Pneumonia in children

According to the World Health Organisation (WHO), pneumonia accounts for 15% of all deaths of children under 5 years old

Pneumonia is a form of acute lower respiratory tract infection that occurs when viruses, bacteria, or other micro-organisms cause inflammation of the lungs. When a patient has pneumonia, pus and fluid fill the alveoli in one or both lungs, which interferes with oxygen absorption, making it difficult to breath.

TYPES OF PNEUMONIA

• Bacterial pneumonia is caused by various bacteria. The most common is streptococcus pneumoniae which occurs when the body is weakened in some way, such as illness, poor nutrition, or impaired immunity, and the bacteria can work their way into the lungs.

• Viral pneumonia is caused by different viruses including influenza (flu) and is responsible for about one-third of all pneumonia cases.

• Mycoplasma pneumonia has somewhat different symptoms and physical signs to other types of pneumonia and is sometimes referred to as “walking pneumonia” since symptoms tend to be milder than pneumonia caused by other germs. Caused by the bacterium mycoplasma pneumoniae, it generally causes a mild, widespread pneumonia that affects all age groups.

CAUSES

Most cases of pneumonia follow a viral respiratory tract infection. Pneumonia is typically caused by a virus or bacteria. Infection can be passed between people from direct contact (usually the hands) or inhaling droplets in the air from coughing or sneezing.

If a viral infection has weakened a child’s immune system, bacteria may begin to grow in the lungs, adding a second infection to the original one. Certain children whose immune defences or lungs are weakened by other illnesses – such as cystic fibrosis, abnormalities in the immune system, or cancer – may be more likely to develop pneumonia.

TRANSMISSION

Pneumonia can be spread in several ways. The viruses and bacteria that are commonly found in a child’s nose or throat, can infect the lungs if they are inhaled. They may also spread via airborne droplets from a cough or sneeze. Early onset pneumonia can be acquired from the mother during labour or delivery, with respiratory distress beginning at, or soon after birth. Because signs of pneumonia are non-specific in neonates, any newborn infant with sudden onset respiratory distress or other signs of illness should be assessed for pneumonia and sepsis.

WHY ARE CHILDREN VULNERABLE?

A healthy child has many natural defences that protect its lungs from the invading pathogens that cause pneumonia. However, children and infants with compromised immune systems have weakened immune defences. Undernourished children, particularly those not exclusively breastfed or with inadequate zinc intake are at a higher risk of developing pneumonia. Similarly, children and infants suffering from other illnesses, such as AIDS or measles, are more likely to develop pneumonia. Environmental factors, such as living in crowded homes and exposure to parental smoking or indoor air pollution, may also have a role to play in increasing children’s susceptibility to pneumonia and its severe consequences.

DIAGNOSIS

Pneumonia can be diagnosed in several different ways. Healthcare providers can diagnose pneumonia by the symptoms (in resource-poor settings), a physical examination or by ordering diagnostics. Laboratory tests can include chest X-rays and cell cultures to look for pathogenic bacteria in the infected part of the body. Usually, there should be a combination of clinical, radiological, and laboratory findings to increase the likelihood of correct diagnosis. Healthcare providers can diagnose many cases by using a stethoscope or observe a child’s respiratory rate and any breathing problems.

COMPLICATIONS

Most children affected by pneumonia recover without any long-term difficulties. However, there are several potential complications including:

• Septicaemia is the most common pneumonia complication and occurs when the bacteria causing pneumonia spreads into the bloodstream. The spread of bacteria can lead to septic shock or metastatic secondary infections like meningitis, especially in infants.

• Pleural effusion injury to the lung due to an infection can lead to increased capillary permeability and accumulation of fluid in the pleural space. Pleural effusion should be considered if a child does not respond to 48-hour treatment with intravenous antibiotics.

• Lung abscesses are thick-walled cavities containing purulent material that are the result of acute destruction of the lung following inflammation, necrosis, and cavitation. They are rare and mostly seen in children with respiratory co-morbidities or neurodevelopment abnormalities.

• Atelectasis is caused due to obstruction of air passages by presence of foreign bodies, mucus plugs, or tumours within the airways/in the wall of the airways.

PREVENTION

Pneumonia kills more children than any other illness. Any efforts to improve overall child survival must make the reduction of pneumonia’s death toll a priority. Preventing children from developing pneumonia in the first place is essential to reducing child deaths.

Key prevention measures include:

• Immunisations help reduce childhood deaths from pneumonia in two ways. First, vaccinations help prevent children from developing infections that directly cause pneumonia such as Haemophilus influenza type b (Hib). Second, immunisations may prevent infections that can lead to pneumonia as a complication (e.g. measles and pertussis).

• Adequate nutrition: Undernourished children areat a substantially higher risk of suffering childhood death or disability. Malnutrition weakens a child’s overall immune system, as adequate amounts of protein and energy are needed for proper immune system functioning. Undernourished children also have weakened respiratory muscles, which inhibits them from adequately clearing secretions found in their respiratory tract

• Exclusive breastfeeding: It is widely recognised that children who are exclusively breastfed develop fewer infections and have less severe illness than those who are not.

• Zinc: Children who lack sufficient amounts of specific micronutrients, particularly zinc, face additional risks of developing and dying from pneumonia. PM

SIGNS ANDSYMPTOMS

Children with pneumonia may have a range of symptoms depending on their age and the cause (bacterial or viral) of the infection.

Common symptoms of pneumonia in children and infants include:

• Rapid or difficulty breathing

• Cough

• Fever

• Chills

• Headache

• Loss of appetite

• Wheezing

Children under five with severe cases of pneumonia may struggle to breathe, with their chests moving in or retracting during inhalation(known as ‘lower chest wall indrawing’). Infants may suffer convulsions, unconsciousness, hypothermia, lethargy, and feeding problems.

TREATMENT

Treating pneumonia depends on its likely cause and how ill the child is. The usual approach is to give antibiotics effective against bacterial and mycoplasma pneumonia. There is no clearly effective treatment for viral pneumonia, which usually resolves on its own.

Other treatment may include:

• Appropriate diet

• Increase fluid intake

• Enough rest

• Cool mist humidifier in the child’s room

• Nebulizer treatments

• Acetaminophen (for fever and discomfort)

• Medication for cough