Community acquired pneumonia in children

Definitions of tachypnoea in children:

  • <2 months: >60/min
  • 2 – 12 months: >50/min
  • >12 months: >40/min.

Triad of symptoms suggesting CAP in children:

  • Tachypnoea
  • Chest recession
  • Persistent fever >38.5

No definitive scoring systems for CAP severity exist. However, the following are considered markers of severity:

Markers of severe CAP in infants

  • Not feeding
  • Intermittent apnoea
  • T >38.5
  • RR > 70
  • Tachycardia
  • Cap refill >2s
  • Sats >92%
  • Nasal flaring
  • Grunting
  • Moderate to severe recession
  • Cyanosis

Markers of severe CAP in children:

  • T > 38.5
  • RR > 50
  • Tachycardia
  • Cap refill > 2s
  • Sats <92%
  • Severe dyspnoea
  • Nasal flaring
  • Grunting
  • Signs of dehydration
  • Cyanosis

Admit if severe or if signs of effusion.

Community management

Mild pneumonia <2 yrs is often viral & may not need Abs. Older children with pneumonia should get amoxicillin (if influenza-associated pneumonia, co-amoxiclav). Oral works as well as IV.
Safety-net and follow up at 48 hours – consider admission if still febrile or unwell after 48 hours treatment.

X-ray indicated only if:

  • Doubt over diagnosis
  • Suspected inhaled foreign body
  • Possible haemoptysis which may have come from other source
  • Relentlessly progressive after 2 – 3 weeks
  • Features such as clubbing or poor weight gain suggesting chronic course

(Pulse learning module)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Infectious Diseases, Paediatrics, Respiratory. Bookmark the permalink.

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