Overview

Every parent dreads seeing their child struggling with a common cold or fever, but what if those minor symptoms hide something more serious? Pneumonia is an infection that causes inflammation in one or both lungs, leading to the pulmonary alveoli (air sacs) filling with fluid or pus, making breathing difficult.¹  There are different types of pneumonia based on what causes the infection, including bacterial and fungal.^2,3 When a virus causes the illness, it is called viral pneumonia. The most common organisms that cause pneumonia in children include the flu (influenza virus), Respiratory Syncytial Virus (RVS), and adenovirus. You can also get viral pneumonia from other viruses, such as rhinovirus and coronavirus.³ 

Viral pneumonia is a common illness that continues to be the primary cause of death in young children, accounting for 14% of all deaths of children under the age of 5 in 2019.⁴ This form of pneumonia can develop quickly and quietly, often resembling the early stages of the common cold. Identifying the early warning signs in your child can make all the difference in ensuring your child receives the necessary medical attention before the infection takes a dangerous turn. Therefore, this article dives into the subtle, yet critical early symptoms of viral pneumonia in children to arm you with the knowledge on how and when to act.

Symptoms

Early symptoms of viral pneumonia in children

When it comes to recognising early symptoms in your child, it is important to note that signs may differ based on the type of pneumonia they present and that symptoms may be different for each child. One of the first symptoms to appear in the early stages of viral pneumonia is dyspnea (shortness of breath), together with Tachypnea (quick, shallow breathing), considered the most important clinical sign for diagnosis;⁵ you may notice that your child is working harder to breath or not able to get enough air due to their chest being tight.⁶

Viral pneumonia starts with upper respiratory tract symptoms,³ which include:

• Sore throat
• High temperature (fever)
• Cough
• Runny or Stuffy Nose 
• Tachypnea 

After 3-5 days, your child may develop a dry cough (non-productive), that does not bring up mucus or phlegm, and start to show signs of breathlessness, which is the hallmark symptom of viral pneumonia.³ Once these signs appear, they tend to progress rapidly, within hours. In addition to the symptoms listed above, your child may show other symptoms,⁷ including:

• Chills
• Fast or hard breathing
• Wheezing noises (babies also make grunting noises)
• Headache
• Fussiness, especially in those <1 year old

Subtle Signs Often Overlooked

Certain symptoms of viral pneumonia, especially in children, may appear subtle and are frequently overlooked.^7,8 These subtle symptoms include:

• Loss of appetite: you may notice that your child may not be eating or drinking as normal. Similarly, babies may show less interest in breastfeeding or bottle-feeding. In extreme cases, babies and children may refuse to eat or drink altogether
• Tiredness (fatigue): children may become unusually tired, or start to show signs of lethargy. These symptoms can often manifest themselves in reduced interest in playing or activities they normally enjoy
• Fussiness or irritability: Older children may seem more unsettled, often presenting no clear reason for this behaviour. Babies will often be harder to soothe, showing irritability and increased crying
• Diarrhoea and vomiting: Though less common, viral infections can cause gastrointestinal issues. These are often mistakenly attributed to stomach issues when they are caused by the viral infection affecting the lungs⁸

As these symptoms can initially resemble those of a common cold, it is essential to keep a watchful eye on the progression of your child's symptoms and seek medical attention if their condition worsens or does not improve after a few days. 

When to seek Immediate Medical Attention

As mentioned above, it is important to monitor the development of your child’s symptoms closely. However, if your child starts presenting more severe symptoms, you must seek immediate medical attention. These include:

• Severe difficulty breathing
• Persistent high fever 
• Cyanosis (bluish skin) - this may present itself around the lips or fingertips

Diagnosis and treatment

How is pneumonia diagnosed?

Diagnosing pneumonia in children can be difficult due to the symptoms being so variable, and often resembling those of a cold. However, despite this, childhood pneumonia is primarily diagnosed clinically.⁸ This means that the diagnosis is based on the signs and symptoms your child presents, together with their health history and physical exam. 

Your child's doctor will ask you questions regarding their symptoms, and the origin of these. In addition to this, you may be asked questions regarding possible exposures, in the attempt to figure out if the infection is viral, bacterial, or fungal.³ 

Following this, a physical exam of your child may take place. During this, the doctor might listen to your child's lungs with a stethoscope, listening for crackling or rumbling noises when they inhale, which are signs of pneumonia. 

Thereafter, if the doctor suspects your child to have pneumonia, a few tests may be performed to confirm the diagnosis and learn about the cause of infection.^3,9 Common tests include: 

• Chest X-rays: performed to observe the location and extent of the inflammation 
• Blood tests: identifying the organism causing the illness and confirming the infection⁹
• Sputum test: a sample of Sputum, a thick mucus produced in the lungs, is tested to help diagnose infections

Given that viral pneumonia is contagious, an early and accurate diagnosis of the cause of viral pneumonia is extremely important.³ 

How is pneumonia treated?

Due to the diagnostic uncertainty of pneumonia, antibiotics are often prescribed as a preventative measure, in the attempt of avoiding bacterial infections.⁸ Research shows that antibiotic prescription rises with diagnostic uncertainty.¹⁰

Antibiotics, however, are not recommended when viral pneumonia is diagnosed because they are only effective against bacteria. Typically, viral pneumonia in children is just left to run its course. In most cases, “watchful waiting” is recommended, where antibiotics are withheld and parents are advised to just watch and wait - it is important to note that this approach is only suggested if the child can be followed closely, and parents are aware of when and how to seek further help.⁸

In some cases, your child may be prescribed antiviral medication from their doctor (i.e., Oseltamivir). Other treatments can help ease your child's symptoms, such as:

• Rest
• Lots of fluids
• Medication - Treatments such as ibuprofen, can be given to help with fever and pain (ibuprofen should not be given to babies under 6 months) 

Preventive Measures 

There are various effective tools for preventing your child from getting viral pneumonia.¹¹ These include:

• Provide a nutritious and well-balanced diet to strengthen your child's immune system 
• Regular hand washing
• Encourage your child to sneeze or cough into a tissue, or their sleeve
• Vaccinations - make sure your child is up to date with their necessary vaccinations
• Avoid sick contacts - avoid your child being in contact with people who are ill

FAQs

Difference between bacterial and viral pneumonia symptoms

According to the British Thoracic Society, if your child presents a fever higher than 38.5°C together with a respiratory rate that is more than 50 breaths a minute, this suggests your child has bacterial pneumonia; in contrast, symptoms such as wheezing, striking chest recession, and fever less than 38.5°C suggest that your child has viral pneumonia.¹¹ Another indicating factor is that, whilst early symptoms of both types of pneumonia are the same, breathing problems occur at a slower rate in viral pneumonia.⁹ 

However, despite this differentiation, it is crucial to understand that the clinical indicators and symptoms of both bacterial and viral pneumonia are highly variable and overlap, meaning that they cannot be relied on.

How quickly can pneumonia develop in a child?

Depending on the type of pneumonia your child presents, the onset of symptoms can occur at a different pace. When it comes to bacterial pneumonia, the onset of symptoms develops suddenly over 24 to 48 hours. During this time, your child is likely to develop a fever and start showing breathing problems, including cough and wheezing.³ Despite its quick development, children with bacterial pneumonia begin to show improvements after 48 hours of antibiotics. Your child's cough may persist for up to 3 weeks after the initial onset of the infection.

In viral pneumonia, symptoms appear more gradually and develop over several days. During this time, your child will start to develop a dry cough and also show signs of breathlessness, due to the inflammation on their lungs.³ It should take around 2-4 weeks for your child to fully recover. 

Summary

Pneumonia is an infection that causes your child's lungs to become inflamed, often causing breathing problems. There are different types of pneumonia based on the organisms that cause the infection. In children, viral pneumonia often begins with symptoms similar to a common cold, such as fever, runny nose, coughing, and sore throat. These symptoms may get worse over time, leading to more serious signs like shortness of breath and a persistent dry cough.

During the early stages of viral pneumonia, it is important to look out for symptoms that are often overlooked, including loss of appetite, fatigue, and irritability. These signs may seem minor but could indicate the onset of pneumonia. Therefore, parents must monitor their child's symptoms and seek medical attention if they notice severe difficulty breathing, persistent high fever, or cyanosis. 

Early detection and appropriate treatment are key to preventing complications from viral pneumonia.