What causes pneumonia ?
- Viruses – For most children and infants pneumonia is caused by viruses. These viruses infiltrate the lung tissue and cause inflammation. The influenza virus is a common cause pneumonia. There are no medications that get rid of viruses. They eventually are eliminated by the body’s own defences. Often the child will have a runny nose, runny eyes, aches and pains and a temperature. There will by a moist cough and shortness of breath.
- Bacteria – Bacteria can cause more severe tissue damage and often the child looks very unwell. Bacteria can be treated with antibiotics. Since the introduction of vaccines such as prevenar and Hib the incidence of pneumonia caused by these organisms is lessening.
- Atypical Organisms – there are several other organisms that can cause pneumonia. The most common of these is mycoplasma. The presentation is very like that of a viral infection but examination shows quite a nasty respiratory infection. Mycoplasma can be treated with antibiotics.
How is Pneumonia diagnosed ?
A child with pneumonia will be unwell, with cough, fever and shortness of breath. Occasionally there will be some chest discomfort. Sometimes the toddler of infant will be grunting between breaths. Vomiting, loss of appetite, and lethargy can also occur. When examined by a doctor the child will appear unwell, with trouble breathing (when not coughing) and the chest examination is abnormal.
A chest X ray will help confirm the diagnosis and will to rule out any serious complications. Blood tests are sometimes taken to ensure no underlying issues. In serious cases there will be fluid between the lungs and the chest wall, which sometimes needs surgical drainage.
How is it treated ?
- The child who is unwell will require hospitalisation. This will often involve an intravenous drip for medication and fluids, and oxygen if needed.
- Any infant suspected of pneumonia (less than one year of age)
- Vomiting and dehydration – unable to take medicine orally
- Need for oxygen due to trouble breathing
- For the child who does not require hospitalisation the medications can be prescribed orally. The choice depends on which organism is suspected. Amoxil, covers nearly all bacterial pneumonias. For the atypical organism such as mycoplasma doctors will use a medicine called roxithromycin or clarithromycin. Often both antibiotics are prescribed. For those children managed at home-
- Small sips of fluid to ensure adequate hydration. (Although parents worry about eating, this is not important. Children will quickly replenish when they feel better)
- Sometimes propping the child up with pillows will lessen the coughing
- Adequate panadol or nurofen to help with pain and discomfort, particularly at night
- Cough mixtures have no role and do not work.
As the child heals most of the symptoms will lessen though a cough can be present of up to 1-2 months.
Can it be prevented ?
Vaccination can protect against some organisms. The prevenar and haemophilus (Hib) injections which are given as part of the standared vaccinations will give significant protection against the most common bacteria. Annual influenza vaccination will protect against the most common influenza viruses which is a common viral cause.