lower respiratory tract infection (LRTI) in a child

Last edited 10/2022 and last reviewed 10/2022

90% of pneumonia in children is viral. Of the 10% that is bacterial, 90% in children aged over three months will be caused by pneumococcus; most of the remainder will be caused by H. influenzae. In the younger child other organisms are implicated; they are considered under neonatal pneumonia.

Pneumonia in infants and children has a variety of aetiologies which can only be distinguished by laboratory, and not clinical or radiological, findings. However, the epidemiology makes blind treatment a practical proposition.

NICE note that clinical features suggestive of pneumonia , in a child less than 5 years, are:

  • tachypnoea
    • RR > 60 breaths per minute age 0-5 months
    • RR > 50 breaths per minute age 6-12 months
    • RR > 40 breaths per minute age > 12 months
  • crackles in the chest
  • nasal flaring
  • chest indrawing
  • cyanosis
  • oxygen saturation <= 95%

Note that with respect to uncomplicated lower respiratory tract infections in children (LRTI) in children (3):

  • in this study eligible children were those aged 6 months to 12 years presenting in primary care with acute uncomplicated LRTI judged to be infective in origin, where pneumonia was not suspected clinically, with symptoms for less than 21 days
  • study authors concluded:
    • amoxicillin for uncomplicated chest infections in children is unlikely to be clinically effective either overall or for key subgroups in whom antibiotics are commonly prescribed
    • unless pneumonia is suspected, clinicians should provide safety-netting advice but not prescribe antibiotics for most children presenting with chest infections

Reference:

  1. NICE (June 2013). Feverish illness in children Assessment and initial management in children younger than 5 years
  2. Drug and Therapeutics Bulletin 1997; 35 (12): 89-92.
  3. Little P et al. Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial. Lancet. 2021 Oct 16;398(10309):1417-1426.