Pneumonia: A-to-Z Guide from Diagnosis to Treatment to Prevention

PneumoniaIntroduction to pneumonia:

The word “pneumonia” sounds alarm bells in many parents. It is understandably disturbing because some pneumonias are quite serious, particularly in those whose immune systems are vulnerable (newborns, the elderly, and people with HIV). The good news is that the great majority of pneumonias in children and adolescents are mild or easily treatable at home.

What is it?

Bronchiolitis, bronchitis, and pneumonia are all words that denote the location in the body of a problem. Bronchiolitis refers to inflammation in the bronchioles, the smaller airways that branch off from the main bronchi or breathing tubes. Bronchitis is inflammation in these larger, main breathing tubes. Pneumonia refers to inflammation of the lungs themselves.

A variety of viruses, bacteria, and other organisms can cause pneumonia. Not all pneumonias, however, are infections. GE reflux, foreign bodies, smoke inhalation, or harsh fumes can all cause pneumonias as well.

Who gets it?

Children who are exposed to inhaled irritants, such as tobacco smoke or toxic fumes, are at a higher risk of developing pneumonia.

Most kids who get pneumonia have a cold or other viral upper respiratory infection first. For this reason, most pneumonia occurs during cold and flu season. The respiratory viruses interfere with the lungs’ normal defense mechanisms. The same viruses (adenovirus, RSV, influenza, parainfluenza [croup]) can spread into the chest. Alternatively, pneumonia-causing bacteria can invade the lungs (pneumococcus, streptococcus, staphylococcus, Haemophilus influenzae).

Other childhood viral infections such as chickenpox, measles, rubella, herpes, and mono can cause pneumonia directly.

Viral pneumonias are fairly common. They peak during the toddler years, and become a bit less common each year.

Bacterial pneumonias are less common. Most occur in children with cystic fibrosis or an underlying immune problem.

All children who get two or more pneumonias within one year should have their immune system and lung anatomy evaluated by their doctor, to ensure they have no underlying illness putting them at greater risk for pneumonias.

What are the symptoms?

Viral pneumonias usually begin with several days of cold symptoms, especially a runny nose and a cough. The cough deepens, the breathing speeds up, and the child acts sicker. There may be signs of respiratory distress, including flaring of the nostrils or retractions (pulling in on the muscles between the ribs) with breathing. There is often wheezing and a fever.

Bacterial pneumonias often start suddenly with shaking chills, a high fever, a cough, and signs of respiratory distress. Sometimes they begin more gradually or mildly.

Is it contagious?

Most pneumonias are contagious.

How long does it last?

The length of the pneumonia depends on the specific organism causing it. Some pneumonias last as little as several days, although two to three weeks is more common. The cough can last even longer.

How is it diagnosed?

The diagnosis is usually based on history, physical examination, and chest x-ray. If a bacterial pneumonia is suspected, appropriate cultures of the sputum and blood are also important.

How is it treated?

Children with bacterial pneumonias need a full course of the appropriate antibiotics. Most children with viral pneumonias do not need antibiotics or specific anti-viral medicines.

All those with breathing difficulties should have the level of oxygen in their blood measured and should receive breathing support, which might include oxygen or nebulized bronchodilator medications (such as albuterol).

Generally, cough suppressants are not wise during pneumonia. The body needs the cough to protect the lungs. We all know how difficult it is to have a child blow his nose to clear mucus from his body. A child’s cough is a powerful tool for moving mucus and clearing an infection from the lungs.

How can it be prevented?

Breastfeeding and avoiding exposure to unhealthy smokes and fumes help prevent pneumonias.

Vaccines are available against some common pneumonias, including pneumococcal, Haemophilus influenza (HIB), measles, and the flu.

Beyond this, the same measures proven to help prevent colds and other upper respiratory infections can also prevent many pneumonias.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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