Pneumonia In Children

Pneumonia is acute infection of the pulmonary parenchyma. Viral infection is common in younger children, but bacterial disease remains important, particularly with focal disease, severe illness, complications or treatment failure.

Major bacterial pathogens include Streptococcus pneumoniae, with Staphylococcus aureus and Gram negative organisms particularly important in severe or complicated disease. Risk is increased by malnutrition, HIV infection, incomplete immunization, prematurity and chronic cardiopulmonary disease.

Typical features include:

• Cough
• Fever
• Tachypnoea
• Difficulty breathing
• Lower chest wall indrawing
• Crackles
• Bronchial breathing
• Reduced feeding
• Hypoxaemia

Fast breathing thresholds in children aged 2 to 59 months:

• 2 to 11 months: ≥50 breaths/min

• 12 to 59 months: ≥40 breaths/min

Features suggesting severe disease include central cyanosis, SpO₂ below 90%, grunting, inability to feed or drink, marked respiratory distress and altered consciousness.

Pneumonia is primarily a clinical diagnosis.

Measure oxygen saturation.

Chest radiography is not routinely necessary in uncomplicated outpatient disease but is indicated when severe pneumonia, treatment failure or complications are suspected.

Consider:

• Pleural effusion or empyema
• Pneumothorax
• Cavitation or abscess
• Tuberculosis
• Foreign body aspiration
• Asthma
• Bronchiolitis
• Heart failure
• Pneumocystis pneumonia in an appropriate immunocompromised child

Blood cultures are most useful in severe or complicated disease and should not delay antibiotic administration.

Non severe pneumonia

Give:

Amoxicillin 40 to 45 mg/kg/dose PO every 12 hours.

Provide adequate feeding and fluids. Give antipyretic treatment for discomfort.

Review promptly if breathing worsens, feeding deteriorates, cyanosis develops or the child becomes less responsive.

Treatment failure requires reassessment, not automatic escalation.

Look for empyema, resistant bacterial disease, tuberculosis, HIV associated infection, foreign body aspiration, poor adherence or an incorrect initial diagnosis.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Acute Tonsillitis And Pharyngitis

Acute pharyngitis and tonsillitis are usually viral. Group A Streptococcus is the major bacterial pathogen because treatment can reduce symptom duration modestly, limit transmission and prevent suppurative and post streptococcal complications in susceptible populations.

Viral features such as cough, coryza, conjunctivitis, oral ulceration and hoarseness reduce the likelihood of streptococcal infection.

Typical bacterial pharyngitis may cause:

• Sudden sore throat
• Fever
• Painful swallowing
• Tonsillar erythema or exudate
• Tender anterior cervical lymphadenopathy
• Palatal petechiae
• Absence of cough

Scarlet fever may produce a fine sandpaper like rash and strawberry tongue.

Features suggesting deep neck infection include:

• Trismus
• Drooling
• Muffled or hot potato voice
• Unilateral tonsillar swelling
• Uvula deviation
• Neck swelling
• Torticollis
• Respiratory difficulty

Diagnosis is primarily clinical.

Clinical scoring systems such as FeverPAIN or Centor can support antibiotic decisions in older children but should not replace clinical judgment.

Routine throat swabs are not necessary for every child.

Rapid antigen testing or throat culture may be useful where confirmation would alter management.

Consider:

• Infectious mononucleosis
• Diphtheria
• Peritonsillar abscess
• Retropharyngeal abscess
• Epiglottitis
• Kawasaki disease

Most uncomplicated sore throats require:

• Oral fluids
• Analgesia
• Antipyretics

When bacterial pharyngitis is sufficiently likely or confirmed:

Phenoxymethylpenicillin PO for 10 days is a narrow spectrum first line option.

Typical dosing:

• 1 to 5 years: 125 mg four times daily or 250 mg twice daily
• 6 to 11 years: 250 mg four times daily or 500 mg twice daily
• 12 years and older: 500 mg four times daily or 1 g twice daily

A full 10 day course gives greater microbiological eradication than shorter treatment.

For penicillin allergy:

Clarithromycin 7.5 mg/kg PO twice daily for 5 days, maximum according to age and weight.

Peritonsillar abscess requires ENT review, IV antibiotics and drainage where indicated.

Retropharyngeal or parapharyngeal abscess requires urgent imaging and ENT management.

Pneumonia In Children

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management