Pneumonia: When Should You Worry?

First Published: June 2021
Updated: August 2025

Cold and flu season can be a stressful time for parents. Deciding when your child needs to see their doctor is not always easy. You may wonder: is this just a head cold, or could it be a dreaded pneumonia?

What Is Pneumonia?

Pneumonia is an infection of the air sac of the lungs. Symptoms vary depending on the cause and severity, but it often begins as a cough with fever and chills. More serious cases can cause difficulty breathing, chest pain (especially when coughing or taking a deep breath), and may require hospitalization.

You should seek medical attention if your child develops:

• Cough with fever for more than 3-5 days (if older than 1 year)
• Lack of appetite
• Unusual tiredness or lethargy
• Trouble breathing or fast breathing

How Is Pneumonia Diagnosed?

Diagnosis begins with a physical exam, checking oxygen levels, and reviewing the patient’s medical history. Sometimes a chest x-ray and blood work are needed. Identifying the exact cause often requires a sample from deep in the lungs, which is difficult to obtain. For this reason, many doctors treat based on symptoms, history, and illness severity.

Types of Pneumonia

1. Bacterial Pneumonia: Caused by bacteria deep in the lungs, bacterial pneumonia leads to inflammation and accumulation of debris in the air sacs. Many cases can be prevented by the pneumococcal vaccine, which is included in the standard childhood immunization schedule. By 12 months, most children are protected if vaccinated on schedule in accordance with the American Academy of Pediatrics guidelines. Bacterial pneumonias do need to be treated with antibiotics.
2. Viral Pneumonia: Viral pneumonia is irritation of the lung from a viral illness. Influenza, respiratory syncytial virus (RSV) and now COVID-19 are all causes of viral pneumonia. Treatment focuses on rest and supportive care while the body fights the infections. There are no antibiotics that treat viral pneumonias. Some patients start with a viral pneumonia, then somewhat get better, and then develop a bacterial pneumonia. Therefore, if your child has a viral infection with runny nose, cough and congestion and then spikes a new fever after having these symptoms for 4-6 days, or if gets better and then becomes worse, your child should see their pediatrician. Antibiotics may be needed at that time.
3. Recurrent Pneumonia: Most children have pneumonia only a few times, if at all. Multiple episodes in a short period may suggest an underlying issue such as a structural lung difference present from birth, swallowing dysfunction, or an immune system problem. In these cases, your child may be referred to a pediatric pulmonologist or another specialist.

To learn more about our Pulmonary Medicine department, click here or call (614) 722-4766.