Recurrent Pneumonia in Children

Recurrent Pneumonia in children is an illness that consists of repeated or frequent episodes of pneumonia. Before discussing causes and treatment of recurrent pneumonia in children, it is important to understand pneumonia and how it develops.

Pneumonia in Children

Pneumonia is a general term that refers to lung infections causing inflammation of the air sacs.  Bacteria, fungi, parasites or most commonly viruses can cause pneumonia in children. Pneumonia typically starts after a child has a cold, flu or upper respiratory infection. For most healthy children, pneumonia clears up in 2 or 3 weeks, but in some cases, children become very ill and require hospitalization. For children with weakened immune systems or other health conditions, pneumonia can be a very serious illness.

Causes of Pneumonia in Children

Pneumonia in children typically begins after an upper respiratory tract infection, a cold or flu and can be caused by any of the following:

• Viruses: The same viruses that cause colds and flus can cause pneumonia. Viruses are the most common cause of pneumonia in children under 5 years of age. In general, viral pneumonia is mild, but it can become serious. Viruses include adenovirus, rhinovirus, Influenza virus, respiratory syncytial virus (RSV), Human metapneumovirus, parainfluenza virus.
• Bacteria: Bacteria can cause pneumonia after a cold or flu or on it’s own. Streptococcus pneumonia is the most common bacterial cause of pneumonia in the US.
• Fungi: Pneumonia caused by fungi is more commonly seen in children with weakened immune systems or who have inhaled large amounts of organisms.

Symptoms of Pneumonia in Children

Symptoms of pneumonia in children vary greatly and depend on a child’s age, overall health, cause of the infection, type of pneumonia, and even location of pneumonia in the lung. For example, if pneumonia is caused by bacteria, severe symptoms may come on quickly. When a virus is the cause, pneumonia symptoms typically develop more gradually. Milder symptoms of pneumonia in children are similar to a cold or flu and include:

• Fever
• Chills
• Cough
• Fatigue
• Nausea or vomiting
• Shortness of breath

Risk factors for Pediatric Pneumonia

• Children under 2 years of age
• Chronic disease
• Asthma
• Weakened immune system: Children who have received an organ transplant, have HIV, have had chemotherapy or long-term steroids.
• Hospitalization

Complications of Pneumonia in Children

• Breathing difficulty: Pneumonia in children with chronic lung disease such as asthma can make it very difficult for a child to breathe and take in enough oxygen.
• Fluid accumulation around the lungs (pleural effusion): Pneumonia can cause fluid to accumulate in the space between the tissue lining of the lungs and chest cavity (pleura). The fluid can potentially become infected and need to be drained through surgery or a chest tube.
• Bacteria in the bloodstream (bacteremia): Bacteria from the lungs can enter the bloodstream and spread the infection to other organs.
• Lung abscess: When pus forms in a cavity of the lungs, it is known as a lung abscess and requires antibiotics and sometimes drainage.

Recurrent Pneumonia in Children

Pneumonia can be a serious illness, recurrent pneumonia is a concerning and potentially dangerous condition in children. Recurrent pneumonia is defined as 2 or more episodes of pneumonia in a year or 3 episodes ever separated by an asymptomatic period of a month or clear chest X-rays. Recurrent pneumonia in children typically has underlying causes.

Underlying Causes of Recurrent Pneumonia in Children

Most children with correctly identified recurrent pneumonia have a known predisposing factor. Some of theses factors and underlying medical conditions include:

• Aspiration Syndrome was the most common underlying cause in children with recurrent pneumonia
• Pulmonary anomalies and structural abnormalities
• Immune disorders and immunological abnormalities
• Congenital Heart Defects
• Gastroesophageal Reflux (GERD)
• Sickle cell anemia
• Asthma
• Hypersecretory Asthma: excess production of bronchial secretions
• Bronchiectasis: Causes of bronchiectasis include cystic fibrosis, primary ciliary dyskinesia, immunodeficiency, retained foreign body and recurrent aspiration

Diagnosing Pneumonia and Chronic Pneumonia in Children

If pneumonia is suspected after listening to your child’s lungs with a stethoscope, your doctor will likely order some of the following pulmonary tests:

• Chest X-ray: The presence of pneumonia and the location of pneumonia in the lung can been see on X-ray.
• Blood test:  A blood test can detect the presence of infection and sometimes indicate the cause of the pneumonia.
• Sputum test: This test can also help determine the cause by taking a sample of fluid from the lings (sputum).
• Pulse oximetry: If your child is having difficulty breathing, this test can be used to determine if the child is getting enough oxygen.

Treatment of Pneumonia Recurrent Pneumonia in Children

Type of treatment depends on the cause of pneumonia, severity of infection and age of child. Medication, both prescription and over the counter, is typically the most effective treatment.

• Antibiotics: Antibiotics are medications that treat infections and are used to treat bacterial pneumonia.
• Over the counter (OTC) medications: Medications such as ibuprofen (Advil) and acetaminophen (Tylenol) are used to reduce a child’s fever.
• Hospitalization: Children may need to be hospitalized for more intense treatment if they have a rapid heat rate, rapid breathing, having difficulty breathing, have a low temperature, a––re dehydrated, younger than 2 months old.

Treatment of recurrent pneumonia is typically aimed at treating the pneumonia itself since symptoms and complications are an immediate concern in children. Treatment typically follows the same course as single episodes of pneumonia with medications. Because underlying medical conditions usually exist, it is imperative to identify these conditions, assess risks and possible complications and tailor treatment accordingly.  Once the pneumonia has resolved, treatment of the underlying cause may be necessary.

Board certified pediatric pulmonologists;  Dr. Peter Schochet and Dr. Hauw Lie are dedicated to the care of infants, children and adolescents with acute or chronic respiratory disorders like recurrent pneumonia.

For more information about pediatric respiratory disease please submit an online appointment request or contact the office of Dr. Peter N. Schochet and Dr. Hauw Lie at 972 981 3251.