Pneumonia

Dr. Sears Guide to Identifying If Your Child Could Have Pneumonia

Your child has been coughing for several days. The cough then becomes deeper and junkier, and he starts having fevers. He (and you) are up all night, and cough medicine doesn’t seem to be helping. You begin to worry, “Could my child have pneumonia?”

You hear a child at school was diagnosed with pneumonia. Your own child has had a bit of a cough lately. You wonder just how contagious is pneumonia? Could your child have it?

These are very common situations. There is really no good way for any parent to tell if their child has pneumonia. However, there are many ways to tell if your child probably does NOT have pneumonia. Here is the Dr. Sears guide.

WHAT IS PNEUMONIA?

Pneumonia is an infection inside the lungs. It occurs when either bacteria or viruses get stuck in the lungs – the germs multiply and form an infected area. The most common bacterium is called pneumococcus (the new vaccine Prevnar protects against this). There are several viruses that can cause it.

HOW DOES PNEUMONIA OCCUR?

It occurs during the course of any normal cough or cold. The mucus secreted in the lungs is a great breeding ground for bacteria and viruses. Over several days, the germs multiply enough to create an infected pocket of mucus and pus. That is why our lungs are designed to cough during an illness – to cough out the pockets of mucus before an infection sets in.

WHAT ARE THE SYMPTOMS OF PNEUMONIA?

The major symptoms are:

Moderate to severe cough – often junky sounding, but not always.
Sustained rapid or labored breathing (as opposed to temporary rapid breathing from a high fever).
Medium to high fever – usually will be over 102, but not always.
Chest pains – not just during coughing, but in between coughing fits as well.
Vomiting – not just vomiting from a big coughing fit, but vomiting even in between coughing fits.
Blue color around the lips and face – from lack of oxygen.
Wheezing – although wheezing is more often a sign of a viral chest cold, it sometimes can mean pneumonia.

HOW DO I DECIDE IF MY CHILD MAY HAVE PNEUMONIA?

If your child has ALL the above symptoms, then he probably has pneumonia.
If your child has only one or two symptoms, then he probably does NOT have it.
The most important indicators are the first three above – cough AND fever AND labored or rapid breathing.
For example, if your child has a bad cough, fever, and mild chest pain with coughing, but is breathing comfortably without pain when not coughing, then pneumonia is less likely.
If your child has a bad cough with some fits ending in vomiting, but has NO FEVER, then pneumonia is less likely.

WHEN TO WORRY AND CALL YOUR DOCTOR

If your child has ALL the above symptoms with rapid or labored breathing, but IS NOT BLUE on the lips or face, then you should call the office to be seen immediately if it is daytime office hours, or page your doctor after hours.
If your child has the above symptoms and his lips or face ARE BLUE colored, you should go to an ER immediately (don’t even bother paging your doctor). Your child probably needs oxygen.
There is no need to page your doctor after hours if your child has the above symptoms, but does NOT have rapid or labored breathing, and is NOT blue colored. This can probably wait until normal office hours the next day. If it will be one or two days before the office is open, then page your doctor (not overnight) to discuss the situation.
ABOVE ALL, if you are not sure, you should contact your doctor.

WHAT ARE THE TREATMENTS?

Antibiotics – these are usually used to help fight the bacterial infection. However, some pneumonia is caused by a virus, in which case antibiotics are not helpful. Only your doctor can decide if it is bacterial or viral.
Chest pounding (percussion) therapy – this is VERY IMPORTANT. Four to six times each day, take your child into the bathroom with the hot shower on and let him breathe the steam for 10 minutes. Use your cupped hand to firmly clap on your child’s chest, concentrating on the area that the pneumonia is. Pound rapidly for one minute, then rest a minute, then continue again on and off for ten minutes. This will shake the mucus and pus pocket loose so your child can cough it up. Encourage coughing during this time.
Cough medicine – do not suppress the cough during the day. Your child needs to cough it up. You can use an expectorant (to loosen the mucus stuck in the chest) during the day. At night (or during the day if your child is miserable from coughing) you can use a combination expectorant and cough suppressant if your child is coughing a lot. If the cough is not too frequent, then don’t use a suppressant.Click here for more help with cough medicines

DOES MY CHILD NEED TO BE HOSPITALIZED?

Usually not. Most cases get better with antibiotics by mouth at home. If your child, however, is blue or has rapid or labored breathing, he may need to stay in the hospital for a day or two on IV antibiotics and oxygen until he is well enough to go home on antibiotics by mouth.

IS PNEUMONIA CONTAGIOUS?

Yes it is, but it is LESS contagious than most people think. The cold virus that started the cough in the first place is contagious. But the pneumonia part of the illness down in the lungs is far less contagious. People who are exposed to someone with pneumonia may catch the normal cough and cold symptoms of the virus, but usually don’t progress to pneumonia. The formation of the pneumonia is not determined by the particular cold virus or bacteria that the person has, but rather by each person’s susceptibility in their own lungs.

Therefore, just because someone in your house or school has pneumonia and is on antibiotics, does NOT mean everyone else in the vicinity with a cough has pneumonia. Wait and see how the illness progresses before asking your doctor for antibiotics.

WHAT IS WALKING PNEUMONIA?

This is simply a milder case, where the child does not appear as sick. When the doctor hears pneumonia in the chest, but the child is acting fine, with almost no other symptoms of pneumonia, then it may be walking pneumonia. Your child has it, but is well enough to “walk around” with it.

DO ONLY CHILDREN WITH A WEAK IMMUNE SYSTEM CATCH PNEUMONIA?

No. Anyone can catch it, but children with weaker immune systems or lung problems are more susceptible.

IS MY CHILD MORE LIKELY TO CATCH IT AGAIN IF HE HAS IT ONCE?

For a few months your child is more susceptible, but after this time, his risk is similar to anyone else.

IS THERE A VACCINE FOR PNEUMONIA?

Yes. The most common cause of pneumonia in infants and children is the pneumococcus bacteria. Prevnar is a new vaccine released in 2000 that prevents infections from this bacteria. Pneumococcus can also cause meningitis, blood infections and ear infections. This is therefore a very important vaccine and is now part of the routine infant vaccination schedule. Click here for a complete discussion on what to do for normal colds and coughs.