Demystifying childhood pneumonia

What you need to know about symptoms, diagnoses and treatment

Pneumonia sounds scary, but serious pneumonia has become less common with the current vaccine schedule, and most children with pneumonia can be successfully treated with oral medications and supportive care.

“Pneumonia” refers to infection of the lung tissue. Pneumonia can be caused by viruses, bacteria, fungi or parasites. Viral pneumonia is the most common type. Pneumonia often occurs after an upper respiratory infection (the “common cold”). In these cases, the infection moves from the upper respiratory tract to the lungs. Fluid, white blood cells and debris gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.

Children ages one to five have the highest rates of pneumonia. The classic symptoms of pneumonia are cough and fever. Children with pneumonia can develop signs of difficulty breathing, such as breathing fast, belly breathing, using the muscles between the ribs to breathe, flaring of the nostrils or grunting. In serious cases, children can develop bluish or gray color of the lips and fingernails indicating a lack of oxygen supply. Children with pneumonia can also have chest pain, stomachache, vomiting, decreased activity or loss of appetite.

Pneumonia can be diagnosed with a lung examination. Your health care provider may hear decreased breath sounds and/or crackling sounds when listening to your child’s lungs with a stethoscope. The primary diagnostic test for pneumonia is an X-ray of the chest. Blood tests can help doctors distinguish between bacterial and viral types of pneumonia, but do not diagnose pneumonia.

Children with pneumonia caused by bacteria can become sick fairly quickly, while those with pneumonia caused by viruses often have symptoms that appear more gradually and are less severe. While pneumonia is not contagious, the viruses and bacteria are transmissible, so it’s important for children with pneumonia to wash their hands often and avoid sharing utensils or drinking glasses.

Vaccines can prevent some e types of bacterial pneumonia. The standard childhood vaccine schedule recommended by the Centers for Disease Control includes immunizations against Streptococcus pneumonia, the most common bacterial cause of pneumonia, as well as other bacteria that can cause pneumonia. Since the introduction of these vaccines, the rates of hospitalization for pneumonia in children have decreased.

Children with chronic illnesses such as asthma, lung or heart disorders, or immunocompromise can be at an increased risk of getting pneumonia. The annual flu vaccine is recommended for all healthy children age 6 months through 19 years, and especially for children with chronic illnesses.

Bacterial pneumonia is treated with antibiotics. With treatment, most types of bacterial pneumonia get better within one to two weeks, although walking pneumonia may take four to six weeks to go away completely. Viral pneumonia does not respond to antibiotic therapy, so the treatment of viral pneumonia is primarily supportive.

While most children do well with oral antibiotics, those who are sicker or who do not improve may need to be hospitalized and treated with IV antibiotics. Patients who require oxygen treatment also need to be admitted to the hospital.

If your child has a fever, cough, and/or difficulty breathing, it’s a good idea to have them evaluated. 

Maia S. Rutman, MD is the Medical Director of Pediatric Emergency Services at Dartmouth-Hitchcock Medical Center. For more information, go to

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