Pneumonia symptoms in children. How to recognize pneumonia in a child

Pneumonia is an infectious-inflammatory disease that affects the human lungs. It often occurs in childhood and accounts for about 80% of all pulmonary pathologies.

Even with the modern level of medicine, pneumonia in a child is a fairly common cause of death.

Therefore, it is considered necessary to know how pneumonia manifests itself in children. Such information will allow you to recognize the disease in a timely manner and help prevent its further development.

Features of the disease and possible consequences for young children

In most cases, pneumonia in children develops around the fourth day of acute respiratory viral infection. This is due to the detrimental effect of viral infection on human immunity and the protective barriers of the respiratory tract. Thus, foci of bacterial infection are formed, from which pneumonia begins.

As for the characteristics of the development of the disease, the symptoms of the disease in children are somewhat different. This is determined by the following indicators:

All of these factors create a favorable environment for the emergence and spread of the inflammatory process.

It is also worth noting the child’s immune system: it is obvious that in the first days of life the baby’s body is exposed to significant attacks from various pathogenic microorganisms. Therefore, it is important to pay sufficient attention to each manifestation, because any disease during this period can lead to irreversible consequences in the future.

As for pneumonia, this is an extremely dangerous disease for children. Microbes cause various complications through their activities. To fully understand how pneumonia manifests itself, it is necessary to consider the following points in the development of pneumonia:

Such consequences have too much influence on the functioning of the child’s body, so it is important to study and remember the first signs of pneumonia in children.

Pneumonia: symptoms in children based on age

Every mother should know how to identify pneumonia in a child. Recognizing inflammation is quite simple - you just need to carefully monitor the baby. But it is worth considering that the age of the child determines the characteristics of the manifestations.

First, it’s worth considering the signs of pneumonia in a child under 1 year of age. First of all, this concerns the behavior of the newborn. If he always wants to sleep, is lethargic or apathetic, then you should start to worry. In addition, the opposite situation is also possible: the baby, on the contrary, begins to be capricious and cry more, and refuse to eat. It is also worth considering the fact that the first signs of inflammation are changes in body temperature.

But for children under 1 year of age, this symptom is not decisive. This is due to certain characteristics of the body - during this age period the temperature does not rise above 37.6 degrees. In addition, it does not determine the severity of the condition.

So, the first symptoms of pneumonia in children are:

1. Without any adequate reason, anxiety, lethargy, decreased appetite and breast refusal may occur.
2. Sleep becomes restless and short.
3. The stool becomes liquid.
4. Constant feeling of nausea with vomiting.
5. Stuffy nose and cough, which can become an attack when crying or feeding.

The main manifestations of pneumonia are changes in breathing and accompanying processes:

An important point in the question “How to recognize pneumonia in children?” is a change in the relief of the skin surface during breathing.

This can be observed if you look at the skin on the baby’s ribs: how it retracts when inhaling. If there is asymmetry between the two sides of the chest, then this may indicate the disease in question. In some situations, one can note causeless interruptions in breathing and the frequency of the process, its stopping for a short period of time. Due to damage to one half of the lung, the child tends to lie on a certain side.

Upon visual examination, a disease affecting the pulmonary organ may manifest itself in cyanosis of the nasolabial triangle. It allows you to identify violations in the normal supply of oxygen to the body. Looks like blue discoloration between the baby's lips and nose. It is easy to notice at the moment when the baby is breastfeeding. If the disease has had a significant impact on the body, then blue discoloration can be observed not only on the facial part, but also on other parts of the body.

It is also worth considering the signs of pneumonia in children over 4 years of age. This is due to the fact that at the age of 4 the child’s organ in question is sufficiently formed. The presence of the following symptoms is a sufficient reason to consult a doctor for a detailed diagnosis:

1. After an acute respiratory viral infection, no improvement in the body’s condition is observed for 5 days. Or, after a short recovery of the body, the temperature suddenly rises and a severe cough occurs.
2. Poor appetite and sleep or their complete absence.
3. It is also worth noting the pallor of the skin.
4. Body temperature can reach 38 degrees. However, most antipyretic drugs cannot cope with their purpose.
5. Shortness of breath occurs. Again, you need to know the rate of breaths per minute to determine the presence of a violation in the respiratory process: from 4 to 6 years: 25 IM; in adolescents from 10 years of age, the norm almost reaches the adult level: 15-20 IM.

Obviously, if real indicators exceed these figures, then this is a sign of pneumonia.

You need to understand that this is a fairly serious disease - pneumonia. Symptoms in children have some characteristics - age determines the main nuances.

Symptoms in children, taking into account the form of the disease

Pneumonia can appear in several forms. Each variety has its own specific symptoms, so it is important to become familiar with each of them.

So, initially it is necessary to consider the so-called focal pneumonia, which develops as a result of complications of acute respiratory viral infection. The first signs of this form are no different from the common cold: runny nose, cough, slight fever.

But over time, the disease penetrates inside, affecting more and more layers of lung tissue, as a result of which the body’s condition worsens significantly after just 7 days:

Although the focal form of the disease is not considered severe, possible complications can still lead to death.

The next type of pneumonia is segmental, characterized by its rarity of occurrence and dangerous symptoms. The inflammatory process affects a fairly large area of ​​the lung. This form occurs quickly and acutely. It is characterized by the following characteristics:

In the initial stages, segmental pneumonia is quite difficult to diagnose due to the absence of wheezing and cough.

Lobar pneumonia is considered the most dangerous form. Children over four years of age are at risk. It appears as a result of severe hypothermia, so symptoms appear quite quickly:

• chills, which is accompanied by a temperature of 40 degrees. It can fall or rise sharply;
• increased sweating;
• pain in the chest area when breathing;
• The cough is dry at first. Then it acquires a wet character with the release of sputum mixed with blood;
• the skin is pale, but a feverish blush can often be observed;
• Depending on the location of pneumonia, abdominal pain, headaches with vomiting, and convulsions may occur.

It is not always possible to identify pneumonia as the cause of such manifestations, since they are not characteristic of a pulmonary infection.

Inflammation of the lungs is accompanied by symptoms of a detrimental nature, which significantly affect the general condition of the child. It is important to understand that in such a process it is necessary to respond to each sign in a timely manner and in no case delay contacting a doctor, since pneumonia has a high probability of death.

Absolutely any child can catch pneumonia. Every mother thinks with horror about how dangerous the complications of this disease can be. How parents should behave if their baby catches pneumonia is described in this article.

What is it?

Pneumonia is inflammation of the lung tissue. A variety of reasons can lead to the development of this condition in a child.

In childhood, as a rule, this disease is very severe.

At high risk for possible complications of the disease are weakened babies and children suffering from concomitant chronic diseases.

The inflammatory process in the lungs triggers a cascade of different reactions that have a very adverse effect on the entire body. The complex of these disorders leads to the appearance of numerous respiratory disorders in the baby.

The severity of the disease largely depends on the initial state of health of the child. With local inflammation only in the lung tissue, doctors talk about the presence of pneumonia. If the bronchi are also involved in the inflammatory process, then this condition is already called bronchopneumonia.

The prevalence of this disease in the pediatric population varies. According to statistics, younger children get sick somewhat more often. Thus, the incidence of this disease in children under 5 years of age is 20-25 cases per 1000 children. At older ages, this figure decreases and amounts to 6-8 cases per thousand children.

Among newborn babies, the prevalence of pneumonia is relatively rare. This feature in infants is largely due to the presence of specific antibodies that they receive from their mother during breastfeeding.

Maternal immunoglobulins protect the child’s fragile body from a variety of infectious pathogens, which in the vast majority of cases cause pneumonia.

Causes

Currently, there is a huge variety of different causative factors that contribute to the appearance of these symptoms in a child.

Infection of a baby with beta-hemolytic streptococcus plays a huge role in the development of bronchopneumonia. Also, these microbes quite often cause interstitial forms of this disease. Streptococcal pneumonia is very contagious to others.

The presence of streptococcus in a child’s throat is an extremely unfavorable situation. In this case, an infected baby can easily infect a healthy one. A decrease in immunity in such a situation leads to rapid infection of the child’s body and the development of adverse symptoms.

Streptococcal infection, as a rule, spreads rapidly in crowded groups attended by a large number of children.

It is important to note that streptococcal pneumonia in a baby can also occur during fetal development.

In this case, the infected mother passes the infection to her baby. Infection occurs through the placental bloodstream. Streptococci are very small in size, which allows them to quite easily enter the common system of placental arteries and reach the lungs and bronchi of the fetus.

Every third pneumonia in children, according to statistics, occurs due to infection with mycoplasma. Infection with these microorganisms can occur in a variety of ways.

Many scientists believe that the development of the mycoplasma variant of pneumonia requires additional aggravating conditions. These include a general decrease in immunity or the initially weakened state of the child.

Another similar microorganism that leads to the development of pneumonia in babies is chlamydia. It causes infection much less frequently. In most cases, cases of chlamydial infection are recorded through the blood.

Pediatric doctors identify quite a few cases of intrauterine infection. Chlamydial pneumonia is usually sluggish and manifests itself by the appearance of very mild adverse symptoms of the disease.

In almost a quarter of all cases, pneumonia is caused by pneumococci. These microorganisms “prefer” to live and multiply in the lung tissue, since there they have the most optimal conditions for life.

The course of pneumococcal infection is usually accompanied by the development of severe unfavorable symptoms of the disease. The disease progresses quite brightly. This clinical variant of the disease can cause various complications in the sick child.

Staphylococcal flora can also cause disease in babies. The most aggressive pathogen is Staphylococcus aureus.

According to statistics, the peak incidence occurs in preschool age. Children attending educational institutions have a higher risk of becoming infected with staphylococcal flora. Quite often, massive outbreaks of staphylococcal pneumonia are recorded in children during the cold season.

Quite rarely, infection with fungal flora leads to the development of pneumonia. This form of the disease often occurs in children who suffer from diabetes.

Immunodeficiency pathologies are also important in the development of pneumonia in a child.

There are alternative microorganisms that can cause pneumonia in babies. It should be noted that they lead to the formation of pneumonia somewhat less frequently. These include: Escherichia coli, Mycobacterium tuberculosis, Haemophilus influenzae and Pseudomonas aeruginosa, Pneumocystis and Legionella.

In some cases, pneumonia occurs as a complication of previous viral infections. Specific childhood diseases quite often cause the development of inflammation in the lungs. Such infections include: rubella, influenza and parainfluenza, cytomegalovirus and adenovirus infection, chicken pox, herpes infection of various origins.

The course of viral pneumonia is usually accompanied by the development of numerous symptoms of the disease, which manifest themselves quite rapidly in the sick child.

Doctors identify several options for the development of this disease:

• Children who get sick at home are most often infected with Haemophilus influenzae or pneumococci.
• Children attending preschool educational institutions quite often become ill with mycoplasma and streptococcal forms of the disease.
• Schoolchildren and adolescents are at high risk of developing the chlamydial variant of the disease.

The course and development of the disease is also influenced by a variety of factors. Their impact greatly weakens the child’s body and leads to the progression of the disease. These factors include:

• Frequent colds. If a baby suffers from acute respiratory viral infections or acute respiratory infections several times during the year, then he has a fairly high risk of contracting pneumonia.
• Concomitant chronic diseases of internal organs. Diabetes mellitus and other endocrine diseases top the list of pathologies that affect the general condition of the child’s body.

Cardiovascular diseases, which are quite severe, also lead to weakening of the child’s health.

• Severe hypothermia. For some children, it only takes getting their feet very wet to catch pneumonia. The ineffective functioning of the immune system in children and inadequate thermoregulation only aggravate the process.
• Insufficient intake of microelements. Reducing the intake of vitamins from food contributes to disruption of metabolic processes in the body. This is especially dangerous during periods of intensive growth and development of the baby.
• Immunodeficiency states. They can be either congenital or acquired pathologies. Reduced functioning of the immune system contributes to the active reproduction of various microorganisms in the child’s body, which are the root cause of the development of this disease.
• Aspiration. The entry of acidic stomach contents into the respiratory tract causes damage to the lung tissue in babies. This situation most often occurs in the youngest patients during regurgitation. The entry of a foreign body into the respiratory tract also contributes to the development of aspiration in babies and contributes to the appearance of adverse symptoms.

Classification

The variety of causes of pneumonia in children contributes to the presence of a wide variety of clinical options. This classification is used by doctors to establish a diagnosis and prescribe appropriate treatment. Every year new types of disease are introduced into it.

Taking into account the initial manifestation of symptoms pneumonia can be acute or chronic. It must be said that the first variant of the disease occurs somewhat more often in children. Acute pneumonia is characterized by the appearance of a huge number of very diverse symptoms, which manifest themselves quite clearly in the sick child.

The inflammatory process can occur on one side or move to the other. Most often, children develop right-sided pneumonia.

This feature is due to the anatomical structure.

The right-sided bronchus, which is part of the bronchial tree, is usually somewhat shorter and thicker than the left. This means that microorganisms usually penetrate it and subsequently develop in the right lung.

Left-sided pneumonia is usually much less common. Unilateral pneumonia has a more favorable prognosis.

In some cases, a two-way process may also occur. Inflammation in both lungs is usually quite severe in a child and causes multiple adverse symptoms. To eliminate them, a whole complex of treatment is required.

Taking into account the localization of the inflammatory focus, several clinical variants of the disease are distinguished:

1. Focal. It is characterized by the presence of a lesion that can be localized in a variety of areas of the lung.
2. Radical. Inflammation is localized mainly in the root of the lung.
3. Segmental. The inflammatory process spreads to some anatomical area of ​​the lung.
4. Share. Inflammation affects the entire lobe of the affected lung.

In some cases, pneumonia is asymptomatic or hidden. The disease in such a situation can only be determined using additional diagnostic methods.

As a rule, a general blood test and chest x-ray can establish the correct diagnosis. These studies detect inflammation in lung tissue even at the earliest stages.

Taking into account the causative agent of the disease, the following clinical forms of pneumonia are most common:

• Viral. The development of the disease is caused by various viruses that perfectly penetrate the lung tissue, causing an inflammatory process in it.
• Bacterial. It is accompanied by a fairly severe course and the appearance of a huge number of unfavorable symptoms that bring severe discomfort to the sick child. The most dangerous clinical variants develop into destructive forms, accompanied by massive death of lung tissue.
• Atypical. Caused by microorganisms that have certain structural features. Such microbes are also called “atypical”. These include: chlamydia, mycoplasma, legionella and others. Mycoplasma pneumonia occurs with the development of many adverse symptoms.

The course of the disease is usually quite long.

Doctors distinguish several specific types of disease. Lobar pneumonia is accompanied by the appearance of liquid exudate in several parts of the lungs. The course of the disease is quite severe.

This pathology occurs in children with the development of severe intoxication syndrome. This clinical variant is more common in older children and adolescents.

Community-acquired pneumonia is inflammation of the lungs that developed in a child while he was outside the walls of a hospital. This form of the disease is quite common among children of all ages. It is characterized by the development of severe symptoms and a specific picture on the radiograph.

Aspiration pneumonia occurs mainly in children in the very first years of life. The reason for the development of this clinical variant is aspiration of the lungs by some foreign body or the entry of acidic stomach contents into the respiratory tract.

The disease develops rapidly. A sick child requires mandatory emergency medical care.

Symptoms

The incubation period for pneumonia can be very different. This is explained by a huge variety of reasons that contribute to the development of the disease.

Incubation period bacterial forms is usually 7-10 days.

The appearance of adverse symptoms for viral infections usually occurs within a couple of days.

The incubation period of some forms of fungal pneumonia may take 2-3 weeks.

Pneumonia in a baby is manifested by the development of a complex of respiratory disorders. The severity of these symptoms is a significant difference between this disease and bronchitis.

A more severe course of the disease is accompanied by the appearance of pronounced clinical signs of the disease, which significantly impair the child’s well-being.

The most characteristic symptom of pneumonia is severe intoxication syndrome. This pathological condition occurs in more than 75% of all cases. Intoxication is characterized by an increase in body temperature.

With pneumonia, febrility is quite often recorded. In this case, the body temperature of the sick baby rises to 38-39 degrees. Against the background of a high febrility, the child feels fever or severe chills.

Some clinical forms of pneumonia occur without an increase in temperature to high values.

In this case, the child only develops a low-grade fever. Typically, this option is typical for fungal pneumonia.

A prolonged course of the disease can also be accompanied by a rise in body temperature only to 37-37.5 degrees.

A sick baby feels increased weakness and fatigue. Even habitual activities lead to the child getting tired quickly. The baby's appetite decreases.

Infants in the acute period, as a rule, do not attach well to the mother's breast. Expressed intoxication syndrome may be accompanied by increased thirst. This symptom manifests itself well in children aged 2-4 years.

Viral pneumonia caused by adenoviruses occurs with impaired nasal breathing. Viruses that settle on the mucous membranes of the nose contribute to the development of a severe runny nose. The discharge is mucous and profuse. In some cases, the child also develops concomitant symptoms of conjunctivitis.

A sick baby usually develops a cough. In most cases it is productive with sputum discharge.

Prolonged forms of pneumonia are often accompanied by simply a dry cough. In this situation, the child practically does not produce sputum. The course of prolonged pneumonia can be quite long.

The color and consistency of sputum may vary:

• Staphylococcal and streptococcal flora cause the discharge from the lungs to have a yellow or greenish color.
• Mycobacterium tuberculosis promote the release of gray and foamy sputum, which in the active stage of the disease has bloody streaks.
• Viral pneumonia usually accompanied by the discharge of white or milky sputum.

With a mild course of the disease, the amount of sputum per day may be insignificant. In this case, the volume of discharge does not exceed a tablespoon. In more severe cases of the disease, sputum is released in fairly large quantities. In some situations, its amount can be ½ cup or more.

Chest tenderness or congestion also occurs with various types of pneumonia. Typically, the pain intensifies after coughing or when changing body position. The severity of pain is significantly reduced during treatment.

The presence of inflammatory fluid inside the lungs causes the child to develop characteristic wheezing.

They can occur both during inhalation and exhalation.

In severe cases of the disease, parents hear the child wheezing from the side. The appearance of shortness of breath is a very unfavorable symptom, indicating that the baby is showing the first signs of respiratory failure.

If inflammation from the lung tissue spreads to the pleura, then the baby develops pleurisy. This pathological condition quite often accompanies pneumonia.

Pleurisy can be suspected by increased pain in the chest. Usually this symptom can already be identified in a child at the age of 3 years.

Severe intoxication syndrome significantly affects the overall well-being of the baby. The baby becomes more capricious and whiny.

A sick child tries to spend more time at home. The child tries to avoid active games with peers. A sick child's sleepiness increases significantly, especially during the daytime.

Intoxication leads to increased work of the cardiovascular system. This is manifested in the child by an increase in heart rate and pulse. Tachycardia is a fairly common symptom of severe disease. Babies suffering from cardiovascular pathologies may also experience surges in blood pressure.

In some cases, the appearance of a child with pneumonia also changes. The baby's face becomes pale and his cheeks become red. Severe disease, accompanied by the development of respiratory failure, is accompanied by blue discoloration of the nasolabial triangle. Visible mucous membranes and lips become dry, with areas of increased peeling.

Some, especially atypical forms of pneumonia, are accompanied by the appearance of symptoms not associated with respiratory manifestations. Such clinical signs include: the appearance of pain in the abdomen, pain in muscles and joints, abnormal bowel movements and others.

The severity of these symptoms largely depends on the original cause of the disease.

To learn about the types and symptoms of pneumonia, watch the following video.

First signs in a one-year-old child

According to statistics, the peak of the disease in babies under one year of age occurs between 3.5 and 10 months. This is largely due to the characteristics of the child’s body.

The bronchi of newborns and infants are much shorter than those of older children. All anatomical elements of the respiratory tree are very well supplied with blood.

This leads to the fact that any infection that gets there undergoes rapid development.

Recognizing pneumonia in infants is a rather difficult task. Parents will not be able to cope with this at home on their own. If they experience any adverse symptoms associated with breathing disorders, they should definitely seek advice from their doctor. Often, the diagnosis of pneumonia in young children is carried out quite late.

Pneumonia in a one-year-old child usually manifests itself nonspecifically. Many fathers and mothers mistakenly “write off” the symptoms of the disease to the fact that the child is “just teething.”

Such false diagnosis leads to the fact that the disease is detected extremely late in children. Untimely treatment only aggravates the course of the disease and contributes to the development of complications.

Consequences

Pneumonia is dangerous due to the development of various complications. Those at highest risk for adverse consequences of the disease are children with concomitant chronic diseases of internal organs and children suffering from immunodeficiency pathologies.

A fairly common complication of the disease is the development of pleurisy. This is a condition in which the pleura is involved in the inflammatory process. The danger of this pathology is that it can lead to the transition of an acute process to a chronic one.

The combination of pleurisy and pneumonia usually has a more severe course and is accompanied by the appearance of a large number of adverse symptoms of respiratory disorders.

Lung abscess is one of the most dangerous complications of pneumonia. It occurs in children with severe disease. This pathology is accompanied by the appearance of an abscess that is located in the lung tissue.

Lung abscess can only be treated in a hospital setting. To eliminate such an abscess, a surgical operation is required to remove it.

The development of broncho-obstructive syndrome often accompanies bronchopneumonia. In this case, the child usually experiences classic manifestations of respiratory failure.

The sick baby feels very bad: his shortness of breath increases and his general weakness increases sharply. Poor breathing is accompanied by a cough, which bothers the baby both day and night.

Pulmonary edema, as a complication of pneumonia, is quite rare in children.

This emergency condition can occur in a sick child against the background of complete well-being. Symptoms of pulmonary edema appear suddenly in the baby. Treatment of this pathological condition is carried out only in the intensive care unit.

Bacterial infections can cause infectious-toxic shock in sick babies. This emergency condition is characterized by a sharp drop in blood pressure.

Babies who have signs of infectious-toxic shock may lose consciousness. Some children experience convulsions and severe dizziness. Treatment of infectious-toxic shock is carried out immediately only in a hospital setting.

Bacterial complications of the cardiovascular system and other vital organs are also quite common in children who have suffered severe pneumonia.

Inflammation of the heart muscle is accompanied by the development of myocarditis or endocarditis. These conditions manifest themselves by the development of arrhythmia - disturbances in heart rhythm. Quite often, these pathologies have a chronic course and significantly impair the health of children.

The spread of microorganisms that cause pneumonia in babies throughout the body leads to the development of sepsis. This extremely unfavorable condition is characterized by a pronounced intoxication syndrome.

The baby's body temperature jumps to 39.5-40 degrees. The baby’s consciousness becomes confused, and in some cases the child may even fall into a coma. Treatment of bacterial sepsis is carried out in the ward of the intensive care unit of the hospital.

Diagnostics

Pneumonia can be recognized at the earliest stages. To do this, it is necessary that the attending physician has sufficient experience in identifying such diseases in children.

The correct algorithm for a medical clinical examination is very important in diagnosing pneumonia. During such a study, the doctor identifies the presence of pathological wheezing in the chest, and also determines hidden signs of respiratory failure.

Parents should suspect pneumonia if they detect several symptoms of impaired breathing in their sick child.

A long-term acute respiratory viral infection in a child should also raise alarm bells; parents should think about conducting a set of advanced diagnostics.

To clarify the diagnosis, a variety of laboratory tests are performed. They help to identify various signs of infection in the child’s body and determine the severity of functional respiratory disorders.

A general blood test is a basic test that is performed on all children if pneumonia is suspected. An increase in the level of leukocytes and an accelerated ESR quite often indicate the presence of an inflammatory process in the child’s body.

Bacterial infections lead to changes in the normal values ​​in the leukocyte formula in a general blood test.

A change in the number of band neutrophils occurs when a child’s body is infected with various types of bacteria. Most clinical variants of pneumonia are characterized by an increase in the total number of lymphocytes. These immune cells normally prevent the body from various infections.

For a more accurate diagnosis, various bacteriological studies are carried out on sick children. The biological material for such analyzes can be a variety of compartments from the nasal cavity, pharynx, and oropharynx.

After 5-7 days, doctors receive an accurate result, allowing them to identify the causative agents of a specific disease. For the accuracy of the study, technically correct sampling of biomaterial is required.

To identify “atypical” pathogens, ELISA and PCR methods are used. These studies allow the identification of microbes intracellularly. These tests are well and successfully used to diagnose chlamydial and mycoplasma infections.

The “golden” diagnostic standard for determining pneumonia is radiography.

On an x-ray, doctors can see various pathological areas of the lung tissue, in which there are signs of severe inflammation. These areas look different from healthy lung tissue. Chest X-ray can also reveal some complications, such as pleurisy and abscess.

In some complex diagnostic cases, more accurate diagnostic methods are required. Such studies include computed tomography and magnetic resonance imaging.

These examinations make it possible to identify affected areas of lung tissue quite effectively.

The resolution of modern devices used for tomography makes it possible to detect pneumonia already at the stage of growth of a pathological focus of several centimeters.

To make a correct diagnosis, a whole range of diagnostics is required. Unfortunately, pneumonia cannot be detected with just one blood test. The importance of diagnosing pneumonia is very serious.

A timely diagnostic complex of diagnostic measures allows doctors to prescribe the necessary drug therapy regimen.

Treatment

Pneumonia is treated in children under three years of age in a hospital setting. Hospitalization is also carried out in severe cases of the disease.

Babies who cannot receive proper care at home are also hospitalized in a children's hospital for the necessary range of treatment.

The treatment regimen for pneumonia includes not only the prescription of medications. Following a daily routine plays an important role in the treatment of pneumonia. The child should remain in bed throughout the acute period of the illness. Such forced bed rest is necessary to prevent multiple complications of the disease. Doctors recommend that the baby stay in bed throughout the entire period of high fever.

For a quick recovery, a sick child is prescribed a special therapeutic diet. This diet includes the consumption of gently processed foods.

It is better to steam or boil dishes. Baking in the oven or using a multicooker is also allowed. Frying in oil to form a thick crispy crust is completely prohibited.

The basis of nutrition for a sick child is various protein foods and cereals. For younger children, these products should be finely chopped. Eating gentle food is necessary. This allows you to optimize digestion. Pre-chopped food is better absorbed, which is required during an acute illness.

To recover from pneumonia, a child must receive the required amount of vitamins and microelements. These chemical components are necessary for the child's body to actively fight the disease.

Various fruits and berries can be used as sources of vitamins and microelements in the summer. In winter, it is necessary to prescribe multivitamin complexes.

Drinking regimen also plays an important role in the treatment of pneumonia. The incoming liquid flushes out toxic breakdown products of substances from the child’s body, which are formed in large quantities during the inflammatory process in the lungs.

Pronounced thirst only provokes the consumption of large amounts of liquid.

To replenish water in the body of a sick child, at least 1-1.5 liters of fluid are required.

Various fruit drinks and compotes are well suited as drinks. They can be easily prepared at home. Cranberries or lingonberries, dried fruits and various fruits are great for making drinks. The finished fruit drink can be additionally sweetened. Honey can be a substitute for the usual sugar.

To improve breathing, it is necessary to observe certain indicators of the microclimate in the room. Normal humidity in a children's room should vary from 55 to 60%.

Too dry air only contributes to difficulty breathing and the development of dry mucous membranes of the respiratory tract. To maintain optimal humidity in the children's room, special devices are used - room humidifiers.

Compliance with quarantine is a necessary measure that is necessary for all children with signs of pneumonia. This will help prevent the development of mass outbreaks of the disease in organized children's groups.

Not only children, but also schoolchildren should observe quarantine. The baby should stay at home until complete recovery. After the treatment, the doctor monitors the effectiveness of the therapy and issues the child a certificate about the opportunity to attend an educational institution when the child has recovered.

Drug therapy

Prescribing medications is a necessary condition for the baby’s recovery. For pneumonia, a whole range of different drugs are used.

The therapy regimen is tailored individually for each child. In this case, the attending physician must take into account the presence of existing concomitant diseases in a particular child, which may become contraindications to the use of certain medications.

Considering that bacterial pneumonia is the most common, the prescription of antibacterial drugs is a necessary condition when drawing up a treatment regimen.

Doctors prefer antibiotics that have a broad spectrum of action.

They allow you to quickly achieve a successful result. Modern drugs are well tolerated and cause fewer adverse side effects in children.

During antibiotic therapy, the effectiveness of the prescribed treatment must be monitored. It is usually carried out 2-3 days after the start of medication use.

If the result is positive, the child’s general well-being improves, body temperature begins to decrease, and the indicators in the general blood test normalize. At this stage, there are no significant changes in the radiograph yet.

If the result is not achieved after prescribing antibacterial drugs, the basic therapy is subject to correction. In such a situation, one drug is replaced by an alternative.

In some cases, combination therapy is used, when several antibiotics are prescribed simultaneously. The selection of antibacterial drugs is an individual situation, which is carried out only by the attending physician.

Parents should remember that they should not prescribe antibiotics to their child for pneumonia under any circumstances!

The choice of basic therapy is largely determined by the initial condition of the baby, as well as his age.

Several groups of drugs are currently used in the treatment of pneumonia in children, which include:

• clavulanic acid-protected penicillins;
• cephalosporins of the latest generations;
• macrolides.

These drugs are considered first-line therapy. Other medications are used only in exceptional cases when there is no effect from primary basic therapy.

In the first months of life, babies are usually prescribed semi-synthetic penicillins to eliminate unfavorable symptoms.

"Amicillin" or "Amoxiclav" in combination with cephalosporins are used in babies with developed pneumonia in the very first days after birth.

If the pathology was caused by Pseudomonas aeruginosa, then in this case “Ceftazidime”, “Cefaperazone”, “Tienam”, “Ceftriaxone” and others are used.

Macrolides are used to treat pneumonia caused by atypical microorganisms.

These agents have a detrimental effect on microbes that are located intracellularly. Such drugs will be effective for the treatment of pneumonia caused by mycoplasmas or chlamydia.

Pneumonia is a pathological process in the tissue of these organs caused by infection. The ability to cure the disease without consequences is increasing thanks to modern diagnostic methods and a wide selection of antibiotics. In order to detect the disease in a timely manner, it is necessary to familiarize yourself with the typical symptoms of pneumonia and, if they are detected, begin treatment.

Pneumonia is a dangerous pathology, for a complete cure it is necessary to apply a set of measures after the first symptoms appear. If the lung tissue suffers from the action, the functioning of the entire respiratory system is disrupted. The main symptom of the typical form of the disease is the implementation of respiratory function not in full. The cells receive insufficient oxygen, which negatively affects the general condition of the patient. Visually, you can notice the appearance of severe weakness and fatigue. The child is practically not interested in things that were of value to him before. Drowsiness appears.

Infectious agents

The following infectious agents can affect the occurrence of pneumonia:

1. Bacteria. Inflammation of the lung tissue is caused by staphylococcus, pneumococcus, Haemophilus influenzae or Escherichia coli.
2. Viruses.
3. Fungal.
4. Chlamydia, mycoplasma.
5. Helminths. If a child fell ill with pneumonia at the age of 2 years, it is possible that the occurrence of the pathological process was influenced by larvae. If roundworms are present in the body, the larvae can spread through the pulmonary circulation, reaching the lung tissue.

Deterioration of the immune response

A child’s immunity improves slowly, and bacterial infections have a particular negative impact. If a child at the age of 2 begins to attend any clubs or goes to kindergarten, the likelihood of developing a dangerous disease, including pneumonia, increases. If your child suffers from frequent runny noses that turn into sinusitis, or has a sore throat several times a year, it is possible that his body will not be able to cope with even a simple infection.

Deterioration of local immunity

The condition of the nasal mucosa affects the ability to clean the air from pathogenic bacteria. When air enters the nasal cavity, it is cleared of negative impurities, in particular, dangerous microorganisms. If for any reason the standard structure of the mucous membrane is disrupted, a runny nose occurs, due to which a person cannot breathe through the nose, bacteria and viruses quickly penetrate below. An inflammatory process may occur in the tissues of the respiratory organs. Pharyngitis and bronchitis develop, and pneumonia is possible.

Note! It is necessary to promptly pay attention to protracted pharyngitis and carry out proper treatment in order to eliminate the likelihood of dangerous complications.

Physiological reasons

In most cases, children aged 2 years have anatomical features that can affect the occurrence of pneumonia.

Risk factors:

1. Insufficient airway patency, which affects the rapid increase in the number of infections and the emergence of difficulties in relieving the symptoms of the disease.
2. Slow ventilation of the lungs, which is caused by insufficient development of the bone tissue of the ribs.
3. The respiratory system is not fully developed, which increases the risk of atelectasis, which provokes the preparation of an optimal environment for the proliferation of dangerous microorganisms.
4. Constantly keeping a child in a lying position poses a risk of congestion.

Signs of illness

Main symptoms:

Violation	Peculiarities
General restlessness, sleep pathologies	Parents immediately notice a child’s poor appetite; causeless whims may appear even in calm children
Constantly increasing nasal congestion	Difficulty breathing
Cough	At the first stage of the disease, this symptom may be absent
Increased body temperature	This phenomenon is not always observed. It is necessary to be attentive to the child’s condition in order to promptly identify the disease, even if it is not accompanied by an increase in temperature
Apnea	Often, with pneumonia in children over two years of age, breathing stops are observed, which last for several minutes. This deviation can affect the baby’s behavior and cause psychological disorders.
Change in skin tone in the area of ​​the nasolabial triangle	During this process, the wings of the nose and corners of the mouth may turn pale, sometimes these areas become bluish
Stool pathologies	Possible constipation as a result of dehydration, as well as diarrhea if the infection has spread not only to the lung tissue, but also to the gastrointestinal tract

Characteristic symptoms of pneumonia

When a child reaches the age of 2 years, a significant improvement in the body’s protective functions is observed. At the same time, the likelihood of developing a bacterial infection remains, leading to serious health problems. Often children suffer from pleurisy, accompanied by the release of exudate. In some cases, pneumonia does not occur as the only disease, but occurs along with pharyngitis and severe sore throat. If a serious allergic reaction develops due to taking a large number of antibiotics, the lumen in the bronchi may narrow.

The first symptoms of pneumonia:

1. Deterioration of the general condition of the body.
2. Signs of severe intoxication without other symptoms of poisoning.
3. If the temperature rises, this indicator does not decrease. You need to worry if such a deviation lasts for 3 days.
4. When breathing, the intercostal muscles are activated, which is why they are often pulled inward over the affected area.
5. Cyanosis occurring in the area of ​​the nasolabial triangle. This deviation can manifest itself in a calm state of the baby, but most often intensifies during crying or emotional stress.

Note! Typically, pneumonia develops at the age of two due to the action of bacteria. The body at this age is less susceptible to viruses, but the immune system has not yet adapted sufficiently to fight bacteria. When listening, hard breathing is diagnosed, the doctor notes moist rales.

As the disease worsens, severe shortness of breath occurs. This deviation develops quite quickly, since organs and cells receive insufficient amounts of oxygen. Signs of pneumonia are often associated with a respiratory viral infection. Parents first of all pay attention to an increasing runny nose, cough, and increased body temperature. At this age, inflammation of one lung or its lobe most often appears.

Pneumonia can occur unexpectedly or after a severe viral infection. You should pay attention to a severe cough that cannot be stopped with standard medications. If you notice this symptom, you need to contact a specialist as soon as possible. In some cases, when pneumonia develops, the cough worsens at night. The child's general condition worsens, activity slows down. At the same time, the baby may show severe anxiety, especially if negative symptoms worsen.

It is worth paying attention to poor appetite. With pneumonia, one of the characteristic symptoms is pale skin and an increase in breathing rate up to 40 times per minute. It is necessary to take into account the presence of a large number of cases of pneumonia without a strong increase in temperature, in conditions of an erased clinical picture.

Note! It is necessary to assess the child’s condition, paying attention to specific indicators, in particular temperature.

Dangerous forms of pneumonia

The latent form of pneumonia is characterized by mild symptoms. It is the most dangerous type of the disease. It is necessary to carefully monitor the child's behavior. With pneumonia, his condition worsens significantly; usually parents notice whims and crying, but no cough or runny nose occurs.

A latent form of pneumonia can appear when immunity deteriorates. The risk of this disease increases if parents do not monitor the dosage and frequency of taking medications. These drugs negatively affect human immunity and are especially dangerous at an early age. Antibiotics often have a negative effect together with antitussive drugs, since by blocking the process that regulates the release of sputum along with mucus, the risk of infection and spread of infection increases. Children who suffer from immunodeficiency from birth have an increased risk of pneumonia.

Note! Atypical pneumonia is caused by chlamydia and mycoplasma. Strong structural changes in the lung tissue may occur, while general signs do not reflect the symptomatic picture.

The main signs of atypical pneumonia:

1. Severe intoxication that does not go away for no apparent reason.
2. Pain in the head.
3. Unpleasant sensations in the muscles.
4. Hyperhidrosis.
5. Increased body temperature (this symptom may be absent).
6. The amount of food consumed per day is significantly reduced. The child may completely refuse to eat.
7. Enlarged lymph nodes.

With atypical pneumonia, the disease can be detected by retraction of the skin in the area of ​​the inflamed area when breathing. If pneumonia occurs as a result of mycoplasma activity on the skin, a polymorphic rash may form. It is possible that the spleen and liver may increase in size, which is most often noted only at a doctor’s appointment. Pneumonia often occurs with an erased symptomatic picture, which is why people confuse it with pharyngitis, a persistent sore throat. It is necessary to identify the disease as early as possible to eliminate the risk of complications.

Video - How to suspect pneumonia?

How is the diagnosis made?

Signs for which a diagnosis of pneumonia is made:

1. Continuous shortness of breath, in some cases there is difficulty breathing. In young children, shortness of breath is especially severe, and this phenomenon also intensifies in proportion to the area of ​​​​the area of ​​​​inflammation.
2. Characteristic wheezing, retraction of the affected area inward during breathing.
3. Reduced duration of percussion sound in approximately half of patients. Even if this symptom is absent in the first stages of the disease, one cannot assert the absence of inflammation.
4. Wheezing when breathing. If the disease occurs in an acute form, this phenomenon may not be detected. If wheezing is heard evenly, this often indicates not pneumonia, but bronchitis.
5. Decreased breathing. If characteristic wheezing is not observed during pneumonia, this symptom is often diagnosed. To clarify the diagnosis, it is necessary to conduct additional examination.

Important, but not characteristic signs of pneumonia in children are disorders of the gastrointestinal tract, symptoms of severe intoxication in the body, increased body temperature, and hyperhidrosis. Please note that if you experience a cough after taking a deep breath, you should immediately consult a specialist, as this symptom may indicate serious respiratory diseases.

Note! When taking a blood test for pneumonia, leukocytosis is often diagnosed, which is also an important diagnostic criterion. To determine the causative agent of the disease, a bacteriological study is carried out. Also, during a diagnostic examination, sensitivity to antibiotics is revealed, which allows you to select the optimal medications.

Video - How to diagnose pneumonia?

How to prevent pneumonia?

It is necessary to follow the basic rules to reduce the likelihood of developing the disease:

1. Pay attention to the recommendations and advice of your doctor if you detect a viral or bacterial infection.
2. Pneumonia may appear as a complication of acute respiratory viral infection. To prevent the occurrence of the disease, it is necessary to promptly treat a runny nose, pharyngitis and other common diseases.
3. When recovering from ARVI, you should not immediately send your child to kindergarten or other places where there is an increased risk of contracting a bacterial or viral infection. It is advisable to wait about 2 weeks. During this time, the immune system will return to normal, which will reduce the likelihood of complications. Antibiotics can only be used if prescribed by a specialist.
4. If you find out about the spread of any epidemic, it is advisable to spend more time at home and not go to places with a lot of people. During the epidemic, it is advisable to refuse to attend kindergarten and, if possible, leave the child at home.
5. Maintaining good hygiene will help reduce the risk of infection entering the body. It is necessary to accustom the child to basic hygiene standards from infancy.

Note! If pneumonia is diagnosed, a specialized course of therapy must be prescribed. In some cases, it is necessary to move the child to a hospital. It is prohibited to independently select a treatment regimen. You can treat a child at home only after visiting a doctor and receiving the appropriate permission.

Pneumonia can occur either according to the classical pattern or atypically. In both cases, rapid identification of the disease is necessary, as well as competent treatment. Knowing the main signs of pathology, you can diagnose pneumonia in a timely manner in order to prevent the development of complications.

Pneumonia in a child is a serious infectious disease, and the pathology is more typical for children, due to the peculiarities of the structure of the respiratory system and the underdevelopment of immune processes. Pneumonia in a child is usually of an acute infectious nature, with water-electrolyte and metabolic disorders, changes in all organ systems of a pathological nature. But, on the other hand, the concept of pneumonia in a child should be understood as a whole group of infectious and inflammatory lung diseases, with the obligatory presence of intra-alveolar exudative fluid. It is this exudate that interferes with physiological gas exchange in the pulmonary structures. The amount of oxygen is sharply reduced, causing disruption of the bloodstream. This condition poses an extreme danger to health, but not only, but also to life in general, increasing the possibility of death, so you should immediately seek medical help for prompt treatment.

This disease accounts for almost 80% of the pathology of the respiratory system, annually claiming the lives of 1.4 million children under 5 years of age. Among hospitalized patients under 1 year of age, 25-30% of cases occur; pneumonia in a child 2 to 5 years of age occurs in more than 50%. In schoolchildren and adolescents, the incidence is significantly reduced and amounts to 8-12%.

Inflammation of the lungs in a 4-year-old child can differ significantly from such manifestations in an infant; this is manifested both by a specific symptom complex and on X-ray images. The highest mortality rates were recorded before the age of four. Do not forget that children of any age group, even newly born ones, can get sick. And since this is an extremely dangerous disease with its course and complications, especially for a child’s body and extremely dangerous for infants, it is important to suspect, recognize and begin treatment in time, differentiating other respiratory diseases. Delay leads to very severe conditions that are difficult to correct in the future. An X-ray examination will help with this, because it will clearly identify the obvious dark spots inherent in pneumonia.

Pneumonia in a child is classified into the following forms:

Focal – most often diagnosed in the age range of 1-3 years. The pathology is secondary and, mainly, as a result of bronchitis. Symptom complex: hyperthermia, dry and deep cough. It is treated for 2-3 weeks using antibiotic drugs.

Segmental - partially affects the lung, while the baby does not take food well, refuses it, does not want to play, sleeps poorly, and a temperature of 37-38°C occurs. The cough may practically not manifest itself, which is why this type is often difficult to detect from the first days.

Lobar - involving only one or several lobes of the lung.

Confluent - when the process from several lobe-segments merges into one large lesion.

Total – damage to the entire lung tissue.

Lobar - the lesion can equally be left-sided or right-sided. The baby has hyperthermia up to 39-40°C. There is pain in the projection area of ​​the lung and abdominal area, a wet cough with rusty sputum, red rashes on the torso and one-sided redness of the face.

Staphylococcal - more typical for newborns and infants. The main symptom complex includes: shortness of breath, low-grade fever, vomiting, coughing tremors, and wheezing audible to the ear. With timely and adequately prescribed treatment, the disease recedes in about 2 months, followed by a rehabilitation course of 10 days.

If the lesion is localized in only one lung, then such pneumonia in a child is called unilateral, both are called bilateral. They also distinguish a primary condition - the development of the disease independently, a secondary one - as a consequence of a previously suffered infectious disease.

Based on the causes of infection, the following forms are distinguished:

Hospital - the child falls ill after spending three days in the hospital or three days after discharge.

Community-acquired - infection that is in no way associated with medical institutions. The most common type. It is subdivided with or without impaired immunity.

From medical interventions - pathogens are introduced into the human body during procedures, operations, and often provoke frequent hospitalizations, hemodialysis, and parenteral administration of drugs.

Aspiration - manifests itself when foreign particles, pieces of food or liquid, or infectious sputum enter the respiratory tract from the nasopharynx.

Ventilation – early (up to 72 hours) and late (after 96 hours), when a person is on a ventilator.

Intrauterine - a congenital form identified in the first 3 days from the birth of a child.

Cytostatic – when taking cytostatic drugs.

Atypical form – with etiopathogenetic rare types of pathogens (mycoplasma, chlamydia).

The frequency of pneumonia in children is explained by the following factors: the lung tissue is not yet fully mature; airways are narrow; the mucous membranes are saturated with blood vessels, which is why they tend to swell instantly, which leads to a deterioration in ventilation functions; the ciliated epithelium is unable to adequately eliminate sputum and the infection easily penetrates, settles and multiplies; due to the underdevelopment of the additional sinuses of the nose, the lower nasal passage, the immaturity of local factors - the air is not warmed enough when inhaling and is not purified to the required extent; immaturity of alveoli and surfactant; there is rich vascularization in the roots of the lungs; the length and width of individual bronchi differs from those in adults, which creates unequal drainage conditions. It differs from the adult form in its lightning speed of flow; in young children it is rarely contagious, more often secondary - as a complication of tonsillitis, bronchitis, laryngitis.

Pneumonia in a 2-year-old child is risky for life because breathing is shallow, the lungs are less ventilated, and this is a wonderful breeding ground for the development of etiopathogenic agents.

Pneumonia in a child: causes

The causes of pneumonia in a child and an adult are the same - the direct presence of the pathogen itself and reduced immunity.

Inflammation can be caused by:

- Bacteria. The most common etiopathogenetic agent is pneumococcus, as it is most susceptible to lung tissue. Staphylococcus, streptococcus, chlamydia, mycoplasma, legionella, and escherichia can also act as provocateurs.

— Viruses. Occupy 50% of the etiological cohort. This is the Afanasyev-Pfeiffer bacillus, adenovirus, chickenpox virus, RS virus, .

- Fungi. Fungal contamination (for example, candidiasis or) occurs quite rarely. Basically, this subtype of lesion is characteristic of severe changes in immunity and a very severe course of the disease is observed.

There are a number of etiopathogenetic factors for pneumonia in a child:

- intrauterine hypoxia or lack of oxygen during childbirth;

- complicating factors during childbirth (trauma, asphyxia);

— prematurity with morphofunctional immaturity;

- infection that occurred from mother to child (chlamydia, herpes);

— unfavorable living conditions, unbalanced nutrition and digestive disorders;

- exudative diathesis;

— chronic inflammatory foci of the nasopharynx (tonsillitis, adenoiditis, pharyngitis, laryngitis);

- frequent recurrent bronchitis;

— lack of vitamin substrates and microelements;

- inhalation of toxic chemical fumes (household chemicals, nearby construction work);

- allergic processes, especially with accompanying cough;

- cooling and overheating, overwork. With significant hypothermia, the supporting and protective forces weaken and microbes easily penetrate into the lungs, this also includes the cold season as a predisposing risk factor;

- smoking, alcoholism, drug addiction in adolescents;

- prolonged stay on bed rest in a horizontal position (after fractures, burns, surgical operations);

Auscultation reveals quiet, hard breathing with fine-bubble crepitus rales, which are better heard when crying, when breathing is deeper.

“Preschool children have developed a more stable immune system, and they can present specific complaints, so pneumonia in a child has clear symptoms. Complaints of dizziness, muscle pain, the number of breaths exceeding 30/min, low-grade fever, and with hyperthermia, convulsions may occur, pallor of the skin is very pronounced and in addition a rash may appear, sputum is green-yellow.

— For schoolchildren over 6 years old, the picture does not differ from that of adults. Only the incidence rate increases significantly during the autumn-winter period, due to closely communicating teams and the rapid spread of infection within them.

The symptom complex varies depending on the type of pathogen:

— Bacterial pneumonia in a child. With pneumococcal contamination, the onset is sudden, the state of health suddenly becomes poor, the baby is constantly feverish, breathing is rapid, the face is hyperemic, the child is lethargic, cough with “rusty” discharge, pain in the abdomen and when inhaling. Pfeiffer's bacillus causes a slow-onset form, with prolonged hyperthermia, discharge of green sputum and wheezing. Klebsiella causes a fulminant form with chills and a temperature of up to 40°C, a cough with a viscous mucous substrate. Staphylococcus aureus does not provoke a fever, but there is a bluish-gray complexion, the pulse is thread-like, the abdomen is swollen, and often ends in death. causes nosocomial infection tropic to the lungs, acute development with morning febrile peaks, blue skin, tachypnea with.

— Viral pneumonia in a child. This option was previously called atypical, because it was not possible to find the root cause and the disease did not respond to antibiotic therapy, the symptoms are disguised as colds. Differences appear when the temperature is not brought down by medication and does not subside on its own.

— Atypical pneumonia in children. With mycoplasma infection, the first symptoms to appear are rhinitis, sore throat, and dry cough. Later, “muscle breakdown”, nosebleeds, inflammation of the lymph nodes. The first signs of chlamydia are rhinitis, a jump to 38-39°C, enlarged lymph nodes, allergies, and conjunctivitis in newborns. The Legionella type is characterized by fever up to 40°C, with severe migraine headaches, diarrhea and vomiting.

— Aspiration pneumonia in a child. Pieces of food, liquid, and foreign particles can enter the bronchi, and then an infection begins to develop and pathogenic microbes multiply. If the cause is bacteria, then the temperature gradually rises, a wet cough; when affected by a chemical substance - dyspnea, frothy and pink sputum; if a foreign body is a reflex, painful cough tremors subside after a while, but leaving behind an inflammatory process.

— Focal pneumonia in children. The most common form of childhood. The causative agents are bacteria, viruses, fungi, chemical toxins, and an allergic reaction. One or multiple lesions appear in the child’s lungs, which can develop into a focal-confluent form (segmental or entire lobe lesion). At first, the symptoms are indistinguishable from a cold: the child coughs, is bothered by a runny nose, the condition worsens sharply after a week, and the signs become more and more pronounced: agitation or apathy, confusion, pallor of the skin, noisy breathing, tachycardia, fever 38-38.7°C, cough dry or with mucopurulent sputum; a focus of crepitating rales is objectively heard.

— Segmental pneumonia in a child. Within two days from the moment of penetration of the etiopathogenic agent, the following symptoms appear: temperature reaction, cough, malaise, loss of orientation in space, rapid and difficult breathing, sweating.

— Croupous pneumonia in a child. Preschoolers and schoolchildren get sick more often. It occurs in several forms with their inherent symptoms: abdominal (pain as in appendicitis), meningeal (migraine, drowsiness, convulsions), abortive (can be characterized as follows: acutely and violently began and ended within 1-3 days) pain. Also present: pleural reaction, cough with a rusty admixture, hemoptysis, forced position in bed, feverish flush on the face with cyanosis, herpetic rash on the lips, shortening of percussion tone, bronchial breathing, fine-bubble crepitant rales, icterus of the skin.

— Interstitial pneumonia in a child. It begins acutely, painful cough, vomiting, tachypnea, arrhythmia of inhalation and exhalation.

— Hilar pneumonia in a child. Examination, auscultation and x-rays give a completely different picture of the localization of the lesion, which makes diagnosis difficult. The disease is of a protracted nature, with a pronounced symptom complex or without it at all.

Pneumonia in a child without fever

Pneumonia without fever tends to occur in children with weakened immune systems. This option is also commonly called quiet or secretive. It poses a particular danger to children, since the child is not able to adequately explain his complaints clearly or does not yet know how to speak at all. Pneumonia in a child of this type cannot be transmitted to others, that is, it is not contagious, but has the nature of an infection.

The reasons for the decrease in the body's musculoskeletal defenses are very diverse: the presence of a source of infection - untreated teeth, tonsillitis, laryngitis, bronchitis; hypothermia of the body; may be a consequence of unformed or weak immunity; young age; uncontrolled use of an antibiotic group of medications (self-medication, antibiotics in inappropriately high doses, exceeding the weight-age norm; with prolonged use, the body gets used to it, which will lead to a decrease in the desired therapeutic effect), against the background of prolonged use of antitussives (the mechanism of sputum elimination is suppressed, which leads to accumulation of etiopathogenic flora) drugs.

The symptom complex of pneumonia in children without fever includes:

- the duration of the cough exceeds two weeks, may be with scanty or copious sputum;

- exhausting weakness, constant thirst against the background of decreased appetite, drowsiness, tearfulness, blue discoloration of the nasolabial triangle;

- whistling when breathing, which can be heard, if you focus on this, with retrosternal pain;

- asymmetry of fluctuations in the act of breathing of the chest;

- unhealthy blush of the face on the side of the affected lung, red spots;

- heavy sweating;

- when turning the body, noticeable pain in the chest;

- severe shortness of breath and increased pulse;

- deep breath is painful.

Pneumonia in a child: diagnosis

Diagnosing pneumonia in a child includes the following steps:

— Making a diagnosis requires a lot of work, experience and accumulated knowledge, since changes are not recognized with auscultation and percussion methods. General well-being is assessed by examining the chest, analyzing asymmetry in breathing. You can listen to dry or wet wheezing, sometimes there is a dullness of sound over the lesion.

— General blood and urine tests, biochemical studies and sputum examination are prescribed.

— The most important point is x-ray examination in two projections. They try to find an area of ​​darkening of the lung tissue.

— An X-ray is not always informative, then they resort to computed tomography. Indications for CT: in the presence of symptoms of inflammation, the area affected by inflammation is indeterminable on the radiograph; with relapses more than three times; if the results of the x-ray are not comparable with the symptom complex of the disease.

— Carrying out bronchoscopy - examination with a flexible tube with a camera inserted through the nose and into the lumen of the bronchi, applicable in case of accompanying complications to clarify the diagnosis.

When there is no fever, self-medication is under no circumstances acceptable. For treatment, antibiotics covering a wide spectrum are applicable, most often even a combination of two - Cephalosporin and Macrolide, with a course of not a week. Pathogenetic therapy consists of taking expectorants with mucolytics; for shortness of breath - bronchodilators; inhalation therapy with a nebulizer. Symptomatic use of multivitamins, immunomodulators, physiotherapy, drainage massage.

At the end of treatment, the x-ray examination is repeated. A consultation with a phthisiatrician is necessary, since the possibility of decomposition of the lung parenchyma cannot be ruled out.

The outcome is generally unfavorable, since due to untimely treatment, precious hours are lost and severe damaging processes develop in the body. Deaths account for half of all disease outcomes.

Pneumonia in a child: treatment

The sooner you diagnose and schedule therapy, the better your chances of recovery without complications. Treatment of pneumonia in children includes the following steps:

— The first step is to determine whether the patient requires hospitalization. And starting from an outpatient or inpatient stay, the volume of a complex of procedures and medications is prescribed. Treatment of children under 3 years of age should be carried out strictly in a hospital, since daily dynamic monitoring and, if necessary, emergency care are required; this is not feasible on an outpatient basis. Also, children with severe respiratory failure, rickets, and immunodeficiency conditions should be under constant medical supervision. Urgent hospitalization at any age in the absence of positive dynamics up to two years after the start of treatment.

— Antibiotic therapy consists of using 2–3 generations of antibiotics, since there is already resistance to the previous ones. These are, Cephalosporins, Fluoroquinolones, Macrolides, Carbopenems, Sulfamethoxazole. The therapy is empirical and begins before the results of the background examination are received. If the condition does not change for 2 days, then the medicine changes. In the process of treatment caused by rhino-, adeno-, parainfluenza and influenza viruses, antibiotics often do not bring the expected effect, which means it is necessary to add antiviral drugs to the course of treatment (Oseltamivir, interferon preparations). In case of fungal etiopathogenesis, the use of antifungal drugs (Fluconazole, Diflucan) is mandatory.

— General recommendations include: bed rest with the head elevated, frequent room cleaning and ventilation, diet with easily digestible foods, drinking plenty of warm liquids - tea, fruit juice, herbal infusions.

— Pathogenetic treatment: oxygen therapy – for dyspnea and changes in pulse oximetry, gas components, capnography. In case of severe hypoxia, they are transferred to ventilators under supervision in the intensive care unit. In case of dehydration, oral rehydration with saline solutions or, if necessary, the use of infusions - glucose-saline solutions. Life-saving extracorporeal membrane oxygenation of the bloodstream (oxygen is supplied to the blood through a special apparatus, thus excluding diseased lungs from gas exchange).

Expectorants, mucolytics (Mukaltin), bronchodilators (Ventolin, Eufillin), bronchoscopic sanitation, antipyretics and NSAIDs are applicable.

— Symptomatic therapy: physiotherapy, ultraviolet irradiation, drainage massage, breathing exercises, postural drainage, exercise therapy, nebulizer inhalations, vitamin prophylaxis, immunomodulators, probiotics for restoring intestinal microflora, sorbents for removing toxins (Polysorb, Enterosgel).

Timely treatment will help prevent complications, consequences in the future, and maintain psychological comfort, especially for young children.

Pneumonia in a child: complications

During the inflammatory process in the lungs in children, the development of the following complications is often observed:

- In children under one year of age, the following are more often observed: exudative pleurisy, allergic obstruction of the bronchi, the addition of inflammatory processes in the middle ear - otitis media, tonsillar lesions, pharyngitis, swelling of the already narrow airways or even the lungs themselves.

Pneumonia in a child: consequences

As a result of being ill with such a pathological phenomenon as pneumonia, the child may develop aggravating conditions that require corrective measures in the future:

- broncho-obstructive syndrome, up to progression to frequent obstruction and asthmatic phenomena;

- toxic-infectious shock phenomenon;

- pulmonary atelectasis;

— combined pulmonary-cardiac pathology;

- anemia;

— pneumosclerosis — proliferation of connective tissue elements in the lungs, which entails severe processes of respiratory failure with difficult to correct dynamics.

Advances in medicine are noticeable, perhaps most of all, in the treatment of pneumonia in children - one of the most common, serious, potentially life-threatening diseases, which among the causes of death has gone from first place to far to the middle and even to the end of the list. But this does not change the serious attitude towards pneumonia, since its good prognosis depends on the timeliness of diagnosis and the correctness of treatment tactics.

First of all, what is pneumonia? In Russia, since 1980, pneumonia has been defined as “an acute infectious disease of the pulmonary parenchyma, diagnosed by the syndrome of respiratory distress and/or physical findings in the presence of focal or infiltrative changes on a radiograph.” This does not mean that pneumonia cannot be diagnosed without an x-ray. However, these changes are the “gold standard”, since they make it possible to differentiate pneumonia - a predominantly bacterial disease - from purely viral lesions of the lower respiratory tract (bronchitis and bronchiolitis), which, in particular, is proven by their successful treatment without antibiotics.

Diagnostics

Pneumonia is typically characterized by the presence of a cough, other signs of acute respiratory disease (ARI) are also common, as well as, in most cases, a temperature >38°C (with the exception of atypical forms in the first months of life), without treatment it lasts 3 days or longer, then as with bronchitis, the temperature is usually<38°С или она в течение 1-3 дней снижается до этого уровня.

The first task in diagnosis is to identify damage to the lower respiratory tract in a child with signs of acute respiratory infections; they are characterized by the presence of at least one of the following signs, easily recognized when examining the child:

Increased frequency or difficulty (obstruction) of breathing, retraction of the pliable parts of the chest;

Shortening of percussion sound;

Presence of wheezing.

The second task is to distinguish pneumonia from bronchitis, a predominantly viral infection of the lower respiratory tract. An important symptom of pneumonia is increased breathing, which is observed more often the more extensive the damage to the lungs and the smaller the child. However, this sign is significant only in the absence of symptoms of obstruction, which is characteristic of croup and bronchitis, incl. obstructive. The following respiratory rate parameters (per 1 minute), according to WHO, are characteristic of pneumonia: ≥60 in children 0-2 months, ≥50—2-12 months, ≥40—1-4 years. Bronchial obstruction highly likely excludes typical (caused by pneumococci, Haemophilus influenzae, streptococci) community-acquired pneumonia and occurs only in atypical forms and nosocomial infection.

Shortening of the percussion sound is characteristic of pneumonia, but it occurs only in half of the cases, so its absence does not exclude pneumonia. The same applies to fine-bubbling or crepitating wheezing localized over the site of the lesion and weakened and/or bronchial breathing—their identification allows a diagnosis of pneumonia to be made, but their absence does not exclude this diagnosis. Half of all patients with typical pneumonia do not have wheezing in the acute period. On the other hand, wheezing, evenly heard in both lungs, as well as obstruction, are characteristic of bronchitis, but not pneumonia: dry wheezing is found only in 10%, and scattered wet wheezing is found in 25% of patients, most often they are asymmetrical (mostly with atypical forms).

Since the diagnosis of pneumonia based on the above physical data can be made in less than half of the cases, an algorithm created on the basis of the signs proposed by WHO should be used (Fig.). It allows you to identify patients in whom x-ray examination is highly likely to show pneumonic changes; in the absence of x-rays, their antibacterial therapy is fully justified.

The algorithm frees the pediatrician from the need to make a diagnosis when there is a lack of information. It allows you to reduce the overdiagnosis of pneumonia and reduce the number of unnecessary X-rays and antibiotic prescriptions; its sensitivity is 94% and specificity is 95%.

To what extent do laboratory data help in diagnosis? Leukocytosis of 10-15·10 9 /l is observed in the first days in half of patients with pneumonia, but also in a third of patients with acute respiratory infections, croup, and acute bronchitis. So by itself it does not indicate a bacterial infection and does not require antibiotics. But the number of leukocytes below 10·10 9 /l does not exclude pneumonia; it is characteristic of pneumonia caused by Haemophilus influenzae and mycoplasma, and is also often observed with coccal pneumonia in the first days of the disease. Leukocytosis numbers above 15·10 9 /l (and/or absolute neutrophil count ≥10·10 9 /l and/or band forms ≥ 1.5·10 9 /l) make the diagnosis of pneumonia highly likely. The same applies to an increase in ESR above 30 mm/h; lower numbers do not exclude pneumonia, but they are also common with bronchitis.

Of the additional markers of bacterial infection, C-reactive protein (CRP) helps in diagnosis, levels of which >30 mg/l, as well as procalcitonin levels >2 ng/ml, allow 90% to exclude a viral infection. But low levels of these markers can be observed in pneumonia, more often atypical, so their negative predictive value for the diagnosis of pneumonia is insufficient.

Classification

The most important classification feature of pneumonia is the place of its origin—community-acquired and nosocomial pneumonia differ sharply in etiology and, therefore, require different therapeutic approaches. Community-acquired pneumonia occurs in a child under normal conditions of his life, nosocomial pneumonia occurs after 72 hours of hospital stay or within 72 hours after discharge from there. Pneumonia of newborns is classified separately; pneumonia that develops in the first 72 hours of a child’s life is classified as intrauterine. There are also pneumonias associated with artificial ventilation (ALV) (early - the first 72 hours and late) and pneumonia in people with immunodeficiency states.

It is practically important to distinguish between typical pneumonia caused by coccal or bacterial flora; they appear on an x-ray as pulmonary foci or infiltrates of a fairly homogeneous appearance with clear contours; clinically, these are patients with febrile fever, often toxic, often with local mild wheezing and dullness of percussion sound. Atypical pneumonias caused by mycoplasma, chlamydia and, rarely, pneumocystis look like inhomogeneous infiltrates without clear boundaries or disseminated foci; they are distinguished by an abundance of fine-bubble moist rales, crepitations on both sides, usually asymmetrical with a predominance over the pneumonic focus. The absence of toxicosis is characteristic, although the temperature reaction can be pronounced, as with mycoplasmosis, or absent (in children 1-6 months old with chlamydia).

The severity of pneumonia is determined by toxicosis, pulmonary heart failure, and the presence of complications (pleurisy, infectious-toxic shock, focal-confluent form is fraught with pulmonary destruction). With adequate treatment, most uncomplicated pneumonia resolves in 2-4 weeks, complicated ones - in 1-2 months; a protracted course is diagnosed in the absence of reverse dynamics within a period of 1.5 to 6 months.

Etiology of pneumonia

It is difficult to decipher because it requires isolation of the pathogen from normally sterile environments; therefore, treatment of pneumonia begins empirically based on data on the frequency of a particular etiology at a given age with the corresponding clinical picture (see below). The detection of pneumotropic (pneumococci, Haemophilus influenzae, strepto- and staphylococci) or intestinal flora, as well as viruses, mycoplasmas, chlamydia, fungi, pneumocystis in sputum does not indicate their role as a pathogen, because their carriage is the rule rather than the exception. An increase in antibody titers to pneumotropic pathogens is of relative importance, as it is often observed in any acute respiratory infection (polyclonal activation of the immune system). Detection of IgM antibodies in the blood to mycoplasma and Chlamydia trachomatis, and to a lesser extent to C. pneumoniae, is more reliable. The data below on the bacterial etiology of pneumonia in children of different ages are based on studies to identify the pathogen or its antigen in punctates of the lung and pleural cavity, antibodies to chlamydia and mycoplasma, and pneumococcal immune complexes.

Newborns. The etiological spectrum of pneumonia largely depends on the nature of infection (Table 1). Often pneumonia is of septic origin. Respiratory viruses can only cause an upper respiratory tract infection or bronchitis, but this is often complicated by bacterial pneumonia or the appearance of atelectasis and areas of swelling in the lungs, which also meet the criteria for pneumonia.

Children 1-6 months. At this age, two types of pneumonia are often observed. Pneumonia caused by C. trachomatis is characterized by a gradual onset without fever, stochastic cough, tachypnea, fine rales, absence of obstruction, leukocytosis (often >30 10 9 /l) and eosinophilia (>5%), on images there are many small foci (like with miliary tuberculosis). The history includes vaginal discharge in the mother and conjunctivitis in the first month of life. Staphylococcal pneumonia occurs rarely outside the hospital - in children of the first months of life and immunodeficient ones; nosocomial diseases caused by strains resistant to penicillin, and often to methicillin, often occur. With aerogenic infection, confluent foci with a tendency to necrosis appear in the lungs; with sepsis, a foci appear in the interstitium with the subsequent formation of abscesses. Leukocytosis >25·10 9 /l is typical. Aspiration pneumonia can manifest itself as acute, with toxicosis, high fever, shortness of breath, or as oligosymptomatic with a picture of bronchitis. The bacterial process is caused by intestinal flora, often multiresistant (Proteus spp., K. pneumoniae, P. aeruginosa), as well as anaerobes. Its localization is the right, less often the left upper lobe; in the phase of reverse development, it has the appearance of an inhomogeneous shadow, often with a concave lower border. The resolution of pneumonia is long-term. The diagnosis is confirmed by the identification of dysphagia (observation of feeding!), X-ray contrast examination of the esophagus reveals reflux and esophageal abnormalities.

Community-acquired pneumonia in the first weeks of life usually occurs when infected from an older child in the family and is caused by coccal or bacterial flora. At this age, pneumonia caused by immunodeficiency and cystic fibrosis is common, so all children with pneumonia should be examined in this direction.

IN age 6 months - 5 years the majority of pneumonias are typical, they are caused by pneumococci, 5-10% - by Haemophilus influenzae type b; only 10-15% are mycoplasma and C.pneumoniae. Pneumococcal pneumonia can occur as uncomplicated with moderate toxicosis, but at this age it is often accompanied by the formation of large foci with subsequent destruction and the formation of intrapulmonary cavities, often accompanied by pleurisy. Typical lobar pneumonia is characteristic of adolescents. Pneumonia caused by Haemophilus influenzae type b occurs almost exclusively before the age of 5; it is accompanied by a homogeneous infiltrate with pleurisy and destruction. Low leukocytosis and ESR, hemorrhagic exudate help to suspect it. Streptococcal pneumonia, caused by group A hemolytic streptococcus, develops lymphogenously from a lesion in the pharynx, most often in children 2-7 years old. Characterized by a pronounced interstitial component with foci in both lungs (often with cavities), pleurisy. The clinical picture with a violent onset is indistinguishable from that of pneumococcal pneumonia.

Children and teenagers 5-17 years old. At this age, pneumococcus remains practically the only causative agent of typical pneumonia, which constitutes only 40-60% of all pneumonia, while the rest of the pneumonia is atypical, caused by mycoplasma and chlamydia. M. pneumoniae causes up to 45% of all pneumonia in adolescents. Characteristic: cough, mass of fine-bubble wheezing, often asymmetrical, redness of the conjunctiva with scant catarrhal symptoms, inhomogeneous infiltrate, normal number of leukocytes and slightly increased ESR; a temperature above 39°C is usually combined with a mild condition, which often leads to late (9-12 days) treatment. C. pneumoniae at this age causes 15-25% of pneumonia, sometimes it is combined with pharyngitis and cervical lymphadenitis; characterized by fever and the development of bronchospasm. Blood changes are not typical. Without treatment it lasts for a long time. Diagnostic criteria have not been developed; this etiology is supported by antibodies of the IgM class (micro-ELISA) in a titer of 1:8 and higher, IgG - 1:512 and higher, or a 4-fold increase in their titer.

Complications of pneumonia. Pneumococci of a number of serotypes, staphylococci, H.influenzae type b, GABHS, Klebsiella, Pseudomonas aeruginosa, serration cause synpneumonic purulent pleurisy and early suppurating infiltrates with cavities of destruction in the lungs. A decrease in the immune response (primary immunodeficiency, prematurity, severe malnutrition) or the efficiency of bronchial cleansing (cystic fibrosis, foreign body, food aspiration, etc.) complicates the process. Before the abscess is emptied, suppuration is accompanied by persistent fever and neutrophilic leukocytosis; it is often combined with serous-fibrinous metapneumonic pleurisy, which has an immunopathological nature; it is characterized by a 5-7-day fever, an increase in ESR in the 2nd week of illness.

Respiratory failure is characteristic of disseminated processes (pneumocystosis, chlamydia in children 0-6 months). Toxic complications (disorders of the central nervous system, heart, microcirculation, acid-base status, disseminated intravascular coagulation (DIC)) depend on the severity of the process and the adequacy of therapy. They should be distinguished from compensatory changes (hypercoagulation, oliguria, decrease in circulating blood volume by less than 25%, hemoglobin and serum iron levels, compensated acidosis), the correction of which is impractical and can be dangerous.

Tactics for prescribing antibacterial drugs for pneumonia must take into account the likely etiology of the disease. Although the statements of a number of authors about the impossibility of accurately determining the ethology of pneumonia based on clinical and radiological data are true, nevertheless, at the patient’s bedside, in most cases, a pediatrician can outline the circle of probable pathogens (at least “typical” and “atypical”) and prescribe the drug accordingly spectrum The effectiveness of the drug is assessed by reducing the temperature below 38°C after 24-36 hours of treatment (for complicated forms - after 2-3 days with improvement of condition and local status).

V. K. Tatochenko, Doctor of Medical Sciences, Professor

SCCD RAMS, Moscow