Pneumonia in children: What you need to know

Many people associate pneumonia with the elderly, but it is actually the biggest infectious killer of children worldwide. Every year, pneumonia claims the lives of more than 725,000 children under the age of 5, including around 190,000 newborns, who are particularly vulnerable to infection. 

Every 43 seconds at least one child dies from pneumonia. Almost all of these deaths are preventable.

It is inexcusable that thousands of children are exposed to unnecessary risk and unable to access the essential health services, vaccines, and treatments, which can prevent pneumonia and save their lives.  

What causes pneumonia?

Pneumonia is an acute respiratory infection of the lungs. It doesn’t have one single cause – it can develop from either bacteria, viruses or fungi in the air. When a child is infected, their lungs get inflamed, may fill with fluid or pus and it becomes difficult to breathe. Children whose immune systems are immature (i.e. newborns or premature babies) along with those with poor immunities (i.e. due to undernourishment or diseases like HIV) are more vulnerable to pneumonia.

What are pneumonia symptoms?

As pneumonia is an infection of the lungs, the most common symptoms are coughing, trouble breathing and fever. Children with pneumonia usually experience fast breathing, or their lower chest may draw in or retract when they inhale (in a healthy person, the chest expands during inhalation).

Is pneumonia contagious?

Pneumonia, caused by viruses or bacteria, is contagious and can be spread through airborne particles (a cough or sneeze). The pathogens that cause pneumonia can also be spread through other fluids, like blood during childbirth, or from contaminated surfaces. Not everyone exposed to pneumonia-causing pathogens will fall ill or get pneumonia.

How is pneumonia diagnosed in children?

Health workers can diagnose pneumonia through a physical exam, including checking for abnormal breathing patterns and listening to the child’s lungs. Sometimes they may use chest x-rays or blood tests for diagnosis.

In countries without strong health care systems (i.e. few doctors, lack of access to chest x-rays and laboratories), health workers often rely on diagnosing pneumonia by counting the number of breaths the child takes per minute. For instance, a 5 month old child who takes 50 breaths per minute would be breathing too fast, and could have pneumonia. The number of breaths for ‘fast breathing’ depends on the child’s age – younger children normally have higher rates of breathing than older children.

Health workers, if equipped with the right tools, can also check if a child has low blood oxygen levels, an indicator of severe pneumonia.

What are pneumonia treatments?

The treatment for pneumonia depends on the type of pneumonia. In developing countries, a large number of pneumonia cases are caused by bacteria and can be treated with low cost antibiotics. Yet many children with pneumonia do not receive the antibiotics they need because they lack access to quality health care. Other causes of pneumonia are viruses or mycobacteria (e.g. those causing tuberculosis) requiring other treatments. Tuberculosis, in particular, often remains un-diagnosed in children.

What role can oxygen play in pneumonia treatment?  

Oxygen is an essential and life-saving treatment for children and newborns suffering from severe pneumonia. That’s because the inflammation of their lungs prevents enough oxygen from entering their bloodstream to be circulated to the rest of the body. Low blood oxygen levels can be measured with pulse oximeters.

Access to pulse oximetry and oxygen has for a long time been unavailable to those who need it. In many countries without strong health systems, oxygen is often only available at higher level health facilities and hospitals. 

What can be done to prevent pneumonia?

Preventing pneumonia is possible through increasing protective measures, such as ensuring newborns and young children are breastfed early, vaccinated, have access to clean water, good nutrition and limited exposure to air pollution. Studies have shown that good hygience practices, including improved handwashing with soap reduces the risk of pneumonia by lowering exposure to bacteria.

Is there a pneumonia vaccine?

Pneumonia caused by bacteria is easily preventable with vaccines. However, 33 per cent of children around the world are not fully protected with the primary vaccine to prevent pneumonia – the Pneumococcal (PCV) vaccine. In addition, other vaccines such as Diphtheria-Tetanus-Pertussis and measles-containing vaccines and Hemophilus Influenza B (Hib) vaccine protects children from pneumonia.

Where are the most children dying from pneumonia?

The regions with the largest number of child pneumonia deaths are concentrated in sub-Saharan Africa and South Asia.

Child deaths from pneumonia are concentrated in the world’s poorest countries. Within these countries, it is the most deprived and marginalized children who suffer the most. They often have limited or no access to basic health services and are more likely to suffer from other health threats like malnutrition, infectious diseases and polluted air. They often live in fragile or humanitarian settings, where often risk factors increase and health systems break down.

How does air pollution factor into pneumonia?

Air pollution can significantly increase the risk of respiratory infection, including pneumonia. Almost half of all pneumonia deaths are attributable to air pollution.  

The climate crisis is a child rights crisis and poses a serious threat to children’s health and well-being.

Outdoor air pollution is a risk to children, especially with growing rates of urbanization in high-burden pneumonia countries. But indoor air pollution – generated by unclean fuels for cooking and heating – also poses a global threat.
 

How big a factor is malnutrition in pneumonia related deaths?   

Wasting is the leading risk factor for deaths from pneumonia among children. It’s the most visible and life-threatening form of malnutrition. When a child is too thin and their immune systems are weak, they’re far more vulnerable to diseases like pneumonia. Wasting tends to occur very early in life and disproportionately impacts children under 2 years of age. It’s essential that we invest in nutrition services to prevent children from dying from pneumonia. 

What is needed to stop pneumonia? 

Swift action and investments are required to ensure that no child dies from pneumonia and other preventable or treatable diseases, this includes: reducing risk factors, protecting children’s immune systems and ensuring all children have access to good-quality health care, free at the point of use, with well trained and equipped health workers.

What UNICEF is calling for

• Strengthening and prioritization of routine immunization and scaling up coverage of PCV, measles and DTP vaccines to above 90 per cent to ensure every child is protected from pneumonia.
• Making low-cost antibiotics for the treatment of pneumonia available at the last mile, close to where children live.
• Improving basic oxygen access and use, so no child is left fighting for breath.
• Investing in the prevention and treatment of severe acute malnutrition, to reduce child deaths from pneumonia.
• Investing in health workers and infrastructure to put essential health services within easy reach of families. Health workers must have the right training, medicines and diagnostic tools.
• Continued action to engage and empower communities to support prevention and treatment. 

Urgent action is needed now to end the preventable deaths caused by pneumonia. We can change the course of this disease and help keep every child alive.