Pneumonia in children

Last updated: September 1, 2023

Summarytoggle arrow icon

Pneumonia, a common infection in children, is a respiratory illness characterized by inflammation of the alveolar space and/or the interstitial tissue of the lungs. The etiology is typically bacterial or viral, with respiratory syncytial virus (RSV) being the most common pathogen overall, particularly in those < 2 years old. As with adults, pneumonia in children can be categorized as typical or atypical, according to clinical features. For typical pneumonia, the presentation may be similar to those in adults (including productive cough, tachypnea, fever, and lethargy), with possible additional features such as abdominal pain, difficulty feeding, and grunting. In atypical pneumonia, children may present with a mild, slowly-progressing course that includes malaise, low-grade fever, and widespread wheeze. Management depends on severity and etiology. The first step is to determine whether patients meet the admission criteria for pediatric CAP. All patients require a respiratory viral panel to help guide treatment; for children who meet admission criteria, additional diagnostic tests include imaging and blood studies. Empirical treatment consists of supportive measures (e.g., respiratory support, antipyretics), antibiotics for suspected bacterial infection, and antivirals when available (e.g., for influenza, COVID-19).

The information in this article does not apply to infants < 2 months old. In young infants that present with signs of pneumonia (e.g., apnea, hypotonia, poor feeding), a full workup for sepsis is indicated (see “Fever in infants ≤ 60 days).

Clinical featurestoggle arrow icon

Classic presentation

Features of atypical pediatric pneumonia [7]

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon


Immediate stabilization

Admission criteria for pediatric CAP [7]

Validated criteria for determining severity and/or need for admission in pediatric pneumonia (equivalent to CURB-65 in adults) have not been successfully developed. [7][8][9]

Diagnostics for pediatric CAP

All patients require a respiratory viral panel. Further studies are usually reserved for patients with refractory disease or those who require hospitalization.

Laboratory studies


Additional studies

Inpatient management [1][7]

Outpatient management [1][7]

For pre-school-aged children (2–5 years old), antibiotics are not routinely recommended, as viruses are the most common cause.

Management of bacterial pneumonia in childrentoggle arrow icon

Overview [1][7]

If typical and atypical CAP cannot be distinguished from each other, combine a beta-lactam and a macrolide for empiric therapy. [7]

Empiric antibiotic therapy for pediatric CAP

Intravenous antibiotic therapy

Empiric intravenous antibiotics for CAP in children [7]

Suspected etiology Fully immunized Not fully immunized
Typical bacteria
Atypical bacteria

Transition to oral antibiotics when patients are clinically improving and can tolerate oral fluids including medications. [1]

Oral antibiotics for pediatric pneumonia

Empiric oral antibiotics for CAP in children [7]
Typical bacteria
Atypical bacteria

Outpatient oral antibiotic therapy is typically given for a maximum of 7 days. [1]

Management of viral pneumonia in childrentoggle arrow icon

Viral pneumonia is the most common cause of CAP in children < 5 years of age.


Management of influenza pneumonia in children

Start antivirals immediately in patients with moderate-to-severe CAP and suspected influenza, even before confirming influenza infection. [7]

Management of COVID-19 pneumonia in children

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Preventiontoggle arrow icon

General preventative measures

Immunizations [1]

Pharmacotherapy for high-risk children

Referencestoggle arrow icon

  1. Smith DK, Kuckel DP, Recidoro AM. Community-Acquired Pneumonia in Children: Rapid Evidence Review.. Am Fam Physician. 2021; 104 (6): p.618-625.
  2. Rodrigues CMC, Groves H. Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis. J Clin Microbiol. 2018; 56 (3).doi: 10.1128/jcm.01318-17 . | Open in Read by QxMD
  3. Mishra K, Bhardwaj P, Mishra A, Kaushik A. Acute Chlamydia trachomatis respiratory infection in Infants. Journal of Global Infectious Diseases. 2011; 3 (3): p.216.doi: 10.4103/0974-777x.83525 . | Open in Read by QxMD
  4. Hammerschlag MR. Chlamydia trachomatis and Chlamydia pneumoniae Infections in Children and Adolescents. Pediatrics in Review. 2004; 25 (2): p.43-51.doi: 10.1542/pir.25-2-43 . | Open in Read by QxMD
  5. Chlamydia pneumoniae Infection. Updated: January 10, 2019. Accessed: December 10, 2020.
  6. Davies HD. Community-acquired pneumonia in children. Paediatr Child Health. 2003; 8 (10): p.616-619.doi: 10.1093/pch/8.10.616 . | Open in Read by QxMD
  7. 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; 53 (7): p.e25-e76.doi: 10.1093/cid/cir531 . | Open in Read by QxMD
  8. Ambroggio L, Brokamp C, Mantyla R, et al. Validation of the British Thoracic Society Severity Criteria for Pediatric Community-acquired Pneumonia. Pediatr Infect Dis J. 2019; 38 (9): p.894-899.doi: 10.1097/inf.0000000000002380 . | Open in Read by QxMD
  9. Florin TA, Brokamp C, Mantyla R, et al. Validation of the Pediatric Infectious Diseases Society–Infectious Diseases Society of America Severity Criteria in Children With Community-Acquired Pneumonia. Clin Infect Dis. 2018; 67 (1): p.112-119.doi: 10.1093/cid/ciy031 . | Open in Read by QxMD
  10. Katz SE, Williams DJ. Pediatric Community-Acquired Pneumonia in the United States. Infect Dis Clin North Am. 2018; 32 (1): p.47-63.doi: 10.1016/j.idc.2017.11.002 . | Open in Read by QxMD
  11. Duijts L, Jaddoe VWV, Hofman A, Moll HA. Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy. Pediatrics. 2010; 126 (1): p.e18-e25.doi: 10.1542/peds.2008-3256 . | Open in Read by QxMD
  12. Collins JP, Shane AL. Infections Associated With Group Childcare. Principles and Practice of Pediatric Infectious Diseases. 2018: p.25-32.e3.doi: 10.1016/b978-0-323-40181-4.00003-7 . | Open in Read by QxMD
  13. Thompson EJ, Wu H, Melloni C, et al. Population Pharmacokinetics of Doxycycline in Children. Antimicrob Agents Chemother. 2019; 63 (12).doi: 10.1128/aac.01508-19 . | Open in Read by QxMD

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