Pneumonia in Kids

We have seen an uptick in mycoplasma pneumonia cases, and I think it’s important to discuss pneumonia in general, as it’s something we do see in children. Pneumonia is an infection that inflames the air sacs in one or both lungs, making it harder for children to breathe. Many assume it’s always bacterial, but in children, viral infections (like RSV and flu-related causes) are often behind it. This year, however, we’re also seeing a notable increase in cases of  mycoplasma pneumonia – often called “walking pneumonia.”

Though pneumonia can sound concerning, knowing what to look out for and when to seek help can make it much more manageable.

What’s causing the mycoplasma pneumonia surge?

One of the most common concerns lately is the surge in mycoplasma pneumonia, particularly because it’s affecting younger children who aren’t typically considered high-risk. Mycoplasma pneumonia usually affects school aged children and older, but we have been seeing toddlers have it as well. After a period of lower infection rates during the COVID-19 pandemic, this uptick can be attributed to a few key factors:

Shifts in immunity

Social distancing and reduced exposure to various illnesses over the past few years mean children have lower immunity to certain bacteria, including Mycoplasma pneumoniae.

Bacterial mutations

Changes in the mycoplasma bacteria could be making it more infectious, allowing it to spread more readily, even among those who wouldn’t usually be susceptible.

Natural cycles

Respiratory illnesses often follow cycles, and some years bring higher cases than others – 2024 appears to be a peak year for mycoplasma pneumonia.

Despite this surge, it’s reassuring to know that mycoplasma pneumonia generally causes mild symptoms compared to other types. Most children will recover well with appropriate care.

Does this information make me panic?

As a pediatrician, I know that illness is part of life, and while we can reduce risks, we can’t always control when kids get sick. The good news is that modern medicine and vaccines make pneumonia a condition we can often treat effectively, even though some cases may require hospitalization.

When it comes to mycoplasma pneumonia in particular, it’s usually mild and rarely causes severe illness. Knowing this can offer some peace of mind – most children with mycoplasma will recover well with supportive care and antibiotics. The key is staying informed about symptoms and being proactive when your child doesn’t seem to be recovering from a cold-like illness.

A little more about pneumonia…

Pneumonia is transmitted when the virus or bacteria that causes it enters the lungs, often through respiratory droplets from a cough or sneeze. In young children, viral pneumonia is most common, typically caused by viruses like RSV, influenza, or even common cold viruses, which tend to surge in the fall and winter. These viruses can lead to pneumonia by causing inflammation and fluid build-up in the lungs, which makes breathing difficult and often causes a persistent cough.

Bacterial pneumonia can also occur, sometimes after a viral infection has already weakened a child’s immune system. The most common bacterial causes include Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Vaccination can help reduce the risk; however, due to changes in bacteria and immune systems, bacterial pneumonia is still possible. Bacterial pneumonia tends to start more suddenly, with high fever and thick mucus production, which differentiates it somewhat from viral pneumonia.

Mycoplasma pneumonia, caused by Mycoplasma pneumoniae, is unique because it lacks a cell wall, making it resistant to some common antibiotics. Known as “walking pneumonia,” it generally presents milder symptoms, such as a dry, lingering cough and low-grade fever. Symptoms of mycoplasma pneumonia tend to linger longer and may require specific antibiotics, such as azithromycin.

Common symptoms of pneumonia include a wet or dry cough, fever, shortness of breath, and chest pain. However, symptoms can vary, especially in younger children, who may experience only mild breathing difficulty or even subtle signs like grunting and nasal flaring. So, when should you have a clinician evaluate your child? If you notice a persistent fever that lasts more than 5 days, breathing difficulties, unusual lethargy, inconsolability, persistent vomiting or abdominal pain, signs of dehydration, or a consistent cough that impacts sleep or daily activities. Babies may show subtle signs like nasal flaring or grunting, and if your child has asthma or another underlying health condition, it’s best to seek advice if you have any concerns.

The diagnosis of pneumonia typically involves a medical evaluation that looks at breathing rate, oxygen levels, and lung sounds. In some cases, additional testing like chest x-rays or throat swabs are needed to confirm the type. Treatment is based on the specific causes, with viral pneumonia often requiring supportive care, while bacterial and mycoplasma types may need targeted antibiotics.

How can you reduce the risk of pneumonia?

Preventing pneumonia follows similar steps to avoiding other respiratory illnesses. Regular handwashing with soap and water, especially before meals and after using the restroom, is one of the simplest and most effective ways to reduce the spread of germs. It’s also important to ensure children are up-to-date on their vaccinations, particularly pneumococcal and Haemophilus influenzae type b (Hib) vaccines, which have significantly reduced pneumonia cases from these bacteria. Lastly, keep children home if they are acutely unwell or have a fever, as this helps limit the spread of illness when they’re most contagious.

Want to learn more?

Pneumonia can be complex, and knowing the difference between it and a common cold, or understanding viral vs. bacterial pneumonia, can be a big help during the season. For even more on distinguishing between these, check out the latest PedsDocTalk YouTube video: Viral, Bacteria, and Mycoplasma Pneumonia in Kids. The video also answers common questions from parents like, “How to differentiate between a viral cold and pneumonia?”, “Why is my child’s cough still lingering after antibiotics?”, “Why didn’t my doctor prescribe a cough suppressant?”, “Why won’t my doctor just give antibiotics for a lingering cough?” and “When can my child go back to school after having pneumonia?” Check out the full video to get answers.

On The Podcast

Parents have many stressors and fears when starting solids: the mess, what to give, how to give it, schedules, gagging and choking, and allergies. The fear of allergies can make parents AVOID giving allergenic foods when that can actually be more of a detriment. I welcome Malina Malkani, a pediatric registered dietitian, mom of three, and author of the new book, Safe and Simple Food Allergy Prevention.

We discuss:

• Parental fears surrounding food allergies and how to overcome this

• How we can reduce the risk of food allergies in babies

• What it means to introduce allergenic foods early, often, and consistently

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