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te pneumonia
Acute pneumonia
A cute pneum onia is a v iral, bacterial ( pneum ococcus, Haemophilus influenzae,
staph ylococcus, atypical bacteria) or parasitic ( pneum ocystosis) infection of th e
pulm onary alv eoli.
Pneumonia in children under 5 years of age
T h e m ost com m on causes are v iruses, pneum ococcus and Haemophilus influenzae.
C linical exam ination m ust be d one on a calm ch ild in ord er to correctly count th e
respiratory rate and look for sig ns of serious illness.
Clinical features
P neum onia sh ould be suspected in a ch ild w h o presents w ith cough or difficulty
breathing.
F ev er is often h ig h (> 3 9 °C ), but th e ch ild m ay present w ith low - g rad e fev er or m ay
h av e no fev er (often a sig n of serious illness).
T h e respiratory rate (R R ) sh ould be m easured ov er 1 m inute. A ch ild h as tach ypnoea
(increased respiratory rate) if:
R R ≥ 6 0 breath s/ m inute in ch ild ren und er 2 m onth s
R R ≥ 5 0 breath s/ m inute in ch ild ren from 2 to 1 1 m onth s
R R ≥ 4 0 breath s/ m inute in ch ild ren from 1 2 m onth s to 5 years
O n pulm onary auscultation: d ullness w ith d im inish ed v esicular breath sound s,
crepitations and som etim es bronch ial breath ing or norm al pulm onary auscultation.
Sig ns of serious illness (sev ere pneum onia) includ e:
– C h est ind raw ing : th e inferior th oracic w all d epresses on inspiration as th e superior
abd om en expand s saturation < 9 0 %
– C yanosis (lips, oral m ucosa, fing ernails) o2r O
– N asal flaring
– A ltered consciousness (ch ild is abnorm ally sleepy or d ifficult to w ake)
– Strid or (h oarse noise on inspiration)
– G runting (a sh ort repetitiv e noise prod uced by a partial closure of th e v ocal cord s) on
expiration
– R efusal to d rink or feed
– C h ild ren und er 2 m onth s
– Sev ere m alnutrition
Notes:
– I n m alnourish ed ch ild ren, th e R R th resh old s sh ould b e d ecreased b y
5 breath s/ m inute from th ose listed abov e.
– C h est ind raw ing is sig nificant if it is clearly v isible and present at all tim es. If it is
observ ed w h en a ch ild is upset or feed ing and is not v isible w h en th e ch ild is resting ,
th ere is no ch est ind raw ing .
– I n ch ild ren und er 2 m onth s of ag e, m od erate ch est ind raw ing is norm al as th e
th oracic w all is flexible.
66
Acute pneumonia
A cute pneum onia is a v iral, bacterial ( pneum ococcus, Haemophilus influenzae,
staph ylococcus, atypical bacteria) or parasitic ( pneum ocystosis) infection of th e
pulm onary alv eoli.
Pneumonia in children under 5 years of age
T h e m ost com m on causes are v iruses, pneum ococcus and Haemophilus influenzae.
C linical exam ination m ust be d one on a calm ch ild in ord er to correctly count th e
respiratory rate and look for sig ns of serious illness.
Clinical features
P neum onia sh ould be suspected in a ch ild w h o presents w ith cough or difficulty
breathing.
F ev er is often h ig h (> 3 9 °C ), but th e ch ild m ay present w ith low - g rad e fev er or m ay
h av e no fev er (often a sig n of serious illness).
T h e respiratory rate (R R ) sh ould be m easured ov er 1 m inute. A ch ild h as tach ypnoea
(increased respiratory rate) if:
R R ≥ 6 0 breath s/ m inute in ch ild ren und er 2 m onth s
R R ≥ 5 0 breath s/ m inute in ch ild ren from 2 to 1 1 m onth s
R R ≥ 4 0 breath s/ m inute in ch ild ren from 1 2 m onth s to 5 years
O n pulm onary auscultation: d ullness w ith d im inish ed v esicular breath sound s,
crepitations and som etim es bronch ial breath ing or norm al pulm onary auscultation.
Sig ns of serious illness (sev ere pneum onia) includ e:
– C h est ind raw ing : th e inferior th oracic w all d epresses on inspiration as th e superior
abd om en expand s saturation < 9 0 %
– C yanosis (lips, oral m ucosa, fing ernails) o2r O
– N asal flaring
– A ltered consciousness (ch ild is abnorm ally sleepy or d ifficult to w ake)
– Strid or (h oarse noise on inspiration)
– G runting (a sh ort repetitiv e noise prod uced by a partial closure of th e v ocal cord s) on
expiration
– R efusal to d rink or feed
– C h ild ren und er 2 m onth s
– Sev ere m alnutrition
Notes:
– I n m alnourish ed ch ild ren, th e R R th resh old s sh ould b e d ecreased b y
5 breath s/ m inute from th ose listed abov e.
– C h est ind raw ing is sig nificant if it is clearly v isible and present at all tim es. If it is
observ ed w h en a ch ild is upset or feed ing and is not v isible w h en th e ch ild is resting ,
th ere is no ch est ind raw ing .
– I n ch ild ren und er 2 m onth s of ag e, m od erate ch est ind raw ing is norm al as th e
th oracic w all is flexible.
66
