Pneumonia Symptoms: How to Know the Difference Between Colds, the Flu and Something Worse

Pnuemonia symptoms are subtle which makes recognizing if a child has caught the illness particularly tricky. Luckily there are some good signs a parent can watch for.

by Matthew Utley
Originally Published: 
A girl with pneumonia symptoms lying in bed, blowing her nose

Pneumonia is surprisingly common in children. Approximately 156 million cases of pneumonia are documented in children under five around the globe each year, according to the World Health Organization. Unlike simple congestion caused by the common cold or flu, pneumonia is inflammation of the lungs directly. It occurs when pus or mucus fluids fill the lungs. And fluid-filled lungs can be life-threatening, although modern medicine has largely reduced that risk. But in order for risk to be reduced the subtle symptoms of pneumonia need to be recognized, because if not treated, the illness can still be very dangerous.

“In developed countries, the incidence is 33 cases of pneumonia for every 10,000 children under the age of five,” warns Katie Mysen, DNP, a family nurse practitioner with MobiCare, LLC, and an adjunct instructor at Oakland University. “Pneumonia can occur at any time of year, but is more prevalent in the colder months because kids spend more time in enclosed spaces with other people.”

That’s the same reason why kids are afflicted with more colds and flu in winter – and part of the reason pneumonia is so difficult for parents to identify. At first, it may seem like a chest cold.

“Symptoms of pneumonia in infants and young children can be subtle and can include the combination of fever and cough. Prior to a cough, kids might be breathing faster or have difficulty breathing,” explains Mysen. “The longer the cough, fever and breathing issues are present, the more likely that the child has pneumonia. Infants may present with difficulty feeding, fussiness or restlessness rather than a cough.”

Trouble breathing is typically characterized by noisy breathing with wheezes or grunts, strained breathing with a lot of chest and belly movement, flaring of the nostrils, or very rapid breathing. Trouble breathing can also be present in a number of severe illnesses that require a trip to the doctor – so parents should learn to recognize it.

In infants, trouble breathing is most apparent during feeding. Restricting the airway obviously makes it hard to breathe. So when the bodily mechanics of drinking milk or formula compete with inefficient breathing, breathing is always going to win. So babies having trouble breathing may eat less, sputter or show discomfort. But babies aren’t the only kids particularly vulnerable to pneumonia.

Recognizing Pneumonia Symptoms

  • Pneumonia is surprisingly common: 155 million cases worldwide in children under five. The figures are better in developed nations like the United States, but still represent thousands of patients every year.
  • It’s still dangerous: pneumonia affects the lungs directly, causing them to fill with fluid. Medical developments have made pneumonia easier to treat, but if left untreated, it can be deadly.
  • It’s hard to spot: pneumonia may appear like a cold or flu at first, with a cough and a fever – but one that doesn’t seem to get any better.
  • It makes breathing difficult: kids with pneumonia strain to breathe, and that strain is noticeable. Infants my turn away from feeding in their struggle for breath.
  • It requires a doctor: labored, difficult breathing should be addressed by a doctor. Let the pediatrician determine if a child should be treated at home.

“Kids with cardiac or respiratory conditions are more susceptible to pneumonia,” Mysen warns. “These conditions include things like congenital heart disease, asthma, cystic fibrosis, sickle cell disease and immunodeficiency disorders. Exposure to smoking also increases a child’s risk for pneumonia.”

This can affect a lot of kids – premature babies who otherwise thrive are often plagued with lung problems, and over 6 million kids in the U.S. have asthma. Luckily, parents can exercise some basic precautions in the home and out of it to help their kids avoid infection. This includes basic steps like flu vaccination, hand washing, and covering coughs and sneezes. Importantly, older kids need to exercise the same precautions.

If parents are concerned about the way their child is breathing, they should see a doctor. If their baby is unresponsive or lethargic, they should see a doctor. If the child has been ill and doesn’t seem to be noticeably improving, they should see a doctor. It isn’t a wait-and-see situation.

“Any child with a fever and cough should be evaluated by a health care provider,” advises Mysen. “Approximately half of the children diagnosed with pneumonia require hospitalization. Some cases of pneumonia are viral and may not require antibiotics, but it is important that the child’s breathing to be evaluated by a health care provider to ensure that the child can be safely treated at home.”

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