Pneumonia – Paeds

CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation and treatment.

Clinical Features Typically

  • Cough
  • Fever
  • Breathing difficulties
  • Tachypnoea


  • Wheeze
  • Chest pain
  • Abdo pain
  • Vomit
  • Headache


  • Cough
  • Wheeze
  • Chest pain/Arthralgia
  • Symptoms worse than signs



  • Infant: Temp <38.5, RR <50, Mild recession, Taking full feeds
  • Child: Temp<38.5,  RR <50,  Mild breathless,  No vomiting


  • Infant: Temp >38.5, RR >70, Mod-Severe recession, Nasal flaring, Cyanosis, Apnoea, Grunting, Not feeding, Tachycardia, CRT >2 seconds
  • Child: Temp >38.5, RR >50, Severe Resp. distress, Nasal flaring, cyanosis, Grunting, Signs of dehydration, Tachycardia, CRT >2 seconds


mild-moderate – Investigations are not normally required

  • Amoxicillin or Azithromycin
  • Arrange open access with paediatrics
  • Advice
    • Return if deteriorating
    • No improvement at 48Hours
      • GP review
      • Add Azithromycin for 3 days

Under 2

  • Not normally bacterial
  • If has pneumococcal vaccine treat for viral.
  • Arrange contact with community nursing team [via Paeds.]

severe – Admit child to paediatrics


  • Chest X-Ray
  • Blood Culture


  • Oxygen [maintain SaO >92%]
  • IV Fluids as required
  • Analgesic/Antipyretic
  • Antibiotics
    • Oral Amoxicillin or Azithromycin [Prefered]
    • IV therapy if; Septic or oral not tolerated o Consider adding Azithromycin if mycoplasma suspected
    • If History of Influenza prior, Co-Amoxiclav [Staphylococcus cover]

Antibiotic Guidance


PDF:cap pead

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