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Community-acquired pneumonia in children

Last reviewed: 4 Oct 2024
Last updated: 29 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • cough
  • hypoxemia
  • tachypnea
  • increased work of breathing
  • abnormal auscultatory findings
  • cyanosis
  • apnea
Full details

Other diagnostic factors

  • dyspnea
  • tachycardia
  • wheeze
  • prolonged capillary refill time (CRT)
  • chest pain
  • abdominal pain
  • vomiting
  • difficulty feeding
  • agitation or altered mental status
  • night sweats
Full details

Risk factors

  • younger age (<2 years old)
  • male sex
  • prematurity
  • chronic underlying condition
  • history of severe and/or complicated and/or recurrent pneumonia
  • inhaled foreign body
  • indoor air pollution
  • overcrowded housing
  • parental smoking
  • anatomic lesion such as vascular ring or sling
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • chest x-ray
  • CBC
  • serum electrolytes/BUN
  • acute phase reactants
  • blood cultures
  • polymerase chain reaction (PCR) assays
  • sputum culture
  • pleural fluid culture
  • endotracheal aspirate culture/PCR testing
  • bronchoscopy
  • chest ultrasound
  • chest CT
Full details

Treatment algorithm

ACUTE

outpatient (nonsevere)

inpatient (severe)

Contributors

Authors

Giovanni Piedimonte, MD, FAAP, FCCP

Vice-President for Research and Professor of Pediatrics, Biochemistry and Molecular Biology

Department of Pediatrics, Biochemistry and Molecular Biology

Tulane University

New Orleans

LA

Disclosures

GP declares that he has no competing interests.

Sara Manti, MD, PhD

University Researcher

Pediatric Unit

Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi"

University of Messina

Messina

Sicily

Italy

Disclosures

SM declares that she has no competing interests.

Peer reviewers

Brian Alverson, MD

Professor of Pediatrics

Sidney Kimmel Medical College

Thomas Jefferson University

Philadelphia

PA

Disclosures

BA declares that he has no competing interests.

Alasdair Munro, BSc (Hons), BM, PhD

Senior Clinical Research Fellow In Paediatric Infectious Diseases

NIHR Southampton Clinical Research Facility

Southampton General Hospital

Southampton

UK

Disclosures

AM declares that he has no competing interests.

Saul N. Faust, MBBS, FRCPCH, PhD, FHEA, OBE

Professor of Paediatric Immunology And Infectious Diseases

University of Southampton

Southampton

UK

Disclosures

SNF acts on behalf of University Hospital Southampton NHS Foundation Trust as an investigator and/or providing consultative advice on clinical trials and studies of vaccines and antimicrobials funded or sponsored by manufacturers including Sanofi, Moderna, Janssen, Pfizer, AstraZeneca, GlaxoSmithKline, Novavax, Seqirus, MedImmune, Merck, and Valneva. He receives no personal financial payment for this work.

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  • Guidelines

    • ACR appropriateness criteria: pneumonia in the immunocompetent child
    • The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (archived)
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