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:
- 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
- oxygen saturation <= 95%
- NICE (June 2013). Feverish illness in children Assessment and initial management in children younger than 5 years
- Drug and Therapeutics Bulletin 1997; 35 (12): 89-92.