Pneumonia (peds)

This page is for pediatric patients. For adult patients, see: pneumonia


  • Most common site of infection in neonates

Bugs by Age Group

Clinical Features

Fever and tachypnea are sensitive but not specific

  • Fever
  • Cough
    • Productive cough is rarely seen before late childhood

Differential Diagnosis

Pediatric fever

Pediatric Shortness of Breath



Other diseases with abnormal respiration


  • Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
  • Imaging
    • CXR is not the gold standard!
    • Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
    • Consider for:
      • Age 0-3mo (as part of sepsis workup)
      • <5yr with temperature >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • Pneumonia that is prolonged or not responsive to antibiotics
  • Consider rapid assays for RSV, influenza
  • Blood/nasal culture are low yield
    • in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion [1]
    • consider for sicker ones, those with effusions



1-3 Month

>3mo - 18 years


All Children less than 2 months should be hospitalized[3]

Consider Admission For

  • Age: <2-3 months old
  • History of severe or relevant congenital disorders
  • Immune suppression (HIV, SCD, malignancy)
  • Toxic appearance/respiratory distress
  • SpO2 <90-93%
  • Vomiting/dehydration
  • Unstable social environment

See Also


  1. Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19.
  2. Sanford Guide to Antimicrobial Therapy 2014
  3. AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011