• Does your child behave differently than usual (for example, change of nature)?

This is followed by a physical examination at. With a stethoscope, the doctor listens to the lungs at various points on the back and on the chest. The inflamed lung tissue and the mucus that can accumulate between the alveoli cause typical breath sounds (sounding, fine-bubble rattle sounds).

Further investigations

To assess the extent of the inflammation, a X-ray of the lung prepared. Making a single X-ray in children is safe with regard to radiation exposure. An excessive exposure to radiation and consequential damage would only be expected if very many X-ray examinations were carried out in a very short time. The X-ray examination is the most important examination if pneumonia is suspected.

In order to prove which pathogens caused the pneumonia, a laboratory analysis is necessary. For this purpose, sputum is cultivated. This means that the laboratory is trying to multiply bacteria from the sputum. From this, the responsible bacterium for pneumonia can be identified. A laboratory analysis is useful because different pathogens react differently sensitive to antibiotics. This can also be tested by the excitation breeding from the sputum.

It is important that the sputum sample is obtained before starting the therapy, otherwise it is contaminated by the active ingredient and no longer allows accurate conclusions. A sputum sample is not necessary in every case. It is usually taken only when the doctor can not make a definite diagnosis based on the symptoms present. In complicated cases, for example, if therapy has no effect, it may be necessary to take a mucosal sample (biopsy).

With a blood test can be substantiated the suspicion of pneumonia in children. If there is inflammation in the body, typically the C-reactive protein (CRP) in the blood and the number of white blood cells (leukocytes) are increased.

Treatment of pneumonia in children

Treatment of children depends on the age of the child and the severity of pneumonia. Babies up to the age of six months and children with comorbidities or a very pronounced disease course should be treated in the hospital. Older children without concomitant diseases can be treated at home. However, you must comply with bed rest and parents should strictly ensure that the doctor prescribed therapy is followed.

antibiotics

Bacterially induced pneumonia in children is treated with antibiotics. The treatment takes place for at least seven days, but may also extend over a longer period depending on the pathogen. Which antibiotic is used in each case depends on the bacterial species. Babies and infants up to six months will be given the antibiotic by infusion. Oral intake is still very difficult at this age. To ensure a continuous drug level in the blood and not to risk that the disease worsens, is chosen at this age from the beginning of an intravenous dose.

Antipyretic means

In case of high fever, the doctor prescribes additional antipyretic drugs. The intake is usually, in compliance with the prescribed dosage by the doctor, also safe for smaller children. Commercially suitable fever juices with the active ingredients ibuprofen or paracetamol are available especially for children. Under no circumstances may children receive aspirinbecause it can cause the life-threatening Reye syndrome.

Mucolytic drugs

In pneumonia, a lot of mucus accumulates in the tissue between the alveoli (interstitium). This mucus is transported by coughing outward. To facilitate coughing, expectorant drugs can be administered. Cough suppressants should not be given during the day because they suppress the urge to cough and the child can no longer cough up the mucus in the lungs and they must never be taken at the same time with expectorant drugs. At night, however, the use of cough suppressants is recommended, as children sleep so much better.

Further measures

The exhalation of mucus can be additionally facilitated by an inhalation therapy and by a vibration massage. During inhalation therapy, a solution of saline and expectorants is inhaled. As a rule, the children are dependent on the help of their parents. A so-called vibration therapy is performed by a physiotherapist. For this purpose, a vibrating device is placed on the back, which dissolves the mucus through the vibrations and thus also supports the coughing. In addition to the therapy is important that children drink a lot to compensate for the fluid loss from coughing and fever and that they are physically sparing.

Pneumonia in children – prognosis

There is no consistent prognosis for pneumonia in children. The individual healing process and the duration of the disease depend on the type of the pathogen and the general health of the child. If the child has no other illnesses, the prognosis is usually good and the pneumonia usually heals again within seven to ten days. However, children may still be susceptible to respiratory infections for weeks after surviving pneumonia. Therefore, they should spare even after surviving pneumonia for at least a month.

Pneumonia in children – complications

Complications are rare in children with pneumonia. Often they arise when the doctor prescribed antibiotic therapy is not respected. This may prolong the duration of pneumonia or spread the pathogens in the rest of the body. If the pathogen reaches the lungs in other organ systems, the following complications are possible:

• Pelvic Inflammation (Pleuritis)
• Fluid accumulation in the pleura (pleural effusion)
• Blood poisoning when the bacteria enter the bloodstream (sepsis)
• Meningitis (meningitis)
• Pus accumulation in the lungs (abscess)

Go to the doctor immediately if the symptoms get worse or after three days – despite antibiotic therapy – no significant improvement in the state of health is seen.

Distinction of pneumonia and bronchitis

Distinguishing inflammation of the bronchi (bronchitis) and pneumonia in children is often very difficult even for doctors. In addition, bronchitis can also develop into pneumonia. If your child suffers from it, the bronchitis should be completely cured under medical treatment and physical protection. Although bronchitis is often caused by viruses, preventive antibiotic therapy is often useful to prevent additional bacterial infection (superinfection), thus reducing the risk of pneumonia in children.

Prevent pneumonia in children

You can not generally prevent pneumonia in children. However, the risk of pneumonia in children can be reduced by certain measures. These include, in particular, four important vaccinations. A vaccine that generally protects against pneumonia in children, there is not due to the variety of possible pathogens. At least, however, against some of the most common triggers of pneumonia there are vaccinations that are also recommended by the Standing Vaccination Commission (StiKo) for all children. The following vaccinations can prevent pneumonia:

• Vaccination against measles
• Vaccination against Haemophilus influenza type b
• Vaccination against pneumococci
• Vaccination against chickenpox (varicella)

The best prevention of pneumonia in children is a healthy lifestyle. Make sure your offspring is well-fed and moves regularly. For children with other illnesses or a weakened immune system, you must pay more attention to the fact that your child does not play with sick friends, as in such cases, pneumonia can be life-threatening. A Pneumonia in children is a serious condition that needs to be fully cured before the children return to kindergarten or school.