Cause Pneumonia is a general term referring to an infection of the lungs caused by viruses, bacteria, fungi, and parasites. In otherwise healthy children, viral pneumonia is most common. Viruses causing pneumonia include respiratory syncytial virus (RSV), parainfluenza, influenza, and aden-oviruses. Among bacteria, Streptococcus pneumoniae, Streptococcus pyogenes (group A Streptococcus), and Staphylococcus aureus are the most common causes. Since the introduction of the Hib vaccine, Hemophilus influenzae type B is less often a cause. The sexually transmitted bacterium Chlamydia trachomatis can be passed on from the mother to the baby during delivery, leading to pneumonia. The microbe Mycoplasma pneumoniae also accounts for many cases of pneumonia, especially in older children and adolescents. In parts of California and the Southwest, the fungus Coccidioides immi-tis, found in the soil, can also cause the infection.

Symptoms Symptoms vary depending on the child's age and the cause of infection. They may include fever; chills; cough; unusually rapid breathing; making a "grunting" or wheezing sound with breathing; labored breathing that makes a child's chest wall skin suck in between the ribs and the nostrils flare; vomiting; chest pain; abdominal pain; decreased activity; loss of appetite or poor feeding; and bluish lips, tongue, and fingernails.

How It Spreads The viruses and bacteria are usually spread by nose and throat droplets passed along by coughing, sneezing, or coming in contact with the germ on utensils or used tissues. Although the person with the germ may not have pneumonia, the germ can cause pneumonia when passed on to the child.

Incubation Period The incubation period depends on the organism. Incubation for RSV is four to six days; influenza is one to four days; mycoplasma is one to three weeks.

How Long Symptoms Last With antibiotics, symptoms of most bacterial pneumonia will subside within the first 24 to 48 hours, although it may take several weeks before the lungs return to normal. Symptoms of viral pneumonia may last several days longer. With antibiotics, symptoms of mycoplasma pneumonia will improve over four to five days.

When to Call Your Child's Doctor Call your child's doctor if your child has any signs or symptoms of pneumonia, especially if he is breathing faster than usual, has a cough that is getting worse, has a fever of 101 to 102 degrees Fahrenheit or higher, or has signs of respiratory distress. Take your child to the emergency room if he is making a grunting sound when breathing; is struggling or gasping to breathe; has a bluish color of the lips, tongue, and fingernails; is lethargic or unresponsive; or pauses in breathing for longer than 15 seconds. Call your child's doctor if your child is being treated for pneumonia and symptoms have not improved within 48 to 72 hours.

How the Diagnosis Is Made Your child's doctor will ask about symptoms and listen to your child's chest with a stethoscope to hear where and how breathing is impaired; he or she may order a chest X-ray. The doctor may also take a blood test and a sample of mucus produced by coughing to see what organism is causing the infection.

Treatment In severe cases the child may be hospitalized. Bacterial or mycoplasma pneumonia is treated with antibiotics; the type used depends on the germ. Antibiotics are ineffective against viral pneumonia, and most patients recover with supportive care such as fluids, rest, and, if necessary, extra oxygen. If diagnosed within 48 hours of the infection, viral pneumonia may be treated in some cases with antiviral medication to reduce symptoms.

Home Treatment Use a cool-mist humidifier to increase air moisture. Encourage your child to drink fluids, especially with a fever. Ask your child's doctor before using cough suppressant medications because they can interfere with clearing mucus from the lungs, and this may be harmful in some cases of pneumonia.

Prevention Children younger than two years, those with weakened immune systems, and other high-risk children should be vaccinated against Streptococcus pneumo-niae. The influenza vaccine is also recommended for high-risk children, including those with chronic lung or heart conditions that can make them more likely to develop pneumonia if they are infected with the virus. Pertussis (whooping cough), which can also lead to pneumonia, is the "P" part of the routine DTaP vaccine. The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against infection with this germ. If someone in your house has pneumonia or a respiratory infection that could lead to pneumonia, keep your child away and practice good hygiene, keeping eating utensils separate and washing hands frequently.

Contagious Periods The contagious period depends on the organism.

Complications The mortality rate for children with bacterial pneumonia is less than 1 percent with antibiotic treatment. Almost all children with viral pneumonia recover without treatment, although RSV infections can be life-threatening, especially in infants younger than six weeks or those with heart or lung problems or a weakened immune system.

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