Childhood pneumonia: Everything you need to know

Pneumonia kills more children than any other infectious disease.

Pneumonia vaccine in a Health Center in Mali, March 2018.
UNICEF/UN0198282/Njiokiktjien VII Photo
11 November 2020

Many people associate pneumonia with the elderly, but it is actually the biggest infectious killer of children worldwide. It claims the lives of over 800,000 children under five every year, including over 153,000 newborns, who are particularly vulnerable to infection. That means a child dies from pneumonia every 39 seconds and almost all of these deaths are preventable.

A child dies from pneumonia every 39 seconds. Almost all of these deaths are preventable

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, his lungs are filled with fluid and it becomes difficult to breathe. Children whose immune systems are immature (i.e. newborns) or weakened – such as by undernourishment, or diseases like HIV – are more vulnerable to pneumonia.

What are the symptoms of pneumonia?

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 is contagious and can be spread through airborne particles (a cough or sneeze). It can also be spread through other fluids, like blood during childbirth, or from contaminated surfaces.

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.

What is the treatment for pneumonia?

The treatment for pneumonia depends on the type of pneumonia. In developing countries, a large number of pneumonia cases is caused by bacteria and can be treated with low cost antibiotics. Yet only one third of children with pneumonia 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.

Children with severe pneumonia often require oxygen because the inflammation of their lungs prevents enough oxygen from entering the bloodstream. However, in many countries without strong health systems oxygen is only available at higher level health facilities and hospitals. 

Can pneumonia be prevented?

Pneumonia can be prevented in the first place by increasing protective measures, such as adequate nutrition, and by reducing risk factors like air pollution (which makes the lungs more vulnerable to infection) and using good hygiene practices. Studies have shown that improved handwashing with soap reduces the risk of pneumonia by up to 50 per cent by lowering exposure to bacteria.

Studies show that improved handwashing with soap reduces the risk of pneumonia by up to 50% 

Is there a pneumonia vaccine?

Pneumonia caused by bacteria is easily preventable with vaccines. However, in 2018, 71 million children did not receive the recommended three doses of the primary vaccine to prevent pneumonia (PCV). A new vaccine for one of the main viral causes of pneumonia is under development.

Where are the most children dying from pneumonia?

The countries with the largest number of child pneumonia deaths are concentrated in sub-Saharan Africa and Asia, including Democratic Republic of Congo, Ethiopia, India, Nigeria and Pakistan. Together, these five countries account for more than half of all deaths due to pneumonia among children under five.

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.

Around 50% of childhood pneumonia deaths are associated with air pollution 

How does air pollution factor into pneumonia?

Air pollution can significantly increase the risk of respiratory infection, including pneumonia. Around half of childhood pneumonia deaths are associated with air pollution. 

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 – poses a greater global threat. Indoor pollution contributes to 62 per cent of air pollution-related child pneumonia deaths.

What is needed to stop pneumonia? 

What is needed is a response that reduces risk factors, protects children’s immune system and ensures access to good-quality health care, free at the point of use, with well trained and equipped health workers to all children.

Preventing pneumonia is possible if newborns and young children are breastfed early, vaccinated, have access to clean water, good nutrition, and limited exposure to air pollution. 

Treating pneumonia requires health workers to be within easy reach of families, and to have the right training, medicines and diagnostic tools. 

Both prevention and treatment require strong primary health care as well as engaged and empowered communities. But globally, only 68 per cent of children with pneumonia symptoms are taken to a health care provider.

A child dies from pneumonia every 39 seconds. Urgent action is needed now to end these preventable deaths. Health workers who are trained and equipped to support both prevention and treatment of pneumonia can change the course of the disease and help keep every child alive.

Read: Every child's right to survive: An agenda to end pneumonia deaths