Pneumonia: What needs to be considered in children?
Pneumonia can sometimes be hard to detect in children because they don't always have a cough, a fever or shortness of breath. It can also be caused by different germs than in adults. That is why two vaccinations are recommended for children: one against Haemophilus bacteria and one against pneumococci.
Children get pneumonia more frequently than adults. Not only is their immune system not yet fully developed, but germs such as bacteria and viruses spread very quickly from child to child, especially between the ages of three and six years. That is why infections are generally very common in children.
Pneumonia is more common in babies younger than one year and in toddlers than in school children or teenagers. 35 out of 10,000 children aged below the age of six years develop pneumonia each year, and only 15 out of 10,000 older children do.
Children usually don't have any complications. But pneumonia can be life-threatening if an infant gets pneumonia directly after birth or a child is weakened due to another disease or malnutrition. Globally, pneumonia is one of the most common causes of death in children, especially in poorer regions of the world.
How can I tell if my child has pneumonia?
When children get pneumonia, they may have fever, chills, or a cough with phlegm. But they needn't show these typical symptoms. Many children with pneumonia mainly have a stomach ache. The disease can often only initially be detected in infants because they don’t want to drink, seem lethargic, or vomit. Sometimes they only have a high fever and a very fast pulse.
Children who have pneumonia often breathe faster than normal. If they experience shortness of breath while they have pneumonia, their labored breathing can sound like groaning. When breathing, the skin between their ribs is visibly drawn in and/or their nostrils move considerably. Medical attention should be sought immediately if these symptoms occur.
What are the typical causes in children?
Pneumonia in children is most often caused by bacteria or viruses. Where viruses are involved, they are usually cold viruses or common flu viruses. Bacterial pneumonia is frequently caused by pneumococci, like in adults too. Haemophilus influenzae bacteria infections are also typical in children. Certain streptococci and intestinal bacteria are also possible causes in infants.
When is pneumonia considered to be severe?
Pneumonia in children is classified as “severe” or “not severe.” In both cases, children breathe quickly – infants over 50 times per minute, toddlers more than 40 times per minute, and older children over 20 times per minute. Other warning symptoms can be a sign of severe pneumonia, for example if children are sleepy, do not want to eat or drink, or have seizures. Severe pneumonia is generally treated in a hospital. Shortness of breath, unconsciousness or being less than six months of age are also reasons for hospital treatment.
What’s important to consider when using antibiotics?
Often, children with bacterial pneumonia are also treated with antibiotics. It's important that the active ingredient is effective against the particularly common germs that cause pneumonia in children. Antibiotics can be taken as tablets or syrup. Infusions are often also a particularly good idea in the event of severe infection, or if a combination of two different antibiotics is used. Additional fluid is often given through an infusion because sick children tend not to drink enough and may become dehydrated. Antibiotics needn't be taken for milder infections or if the pneumonia was caused by a virus.
Which vaccinations are advisable for children?
Two vaccinations aim to protect children from becoming infected with pneumonia by the following germs:
Children are given a series of injections at the ages of two, four and around twelve months. An additional pneumococci injection is recommended for premature babies at the age of three months. Depending on the vaccine, a fourth Haemophilus booster can be given at the age of three months. These vaccination appointments can be easily combined with the child's standard pediatric check-up appointments.
If you haven't had your child vaccinated, you should get the vaccinations done as soon as possible. Catch-up vaccinations against Haemophilus can be given until the age of five years, and ones against pneumococci can be given until the child is two years old.
Vaccinations against the childhood diseases measles, whooping cough and chickenpox are also a good idea. Pneumonia can develop as a complication of those diseases. An overview of all vaccinations recommended for children, teenagers and adults can be found on the Federal Centre for Health Education’s (Bundeszentrale für gesundheitliche Aufklärung, BZgA) website www.impfen-info.de.
Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Pädiatrische Pneumologie (GPP). S2k-Leitlinie „Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)“. AWMF-Registernr.: 048-013. March 2017.
Eppinger M, Müller M. Pädiatrie für Studium und Praxis. Breisach: Medizinische Verlags- und Informationsdienste; 2016.
Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet 2015; 386(9998): 1097-1108.
Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 14, 2017. (Epidemiologisches Bulletin; Volume 34).
Weltgesundheitsorganisation (WHO). Pneumonia. September 2016.
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