What you need to know about childhood pneumonia

Many people associate pneumonia with older people, but it is actually the biggest infectious killer of children worldwide. It kills more than 700,000 children under the age of five each year, including more than 153,000 newborns, who are especially vulnerable.

Every day, at least one child dies from pneumonia every 45 seconds, and almost all of these deaths are preventable.

It is inexcusable that thousands of children do not have access to essential health services and treatments that can prevent pneumonia and save lives.

What causes pneumonia?

Pneumonia is an acute respiratory infection of the lungs. It can be triggered by many things, including bacteria, viruses or fungi in the air. When children get pneumonia, their lungs fill with fluid, making it difficult to breathe. Children with immature immune systems (such as newborns) or weakened immune systems (such as malnutrition or infections such as HIV) are more likely to get pneumonia.

What are the symptoms of pneumonia?

Pneumonia is an infection of the lungs, the most common symptoms of which include cough, difficulty breathing and fever. Children with pneumonia often have shortness of breath, or their lower chest may draw in or contract when they inhale (the chest expands when a healthy person inhales).

Is pneumonia contagious?

Pneumonia is contagious and spreads through airborne particles (coughs or sneezes). It can also be spread through other fluids, such as blood during childbirth, or from contaminated surfaces.

How is pneumonia diagnosed in children?

Health workers can diagnose pneumonia with a physical examination, including checking for abnormalities in the child's breathing and auscultating the child's lungs. Sometimes, they also use a chest x-ray or blood test to diagnose it.

In countries with underdeveloped health systems (i.e., shortages of doctors, lack of chest X-ray facilities and laboratories), health workers often rely on counting children's breaths per minute to diagnose pneumonia. For example, a five-month-old toddler breathing 50 times per minute is tachypnea and may have pneumonia. Telling whether a child is "tachybreathing" depends on age: Younger children usually have a higher breathing rate than older children.

How is pneumonia treated?

The way pneumonia is treated depends on its type. In developing countries, a large number of cases of pneumonia are caused by bacteria that can be treated with inexpensive antibiotics. However, only a third of children with pneumonia get the antibiotics they need because they lack access to high-quality health care. Pneumonia caused by other causes, such as viruses or mycobacteria (such as the bacteria that cause tuberculosis), require other treatments. Tuberculosis, in particular, is often undiagnosed.

What role can oxygen play in the treatment of pneumonia?

Oxygen is an essential, life-saving treatment for children and newborns with severe pneumonia. This is because inflammation in the lungs prevents enough oxygen from getting into the blood.

Every year, in low- and middle-income countries, around 7 million children under the age of five are hospitalized with pneumonia and require emergency oxygen treatment to survive.

For too long, oxygen therapy has been denied to those who desperately needed it. In many countries with inadequate health systems, only higher-level health institutions and hospitals have oxygen supply facilities. The stress that COVID-19 has put on oxygen systems has exacerbated existing gaps.

Can pneumonia be prevented?

Preventing pneumonia starts with strengthening protective measures, such as proper nutrition, reducing risk factors such as air pollution (which makes the lungs more susceptible to infection), and practicing good hygiene. Research shows that washing your hands with soap can reduce your chances of being exposed to germs and reduce your risk of developing pneumonia by 50%.

Research has shown that washing your hands with soap can reduce your risk of developing pneumonia by 50%.

Is there a pneumonia vaccine?

Pneumonia caused by the bacteria is easily prevented with a vaccine. Yet more than 50 percent of children worldwide are not adequately protected by the main vaccine against pneumonia, the pneumococcal (PCV) vaccine. A new vaccine against one of the main viruses that cause pneumonia is currently in development.

Where are the most children dying from pneumonia?

The countries with the highest number of childhood pneumonia deaths are concentrated in sub-Saharan Africa and Asia, including the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan. Together, these five countries account for more than half of all pneumonia deaths among children under five.

Children who die from pneumonia are concentrated in the world's poorest countries. In these countries, it is the poorest and most marginalized children who suffer the most. They often have limited or no access to basic health services, and they are more likely to suffer from other health threats such as malnutrition, infectious diseases and air pollution. They often live in fragile or humanitarian settings where risk factors are often elevated and health systems are collapsing.

How does air pollution cause pneumonia?

Concentrating air pollution in countries with the highest number of childhood pneumonia deaths can greatly increase the risk of respiratory infections, including pneumonia. About half of childhood pneumonia deaths are related to air pollution.

The climate crisis is a children's rights crisis that poses serious threats to children's health and well-being.

Outdoor air pollution is a major risk to children, especially in countries with high rates of pneumonia cases as urbanization increases. But indoor air pollution from unclean cooking and heating fuels poses a greater global threat. Indoor air pollution accounted for 62% of air pollution-related childhood pneumonia deaths.

How important is wasting in pneumonia-related deaths?

Wasting is a major risk factor for childhood pneumonia death. This is the most obvious and deadly form of malnutrition. When children are too thin and their immune systems are weakened, they are more susceptible to diseases such as pneumonia. Wasting tends to occur in the early postnatal period, and it disproportionately affects children under 2 years of age. We must invest in nutrition services to prevent children from dying of pneumonia.

What does it take to prevent pneumonia?

We must act quickly to save children from dying from pneumonia and other preventable or treatable diseases.

Prevention of pneumonia requires a response that reduces risk factors, protects children's immune systems, and ensures that all children have free access to quality health services provided by trained and equipped health workers.

Pneumonia can be prevented if newborns and young children are breastfed, vaccinated early, have access to clean water, good nutrition, and reduce their exposure to air pollution.

We must intensify and prioritize routine immunization and expand access to the pneumococcal (PCV) vaccine to ensure that every child is protected from pneumonia.

We need to take steps to improve access to and use of basic oxygen so children no longer struggle to breathe.

It is also important that we address childhood wasting by investing in the prevention and treatment of severe acute malnutrition. This will help accelerate the reduction in child deaths from pneumonia.

To treat pneumonia in children, health workers need close access to children's families and access to appropriate training, medicines and diagnostic tools.

Both prevention and treatment require strong primary health systems and the engagement and empowerment of communities. But globally, only 68 percent of children with symptoms of pneumonia were taken to a health facility.

At least one child dies from pneumonia every 45 seconds. We need urgent action now to end these avoidable deaths. Well-trained and equipped health workers will support the prevention and treatment of pneumonia, helping every child overcome the disease and survive.