Key points to remember about pneumonia

• pneumonia is an infection of the lungs
• pneumonia causes cough, fever and problems with breathing
• viruses and bacteria can both cause pneumonia
• viral pneumonia is more common in children
• most children make a complete recovery from pneumonia
• if you are worried about your child's breathing, you should see a doctor

What is pneumonia?

Immunisation helps to prevent some serious causes of pneumonia.

Pneumonia is an infection of the lungs. It often affects only part of the lungs. 

What causes pneumonia?

A smoke-free environment lowers the chance of your child getting pneumonia.

Viruses and bacteria can both cause pneumonia.

In children, especially young children, viral pneumonia is more common.

It can be difficult to tell whether the pneumonia is due to a virus or bacteria.

Can you catch pneumonia?

Yes, you can catch the viruses that cause viral pneumonia - they can spread easily between people. Most children and adults with a virus just get a cold. Only a few will get pneumonia. Viral infections, including viral pneumonia, are more common in winter.

Bacterial pneumonia does not usually spread between people.

Because it's difficult to tell whether pneumonia is viral or bacterial, it is wise to keep your child with pneumonia away from others.

What puts my child at risk of getting pneumonia?

Anyone can get pneumonia, but some children are more likely to than others. A child will be at greater risk of getting pneumonia if they:

• are very young
• are around cigarette smoke
• haven't had their immunisations
• have a long-lasting condition that affects the lungs (such as bronchiectasis [1] or cystic fibrosis)
• are taking a medicine that affects the infection-fighting (immune) system
• were a premature baby
• have feeding problems, such as food or liquid going down the wrong way, into the lungs (aspiration) 
• have other long-lasting medical problems

What are the signs and symptoms of pneumonia?

Check the signs that show your child is struggling to breathe [2]

Pneumonia causes cough, fever and trouble with breathing. Breathing problems include:

• breathing faster than usual
• noisy or rattly breathing
• difficulty with feeding
• making a grunting sound with breathing
• putting a lot of extra effort into breathing

Your child with pneumonia is usually very tired and looks unwell.

Viral pneumonia

Viral pneumonia usually develops over days. It starts with a cold and a runny nose. Then there is a cough, and sometimes fever, before breathing problems develop.

Bacterial pneumonia

Bacterial pneumonia usually develops faster, over a day. It causes high fever, a cough, and breathing problems. Your child may be very tired and look quite unwell.

Sometimes bacterial pneumonia develops during a viral infection. If this happens, your child will usually have a cold for a few days, and then become more unwell quite quickly.

When should I seek help for my child with pneumonia?

If you are worried that your child may have pneumonia, you need to see a doctor.

When do I need to see a doctor urgently?

You should see a doctor urgently if your child:

• is under 3 months old
• is breathing fast, has noisy breathing and is having to use extra effort to breathe
• is having less than half their normal feeds
• looks pale and unwell
• doesn't seem to be getting better from a mild illness
• suddenly gets worse after beginning to get better

When should I dial 111?

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your child:

• has blue lips and tongue
• has severe difficulty breathing
• is becoming very sleepy and not easy to wake up
• is very pale
• is floppy
• has periods of irregular breathing or pauses in breathing

How is pneumonia diagnosed?

Your family doctor can usually diagnose pneumonia in your child after listening to their chest. Sometimes, they may arrange a chest x-ray which will usually show the pneumonia.

If your child looks very unwell, and especially if they're very young, your doctor may ask you to take them to hospital.

What is the treatment for pneumonia?

Your doctor will give antibiotics to your child if they have bacterial pneumonia. Doctors may use antibiotics when it is not clear whether your child's pneumonia is viral or bacterial. If your child is young or sick enough to be in hospital, they will often have antibiotics by a drip (into a vein) [3].

They may also need support with their breathing and feeding. A small number of children who are extremely unwell with pneumonia need more intensive hospital treatment.

How can I care for my child with pneumonia at home?

If your child is miserable because of pain or fever, you can give paracetamol to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

Your child will need rest to help them recover from pneumonia. Encourage them to drink fluids and eat healthy small meals.

If your doctor has given your child antibiotics, make sure they take all the doses until finished.

It is wise to keep your child with pneumonia away from other children, to limit the spread of infection.

How long does pneumonia last?

If your child is still coughing after 4 weeks, go back to your doctor.

A child usually takes a couple of weeks to fully recover. Over that time the infection-fighting (immune) system will be cleaning up the pneumonia. Coughing up phlegm is part of the cleaning up process. The cough may last up to 4 weeks but should gradually be getting better over this time.

You should take your child back to your doctor if:

• you are worried that the cough is getting worse again
• the cough has not stopped after 4 weeks
• your child is still coughing up phlegm after 4 weeks
• your child has had pneumonia 3 or more times

A long-lasting cough, coughing up phlegm, or repeated pneumonia can be a sign of bronchiectasis [4]. This is a type of scarring in the lungs.

Are there likely to be any complications from pneumonia?

Most children make a full recovery from pneumonia. They do not have any lasting effects.

A small number of children may need specialised treatment for complications. A very small number of children may get very sick.

How can pneumonia be prevented?

Breastfeeding

Breastfeeding your baby protects them from getting pneumonia by boosting their infection-fighting (immune) system. Breastfeeding beyond 4 months of age offers the best protection.

Smoke-free environment

Make sure your child's environment is smoke-free. This will help reduce the chance of your child getting pneumonia. If you want to give up smoking:

• call the free Quitline on 0800 778 778 or text 4006
• check out the Quitline/Me Mutu website [5]
• ask your health professional

Immunisation

Immunisation helps to prevent some serious causes of pneumonia, in particular, immunisation against the following diseases:

• pneumococcal disease
• whooping cough (pertussis) [6]
• Hib (Haemophilus influenzae type b)
• flu [7]

Treatment for long-lasting conditions

Make sure your child keeps up with their treatment for any long-lasting (chronic) conditions such as asthma.

A warm house

Keeping the house warm and well-insulated will also decrease your child's risk of developing pneumonia.

Read about keeping your home warm and dry [8]

Clean hands

Make sure everyone in your family washes their hands regularly and thoroughly, and dries them well including (but not only) before preparing food and eating. 

Balanced diet and healthy weight

Make sure your child has a healthy balanced diet and maintains a healthy weight. Being underweight or overweight can increase your child's risk of getting pneumonia.