Newsletters

Healthy Child Fall/Winter 2004

Pneumonia in Children

JEREMIAS L. MURILLO, M.D.
ATTENDING PEDIATRIC INFECTIOUS DISEASE SPECIALIST

A friend of mine who lives in Georgia recently called me because his son was admitted to the hospital with pneumonia and the doctors were having difficulty treating the infection. His son developed a pneumonia caused by a resistant form of bacteria called Streptococcus pneumoniae, also called pneumococcus. "Why did this happen?" he asked.

Fighting Resistance
Resistant pneumococcus was first described in 1967 and was introduced into the United States in the early 1970s. Since its introduction into this country, the rate of resistance has jumped from 5 percent in 1980 to 25 percent in 1997. The widespread and indiscriminate use of antibiotics has been blamed for the emergence of this resistance. There are some geographic differences in the rates of resistance. In our area, the rates vary from 12 percent to 15 percent. When doctors recognize this particular strain of pneumococcus, a more potent antibiotic called Vancomycin® is generally used.

One way to protect against infection with these dangerous bacteria is thru vaccination. There is a vaccine (Pneumovax®) that protects against 23 strains of pneumococcus but it doesn’t work in children under 2 years of age. A newer vaccine (Prevnar®) works for children from 2 months to 2 years of age but protects only against 7 strains of the bacteria. Even though the protection is limited, the Centers for Disease Control (CDC), a federal agency that monitors this problem, estimated that the number of pneumococcal infections dropped from 60,000 cases in 2000 to 37,000 cases in 2002 as a result of the introduction of this newer vaccine.

According to the CDC, the vaccine can protect against 80 percent of the resistant strains of pneumococcus. Since pneumococcus accounts for
close to 90 percent of all bacterial pneumonia in children over three months of age, it is important that these children receive vaccination to protect against this bacterial infection.

Accurate Diagnosis,Appropriate Treatment
Fortunately, not all pneumonias are caused by bacteria. In fact, 80 percent of all pneumonias are caused by viruses and only 20 percent are caused by bacteria. The most common viruses that cause pneumonia include respiratory syncytial virus (RSV), influenza and parainfluenza viruses. These viruses spread in epidemic fashion during the fall and winter season. This is the reason why the rates of pneumonia increase during those seasons.

Doctors sometimes have difficulty in distinguishing between viral and bacterial pneumonia because the laboratory tests may not be good enough to differentiate between the two. As a general rule, viral pneumonias are usually milder, do not require antibiotics and clear up on their own even though it may take two to four weeks. The doctor may simply listen to the lungs with his stethoscope and not require a chest x-ray. Occasionally a viral pneumonia can become infected with bacteria and thus convert into a bacterial pneumonia. A follow-up visit with your doctor becomes important to detect signs of a developing bacterial pneumonia. At this point, antibiotics are necessary to clear up the bacterial infection.

The signs to watch for in bacterial pneumonia include high fever sometimes with chills, cough with yellow phlegm, rapid and labored breathing sometimes accompanied by chest pain when taking a deep breath. In infants and small children, the only signs that may be evident are fever, irritability, altered feeding patterns and rapid breathing. A good gauge of how difficult the breathing effort is would be the presence of flaring of the nose when they inhale or grunting when they exhale. When you notice these signs, contact your doctor right away. A chest x-ray will be important to confirm the diagnosis of pneumonia.

Prevention
There are several things one might do to prevent a cold or upper respiratory infection from developing into pneumonia. Ensuring adequate fluid intake is important because children generally lose their appetite when they are sick and fluid intake is reduced under these circumstances. In addition, fever increases fluid loss to some degree. Water is important to the body during increased metabolic activity due to illness.

Dehydration not only slows down the recovery but also contributes to the severity of the illness. Sticky secretions in the back of the throat often lead to coughing spasms. Giving warm liquids to drink helps to loosen the secretions and relax the air passages.

Making sure that your child’s room has adequate humidity is another important step. Dry air tends to make a cough worse. Breathing warm, moist air helps to loosen sticky mucus. The new ultrasonic humidifiers are very quiet and very effective in providing more than adequate humidification. Make sure that you use distilled water instead of tap water to avoid aerosolizing impurities that may be present in your tap water.

Lastly, tobacco smoke has been shown to promote pneumonia. Exposure to tobacco smoke and airway pollutants have been shown to be associated with more than 190,000 cases of pneumonia per year in the United States. Make sure your child is not exposed to second-hand tobacco smoke. Sometimes you hear your doctor say not to worry, that your child will outgrow a problem. It is certainly true with the risk for pneumonia. It is estimated that pneumonia will occur in 30-45 cases per 1000 children per year during the first 5 years. That risk will go down as the child gets older to 16-20 cases per 1000 children in the 5 to 9 year old age group and about 7 cases per 1000 children in the over 10 year old age group. Pneumonia definitely becomes less common as the child gets older.

The important things to remember are the signs for the presence of pneumonia. When you see these signs, make sure you contact your doctor and show up for follow-up as well. Remember that an ounce of prevention is worth a pound of cure. Prevent pneumonia by asking for the pneumococcal vaccine and avoiding exposure to tobacco smoke.

For an appointment with any pediatric specialist, please call the Pediatric Specialty Center at the Saint Barnabas Ambulatory Care Center at
(973) 322-7600.

For a complete list of pediatric services, please call 1-888-SBHS-123 or visit our pediatrics website.

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