Clinical Features of Pediatric Pneumonia
General Onset Patterns
| Pattern | Description |
|---|---|
| Insidious | Begins with URTI → progresses over days |
| Acute | Abrupt onset with high fever, tachypnea, dyspnea, grunting |
Core Symptoms
- Fever — high grade in bacterial pneumonia; may be low grade in viral/atypical
- Cough — initially dry, may become productive with thick sputum (rusty in pneumococcal)
- Tachypnea — cardinal sign; most reliable indicator in young children
- Dyspnea / grunting respiration — indicates respiratory distress
- Flaring of alae nasi — early sign of respiratory distress
- Chest pain — occasionally referred to shoulder or abdomen (pneumococcal)
Signs of Respiratory Distress
- Lower chest indrawing (subcostal / intercostal retractions) — WHO danger sign
- Flaring of alae nasi
- Grunting (expiratory) — severe distress; auto-PEEP mechanism
- Use of accessory muscles
- Cyanosis — late sign; indicates hypoxemia
Auscultatory Findings
| Finding | Significance |
|---|---|
| Crepitations (crackles) | Alveolar consolidation (lobar pneumonia) |
| Bronchial breathing | Dense consolidation |
| Diminished air entry | Pleural effusion, collapse, consolidation |
| Bronchophony / whispering pectoriloquy | Consolidation (pneumococcal) |
| Rhonchi | Bronchopneumonia, associated wheeze |
| Percussion dullness | Consolidation or pleural effusion |
Age-Specific Clinical Features
Neonates (<2 months)
Features of sepsis plus respiratory distress:
- Fever ≥38°C OR hypothermia
- Feeding difficulty / not feeding
- Lethargy, seizures
- Grunting, nasal flaring, severe chest indrawing
- Apneic spells, altered sensorium
- Distended abdomen
Any of these in a neonate = possible serious bacterial infection → refer urgently
Infants (2–12 months)
- High fever + rapid breathing
- H. influenzae: may mimic acute bronchiolitis; subacute course
- Staphylococcal: rapid deterioration; pyopneumothorax, pericarditis
- RSV (viral): rapid breathing, mild fever, hyperinflation
Children 1–5 years
- Pneumococcal: abrupt onset, high fever, headache, chills, rusty sputum
- Staphylococcal: toxaemic child, rapid progression, complications
- Atypical (Mycoplasma): insidious onset, dry cough, minimal signs, prominent X-ray findings
Adolescents
- Mycoplasma/Chlamydia: dry cough, malaise, headache, sore throat, myalgia
- Cough precedes other symptoms; dyspnea unusual
WHO / IMNCI Danger Signs (General)
Assess in all children 2 months–5 years:
- Unable to drink or breastfeed
- Vomiting everything
- Convulsions
- Lethargic or unconscious
- Stridor in calm child
- Chest indrawing (lower chest)
- Central cyanosis
Presence of ANY danger sign = Severe pneumonia / Very severe disease → Refer urgently
Meningismus in Apical Pneumonia
- Apical lobar pneumonia can present with neck stiffness (meningismus)
- Must be differentiated from meningitis (LP may be required)