Pneumonia is a complication of many respiratory infections, including Covid-19

If your baby is unusually fussy and doesn’t feed well, it might be a sign that they have pneumonia, even if they don’t have a fever.
PHOTO: The Star/Asia News Network

One of the main worries when a child catches an infection of the respiratory system, is that it will develop into pneumonia, which can be fatal.

In fact, the World Health Organisation (WHO) estimates that the annual death rate of children below the age of five years worldwide due to pneumonia is 18 per cent. That is 1.4 million children every year.

According to consultant paediatric respiratory physician Dr Norzila Mohamed Zainudin, pneumonia is an infection of the lungs involving the alveoli, or air sacs, where oxygen and carbon dioxide are exchanged.

It occurs when microorganisms such as bacteria, viruses and fungi, invade the lungs and infect the alveoli.

Consequently, they become filled with fluid and pus, causing coughs, unrelenting fevers, difficulty breathing and chills.

"As you can see, this is different from the common cold, which is a viral infection that mainly affects the upper respiratory tract."

"With the common cold, there is a runny nose, a little bit of a fever and sneezing."

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"It is normally not serious, and while it cannot be treated with medicine, it usually goes away by itself within a couple of days," she explains.

She adds: "However, the cold is not to be mistaken with influenza, which refers to a specific strain of viruses."

While the symptoms of influenza may be similar to the common cold initially, what distinguishes the two is that influenza can lead to very serious health complications.

In children, this might manifest in the form of bluish lips or a temperature above 40°C.

The symptoms, including fatigue, chills and severe aches, often occur abruptly when compared to the common cold, and may develop into pneumonia.

Subtle signs

The signs and symptoms of pneumonia in children include:

  • Vomiting or diarrhoea
  • Loss of appetite
  • Headaches
  • Fussiness

Dr Norzila cautions parents to be vigilant and cautious as, "in children, pneumonia symptoms can be quite subtle. We're talking about infants aged six months and below here.

"Usually, they can present with just inactivity and might not even have a high fever."

"They could be feeding poorly, and may have vomiting, or even diarrhoea."

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"By the time the parents realise that the child is unwell, they could already be very, very sick with either rapid or irregular breathing."

Bear in mind that it is important that you bring your child to see their doctor if they fall sick.

Pneumonia symptoms may look like other health problems, so parents should always seek a proper medical diagnosis for their children.

"You can't go to the pharmacy and say 'My child has pneumonia' and ask for medicines.

"You wouldn't know. You still need to go to the doctor to make a clinical diagnosis.

"The doctor will make the decision on whether the treatment will be done at home, at the hospital or in an intensive care unit (ICU), " she says.

Test and treat

A variety of tests are available for a doctor to determine whether or not a child has pneumonia.

The first step is the physical examination where the doctor may hear abnormal sounds in the lungs using the stethoscope.

This finding will prompt further testing to determine the root cause of the abnormal sounds.

Both chest X-rays and blood tests can be done to check for signs of infection.

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Another option is a nasal swab to check for common infectious microorganisms.

Once a diagnosis of pneumonia is made, the decision on what treatment to give will depend on how severe the pneumonia is.

Treatment is usually supportive, e.g. bed rest and lots of fluids, as pneumonia is often viral, which has no cure.

Mild symptoms of pneumonia are commonly treated with at least a short course of antibiotics lasting three to five days at home, before the patient is seen again for reevaluation.

"However, if a child is displaying moderate or severe symptoms, they will need to be admitted.

"They will likely need intravenous (IV) antibiotics, we'll monitor the oxygen levels to keep it stabilised and so on.

"Usually, for a majority of children with pneumonia, if given the right treatment, it will get resolved with no residual effects on them, " says Dr Norzila.

Risk of infection

Among the risk factors for developing pneumonia is age. The two most vulnerable groups to pneumonia are children under the age of two years and adults aged 65 and above.

"For the younger children, it's because their immunity is still developing, " Dr Norzila explains.

"Then, you also have children who are not immunised. They are at a greater risk of contracting pneumonia."

These children include those who are born with an immunodeficiency and have low immunity, child cancer patients and those on immunosuppressant medication, e.g. children who have received an organ transplant.

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A lot of risk factors are external.

Exposure to a dirty, unhygienic environment or large crowds of people increases the possibility of being exposed to infectious microorganisms.

The lack of a healthy diet and physical activity can also contribute to lowered immunity to infections.

"This is why immunisation programmes are very, very important, " says Dr Norzila.

"Taking the pneumococcal vaccine, Haemophilus influenzae type B (Hib) vaccine and other flu vaccines available reduces the risk of pneumonia in vulnerable groups, especially the young children."

Besides providing your children with a clean and healthy environment to grow up in, vaccination is a big protective measure to help guard your children against certain infectious diseases.

It is also an affordable measure as the Hib vaccine is provided free to all Malaysian children as part of the National Immunisation Programme, while the pneumococcal vaccine is also set to be provided under the programme starting in June (2020).

A recurring problem

Picture this: Your child falls ill one day and you bring him to the doctor.

The doctor determines that your child has a case of pneumonia and provides the appropriate treatment.

Your child completes the treatment, recovers and goes home well.

However, a couple of months later, he develops another case of pneumonia.

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He gets treated and recovers, but the cycle repeats itself again a couple of months down the road.

This is a major concern for doctors. Says Dr Norzila: "The other thing that I'm always concerned about is recurrent pneumonia.

"There are children who get pneumonia once or twice, but there are some children who keep coming to the hospital with recurrent pneumonia."

As the name implies, recurrent pneumonia is defined as three or more episodes of pneumonia in a lifetime, or two or more episodes within a six-month period.

It is a condition that should be investigated with urgency to determine the underlying causes.

Recurrent pneumonia occurs mainly for three reasons:

  • Structural issues between the bronchus, the breathing tube of the body, and the oesophagus, the feeding tube.
  • Gastro-oesophageal reflux, and
  • Immunodeficiency

A structural problem between the bronchus and the oesophagus, like a fistula between the two tubes, may result in fluid getting into the lungs during drinking or feeding.

This could result in an infection of the air sacs, i.e. pneumonia.

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"Reflux means that when they drink milk, it goes into the stomach, then comes back up again in the opposite direction.

"At most, normally, it goes back into the oesophagus. However, sometimes, it can be so severe that the milk moves so far up that it goes into the lungs, " says Dr Norzila.

As for children with immunodeficiency, their low immunity means that their body is unable to fight off invading microorganisms, causing them to be at risk for recurrent infections, including pneumonia.

Pneumonia is a potentially serious disease that affects many children around the world.

While there are preventive measures and lifestyle adjustments you can make to minimise the risk of your children catching this disease, at the end of the day,

if you suspect your child has pneumonia, do bring them to the doctor quickly.

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