After a week of cold symptoms in their child, parents are frequently come to my office concerned that the child might have  pneumonia. Most often in these cases, children do not have pneumonia -- but occasionally they do.

Dr. Heather McLean, a pediatric hospitalist at Duke, tells us how you might be able to tell the difference between a cold and pneumonia.

-- Dennis Clements, MD, PhD, MPH

What Is Pneumonia?

Heather S. McLeanPneumonia is an infection of the lungs that may be caused by a variety of microorganisms (germs) such as viruses and bacteria. Infrequently, these infections can start as an upper respiratory illness (cold) and then develop into pneumonia a few days later.

Pneumonia is a common and possibly very serious infection that occurs in children throughout the world. In children less than five years of age, the annual incidence of pneumonia in our country is between 34 to 40 cases per 1,000. The good news is that most children are easily treated by their health care provider and can remain at home.

Some common signs and symptoms of pneumonia may include, fever, cough, chest pain, fast breathing, fatigue, vomiting, abdominal pain, or a poor appetite. You should call your child’s doctor or health care provider if you suspect your child has any of the signs and symptoms of pneumonia.

Diagnosis and Treatment

Your child’s health care provider can diagnose your child with pneumonia based on symptoms and physical examination usually. Additional tests such as a chest x-ray or blood tests are sometimes performed to help make the diagnosis.

Most of the time, your child may be treated at home with oral antibiotics. Antibiotics are given to treat bacterial causes of pneumonia. The choice of antibiotic will depend on many factors such as the age of your child, her symptoms, medical health history, or allergies to medicines. If a virus is determined to be the cause of the pneumonia, then antibiotics are generally not used.

If your child has been given an antibiotic, you should give the medicine on schedule for as long as directed. You should encourage your child to drink fluids, especially if she has a fever. Do not force a child to eat but continue to encourage eating healthy foods if she feels up to it.

Cough and cold medicines will not help your child recover and are not recommended. Treating your child’s fever with ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) may help them feel better.

Children with pneumonia occasionally require hospitalization if they:

• Require supplemental oxygen therapy
• Are vomiting and can’t keep their medicine down or become dehydrated
• Have a severe case with rapid or labored breathing or sepsis (bloodstream infection)
• Have other medical problems including those that affect the immune system
• Are young, such as babies under three months of age
• Have gotten worse despite treatment at home with oral antibiotics
• Have recurrent (repeated) episodes of pneumonia

Your child will be discharged home to complete the antibiotics once she has improved and no longer requires more intensive therapies such as oxygen and intravenous fluids.

Complications

Rarely children with pneumonia develop a “complex pneumonia” or pneumonia with an effusion with some types of infection. An effusion is a fluid collection that develops between the lung and chest wall.

If this fluid turns into an empyema (pus), then your child may require an operation to remove the fluid and place a chest tube, so she can get better in addition to the antibiotics already being given.

Prevention

Most causes of pneumonia are not contagious -- although the upper respiratory viruses (cold viruses) that lead to them are.

Here are some tips to prevent the spread of infection to other people:

• Wash your (and your child’s) hands frequently especially after coughing or sneezing.
• Avoid sharing cups and eating utensils.
• Avoid exposing your child to cigarette smoke, as tobacco can damage your child’s lung and ability to ward off infection.
• Give your child immunizations (shots) that prevent common causes of pneumonia such as Hib (Haemophilus influenzae type b), Prevnar (Streptococcus pneumoniae), and the yearly influenza vaccine.

-- Heather S. McLean, MD, is a pediatric hospitalist in Duke's Department of Pediatrics.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.