Peds

Pneumonia in Children

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Pneumonia in Children, Pediatric Pneumonia

  • Epidemiology
  1. Incidence
    1. Worldwide: 155 million cases annually (and 2 million deaths under age 5 years)
  • Causes
  1. See Pneumonia Causes in Children
  2. Viral Pneumonia accounts for 80% of cases in under age 2 year old children
  • History
  1. Age suggests cause and management
  2. Immunizations deficient
    1. Streptococcus Pneumoniae
    2. HaemophilusInfluenzae
    3. Pertussis
  3. Recent hospitalizations
    1. Nosocomial Pneumonia
  4. Day care attendance
    1. Viral Pneumonia
  5. Contagious contacts
    1. Viral Pneumonia
    2. Mycoplasma pneumonia
    3. Tuberculosis
  6. Travel
    1. Influenza
    2. Severe Acute Respiratory Syndrome (Asia)
    3. Fungal Infection
      1. Blastomycosis
      2. Coccidioidomycosis (Southwestern U.S.)
      3. Histoplasmosis (Ohio and Mississippi River Valleys)
  7. Recent antibiotics
    1. Consider Antibiotic Resistance (e.g. PRP)
  8. Comorbid conditions
    1. Cardiopulmonary disease (e.g. Cystic Fibrosis)
    2. Immunodeficiency (e.g. Asplenic)
    3. Neuromuscular Disease
  9. Possible Ingestion
    1. Foreign Body Aspiration
    2. Toxin Ingestion
  • Risk Factors
  1. Young age
  2. Male gender
  3. Tobacco exposure
  4. Pollution exposure
  5. Child care attendance
  6. Malnutrition
  7. Immunodeficiency
  8. Anatomical airway anomalies
  9. Underlying metabolic disorders
  • Precautions
  1. Occult Pneumonia should be considered in the following cases
    1. Fever for more than 5 days (especially if over 39 C)
    2. Leukocytosis with White Blood Cell Count over 20,000
    3. Abdominal Pain (more common presentation in age under 5 years)
  • Symptoms
  1. Respiratory symptoms (see signs below)
  2. Lethargy
  3. Irritability
  4. Decreased oral intake
  5. Dehydration (e.g. decreased Urine Output)
  6. Vomiting
  7. Diarrhea
  8. Abdominal Pain
  • Signs
  1. Pneumonia unlikely without fever and Tachypnea
    1. Consider Chlamydia trachomatisPneumonia in under age 3 weeks if affebrile with Staccato Cough
    2. Consider Mycoplasma pneumonia in older children with malaise, Sore Throat, fever and indolent course
  2. Findings highly suggestive of Pneumonia
    1. Fever
      1. More commonly >101.3 F in Bacterial Pneumonia
    2. Cyanosis
    3. Respiratory distress (one or more of the following)
      1. Respiratory Distress in Children with Pneumonia
      2. Tachypnea
        1. Absence of tachpnea when fever is present has strong Negative Predictive Value
        2. Tachypnea is common with fever and therefore has poor Positive Predictive Value
      3. Cough
      4. Nasal flaring
      5. Intercostal retractions
      6. Grunting
      7. Rales
      8. Decreased breath sounds
  • Differential Diagnosis
  • Labs
  • Efficacy
  1. Tests that are helpful
    1. Rapid viral antigens
      1. Influenza Immunoassay
      2. RSV Test
        1. Not indicated in classic presentations (obtain if unclear diagnosis)
    2. Oxygen Saturation (if respiratory distress)
  2. Tests helpful in severe cases (low yield if moderate)
    1. Gram Stain
    2. Blood Culture
  3. Tests possibly useful in retrospect (identify outbreak)
    1. Mycoplasma pneumoniae titer
    2. Chlamydia pneumoniae titer
  4. Tests which are usually not helpful for diagnosis
    1. Complete Blood Count (CBC)
    2. C-Reactive Protein (CRP)
    3. Erythrocyte Sedimentation Rate (ESR)
  1. Indications
    1. Inpatient
    2. Unclear diagnosis
    3. Prolonged Pneumonia or not responding to antibiotics after 48 to 72 hours of treatment
    4. Pneumonia complications
  2. Findings
    1. Lobar consolidation
      1. More common in Bacterial Pneumonia
      2. May be seen in viral pneumona
    2. Interstitial Infiltrates
      1. More common in Viral Pneumonia
      2. May be seen in Bacterial Pneumonia
  3. Precautions
    1. Chest XRay does not differentiate virus from Bacteria
    2. Chest XRay may be normal in early Pneumonia
    3. Chest XRay may be abnormal for 3-6 weeks after diagnosis
  1. See Pneumonia for other complications
  2. Indications for drainage
    1. Symptomatic
    2. Pleural Effusions >10 mm on lateral XRay
    3. Pleural Effusion >1/4 of hemithorax