Synopsis
Diagnose pneumonia from age-specific clinical features, identify sepsis and respiratory failure, distinguish community from healthcare-associated infection, use severity-directed imaging and microbiology, prescribe narrow first-line antibiotics with current paediatric doses, and detect effusion, empyema and treatment failure.
- Pneumonia is infection of lung parenchyma. In children it is diagnosed clinically from fever, cough, tachypnoea, recession, crackles or bronchial breathing and systemic effect; viral and bacterial features overlap.
- Use age-specific respiratory rate and the whole child. Hypoxaemia, work, perfusion, alertness, drinking, age and comorbidity determine severity more reliably than auscultation alone.
- First line for non-severe community-acquired bacterial pneumonia is oral amoxicillin. Current NICE uses 3 days for most children aged 3 months–11 years when clinically stable, and 5 days for age 12–17 or more severe disease.
Key red flags
Saturation below 90%, cyanosis, grunting, severe recession, apnoea, exhaustion or altered consciousness requires urgent admission and respiratory support.
Investigation priorities
Diagnose clinically and decide oral treatment versus hospital referral.
Management branches
A child has non-severe community-acquired pneumonia and can drink.
- Give oral amoxicillin using the current age dose and 3- or 5-day course.
- Provide fluids, antipyretic comfort and explicit breathing and hydration advice.
Key medicines
AmoxicillinNon-severe community pneumonia: age 3–11 months 125 mg orally three times daily; 1–4 years 250 mg three times daily; 5–11 years 500 mg three times daily, usually 3 days. Age 12–17 years 500 mg three times daily for 5 days.