Pneumonia in children: breathing signs, treatment and recovery

NHS inform explains that clusters of tiny air sacs in the lungs become inflamed and fill with fluid in pneumonia, and that symptoms can develop suddenly over 24 to 48 hours or more slowly over several days. It is more widespread in autumn and winter. Most children with a cough and runny nose have a simple cold, but NHS inform notes that pneumonia can be difficult to diagnose because its symptoms resemble the common cold, bronchitis and asthma.

The NHS says pneumonia is usually caused by a bacterial or viral infection, and can follow another infection such as flu, RSV or COVID-19. NHS inform says pneumococcal bacteria are a common cause overall, and that viruses are a common cause of pneumonia in young children. Pneumonia is not usually passed from person to person in the way a cold is, says NHS inform, so it is safe to be around the child, though people with weakened immunity should avoid close contact until the child starts to get better.

The NHS lists a cough, shortness of breath, high temperature, chest pain, aching body, tiredness, loss of appetite and wheezing, adding that babies may also make grunting noises. NHS inform adds that a GP may ask whether the child feels breathless, is breathing faster than usual, how long the cough has lasted, whether mucus is coming up and its colour, and whether chest pain is worse breathing in or out, and will listen to the chest with a stethoscope.

For breathing in children generally, NHS inform describes signs that a child is working harder to breathe: sucking in the stomach under the ribcage, sucking in at the middle of the neck above the collarbone (tracheal tug), grunting and see-saw breathing. It adds that babies breathe faster than adults, that a newborn may pause briefly for a few seconds, and that a baby too breathless to feed needs medical attention.

The NHS says to ask for an urgent GP appointment or get NHS 111 help if there has been a cough for up to 3 weeks, mucus is yellow or green, chest pain comes and goes or happens with breathing or coughing, or there is shortness of breath. It says to call 999 or go to A&E if someone is struggling to breathe, choking, gasping and unable to speak, has pale, blue or blotchy skin, lips or tongue, is coughing up blood, suddenly feels confused, or if you cannot wake your baby or they feel floppy.

NHS inform adds, for children, a throat area pulling in, pauses in breathing, a rash that does not fade under a glass, and, for babies under 3 months, a temperature of 38C or above or 36C or below with no vaccination in the past 2 days, as reasons for 999 or A&E.

NHS inform says mild pneumonia can usually be treated at home. The NHS says a person may need hospital treatment if a baby or young child has pneumonia, if they are very unwell, or if they are not getting better after taking antibiotics, among other groups. In hospital, the NHS says treatment usually includes antibiotics, sometimes steroids and oxygen, and chest X-rays and blood tests may be arranged. NHS inform adds fluids through a drip and, in very serious cases, breathing support in a high dependency or intensive care unit.

The NHS says pneumonia caused by bacteria is usually treated with antibiotics, and that antibiotics given for home use should be finished even if the child starts to feel better. Contact the doctor if there is no improvement after taking them for 2 to 3 days, says the NHS; NHS inform says to speak to the GP if symptoms do not improve within 3 days of starting antibiotics. The prescriber chooses the antibiotic and dose for a child's age and weight.

At home the NHS suggests resting, drinking plenty of fluids, and paracetamol or ibuprofen if you have been told you can take it for pain or high temperature. It says to cover the mouth and nose when coughing, bin tissues quickly and wash hands regularly, and not to use cough medicine. NHS inform says a warm honey and lemon drink can ease coughing discomfort, though honey should not be given to a child under 12 months, as the NHS cold page says.

The NHS says most people get better in 2 to 4 weeks depending on symptoms, and NHS inform says full recovery can take up to 3 months. NHS inform says a GP may arrange a follow-up in some cases, such as if symptoms have not improved or have come back. The NHS advises staying at home if there is a high temperature or the child is not well enough for normal activities. Pneumonia has no named entry in the UKHSA exclusion table, though the general advice for respiratory infections is to stay at home with more than mild symptoms such as a high temperature.

The NHS lists vaccines that help protect against infections that can cause pneumonia: the pneumococcal vaccine, recommended for babies; the flu vaccine; the RSV vaccine in pregnancy from 28 weeks to help protect the baby after birth; and a seasonal COVID-19 vaccine for people at increased risk. The NHS children's flu vaccine page says flu can cause serious problems such as pneumonia, and that thousands of children each winter need hospital care for flu. Keeping children away from cigarette smoke also helps, as NHS inform lists breathing in cigarette smoke among causes of breathing problems in children.