Pulmonary complications of pneumonia in children. Pneumonia: consequences and treatment

Pneumonia is a disease that occurs quite often among children. According to statistics, it accounts for about 80% of all pathologies of the respiratory system. Signs of pneumonia detected in a child at an early stage make it possible to begin treatment on time and speed up recovery.

Causes of the disease

The causative agents are pathogenic viruses, bacteria, and various fungi. Depending on the nature of the disease, a treatment regimen is selected.

Provoking factors for the development of pneumonia are:

Weakening of the immune system.
Lack of vitamins.
Past respiratory disease.
Penetration of a foreign object into the respiratory tract.
Stress.

Staphylococcal and streptococcal pneumonia can be associated with other diseases and occur after influenza, measles, and whooping cough. Due to insufficiently developed respiratory muscles, the small patient is unable to clear the phlegm that accumulates in the bronchi. As a result, ventilation of the lungs is disrupted, pathogenic microorganisms settle in them, which causes an inflammatory process.

Pathogenic bacteria also cause other diseases. Streptococcus pneumoniae in the throat often causes acute tonsillitis.

First signs

Symptoms of pneumonia in children manifest themselves in certain ways. It depends on various factors. For example, aspiration pneumonia in children develops gradually; at the initial stage, its signs may not be noticed. After some time, cough, chest pain and other symptoms appear, depending on the location of the aspiration. This form of the disease is distinguished by the absence of chills and fever. With atypical pneumonia in children, the symptoms are more pronounced - there is a lump in the throat, watery eyes, headaches, and a dry cough.

By the end of the first week of the disease, the cough intensifies, and the temperature during pneumonia in children can rise to 40⁰C. Possible addition of rhinitis, tracheitis. Many parents are interested in what temperature is considered normal for pneumonia. It depends on the state of the child's immune system. Some types of pneumonia occur without fever at all.

At the initial stage of pneumonia, symptoms in children can manifest themselves in different ways.

Signs of pneumonia in a child under one year old:

Cyanosis of the skin, especially in the area of the nasolabial triangle.
A sharp increase in temperature.
Difficulty breathing due to accumulation of mucus in the lungs.
Cough.
Lethargy.

How pneumonia manifests itself in infants helps determine the number of respiratory movements in 1 minute. For a 2 month old child it is equal to 50 breaths. As you grow, this figure decreases. So, for a child of 3 months it is already 40, and by the year it decreases to 30 breaths. If this indicator is exceeded, you should contact your pediatrician.

Cyanosis of the skin

For pneumonia in children, symptoms and treatment differ at different ages. Children of the older age group are characterized by the appearance of sputum when the pathological process reaches the bronchi. Pneumonia is suspected when wheezing and bluish lips are observed. The main symptom – shortness of breath – helps to recognize inflammation. If it does not disappear after a course of treatment, then additional examination is required.

As Dr. Evgeniy Komarovsky assures, the first symptoms do not cause as much harm as subsequent ones. Therefore, it is important to be able to distinguish the signs of the disease at the initial stage.

Symptoms characteristic of pneumonia

Each type of disease manifests itself differently depending on the location of the inflammatory focus.

Left-sided pneumonia

With this form of the disease, the pathological process develops on the left side. Left-sided pneumonia is much more dangerous compared to other types due to the irreversibility of the consequences that may occur. The lung becomes inflamed due to previous respiratory diseases, when a weakened immune system cannot resist the effects of pathogens. Left-sided pneumonia has mild symptoms, which makes diagnosis difficult.

Among the most characteristic:

Pain in the left chest.
Nausea.
Cough with sputum production, which may contain purulent patches.
A sharp rise in temperature, accompanied by chills.
Feeling of severe pain while inhaling.

It happens that left-sided pneumonia occurs without fever or other obvious signs. Delayed treatment in this case can cause serious complications and increases the risk of death.

Right-sided pneumonia

A form of the disease, which is characterized by the presence of a lesion in one of the lobes of the lung - upper, middle or lower. It is much more common than left-sided pneumonia. Each of the five cases are children under 3 years of age. The disease is most severe in newborns and children under 2 years of age.

It is distinguished by:

Cough, in which there is copious sputum production.
Tachycardia.
Cyanosis of the skin, especially in the area of the nasolabial triangle.
Leukocytosis.

Often the right-sided form occurs with mild symptoms.

Bilateral pneumonia

A disease where both lungs become inflamed. It is very difficult, especially in children under one year old. Therefore, bilateral pneumonia in a child is treated only in a hospital setting.

In newborns and children of the 1st year of life, a characteristic sign is pale skin, shortness of breath, cough, asthenic syndrome, bloating, hypotension. Wheezing can be heard in the lungs. The disease is progressing rapidly and the little man needs urgent hospitalization.

In children 2 years old, symptoms of inflammation often appear as a result of an allergic reaction. In children 3–5 years old, the disease often develops after an acute respiratory infection. When treating, you need to pay attention to elevated temperature that lasts longer than three days.

At the age of over 6 years, pneumonia occurs with alternating sluggish course and exacerbation.

Regardless of age, the following signs help to recognize bilateral pneumonia in a child: fever up to 40⁰C, rapid breathing, decreased appetite, shortness of breath, cyanosis, cough, drowsiness, weakness. Percussion sound when listening is shortened on the affected side, wheezing is heard in the lower parts of the lungs.

Bilateral pneumonia in a child threatens complications such as otitis media, sepsis, and meningitis.

For any viral pneumonia in children, the symptoms and treatment are not much different from the manifestations of the disease and treatment for adults.

Bronchopneumonia

The disease most often occurs in children under 3 years of age. It is an inflammatory process affecting the walls of the bronchioles. The disease has another name - sluggish pneumonia due to the vagueness of symptoms.

They look like slight shortness of breath, cough, arrhythmia, sometimes appearing without fever. Later they intensify, there is a rise in temperature to 39⁰C, and headaches.

Bacterial pneumonia

The pathogens that cause bacterial pneumonia are pneumococci, staphylococci, streptococci, and gram-negative bacteria. The first signs of pneumonia in children are noticed earlier than in adults. They manifest themselves in the form of rapid breathing, vomiting, and pain in the abdominal area. Children with a temperature in the lower part of the lungs sometimes feel feverish.

Mycoplasma and chlamydial pneumonia

Mycoplasma infection, in addition to the main symptoms, causes a rash in the throat and pain. Chlamydia pneumonia in infants can provoke the development of a dangerous form of conjunctivitis. With pneumonia caused by this intracellular bacterium, rhinitis and tracheobronchitis are often diagnosed. Chlamydia pneumonia in children also manifests itself as extrapulmonary symptoms - arthralgia, myalgia. It is believed that this disease accounts for up to 15% of all community-acquired diseases. During epidemic outbreaks, this figure increases to 25%.

The disease can develop either acutely or gradually, becoming protracted. The main symptoms are nasal congestion, difficulty breathing, hoarse voice, and slight mucous discharge from the nose. After these signs appear, the inflammatory process lasts from 1 to 4 weeks. Cough and general malaise sometimes persist for several months. The disease can occur without fever.

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Video - pneumonia

Hidden pneumonia

The course of the disease without pronounced symptoms poses the greatest danger to children under 2 years of age. At this age, they cannot yet communicate what exactly is bothering them. Latent pneumonia in children can manifest itself as a barely noticeable malaise. Having noticed them, parents often attribute it to a cold or teething. Only when the child’s condition deteriorates sharply does treatment begin.

Therefore, it is important to know how to recognize pneumonia in a child, and not to lose sight of such symptoms of pneumonia in children as:

Pallor of the skin.
Blush on the cheeks in the form of spots.
Shortness of breath that appears with little exertion.
Increased sweating.
Breathing with grunting.
Temperature rises to 38⁰C.
Refusal to eat.

With latent pneumonia in children, the symptoms listed above can appear either singly or in combination, sometimes without fever. Having discovered them, you should immediately show the baby to the doctor.

Diagnostics

The question of how to determine pneumonia in a child is easily resolved today with the help of modern diagnostic methods. When collecting anamnesis, the time of detection of the first signs of illness is determined, what diseases preceded the onset of inflammation, and whether there is an allergy. A visual examination can reveal existing respiratory failure, wheezing, and other symptoms characteristic of pneumonia.

Laboratory methods help diagnose the disease.

A blood test for pneumonia in a child is carried out to determine the causative agent of the disease:

Biochemical analysis determines indicators such as the number of leukocytes, ESR, and hemoglobin level.
Thanks to two blood cultures, it is possible to exclude bacteremia and sepsis.
Serological analysis reveals the presence of immunoglobulins.

Sputum culture and scraping of the posterior pharyngeal wall are also performed.

A more accurate diagnosis can be made by determining the extent of lung damage (as well as recognizing bronchitis in a child and any other bronchopulmonary disease) using radiography.

General principles of treatment

Treatment is usually carried out in a hospital setting. How long you stay in the hospital with pneumonia depends on the severity of the disease and the state of your immune system. The main component of the treatment course for the inflammatory process is antibiotics.

You can cope with the disease only by strictly following all the doctor’s prescriptions. Self-medication for such a serious illness is unacceptable. The medicine is taken according to the schedule determined by the doctor. Penicillins, cephalosporins, and macrolides are usually used in treatment. The effectiveness of the use of a particular drug is assessed only after 72 hours. To ensure that the intestinal microflora does not suffer from the action of antibiotics, probiotics are additionally prescribed. In order to cleanse the body of toxins remaining after antibacterial therapy, sorbents are used.

Proper nutrition plays an important role in the treatment process. The patient's diet should contain easily digestible food. These can be vegetable soups, liquid porridges, boiled potatoes, fresh vegetables and fruits. As a drink, it is best to give children rosehip infusion, juices, and raspberry tea.

Prevention

You can avoid the disease by following simple rules:

Do not allow the child to become hypothermic.
Provide quality nutrition that includes all the necessary vitamins.
Perform hardening procedures.
Walk more with your children in the fresh air.
Avoid contact with a sick person who can transmit the infection.
During epidemic periods, do not visit kindergartens or crowded places.
Teach your child to wash their hands thoroughly, lathering them for at least 20 seconds.
Treat infectious diseases in a timely manner.

Taking care of your baby’s health, starting from the first days of his life, is the best protection against disease.

Vaccination helps reduce the risk of infection. Vaccination forms immunity to the causative agent of pneumonia. However, the duration of such protection is no more than 5 years.

Nowadays, cases of pneumonia in children are becoming more common. The reason for this is many pathogenic bacteria and viruses that enter the body when the immune system is weakened. At the same time, a high temperature rises, a severe cough, shortness of breath and, as a result, pulmonary edema appear. Treatment of such patients takes place in a hospital setting and using modern antibiotics. But the disease has subsided, and the doctors are sending me home. That's all? No! There are many complications after the disease. The body, especially children’s, needs to be restored further!

The child suffered from pneumonia. Consequences

After pneumonia in a child, a number of negative consequences for the body can be identified. They can be divided into two groups:

consequences related specifically to the lungs;
extrapulmonary consequences.

The group of complications associated with changes in the lungs includes: pleurisy (exudative, adhesive, pleural empyema), pulmonary destruction, cardiopulmonary failure and, probably the most harmless thing, a prolonged cough with sputum production. Also, untreated pneumonia can take a chronic form, which will lead to decreased immunity, constant relapses and deformation of the chest.

Exudative pleurisy - when it occurs, fluid accumulates in the pleural cavity - exudate. It manifests itself as pain and heaviness in the affected area, dry cough, shortness of breath, fever and sweating. It is treated by puncturing and pumping out fluid.

Adhesive pleurisy – with this type, fibrin accumulates in the pleural area. Which, over time, grows with connective tissue, which leads to the formation of fibrous adhesions. The sheets of the pleura stick together, and eventually it becomes overgrown. In this case, there is a strong paroxysmal cough, high temperature, acute pain in the anterior chest, shortness of breath, fatigue, and sweating. It can only be treated by abdominal surgery on the lung.

Empyema of the pleura or purulent pleurisy - inflammation of the pleural layers with the accumulation of pus in them. Occurs due to harmful microorganisms and bacteria entering this area. In this case, the child will have chills, high body temperature, stabbing pain in the chest extending to the shoulder blade, cough, increased fatigue, and headaches. Treatment is carried out through antibacterial therapy.

Pulmonary destruction – a very dangerous complication that can lead to the death of the child. Massive necrosis and destruction of lung tissue occurs. Destruction manifests itself when the main symptoms of pneumonia subside. The child seems to be recovering, but then the temperature rises sharply again, cough, chills, chest pain, and a strong smell of rot from the mouth. My health is deteriorating very quickly. And if the onset of lung decomposition is not quickly identified and the necessary treatment is not started, the child will simply die.

Cardiopulmonary failure – may occur due to long-term intoxication of the body and respiratory failure during pneumonia.

The second group includes such consequences as: asthenic syndrome, sepsis, urinary retention, convulsions.

Asthenic syndrome – decreased appetite, lethargy, fatigue, low body temperature. The most harmless complication that goes away quite quickly.

Sepsis – a very terrible and serious complication, the mortality rate from which reaches 100%, that is, it is impossible to cure it. It occurs when an infection enters the bloodstream and spreads throughout the body. In this case, purulent spots appear on various parts of the body and the temperature rises sharply.

Urinary retention – this disease occurs very often in children who have recovered from the disease. In this case, diuresis is restored with the help of diuretics.

Convulsions – this complication is also common in young children. Treatment is to stop seizures caused by a lack of oxygen in the blood and swelling of the brain. For this, various drugs prescribed by a doctor are used, and in some severe cases, a spinal puncture is performed.

Fortunately, in our time of advanced medicine, severe complications are rare, thanks to timely treatment with modern antibacterial and other drugs. But you cannot rely only on treatment in a hospital; a favorable outcome of the disease also depends on further rehabilitation after the child is discharged home. What needs to be done so that the child can easily endure this illness without consequences for his body?

Prevention of complications after pneumonia

After discharge from the hospital, the child must be registered with a pediatrician and specialized specialists, such as an ENT doctor, an immunologist and a pulmonologist for a period of 1 year. Doctors draw up an individual follow-up plan for each child separately, depending on the severity of the disease and the consequences that arise. Every 2 months, a clinical blood and urine test is required, and in the case of residual pulmonary effects, X-ray examinations are performed. The attending physician will also prescribe a course of rehabilitation measures, such as:

Physiotherapy - such types as ionogalvanization with calcium or bromine salts, electrophoresis, general ultraviolet irradiation have proven themselves well;
Therapeutic exercise and massage;
Vitamin therapy and the use of immunomodulators to restore the body’s immune forces;
Taking air baths - aerotherapy;
Prescribed drugs to restore intestinal microflora disturbed after antibacterial therapy;
Herbal infusions are prescribed, as well as, if necessary, inhalations and expectorants;
Hardening procedures are carried out, which begin with wiping the body with water, the temperature of which should be equal to 32 degrees and gradually reducing it;
Walking in the fresh air, healthy sleep, and a nutritious diet rich in vitamins and minerals are mandatory.
To avoid relapses in the future, after the child has fully recovered, preventive vaccinations are carried out directly against pneumonia, as well as against influenza, because pneumonia is often a complication of this virus.

You also need moist, fresh air in the children's room, and you must ensure that the child does not breathe tobacco smoke.

And in no case should you let everything take its course; rehabilitation after an illness is mandatory!

How long should a child who has had pneumonia be isolated?

How quickly a child recovers from pneumonia depends on the severity of the disease, the rehabilitation measures taken and the general strength of the body.

With a mild course of the disease, complete recovery can occur in 10-14 days, given the absence of complications. But in most cases, treatment is delayed for 2-3 months. Naturally, all this time you cannot visit public places with large crowds of people. Since the body is still very weakened, the risk of infecting the child with colds and other diseases must be eliminated. You can begin visiting children's educational institutions no less than 10 days after the pediatrician declares a complete recovery.

The phrase “pneumonia” is very scary for parents. At the same time, it does not matter at all how old or months old the child is, this disease is considered one of the most dangerous among mothers and fathers. Is this really so, how to recognize pneumonia and how to treat it correctly, says the famous children's doctor, author of books and articles on children's health, Evgeniy Komarovsky.

About the disease

Pneumonia (this is what doctors call what is popularly called pneumonia) is a very common disease, inflammation of the lung tissue. By one concept, doctors mean several ailments at once. If the inflammation is not infectious, the doctor will write “pneumonitis” on the card. If the alveoli are affected, the diagnosis will sound different - “alveolitis”; if the mucous membrane of the lungs is affected - “pleurisy”.

The inflammatory process in the lung tissue is caused by fungi, viruses and bacteria. There are mixed inflammations - viral-bacterial, for example.

All medical reference books classify the illnesses included in the concept of “pneumonia” as quite dangerous, since out of the 450 million people from all over the world who fall ill with them per year, about 7 million die due to incorrect diagnosis, incorrect or delayed treatment, and also on the speed and severity of the disease. Among the deaths, about 30% were children under 3 years of age.

Based on the location of the source of inflammation, all pneumonias are divided into:

Focal;
Segmental;
Equity;
Drain;
Total.

Also, inflammation can be bilateral or unilateral if only one lung or part of it is affected. Quite rarely, pneumonia is an independent disease; more often it is a complication of another disease - viral or bacterial.

Pneumonia is considered the most dangerous for children under 5 years of age and the elderly; among such patients the consequences are unpredictable. According to statistics, they have the highest mortality rate.

Evgeny Komarovsky claims that the respiratory organs in general are the most vulnerable to various infections. It is through the upper respiratory tract (nose, oropharynx, larynx) that most germs and viruses enter the child’s body.

If the baby’s immunity is weakened, if the environmental conditions in the area where he lives are unfavorable, if the microbe or virus is very aggressive, then the inflammation does not linger only in the nose or larynx, but goes down to the bronchi. This disease is called bronchitis. If it cannot be stopped, the infection spreads even lower - to the lungs. Pneumonia occurs.

However, the airborne route of infection is not the only one. If we consider that the lungs, in addition to gas exchange, perform several other important functions, it becomes clear why sometimes the disease appears in the absence of a viral infection. Nature has entrusted the human lungs with the mission of moisturizing and warming the inhaled air, purifying it from various harmful impurities (the lungs act as a filter), and also similarly filter the circulating blood, releasing many harmful substances from it and neutralizing them.

If the baby has undergone surgery, broken a leg, ate something wrong and got severe food poisoning, got burned, cut himself, this or that amount of toxins, blood clots, etc. enters the blood in varying concentrations. The lungs patiently neutralize this or remove it out with using a defense mechanism - coughing. However, unlike household filters, which can be cleaned, washed or thrown away, lung filters cannot be washed or replaced. And if one day some part of this “filter” fails, becomes clogged, the very disease that parents call pneumonia begins.

Pneumonia can be caused by a wide variety of bacteria and viruses.. If a child gets sick while in the hospital with another illness, then there is a high probability that he will have bacterial pneumonia, which is also called hospital-acquired or hospital-acquired pneumonia. This is the most severe of pneumonia, since in conditions of hospital sterility, the use of antiseptics and antibiotics, only the strongest and most aggressive microbes survive, which are not so easy to destroy.

The most common occurrence in children is pneumonia, which arose as a complication of a viral infection (ARVI, influenza, etc.). Such cases of pneumonia account for about 90% of the corresponding childhood diagnoses. This is not even due to the fact that viral infections are “scary”, but because they are extremely widespread, and some children get them up to 10 times a year or even more.

Symptoms

To understand how pneumonia begins to develop, you need to have a good understanding of how the respiratory system generally works. The bronchi constantly secrete mucus, the task of which is to block dust particles, microbes, viruses and other unwanted objects that enter the respiratory system. Bronchial mucus has certain characteristics, such as viscosity, for example. If it loses some of its properties, then instead of fighting the invasion of foreign particles, it itself begins to cause a lot of “trouble.”

For example, mucus that is too thick, if the child breathes dry air, clogs the bronchi and interferes with normal ventilation of the lungs. This, in turn, leads to congestion in some parts of the lungs - pneumonia develops.

Pneumonia often occurs when the child’s body rapidly loses fluid reserves and bronchial mucus thickens. Dehydration of varying degrees can occur with prolonged diarrhea in a child, with repeated vomiting, high heat, fever, or with insufficient fluid intake, especially against the background of the previously mentioned problems.

Parents may suspect pneumonia in their child based on a number of signs:

Cough has become the main symptom of the disease. The rest, who were present earlier, gradually disappear, and the cough only gets worse.
The child became worse after improvement. If the disease has already subsided, and then suddenly the baby feels unwell again, this may well indicate the development of a complication.
The child cannot take a deep breath. Every attempt to do this results in a severe coughing attack. Breathing is accompanied by wheezing.
Pneumonia can manifest itself through severe pallor of the skin against the background of the symptoms listed above.
The child has shortness of breath, and antipyretic drugs, which previously always quickly helped, ceased to have an effect.

It is important not to engage in self-diagnosis, since the absolute way to determine the presence of inflammation of the lungs is not even the doctor himself, but an X-ray of the lungs and bacterial culture of the sputum, which will give the doctor an accurate idea of which pathogen caused the inflammatory process. A blood test will show the presence of antibodies to viruses if the inflammation is viral, and Klebsiella found in the stool will lead to the idea that pneumonia is caused by this dangerous pathogen. At home, the doctor will definitely listen and tap the area of the little patient’s lungs, listen to the nature of wheezing when breathing and during coughing.

Is pneumonia contagious?

Whatever causes pneumonia, in almost all cases it is contagious to others. If these are viruses, they are easily transmitted to other family members through the air, if bacteria - by contact, and sometimes by airborne droplets. Therefore, a child with pneumonia should be provided with separate dishes, towels, and bed linen.

Treatment according to Komarovsky

Once the diagnosis is made, the doctor will decide where the child will be treated - at home or in the hospital. This choice will depend on how old the child is and how severe his pneumonia is. Pediatricians try to hospitalize all children under 2 years of age, since their immunity is weak, and for this reason the treatment process must be constantly monitored by medical personnel.

All cases of obstruction during pneumonia (pleurisy, bronchial obstruction) are grounds for hospitalization in children of any age, since this is an additional risk factor, and recovery from such pneumonia will not be easy. If the doctor says that you have uncomplicated pneumonia, then with a high degree of probability he will allow you to treat it at home.

Most often, pneumonia is treated with antibiotics, and it is not at all necessary that you have to give a lot of painful and scary injections.

The doctor will determine antibiotics that can quickly and effectively help based on the results of a sputum culture test.

Two-thirds of cases of pneumonia, according to Evgeniy Komarovsky, are perfectly treated with tablets or syrups. In addition, expectorants are prescribed, which help the bronchi to clear accumulated mucus as quickly as possible. At the final stage of the child’s treatment, physiotherapy and massage are indicated. Also, children undergoing rehabilitation are advised to take walks and take vitamin complexes.

If the treatment takes place at home, it is important that the child is not in a hot room, drinks enough liquid, and a vibration massage is useful, which promotes the discharge of bronchial secretions.

Treatment for viral pneumonia will be similar, with the exception of taking antibiotics.

Prevention

If a child gets sick (ARVI, diarrhea, vomiting and other problems), you must ensure that he consumes enough fluid. The drink should be warm so that the liquid can be absorbed faster.

A sick baby should breathe clean, moist air. To do this, you need to ventilate the room, humidify the air using a special humidifier or using wet towels hung around the apartment. The room should not be allowed to get hot.

The best parameters for maintaining a normal level of mucus viscosity are as follows: air temperature 18-20 degrees, relative humidity - 50-70%.

The disease is most common during the off-season, when the frequency of acute respiratory infections increases. Pneumonia, as a rule, occurs secondarily. This is due to a local decrease in immunity.

What is pneumonia in a child, how to understand? This term refers to a group of diseases that have 3 characteristic features:

Inflammatory damage to the lungs with primary involvement in the pathological process of the respiratory sections (alveoli), in which exudate accumulates.
The presence of a clinical syndrome of respiratory disorders (shortness of breath, increased frequency of chest excursions, etc.);
The presence of infiltrative signs on an x-ray (this criterion is considered the most important by the World Health Organization).

However, the causes and mechanisms of development of pneumonia can be very different. They are not decisive in making a diagnosis. The presence of clinical and radiological inflammatory syndrome is important.

The causes of pneumonia are always associated with the presence of a microbial factor. More than 80-90% are bacteria, the remaining cases are viruses and fungi. Among viral particles, the most dangerous are influenza, adenovirus and parainfluenza.

Against the background of severe pneumonia, a lung abscess may develop. What is it and how is it treated:

The nature of the pathogen leaves an imprint on the choice of etiological (affecting the cause) treatment. Therefore, from a clinical point of view, there are 3 main forms of pneumonia:

1). Out-of-hospital - develops at home and has no connection with a medical institution.

2). In-hospital or hospital- develops within 72 hours (3 days) of hospital stay or during the same time period after discharge.

This form poses the greatest danger because... associated with microorganisms that have developed resistance factors to pharmacological drugs. Therefore, microbiological monitoring is regularly carried out in a medical institution.

3). Intrauterine– a child becomes infected from the mother during pregnancy. Clinically, it debuts within 72 hours after birth.

Each of these groups is characterized by the most likely pathogens. These data were obtained from a series of epidemiological studies. They need regular updating, because... The microbial landscape can change significantly over the course of several years.

At the moment they look like this. Community-acquired pneumonia most often associated with microorganisms such as:

up to six months – these are E. coli and viruses;
up to 6 years – pneumococci (less often Haemophilus influenzae);
up to 15 years – pneumococci.

At any age, the pathogens can be pneumocystis, chlamydia, mycoplasma and others (an atypical type of disease).

The infection caused by them occurs with mild clinical manifestations, but rapid development of respiratory failure. Atypical pneumonia in a 3-year-old child is most often associated with mycoplasmas.

Microbial spectrum nosocomial pneumonia different from home. Causal agents may be:

resistant Staphylococcus aureus;
pseudomonas (their role is especially important in various medical procedures);
serrations;
Klebsiella;
opportunistic microflora in patients on artificial ventilation.

There is a group of children whose risk of developing pneumonia is increased. They have predisposing factors:

tobacco smoke if parents or other people around smoke;
ingestion of milk into the respiratory tract (in babies);
chronic lesions in the body (tonsillitis, laryngitis, etc.);
hypothermia;
hypoxia suffered during childbirth (in infants);
immunodeficiency states.

The first signs of pneumonia in a child

Signs of pneumonia in a child are characterized by an increase in body temperature. This is a nonspecific reaction to the presence of an infectious agent in the body. Usually it rises to high levels, but sometimes it is low-grade.

The inflammatory reaction of the pleura leads to painful breathing. It is often accompanied by a grunting sound that appears at the beginning of exhalation. It can be mistakenly taken for a sign of bronchial obstruction (for example, as in bronchial asthma).

Accessory muscles are often involved in breathing. But this sign is nonspecific, because may be observed in other diseases.

Lower right-sided pneumonia in a child can simulate liver disease. This is due to the appearance. However, with pneumonia there are no symptoms observed with damage to the digestive system - (may be with severe intoxication), diarrhea, rumbling in the stomach, etc.

Severe intoxication during pneumonia causes the appearance of general symptoms:

complete lack of appetite or its significant decrease;
child's agitation or indifference;
poor sleep;
increased tearfulness;
pale skin;
convulsions that appear against the background of a rise in temperature.

Symptoms of pneumonia in children

Symptoms of pneumonia in children may vary depending on the causative microorganism. This forms the basis of clinical and epidemiological diagnostics, which allows you to select the most rational antibiotic without laboratory examination.

Distinctive features pneumococcal lesions lungs are:

high temperature increase (up to 40°C);
chills;
cough with rust-colored sputum;
chest pain;
frequent loss of consciousness;
can develop in children starting from 6 months of age.

Streptococcal pneumonia:

children aged 2 to 7 years are more susceptible;
purulent complications (purulent pleurisy, lung abscess);
violations of the blockade of impulses from the atrium to the ventricles.

Haemophilus influenzae infection:

most often observed before 5 years of age;
acute onset;
severe toxicosis;
slight increase in leukocytes in the blood;
extensive process in the lungs with the development of hemorrhagic edema;
ineffectiveness of prescribed penicillin.

Mycoplasma pneumonia:

more common among schoolchildren;
long-lasting cough;
non-severe general condition causing late referral to a pediatrician;
redness of the conjunctival membrane of the eyes (“red eyes”);
normal level of leukocytes in the blood;
asymmetrical infiltration of pulmonary fields.

Diagnostics and tests

Diagnosis of pneumonia in childhood is based on the results of clinical, radiological and laboratory examinations. If there are symptoms suspicious for the disease, pulmonary radiography is performed.

It allows you to determine the extent of damage to the respiratory system and identify possible complications. With a characteristic x-ray picture, an accurate diagnosis of pneumonia is established.

Indications for prescribing and norms of biochemical blood tests in children:

At the second stage the causative agent is identified. For this purpose, various studies can be carried out:

Sputum culture as part of bacteriological analysis.
Blood cultures to rule out sepsis.
Determination of immunoglobulins (antibodies) to atypical pathogens in the blood (serological analysis).
Detection of pathogen DNA or RNA. The material for research is scraping from the back wall of the pharynx, conjunctiva or sputum.

All children with fever are required to undergo a general clinical and biochemical blood test. With pneumonia, it will have the following changes:

increase in leukocyte levels. However, in viral and mycoplasma infections, leukocytosis rarely exceeds 15,000/μl. It is maximum with chlamydial infection (30,000/μl or more);
a shift of the formula to the left with the appearance of juvenile forms and toxic granularity of leukocytes (the most typical sign of bacterial pneumonia);
increased ESR (20 mm/h or more);
decrease in hemoglobin due to its redistribution between organs and the microcirculation system;
increased fibrinogen levels;
acidosis.

Basic principles of treatment of pneumonia in children

Treatment of pneumonia begins with the correct regimen and diet. Bed rest is recommended for all sick children. Its expansion becomes possible after the temperature decreases and stabilizes within normal values.

The room in which the child is located must be ventilated, because... fresh air deepens and shortens breathing. This has a positive effect on the course of the disease.

Learn more about the causes, signs and treatment methods of pneumonia in adults:

Dietary nutrition includes:

easily digestible foods predominate in the diet;
products must have a low allergenic index;
the amount of protein foods (meat, eggs, cottage cheese) increases in the diet;
drink plenty of fluids (purified water, teas).

Antibiotics for pneumonia in children are the main treatment, because are aimed at eliminating the causative agent that caused the disease. The sooner they are prescribed, the faster they will begin to act, and the child’s condition will return to normal.

The choice of antibacterial drug depends on the form of pneumonia. It is carried out only by a doctor - self-medication is unacceptable.

The main antibiotics approved for use in childhood are:

Amoxicillin, incl. protected form (Amoxiclav);
Ampicillin;
Oxacillin.

Alternative antibiotics (prescribed in the absence of the main ones or intolerance) are cephalosporins:

Cefuroxime;
Ceftriaxone;
Cefazolin.

Reserve antibiotics are used when the above are ineffective. Their use is limited in pediatrics due to increased risk of side effects. But in situations of pharmacological resistance of microorganisms, this is the only method of etiotropic treatment.

Representatives of these drugs are:

Vancomycin;
Carbopenem;
Ertapenem;
Linezolid;
Doxycycline (in children over 18 years of age).

At the same time, symptomatic therapy is carried out.

It depends on the complications that have developed and the general condition of the child:

Fever - antipyretics (non-steroids and Paracetamol).
Respiratory failure - oxygen therapy and artificial pulmonary ventilation (in severe cases).
Pulmonary edema - careful consideration of the administered fluid to avoid overhydration and artificial ventilation.
Disseminated blood coagulation in blood vessels - prednisolone and heparin (in the phase of increased blood coagulation).
Septic shock - adrenaline and prednisolone to increase blood pressure, assessment of the effectiveness of antibiotics used, sufficient infusion therapy, artificial methods of blood purification (in severe cases).
Anemia - iron-containing drugs (but in the acute period of the disease they are contraindicated).

Forecast and consequences

The prognosis for pneumonia in children depends on the timeliness of treatment and the state of the premorbid background (the presence of aggravating factors). If therapy is started within 1-2 days from the onset of the disease, then complete recovery occurs without residual changes.

If the first signs of the disease are missed, complications may develop.

The consequences of pneumonia can be different. Their severity depends on the causative agent. Most often, the most severe consequences are caused by Haemophilus influenzae, pneumococci, staphylococci, streptococci, Klebsiella and serracia. They contribute to the development of lung destruction.

The severity of the infectious process may be associated with an unfavorable premorbid background:

prematurity of the child;
nutritional deficiency;
foreign body in the respiratory tract;
habitual entry of food into the respiratory system.

Classified into 3 types (depending on topography):

1. Pulmonary:

inflammation of the pleura;
lung abscess;
pulmonary edema;
– entry of air into the pleural cavity during rupture of the lung tissue with subsequent compression.

2. Cardiological:

heart failure;
endocarditis;
myocarditis.

3. System:

bleeding disorder (DIC syndrome);
septic shock, manifested by a critical drop in pressure and impaired microcirculation in organs;
sepsis – the presence of microorganisms in the blood and their spread to various organs (an extremely serious condition).

After suffering from pneumonia, a child may cough for a long time in the morning. This is due to the restoration of the mucous membrane not yet completely completed. The cough is usually dry. To eliminate it, it is recommended to inhale salty sea air and general hardening of the body. Physical activity is allowed only 1.5 months after recovery for mild pneumonia, and 3 months after severe pneumonia (with complications).

Prevention

Specific prevention (vaccination) of pneumonia in childhood is carried out against the most dangerous and common pathogens. This is how a vaccine against Hib infection (Haemophilus influenzae) was developed and put into practice.

Nonspecific prevention implies the following rules:

avoiding hypothermia;
rational and balanced nutrition of the child, which does not lead to underweight or obesity;
parental cessation of smoking;
general hardening;
timely treatment of colds (not self-medication, but therapy prescribed by a doctor).

Pneumonia should be understood as an acute or chronic infectious-inflammatory process that develops in the lung tissue and causes a syndrome of respiratory distress.

Pneumonia is a serious disease of the respiratory system in children. The incidence is sporadic, but in rare cases, outbreaks of the disease may occur among children in the same group.

The incidence rate of pneumonia in children under 3 years of age is about 20 cases per 1 thousand children of this age, and in children over 3 years old - about 6 cases per 1 thousand children.

Causes of pneumonia

Pneumonia is a polyetiological disease: different pathogens of this infection are more typical for different age groups. The type of pathogen depends on the condition and on the conditions and location of children during the development of pneumonia (in a hospital or at home).

Pneumonia can be caused by:

pneumococcus – in 25% of cases;
– up to 30%;
chlamydia – up to 30%;
(golden and epidermal);
coli;
fungi;
mycobacterium;
hemophilus influenzae;
Pseudomonas aeruginosa;
pneumocystis;
legionella;
viruses (parainfluenza, adenovirus).

Thus, in children aged from the second half of life to 5 years old who fall ill at home, pneumonia is most often caused by Haemophilus influenzae and pneumococcus. In children of preschool and primary school age, pneumonia can be caused by mycoplasma, especially during the transitional summer-autumn period. In adolescence, chlamydia can cause pneumonia.

When pneumonia develops outside a hospital setting, the patient's own (endogenous) bacterial flora located in the nasopharynx is more often activated. But the pathogen can also come from outside.

Factors contributing to the activation of one’s own microorganisms are:

development ;
hypothermia;
aspiration (entry into the respiratory tract) of vomit during regurgitation, food, foreign body;
in the child’s body;
Congenital heart defect;
stressful situations.

Although pneumonia is primarily a bacterial infection, it can also be caused by viruses. This is especially true for children in the first year of life.

With frequent regurgitation in children and possible entry of vomit into the respiratory tract, pneumonia can be caused by both Staphylococcus aureus and Escherichia coli. Pneumonia can also be caused by Mycobacterium tuberculosis, fungi, and in rare cases, Legionella.

Pathogens enter the respiratory tract and from the outside, through airborne droplets (with inhaled air). In this case, pneumonia can develop as a primary pathological process (lobar pneumonia), or it can be secondary, occurring as a complication of the inflammatory process in the upper respiratory tract (bronchopneumonia) or in other organs. Currently, secondary pneumonia is more often recorded in children.

When infection penetrates into the lung tissue, swelling of the mucous membrane of the small bronchus develops, as a result of which the supply of air to the alveoli becomes difficult, they collapse, gas exchange is disrupted, and oxygen starvation develops in all organs.

There are also hospital-acquired (nosocomial) pneumonias, which develop in a hospital setting during treatment of a child for another disease. The causative agents of such pneumonia can be “hospital” strains resistant to antibiotics (staphylococci, Pseudomonas aeruginosa, Proteus, Klebsiella) or microorganisms of the child himself.

The development of hospital-acquired pneumonia is facilitated by the antibacterial therapy the child receives: it has a detrimental effect on the normal microflora in the lungs, and instead of it, flora alien to the body populates them. Hospital-acquired pneumonia occurs after two or more days of hospital stay.

Pneumonia in newborns in the first 3 days of life can be considered a manifestation of hospital pneumonia, although in these cases it is difficult to exclude intrauterine infection.

Pulmonologists also distinguish lobar pneumonia, caused by pneumococcus and involving several segments or the entire lobe of the lung with a transition to the pleura. More often it develops in children of preschool and school age, rarely before 2-3 years. Typical for lobar pneumonia is damage to the left lower lobe, less often to the right lower and right upper lobes. In infancy, it manifests itself in most cases as bronchopneumonia.

Interstitial pneumonia is manifested by the fact that the inflammatory process is predominantly localized in the interstitial connective tissue. It is more common in children in the first 2 years of life. It is particularly severe in newborns and infants. It is more common in the autumn-winter period. It is caused by viruses, mycoplasma, pneumocystis, chlamydia.

In addition to bacterial and viral, pneumonia can be:

occur when ;
associated with the action of chemical and physical factors.

Why do young children get pneumonia more often?

The smaller the child, the higher the risk of developing pneumonia and the severity of its course. The frequent occurrence of pneumonia and its chronicity in children is facilitated by the following characteristics of the body:

the respiratory system is not fully formed;
the airways are narrower;
the lung tissue is immature, less airy, which also reduces gas exchange;
the mucous membranes in the respiratory tract are easily vulnerable, have many blood vessels, and quickly become inflamed;
the cilia of the mucosal epithelium are also immature and cannot cope with the removal of mucus from the respiratory tract during inflammation;
abdominal type of breathing in babies: any “problem” in the abdomen (bloating, swallowing air into the stomach during feeding, enlarged liver, etc.) further complicates gas exchange;
immaturity of the immune system.

The following factors also contribute to the occurrence of pneumonia in babies:

artificial (or mixed) feeding;
passive smoking, which occurs in many families: has a toxic effect on the lungs and reduces the supply of oxygen to the child’s body;
malnutrition, rickets in a child;
insufficient quality of child care.

Symptoms of pneumonia

According to the existing classification, pneumonia in children can be unilateral or bilateral; focal (with areas of inflammation 1 cm or more); segmental (inflammation spreads to the entire segment); drain (the process involves several segments); lobar (inflammation is localized in one of the lobes: the upper or lower lobe of the lung).

Inflammation of the lung tissue around the inflamed bronchus is interpreted as bronchopneumonia. If the process extends to the pleura, pleuropneumonia is diagnosed; if fluid accumulates in the pleural cavity, this is already a complicated course of the process and has arisen.

The clinical manifestations of pneumonia largely depend not only on the type of pathogen that caused the inflammatory process, but also on the age of the child. In older children, the disease has more clear and characteristic manifestations, and in children, with minimal manifestations, severe respiratory failure and oxygen starvation can quickly develop. It is quite difficult to predict how the process will develop.

Initially, the baby may experience slight difficulty in nasal breathing, tearfulness, and loss of appetite. Then the temperature suddenly rises (above 38°C) and persists for 3 days or longer, increased breathing and pallor of the skin, pronounced cyanosis of the nasolabial triangle, and sweating appear.

Auxiliary muscles are involved in breathing (the retraction of the intercostal muscles, supra- and subclavian fossae during breathing is visible to the naked eye), and the wings of the nose swell (“sail”). The respiratory rate during pneumonia in an infant is more than 60 per minute, in a child under 5 years old it is more than 50.

A cough may appear on days 5-6, but it may not exist. The nature of the cough can be different: superficial or deep, paroxysmal, unproductive, dry or wet. Sputum appears only if the bronchi are involved in the inflammatory process.

If the disease is caused by Klebsiella (Friedlander's bacillus), then signs of pneumonia appear after previous dyspeptic symptoms (and vomiting), and a cough may appear from the first days of the disease. It is this pathogen that can cause an epidemic outbreak of pneumonia in a children's group.

In addition to palpitations, other extrapulmonary symptoms may occur: muscle pain, skin rashes, diarrhea, confusion. At an early age, a child may appear at high temperatures.

When listening to the child, the doctor may detect weakened breathing in the area of inflammation or asymmetric wheezing in the lungs.

With pneumonia in schoolchildren and adolescents, there are almost always previous minor manifestations. Then the condition returns to normal, and a few days later chest pain and a sharp rise in temperature appear. The cough occurs over the next 2-3 days.

With pneumonia caused by chlamydia, catarrhal manifestations in the pharynx and enlarged neck are noted. And with mycoplasma pneumonia, the temperature may be low, a dry cough and hoarseness may be noted.

With lobar pneumonia and spread of inflammation to the pleura (that is, with lobar pneumonia) breathing and coughing are accompanied by severe chest pain. The onset of such pneumonia is violent, the temperature rises (with chills) to 40°C. Symptoms of intoxication are expressed: vomiting, lethargy, and possibly delirium. Abdominal pain, diarrhea, and bloating may occur.

Herpetic rashes on the lips or wings of the nose and redness of the cheeks often appear on the affected side. Can be . The breath is moaning. The cough is painful. The ratio of respiration and pulse is 1:1 or 1:2 (normally, depending on age, 1:3 or 1:4).

Despite the severity of the child’s condition, when listening to the lungs, scanty data are revealed: weakened breathing, intermittent wheezing.

Lobar pneumonia in children differs from its manifestations in adults:

“rusty” sputum usually does not appear;
The entire lobe of the lung is not always affected; more often the process involves 1 or 2 segments;
signs of lung damage appear later;
the outcome is more favorable;
wheezing in the acute phase is heard in only 15% of children, and in almost all of them it is in the resolution stage (moist, persistent, not disappearing after coughing).

Special mention should be made staphylococcal pneumonia, given its tendency to develop complications in the form of abscesses in the lung tissue. Most often, it is a variant of nosocomial pneumonia, and Staphylococcus aureus, which caused the inflammation, is resistant to Penicillin (sometimes to Methicillin). Outside the hospital, it is recorded in rare cases: in children with an immunodeficiency state and in infants.

Clinical symptoms of staphylococcal pneumonia are characterized by a higher (up to 40°C) and longer-lasting fever (up to 10 days), which is difficult to respond to antipyretics. The onset is usually acute, and symptoms (blueness of the lips and extremities) increase quickly. Many children experience vomiting, bloating, and diarrhea.

If there is a delay in starting antibacterial therapy, an abscess (abscess) forms in the lung tissue, which poses a danger to the child’s life.

Clinical picture interstitial pneumonia differs in that signs of damage to the cardiovascular and nervous systems come to the fore. Sleep disturbance is noted, the child is first restless, and then becomes indifferent and inactive.

Heart rate up to 180 per minute may be observed. Severe blueness of the skin, shortness of breath up to 100 breaths in 1 minute. The cough, initially dry, becomes wet. Foamy sputum is characteristic of Pneumocystis pneumonia. Elevated temperature within 39°C, wavy in nature.

In older children (preschool and school age), the clinical picture is poor: moderate intoxication, shortness of breath, cough, low-grade fever. The development of the disease can be both acute and gradual. In the lungs, the process tends to develop fibrosis and become chronic. There are practically no changes in the blood. Antibiotics are ineffective.

Diagnostics

Auscultation of the lungs will suggest pneumonia.

Various methods are used to diagnose pneumonia:

A survey of the child and parents makes it possible to find out not only complaints, but also to establish the timing of the disease and the dynamics of its development, clarify previous diseases and the presence of allergic reactions in the child.
Examination of the patient gives the doctor a lot of information in case of pneumonia: identifying signs of intoxication and respiratory failure, the presence or absence of wheezing in the lungs and other manifestations. When tapping the chest, the doctor can detect a shortening of the sound over the affected area, but this sign is not observed in all children, and its absence does not exclude pneumonia.

In young children, clinical manifestations may be few, but intoxication and respiratory failure will help the doctor suspect pneumonia. At an early age, pneumonia is “seen better than heard”: shortness of breath, retraction of auxiliary muscles, cyanosis of the nasolabial triangle, refusal to eat may indicate pneumonia even if there are no changes when listening to the child.

An X-ray examination (x-ray) is prescribed if pneumonia is suspected. This method allows not only to confirm the diagnosis, but also to clarify the localization and extent of the inflammatory process. This data will help prescribe the correct treatment for your child. This method is also of great importance for monitoring the dynamics of inflammation, especially in the event of complications (destruction of lung tissue,).
A clinical blood test is also informative: with pneumonia, the number of leukocytes increases, the number of band leukocytes increases, and the ESR accelerates. But the absence of such changes in the blood characteristic of the inflammatory process does not exclude the presence of pneumonia in children.
Bacteriological analysis of mucus from the nose and throat, sputum (if possible) allows you to identify the type of bacterial pathogen and determine its sensitivity to antibiotics. The virological method makes it possible to confirm the involvement of the virus in the occurrence of pneumonia.
ELISA and PCR are used to diagnose chlamydial and mycoplasma infections.
In the case of severe pneumonia, if complications develop, a biochemical blood test, ECG, etc. are prescribed (according to indications).

Treatment

Treatment in a hospital setting is carried out for young children (up to 3 years), and at any age of the child if there are signs of respiratory failure. Parents should not object to hospitalization, as the severity of the condition can increase very quickly.

In addition, when deciding on hospitalization, other factors should be taken into account: malnutrition in the child, developmental abnormalities, the presence of concomitant diseases, the child’s immunodeficiency state, socially vulnerable family, etc.

For older children, treatment can be arranged at home if the doctor is confident that the parents will carefully follow all prescriptions and recommendations. The most important component of treating pneumonia is antibacterial therapy taking into account the probable pathogen, since it is almost impossible to accurately determine the “culprit” of inflammation: it is not always possible to obtain material for research from a small child; In addition, it is impossible to wait for the results of the study and not begin treatment until they are received, so the choice of a drug with the appropriate spectrum of action is based on the clinical characteristics and age data of young patients, as well as the experience of the doctor.

The effectiveness of the selected drug is assessed after 1-2 days of treatment based on the improvement of the child’s condition, objective data during examination, and dynamic blood tests (in some cases, repeated radiography).

If there is no effect (preservation of temperature and deterioration of the X-ray picture in the lungs), the drug is changed or combined with a drug from another group.

To treat pneumonia in children, antibiotics from 3 main groups are used: semisynthetic penicillins (Ampicillin, Amoxiclav), cephalosporins of the second and third generations, macrolides (Azithromycin, Rovamycin, Erythromycin, etc.). In severe cases of the disease, aminoglycosides and imipinemes can be prescribed: drugs from different groups are combined or in combination with Metronidazole or sulfonamides.

So, newborns For the treatment of pneumonia that developed in the early neonatal period (within the first 3 days after birth), Ampicillin (Amoxicillin/clavulanate) is used in combination with third-generation cephalosporins or an aminoglycoside. Pneumonia at a later stage of occurrence is treated with a combination of cephalosporins and Vacomycin. In case of isolation of Pseudomonas aeruginosa, Ceftazidime, Cefoperazone or Imipinem (Tienam) are prescribed.

Babies in the first 6 months after birth, the drug of choice is macrolides (Midecamycin, Josamycin, Spiramycin), because most often in infants it is caused by chlamydia. Pneumocystis pneumonia can also give a similar clinical picture, therefore, if there is no effect, Co-trimoxazole is used for treatment. And for typical pneumonia, the same antibiotics are used as for newborns. If it is difficult to determine the likely pathogen, two antibiotics from different groups are prescribed.

Legionella pneumonia is preferably treated with Rifampicin. For fungal pneumonia, Diflucan, Amphotericin B, and Fluconazole are necessary for treatment.

In case of non-severe community-acquired pneumonia and if the doctor has doubts about the presence of pneumonia, the start of antibacterial therapy can be postponed until the results of the X-ray examination are obtained. In older children, in mild cases, it is better to use internal antibiotics. If antibiotics were administered by injection, then after the condition improves and the temperature normalizes, the doctor transfers the child to internal medications.

Of these drugs, it is preferable to use antibiotics in the form of Solutab: Flemoxin (Amoxicillin), Vilprafen (Josamycin), Flemoclav (Amoxicillin/clavulanate), Unidox (Doxycycline). The Solutab form is very convenient for children: the tablet can be dissolved in water and can be swallowed whole. This form has fewer side effects such as diarrhea.

Fluoroquinolones can be used in children only in extremely severe cases for health reasons.

Along with antibiotics or after treatment, it is recommended taking biological products to prevent dysbacteriosis (Linex, Hilak, Bifiform, Bifidumbacterin, etc.).
Bed rest is prescribed for the period of fever.
It is important to ensure required volume of liquid in the form of a drink (water, juices, fruit drinks, herbal teas, vegetable and fruit decoction, Oralit) - 1 liter or more, depending on the age of the child. For a child under one year of age, the daily fluid volume is 140 ml/kg body weight, taking into account breast milk or formula. The liquid will ensure normal flow and, to some extent, detoxification: toxic substances will be removed from the body with urine. Intravenous administration of solutions for the purpose of detoxification is used only in severe cases of pneumonia or when complications occur.
In case of extensive inflammatory process, in order to prevent the destruction of lung tissue in the first 3 days, they can be used antiproteases(Gordox, Kontrikal).
In cases of severe hypoxia (oxygen deficiency) and severe disease, it is used oxygen therapy.
In some cases, the doctor recommends vitamin preparations.
Antipyretics Prescribed at high temperatures for children at risk of developing seizures. They should not be given to your child systematically: firstly, fever stimulates defenses and the immune response; secondly, many microorganisms die at high temperatures; thirdly, antipyretics make it difficult to assess the effectiveness of prescribed antibiotics.
If complications occur in the form of pleurisy, they can be used in a short course; for persistent fever - (Diclofenac, Ibuprofen).
If a child has a persistent cough, use mucus thinners and facilitating its release. For thick, viscous sputum, mucolytics are prescribed: ACC, Mukobene, Mucomist, Fluimucin, Mukosalvan, Bisolvon, Bromhexine.

A prerequisite for thinning sputum is sufficient drinking, since with a lack of fluid in the body, the viscosity of sputum increases. In terms of mucolytic effect, inhalation with warm alkaline mineral water or a 2% solution of baking soda is not inferior to these drugs.

To facilitate the discharge of sputum, it is prescribed expectorants, which increase the secretion of liquid sputum contents and enhance bronchial motility. For this purpose, mixtures with marshmallow root and iodide, ammonia-anise drops, Bronchicum, and “Doctor Mom” are used.

There is also a group of drugs (carbocysteines) that thin mucus and facilitate its passage. These include: Bronkatar, Mucopront, Mukodin. These drugs help restore the bronchial mucosa and increase local mucosal immunity.

As expectorants, you can use infusions of plants (ipecac root, licorice root, nettle herb, plantain, coltsfoot) or preparations based on them (Mukaltin, Eucabal). Cough suppressants are not indicated.

For each individual child, the doctor decides on the need for antiallergic and bronchodilator drugs. Mustard plasters and cupping are not used in children at an early age.
The use of general stimulants does not affect the outcome of the disease. Recommendations for their use are not supported by evidence of their effectiveness.
Physiotherapeutic methods of treatment (microwave, electrophoresis, inductothermy) can be used, although some pulmonologists consider them ineffective for pneumonia. Physical therapy and massage are included in treatment early: after the fever disappears.

The air in the room (ward or apartment) with a sick child should be fresh, humidified and cool (18°C -19°C). You should not force feed your child. As your health and condition improve, your appetite will appear, this is a kind of confirmation of the effectiveness of the treatment.

There are no special dietary restrictions for pneumonia: nutrition must meet age requirements and be complete. A gentle diet may be prescribed in case of bowel dysfunction. In the acute period of illness, it is better to give the child easily digestible foods in small portions.

For dysphagia in infants with aspiration pneumonia, it is necessary to select the position of the child during feeding, the thickness of the food, and the size of the hole in the nipple. In particularly severe cases, feeding the child through a tube is sometimes used.

During the recovery period, it is recommended to carry out a set of health measures (rehabilitation course): systematic walks in the fresh air, drinking oxygen cocktails with juices and herbs, massage and physical therapy. The diet of older children should include fresh fruits and vegetables and be complete in composition.

If a child has any foci of infection, they need to be treated (carious teeth, etc.).

After suffering from pneumonia, the child is observed by a local pediatrician for a year; blood tests and examinations by an ENT doctor, an allergist, a pulmonologist, and an immunologist are periodically performed. If the development of chronic pneumonia is suspected, an x-ray examination is prescribed.

In case of relapse of pneumonia, a thorough examination of the child is carried out in order to exclude an immunodeficiency state, abnormalities of the respiratory system, congenital and hereditary diseases.

Outcome and complications of pneumonia

Children are prone to developing complications and severe pneumonia. The key to successful treatment and a favorable outcome of the disease is timely diagnosis and early initiation of antibacterial therapy.

In most cases, complete recovery of uncomplicated pneumonia is achieved in 2-3 weeks. If complications develop, treatment lasts 1.5-2 months (sometimes longer). In particularly severe cases, complications can cause the death of the child. Children may experience recurrent pneumonia and the development of chronic pneumonia.

Complications of pneumonia can be pulmonary or extrapulmonary.

Pulmonary complications include:

lung abscess (ulcer in the lung tissue);
destruction of lung tissue (melting of tissue with the formation of a cavity);
pleurisy;
broncho-obstructive syndrome (obstruction of the bronchial tubes due to their narrowing, spasm);
acute respiratory failure (pulmonary edema).

Extrapulmonary complications include:

infectious-toxic shock;
, endocarditis (inflammation of the heart muscle or the inner and outer lining of the heart);
sepsis (spread of infection through the blood, damage to many organs and systems);
or meningoencephalitis (inflammation of the membranes of the brain or the substance of the brain with membranes);
DIC syndrome (intravascular coagulation);

The most common complications are destruction of lung tissue, pleurisy and increasing pulmonary heart failure. Basically, these complications arise from pneumonia caused by staphylococci, pneumococci, and Pseudomonas aeruginosa.

Such complications are accompanied by an increase in intoxication, high persistent fever, an increase in the number of leukocytes in the blood and an acceleration of ESR. They usually develop in the second week of the disease. The nature of the complication can be clarified by repeated x-ray examination.

Prevention

There are primary and secondary prevention of pneumonia.

Primary prevention includes the following measures:

hardening of the child’s body from the first days of life;
quality child care;
daily exposure to fresh air;
prevention of acute infections;
timely sanitation of foci of infection.

There is also vaccination against Haemophilus influenzae and against pneumococcus.

Secondary prevention of pneumonia consists of preventing relapses of pneumonia, preventing re-infection and the transition of pneumonia to a chronic form.

Summary for parents

Pneumonia is a common serious lung disease among children that can threaten a child’s life, especially at an early age. The successful use of antibiotics has significantly reduced mortality from pneumonia. However, untimely consultation with a doctor, delayed diagnosis and late initiation of treatment can lead to the development of severe (even disabling) complications.

Taking care of the child’s health from early childhood, strengthening the baby’s defenses, hardening and proper nutrition are the best protection against this disease. In case of illness, parents should not try to diagnose their child themselves, much less treat him. A timely visit to the doctor and strict implementation of all his prescriptions will protect the child from the unpleasant consequences of the disease.

Which doctor should I contact?

Pneumonia in a child is usually diagnosed by a pediatrician. She is being treated in an inpatient setting by a pulmonologist. Sometimes additional consultation with an infectious disease specialist or phthisiatrician is necessary. During recovery from an illness, it will be useful to visit a physiotherapist, a specialist in physical therapy and breathing exercises. If you have frequent pneumonia, you should contact an immunologist.

We present to your attention a video about this disease.