Pneumonia

What are the different types of pneumonia?

There are three main types of pneumonia—bacterial pneumonia, viral pneumonia and mycoplasma pneumonia.

Bacterial pneumonia

Bacterial pneumonia is caused by various bacteria, most often the bacteria called streptococcus pneumoniae. Other bacteria that may cause bacterial pneumonia are:

• group B streptococcus (most common in newborns)
• staphylococcus aureus
• group A streptococcus (most common in children over age 5)

Bacterial pneumonia may have a quick onset and you may notice the following symptoms in your child:

• productive cough (your child coughs up mucus)
• pain in the chest
• vomiting or diarrhea
• decrease in appetite
• fatigue

Viral pneumonia

Viral pneumonia is caused by viruses, including:

• respiratory syncytial virus, or RSV (most often seen in children under age 5)
• parainfluenza virus
• influenza virus
• adenovirus

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. However, with viral pneumonia, the respiratory involvement happens slowly. You may notice your child wheezing, and his cough may worsen.

Viral pneumonias may make your child susceptible to bacterial pneumonia.

Mycoplasma pneumonia

Mycoplasma pneumonia is caused by mycoplasmas, the smallest free-living agents of human disease. These organisms have the characteristics of both bacteria and viruses, but are not classified as either. They generally cause a mild, widespread pneumonia that affects all age groups.

Symptoms of this kind of pneumonia are different from the other types. The symptoms usually do not begin with a cold, and may include:

• fever and cough are the first to develop
• persistent cough that may last three to four weeks
• severe cough that may produce some mucus

Other less common pneumonias may be caused by the inhaling of food, liquid, gases or dust, or by fungi.

What are the other symptoms of pneumonia?

In addition to the symptoms listed above, all pneumonias share the following symptoms (though keep in mind that each child may experience them differently):

• fever
• chest or stomach pain
• decrease in appetite
• chills
• breathing fast or hard
• vomiting
• headache
• not feeling well
• fussiness

How is pneumonia diagnosed?

Diagnosis is usually made based on the season and the extent of your child’s illness. Your child’s physician may diagnose simply on a thorough history and physical examination, but may also include any of following tests to confirm the diagnosis:

• chest x-ray: a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
• blood tests: blood count for evidence of infection; arterial blood gas to analyze the amount of carbon dioxide and oxygen in the blood.
• sputum culture: a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.
• pulse oximetry: an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto your child’s finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

How do we treat pneumonia?

Treatment may include antibiotics for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma pneumonia and some special cases. There is no clearly effective treatment for viral pneumonia, which usually clears up on its own. Other treatment may include:

• appropriate diet
• increased fluid intake (giving your child more liquids to drink)
• cool mist humidifier in your child's room
• acetaminophen (for fever and discomfort)
• medication for cough

Your child may be treated in the hospital if she is having severe breathing problems. While in the hospital, treatment may include:

• intravenous (IV) or oral antibiotics
• intravenous (IV) fluids, if your child is unable to drink well
• oxygen therapy
• frequent suctioning of your child's nose and mouth (to help get rid of thick secretions)
• breathing treatments, as ordered by your child's physician

Deidre Riley Thomson

Pneumonia

I recently found myself in the Boston Children’s Hospital Emergency Room, waiting to have my toddler admitted for symptoms of pneumonia, including respiratory distress, high fever and hypoxia (low levels of oxygen). From the get-go, I attempted to keep my imagination in check and acknowledge that for all my son’s discomfort, we would most likely be walking out of the hospital, a little sleep deprived but none the worse for wear, in a matter of days.

I had time to sit, think and observe — and it became clearly apparent that in its years of operation, Children’s has taken very seriously its responsibility to its patients and their families, soliciting and acting on feedback regarding how to make the difficult experience of being in the hospital as comfortable as possible. From the lively, engaging lobby with its ample seating, good food and entertaining displays, to the brightly lit floors with their happy visuals, the hospital does a good job at masking the serious nature of one’s visit.

While it broke my heart that some children are here long enough to merit individually painted windows in their rooms, I appreciate that they were allowed that little touch of humanity. Using small chunks of the hospital budget for things like stocked kitchens on the floors translate to big comfort and convenience for patients. When my son was taken off IV fluids and finally showed an interest in drinking again, it was a relief not to leave him alone at midnight, as there was some milk available a few doors down in the kitchen. The activity rooms on each floor, with their array of toys, books, movies and interactive projects, were a happy reminder of the fun things that childhood should be about.

I hope I never have to have either of my children admitted to Children’s again, but should I need to, I’ll be completely confident that they’re in the best possible place.

Thank you to all involved, for helping give parents that peace of mind.