When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 9 Apr 2025
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

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

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

Diagnostic tests

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

Treatment algorithm

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bradley JS, Byington CL, Shah SS, et al. 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. Clin Infect Dis. 2011 Oct;53(7):e25-76.Full text  Abstract

Harris M, Clark J, Coote N, et al; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011 Oct;66 Suppl 2:ii1-23.Full text  Abstract

Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age​: recommendations for ages 18 years or younger, United States, 2024. Nov 2023 [internet publication].Full text

Chan SS, Kotecha MK, Rigsby CK, et al; Expert Panel on Pediatric Imaging. ACR appropriateness criteria®: pneumonia in the immunocompetent child. J Am Coll Radiol. 2020 May;17(5 Suppl):S215-25.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

Use of this content is subject to our disclaimer