Pneumonia is a respiratory tract disease that is quite common in children. Pneumonia can be mild or severe, leading to various complications.
Pneumonia is an infection of the respiratory organs, namely the lungs. The lungs play a crucial role in the respiratory system. As a vital organ, the lungs play a vital role in the respiratory process, which involves the exchange of oxygen needed by all body cells and carbon dioxide that must be expelled from the body.
In addition to respiration, the lungs also play a crucial role in maintaining the balance of blood acidity or pH. The lungs also play a role in regulating the humidity and temperature of air entering the body, thus protecting against pathogens. Pneumonia can be caused by various pathogenic infections, from viruses and bacteria to fungi. The underlying cause of pneumonia will significantly influence the treatment and the severity of the symptoms.
Reason
Pneumonia can be caused by various microorganisms, from viruses, bacteria, fungi, and parasites. Viral pneumonia is most commonly caused by influenza viruses, parainfluenza viruses, adenoviruses, rhinoviruses, and respiratory syncytial virus. Bacterial pneumonia can be triggered by infections with Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Staphylococcus aureus.
Fungal pneumonia is usually closely related to a weakened immune system, such as in people with HIV/AIDS. Fungal infections that can cause pneumonia include Pneumocystis jiroveci, Histoplasma, Blastomyces, and Coccidioides. In addition to viruses, bacteria, and fungi, parasitic infections can also cause pneumonia. Although this type of pneumonia tends to be less common,
Symptom
Because pneumonia is an infection of the lungs, the symptoms are closely related to the respiratory system. Symptoms can vary widely, from mild to very severe. This can be influenced by the microorganism causing the pneumonia and the child's immune system. A common symptom often found in children with pneumonia is a high fever. Due to the increased body temperature, children also tend to sweat more frequently. Furthermore, children may experience a cough, whether accompanied by or without phlegm.
A cough with phlegm is usually greenish in color. In severe cases, pneumonia can trigger shortness of breath in children. The child's breathing may become faster and deeper. This complaint is often accompanied by chest pain. Shortness of breath may also be accompanied by wheezing when the child breathes. If shortness of breath persists for a long time, it can affect blood oxygen levels. If needs are not met properly, it can lead to cyanosis in children, a blue appearance of the skin and lips.
If a child begins to experience respiratory distress, it is crucial to have an oxygen saturation monitor. It is beneficial to have one available so that it can be monitored regularly. However, if the child's condition tends to worsen, it is highly recommended to consult a doctor immediately. Other symptoms that may accompany pneumonia in children include decreased appetite due to discomfort, including difficulty breathing.
Furthermore, due to decreased intake, children may become weak and tire easily. Children may also experience abdominal pain and vomiting, although these symptoms are not specific to pneumonia.
Risk Factors
Pneumonia is highly influenced by the immune system and the risk of exposure to various microorganisms that can cause pneumonia in children. In children under 2 years of age, the immune system tends to be underdeveloped, making them more susceptible to infections and pneumonia. This risk can be higher in premature babies, whose immune systems have not yet developed optimally. Furthermore, other factors that can affect a child's immunity include a history of other illnesses, such as HIV/AIDS.
Children with malnutrition and severe nutritional disorders tend to have poor immune systems and are more susceptible to various infections and pneumonia. Respiratory tract infections in children that are initially mild, such as common viral infections, can lead to pneumonia if not treated properly and the child lacks a strong immune system to fight the infection.
Inappropriate use of antibiotics can also increase the risk of antibiotic resistance. Certain bacterial infections that should be treated with antibiotics become ineffective due to resistance. This can lead to worsening conditions and complications such as pneumonia. Exposure to microorganisms can also increase a child's risk of pneumonia.
Living in an area with poor sanitation, exposure to infectious diseases in a nursing home, or having a family member with a respiratory infection can increase the risk of transmission to children, potentially triggering pneumonia. Furthermore, immunization plays a crucial role in helping minimize pneumonia symptoms.
If a child has not received all of the necessary vaccinations, such as those against pneumococcal and Haemophilus influenzae type b (Hib), they are at risk of developing pneumonia with more severe symptoms. This can occur because the body's immune system has not yet developed against these microorganisms. However, if vaccinated, antibodies have already developed and can fight these microorganisms if they enter the body.
Diagnosis
Anamnesis
During the initial examination, the doctor will conduct a medical interview or history taking to determine the course of the disease and the various symptoms experienced and complained of. For children, the history taking is usually conducted through an alloanamnesis, where the doctor will ask the parents or other caregivers in detail about the child's signs and symptoms.
If the child complains of a fever, they will be asked more in-depth questions about its duration, characteristics, pattern, body temperature, and whether it can be treated with fever-reducing medication. Furthermore, a typical symptom that usually accompanies pneumonia in children is shortness of breath. It is crucial to determine its duration, whether there are any previous triggers for the shortness of breath, the characteristics of the shortness of breath, and whether cyanosis, or bluish lips or skin, has been observed.
Physical examination
During the physical examination, vital signs will be checked, including blood pressure, heart rate, respiratory rate, and oxygen saturation. In pneumonia, the heart rate typically increases, as does the respiratory rate. Oxygen saturation, on the other hand, tends to decrease. A thorax or chest examination will also be performed.
The child will be inspected for retractions during breathing and the characteristics of the breathing, such as whether it is deep or shallow but rapid. Palpation and percussion of this area will also be performed, especially if there is suspicion of pneumonia accompanied by complications such as pleural effusion or empyema, which can be found in bacterial infections.
The doctor will also perform auscultation using a stethoscope. This is done to assess breath sounds and confirm the presence of wheezing or other abnormal breath sounds. The skin and lips will also be assessed for bluish discoloration, as in cyanosis.
Supporting investigation
A routine supporting examination for pneumonia in children is a complete blood count. This test will check for signs of infection, indicated by an increase in leukocytes or white blood cells. If necessary, the doctor may also recommend a blood culture to confirm the bacteria causing the pneumonia.
In addition to blood cultures, the doctor may also recommend a sputum culture if a specific microorganism is suspected and to provide appropriate therapy. An arterial blood gas test may also be performed, especially in cases of pneumonia accompanied by respiratory distress and cyanosis. This test can assess oxygen, carbon dioxide, and blood pH levels.
Another supporting examination that may be performed is a chest x-ray. This examination allows the doctor to visualize the lungs, which may show typical signs of pneumonia. If necessary, the doctor may also recommend a CT scan or bronchoscopy.
Therapy
The treatment and management of pneumonia in children are greatly influenced by the cause and severity of the symptoms. The doctor will provide supportive therapy based on the patient's symptoms. For fever, the doctor will prescribe antipyretics to help lower the body temperature. Furthermore, it is crucial to ensure the child gets enough rest to speed up the recovery process. It is also crucial to maintain the child's intake to ensure their nutritional needs are met, including their daily fluid intake to prevent dehydration.
If the child is experiencing shortness of breath and decreased oxygen saturation, oxygen therapy will be given. Furthermore, if the child is experiencing wheezing and phlegm that is difficult to expel, the doctor may recommend nebulization therapy. For definitive therapy, it is crucial to identify the primary microorganism causing the pneumonia. If it is caused by bacteria, antibiotics will be given. If it is caused by fungi, antifungals can be given. For viral infections, antivirals can be given if necessary.
For bacterial pneumonia, if antibiotics have been given but symptoms do not improve, antibiotic resistance should be suspected. Therefore, further testing can be performed to identify alternative antibiotics for more effective therapy.
Prevention
Vaccination plays a crucial role in preventing pneumonia in children. In addition to the mandatory basic immunizations recommended by the government for children, there are several other vaccinations that can be given:
Pneumococcus
One bacterial infection that can trigger pneumonia is pneumococcus. Therefore, this vaccination is important to help develop antibodies against pneumococcus.
Haemophilus influenzae type b
This vaccination helps protect and build immunity against infections caused by Hib bacteria.
Influenza
Influenza is a fairly common type of virus that causes infections. While it tends to cause mild symptoms, it can also cause severe symptoms in children with compromised immune systems. Furthermore, this virus changes rapidly, requiring annual boosters to maintain protection.
COVID-19
This virus can cause mild to severe symptoms, such as pneumonia, if it infects someone. Therefore, if you meet the criteria or are susceptible to infection, it is important to receive the COVID-19 vaccination. In addition to vaccination, you can protect yourself from various infections by maintaining personal and environmental hygiene.
One simple way to protect yourself is by regularly washing your hands, including educating your children about the risks. It is crucial to keep your hands clean by washing them with running water and soap, especially before eating and after coughing or sneezing.
It is also crucial to teach proper coughing and sneezing etiquette in public places to minimize the risk of infection. Furthermore, a healthy lifestyle is crucial for a healthy immune system. Maintaining a balanced diet, drinking enough water, and exercising regularly is crucial.
Complications
Pneumonia is a complication of respiratory tract infections. Furthermore, pneumonia in children, if not properly treated, can lead to various complications.
Pleural effusion
Pneumonia caused by bacterial infections, if left untreated, can lead to fluid buildup in the lining of the lungs. This can worsen shortness of breath, requiring further intervention to remove the fluid from the cavity.
Empyema
In addition to fluid in the space between the lung and its membrane, the area can also fill with pus in severe infections. This requires more intensive antibiotic therapy and prompt drainage of the pus before the infection spreads.
Sepsis
If left untreated, lung infections in pneumonia can spread to the bloodstream and trigger an inflammatory reaction. This condition can worsen to shock and can be life-threatening.
respiratory failure
One of the symptoms of pneumonia is shortness of breath. This occurs due to a lack of oxygen needed by cells throughout the body. If prolonged, this not only causes cyanosis but can also lead to respiratory failure.
Developmental disorders
In cases of recurrent pneumonia in children, the nutrients from food consumed are used more to combat infection and inflammation. This condition results in children lacking the nutrients necessary for growth and development.
When to See a Doctor?
If your child exhibits typical symptoms of pneumonia, such as fever, cough, and shortness of breath, especially accompanied by cyanosis, you should immediately consult a doctor for evaluation and further treatment. Furthermore, if your child experiences persistent fever, cough, and cold, it's important to seek further evaluation, even if the symptoms are mild. This is crucial to prevent the disease from progressing to pneumonia.
Giving antibiotics to children without a doctor's prescription is strongly discouraged. Inappropriate antibiotic use can increase the risk of antibiotic resistance and worsen pneumonia symptoms in children, as resistance is difficult to treat. It's crucial to have a full set of basic immunizations to boost your child's immune system with the antibodies produced by vaccination.
Additional vaccinations can also be given to reduce the risk of severe symptoms when a child develops pneumonia. This is especially recommended for children at high risk of developing severe pneumonia. Children with low immunity, whose immune systems are not yet fully developed, and who are at risk of exposure to various microorganisms that can cause pneumonia.
Written by Dr. Valda Garcia. Reviewed by Dr. Ernest Eugene
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