Diagnostic and Treatment Approach for Pediatric Pneumonia

Diagnostic Approach

The American Academy of Pediatrics recommends that pulse oximetry should be performed in all children with suspected pneumonia to assess for hypoxemia and guide decisions about site of care and further diagnostic testing 1, 2
The Infectious Diseases Society of America suggests that complete blood count is not necessary in all outpatient cases but may provide useful information in more severe disease 1, 3
The Pediatric Infectious Diseases Society states that acute-phase reactants (ESR, CRP, procalcitonin) cannot reliably distinguish between viral and bacterial causes and are not routinely needed in fully immunized outpatient children 2, 3
Chest radiographs (CXR) should not be routinely performed in children with suspected pneumonia who are well enough to be treated as outpatients, but should be obtained in hospitalized patients and those with hypoxemia, significant respiratory distress, or failed initial therapy 1, 2, 3

The American Academy of Pediatrics recommends that antimicrobial therapy is not routinely required for preschool-aged children with CAP, as viral pathogens are responsible for most cases 5, 8
The Infectious Diseases Society of America suggests that amoxicillin is first-line therapy for children under 5 years with CAP, effective against Streptococcus pneumoniae, the most common bacterial pathogen 6, 9, 8
The Pediatric Infectious Diseases Society states that macrolides should be considered as first-line empirical treatment for children 5 years and older with CAP due to higher prevalence of Mycoplasma pneumoniae 6, 7
The American Thoracic Society recommends that oxygen therapy should be provided to maintain saturation above 92% 6, 7
The Society for Healthcare Epidemiology of America suggests that intravenous fluids, if needed, should be given at 80% basal levels with monitoring of serum electrolytes 6, 7

The American Academy of Pediatrics recommends that antipyretics and analgesics can be used for comfort and to help with coughing 6, 7
The Infectious Diseases Society of America suggests that chest physiotherapy is not beneficial and should not be performed 6, 7

The Pediatric Infectious Diseases Society states that children treated at home should be reviewed if deteriorating or not improving after 48 hours 6, 7
The American Academy of Pediatrics recommends that families need information on managing fever, preventing dehydration, and identifying deterioration 6, 7
The Infectious Diseases Society of America suggests that follow-up CXRs at 4-6 weeks should be obtained only in patients with recurrent pneumonia in the same lobe or lobar collapse with suspicion of anatomic anomaly 5, 8