April 11, 2025, 9:00 am | Read time: 7 minutes

Worldwide, about 1.8 million children die from pneumonia each year. In Germany, the mortality rate for children with pneumonia is significantly lower compared to international figures. This is due to high-quality medical care and existing vaccination programs that specifically protect against the most common pathogens.¹

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What makes the disease so dangerous

Pneumonia is understood as a chronic or acute inflammation of the lung tissue, which occurs particularly frequently in children–as FITBOOK has previously reported.

Pneumonia in children is problematic for two reasons:

• On one hand, the immune system in children is not yet fully developed.
• On the other hand, pathogens such as bacteria or viruses are more easily transmitted among them–especially through coughing or sneezing (droplet infection).

Places like kindergartens, schools, and homes particularly facilitate the spread of pathogens. Children aged three to six are at high risk because they are often in close contact with peers, and infections are generally more common in this age group.

Frequency

Statistically, about 35 out of 10,000 children under six years old develop pneumonia annually, while for older children, it’s only about 15 out of 10,000. Infants in their first year and toddlers are most frequently affected.

Even though the disease usually progresses without complications, there are exceptions. For newborns or children weakened by malnutrition or other pre-existing conditions, pneumonia can be life-threatening. It is not without reason that it is one of the leading causes of death among children in poorer regions of the world.²

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Causes of pneumonia in children

Pneumonia in children can arise as a result of an existing respiratory disease (such as asthma) or as a complication of chronic conditions like cystic fibrosis. It is less common in children without identifiable pre-existing conditions or risk factors.

Bacterial pneumonia in children

Similar to adults, bacteria are among the most common causes in children. Additionally, babies and toddlers are susceptible to certain pathogens against which older children and adults are usually immune.

The most common bacterial pathogens include:

• Pneumococci (Streptococcus pneumoniae)
• Streptococcus agalactiae
• Haemophilus influenzae
• Escherichia coli.

In contrast, school-aged children may experience so-called atypical pneumonias, which are caused by organisms like chlamydia or mycoplasma. The symptoms of bacterial pneumonia are generally more pronounced than those of a viral form. Often, bacterial pneumonia develops following a viral infection–in this case, it is referred to as a superinfection.

Viral pneumonia

Typical viral causes of pneumonia in young children include the respiratory syncytial virus (RSV), adenovirus, and influenza virus. Infants are particularly at risk, as an RSV infection can sometimes lead to a severe course of illness.

Fungal pneumonia

Fungi are rarely responsible for pneumonia in childhood. This usually affects children with weakened immune systems or premature infants whose defenses are not yet fully developed.

How pneumonia manifests in children

The tricky part about the disease in children–especially in toddlers and infants–is that it is often difficult to recognize, as its symptoms resemble those of a cold or may be absent altogether. Particularly in babies who cannot express their discomfort, it is important to watch for certain warning signs that may indicate a serious infection.

Possible signs of pneumonia include:

• Refusal to eat
• Lack of interest in drinking
• Cough with yellowish or greenish sputum
• Rapid and shallow breathing (tachypnea)
• Nasal flaring (noticeable movement of the nostrils during inhalation), which can indicate respiratory distress
• High fever
• State of lethargy

Additional signs that may indicate a severe course and require a prompt doctor’s visit include:

Infants appear apathetic, refuse to drink, or vomit milk–these are often the only symptoms. A very rapid heartbeat can also be a warning signal in babies. It is also alarming if the breathing rate is significantly increased:

• More than twenty breaths per minute in older children
• More than forty breaths per minute in toddlers
• More than fifty breaths per minute in infants

A distinctly audible groan when breathing or visible retraction of the skin between the ribs can also indicate serious respiratory distress.³

In older children

Pneumonia is generally easier to diagnose in older children because they can express their symptoms. In addition to a general feeling of illness, they often report headaches, body aches, chills, and chest pain when coughing, which sometimes radiates to the right lower abdomen. They also frequently experience fever, cough, and fatigue.⁴

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Diagnosis

In fact, diagnosing pneumonia in children is similar to that in adults. It begins with a detailed medical history, where parents provide information about the child’s health (since the children are too young). Important questions determine symptoms such as persistent cough, fever, changes in eating behavior, or noticeable changes in condition. This is usually followed by a physical examination, where the back and lungs are listened to with a stethoscope. This can reveal typical sounds like fine crackles, indicating mucus formation or inflamed tissue.

Treatment

The subsequent therapy depends on the child’s health status, age, and severity of the disease. However, it must be noted that infants up to six months old and children with pre-existing conditions or severe cases must be treated in the hospital. If the child has no additional risks, they can be treated at home–though this must still be under medical supervision and with strict adherence to prescribed measures.

Antibiotics

If it is a bacterial pneumonia, children are usually given antibiotics for several days. The choice of drug depends on the suspected pathogen. The medication can be administered in various forms: older children usually receive it as syrup or tablets, while infants under six months receive it via infusion.

In the case of a viral infection, antibiotics are also used to treat a concurrent bacterial infection or as a preventive measure against a superinfection.

Antipyretics

If there is a high fever, the doctor prescribes antipyretic medications suitable for children. These include syrups with ibuprofen or acetaminophen.

Expectorants and cough suppressants

To facilitate coughing up mucus, expectorant medications can also be used. At night, a cough suppressant may be used–however, both should not be used simultaneously, as the mucus may not be coughed up, leading to respiratory distress.⁵

Complications

Although complications are rare, they are possible–especially if the therapy is not properly conducted. As a result, the disease may be prolonged or even spread to other organs. Possible complications include:

• Pleurisy (inflammation of the pleura)
• Fluid accumulation in the chest cavity (pleural effusion)
• Lung abscess (pus accumulation in lung tissue)
• Blood poisoning (sepsis)
• Meningitis (inflammation of the brain membranes)

More on the topic

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Dangerous Meningitis Meningitis: Causes, Symptoms and Treatment Options

Prognosis

Generally, the recovery from pneumonia in children depends on the pathogen and the child’s health status. In healthy children, the disease usually resolves on its own after about seven to ten days. However, susceptibility to respiratory infections may persist for several weeks afterward. Therefore, a recovery period of at least one month is recommended.

Prevention

Since many different causes can trigger pneumonia, it is not possible to completely prevent it. However, effective vaccinations significantly reduce the risk. The Standing Committee on Vaccination (STIKO) recommends, among others:

• Measles vaccination (as MMR combination vaccine)
• Pneumococcal vaccination
• Haemophilus influenzae type b (Hib)
• Chickenpox vaccination (as MMRV combination vaccine)

In addition to vaccinations, a healthy lifestyle with a balanced diet and sufficient exercise significantly contributes to prevention. Children with pre-existing conditions or weakened immune systems should avoid close contact with acutely ill children, as they are at increased risk for severe courses. Most importantly: A recovered pneumonia must be fully healed before a child returns to daycare or school–this is the only way to effectively prevent relapses and complications.