Recognizing Signs Of Pneumonia In Toddlers

Pneumonia in children

Pneumonia¹ is an infection of the lungs that results in the inflammation of the pulmonary parenchyma, including the alveoli (small air sacs within the lungs), which provide oxygen to our blood.

Pneumonia not only causes inflammation of these alveoli but can also lead to fluid or pus build-up and associated decreased oxygenation, as well as the symptoms of pneumonia in adults and children, such as a cough, fever, breathlessness, or chills. 

Pneumonia is caused by various microorganisms, including bacteria, viruses, and fungi. The pneumonia of these different infectious agents in children and toddlers can differ extensively depending on many factors.

Some of these factors include the environment, such as community or hospital transmission and geographic region, as well as the toddler's age and disease state or immunity.

In children, pneumonia is the single largest infectious cause of death worldwide. It has been reported² to cause 14% of all deaths of children under five years old and 22% of all deaths in children and toddlers aged 1 to 5 years. However, in resource-rich countries, fatality rates are much lower than 1%.³

Pneumonia is an infection that can affect anyone; however, the prevalence of deaths in children and toddlers is highest in areas such as South Asia and sub-Saharan Africa. 

Although pneumonia is a disease that may never be fully prevented, ways to protect children and toddlers from pneumonia are available, such as appropriate immunizations, recognizing the early signs of pneumonia, and providing quick intervention and treatments. 

Causes and risk factors

Pneumonia is caused by several infectious microorganisms, including bacteria, viruses, and fungi. Depending on the type of bacteria, virus, or fungus, resulting pneumonia may be mild and easily treated or severe, resulting in hospitalization.

Viruses are the most common cause of community-acquired pneumonia in toddlers younger than five. More than 50% of cases are caused by viruses. The most common virus in this context is the respiratory syncytial virus⁴ (RSV). However, with the advent of SARS-CoV-2, the most common cause recently has been COVID-19 pneumonia.

From a bacterial perspective, the most common bacterial pathogen is S. pneumoniae. However, S. Aureus can also be encountered mainly subsequently to varicella or influenza infection.

Children with immune-compromised, such as those with AIDS, are at a higher risk of contracting fungal pneumonia caused by fungi such as Pneumocystis jiroveci, which is responsible for at least one-quarter of all pneumonia deaths in HIV-infected infants.

In most cases, children have no problem recovering from pneumonia and fighting the infection. However, some risk factors can put toddlers at a higher risk of pneumonia and a more serious infection. 

The risk of pneumonia is also increased in children and toddlers who live in moldy and/or overcrowded homes, who are exposed to air pollution, who have malnutrition or undernourishment, and who are exposed to secondhand cigarette smoke or have diseases such as cystic fibrosis, asthma, sickle cell disease or neuromuscular disorders.

For children at higher risk of developing pneumonia, it is therefore important to recognize the early symptoms to diagnose and treat pneumonia before the infection has a chance to worsen. Luckily for us, diagnosis is generally easy, many treatments are available, and preventative measures can be taken to dramatically decrease the risk of a serious infection. 

Signs and symptoms 

The most important way to prevent a serious pneumonia infection in your child or toddler is to ensure that your child is vaccinated. If your child gets sick, recognizing the symptoms of pneumonia and catching them as early as possible can be important, and the symptoms in younger children can be subtle. By doing so, a doctor can diagnose and prescribe a treatment plan to prevent the infection from worsening. 

Depending on the age of the toddler or child and the cause of the infection, you may observe some differences in symptoms. You or your child may notice the following signs and symptoms of pneumonia.

Very young children: 

• Fever

• Cough

• Looking pale

• Feeling lethargic

• Feeding poorly

• Crying more than normal

• Feeling irritable or restless

• Vomiting

• Breathing rapidly

Toddlers and older children: 

• For a mild infection, children may experience a dry cough; however, this may progress to a moist or wet cough

• Fever and chills

• Shortness of breath and wheezing

• Chest pains

• Abdominal pain, vomiting, and diarrhea

• Irritability and lethargy

• Lost appetite

• Flushed skin

• Nuchal rigidity (neck stiffness)

In severe cases, children may also experience hypothermia (low body temperature), unconsciousness, and convulsions.

Diagnosis

When your child first presents with symptoms of pneumonia, it is important to take them to a health professional to be diagnosed. 

Your GP will examine your toddler using a range of tests, such as a chest x-ray and a blood sample, and ask about their medical history and a proper physical examination. Once pneumonia is suspected, a treatment regime will be created for your toddler and later tailored following elucidation of the cause. 

Treatment

Depending on the cause of pneumonia as well as the severity of the infection, the treatment plan may change. 

In most cases, viral pneumonia in children does not require any specific treatment, except for antivirals against COVID-19 and influenza if and when appropriate; however, it is recommended that proper rest and hydration be maintained to help speed up the recovery process.

For toddlers with bacterial pneumonia, antibiotics are the first line of offense. The first antibiotic treatment for children is generally amoxicillin, which can be administered orally. 

If amoxicillin fails to treat bacterial pneumonia, clindamycin, linezolid, or levofloxacin may be prescribed. In worst-case scenarios, hospitalization and intensive care may be needed. Additionally, for fungal pneumonia, children may be given anti-fungal medications.

Prevention 

Preventing pneumonia in toddlers is the most important strategy to reduce child mortality. You have many alternatives for preventing pneumonia infections. The main preventative measures for viral pneumonia are immunizations, including Hib, pneumococcus, COVID-19, and whooping cough.

Additionally, adequate nutrition, a dry and clean home environment, good hygiene, and reduced household overcrowding are important strategies to reduce the risk of pneumonia in toddlers.

The lowdown 

Pneumonia is a lung infection caused by bacteria, viruses, or fungi that can cause a mild to severe illness in toddlers.

To decrease the chance of your toddler catching pneumonia, you must be able to recognize the signs and symptoms early on. This ensures that early diagnosis and intervention are undertaken before the infection develops or worsens.