Pneumonia in toddlers: signs, home care and when to go to hospital

Pneumonia in toddlers is an infection of the lung. KKH says viruses cause most cases, though bacteria can too. Watch for fast or hard breathing with a cough or fever. If you see that, take your child to a GP or polyclinic. Once a doctor has made the diagnosis, mild pneumonia can usually be cared for at home, says RCH.

What to do when your toddler might have pneumonia, step by step

1. Count your child's breaths while they're calm or asleep. Set a timer for one minute and count each rise of the chest or tummy.
2. Check the count against your child's age. NICE, the UK guideline body, treats more than 40 breaths a minute as fast in a child over 12 months.
3. Watch the chest as your child breathes in. RCH says ribs or skin under the neck sucking in, or flaring nostrils, mean breathing has become hard work.
4. Take your child to a GP or polyclinic if you see fast or hard breathing with a cough or fever. RCH says to see a GP if you think it's pneumonia.
5. Offer drinks often, in small sips, and give milk feeds more often to a younger child. RCH says it's fine if your child won't eat, as long as they're drinking.
6. Give antibiotics only if the doctor prescribes them, and finish the course. RCH says to complete it even if your child seems much better.
7. Skip cough medicine unless the doctor prescribes it. KKH says cough and phlegm medicines may do more harm than good in children under 2.
8. Ask the doctor or pharmacist before giving paracetamol or ibuprofen for fever or chest pain, and use the dose on the label. RCH says never give aspirin to children.
9. Keep your home smoke-free. RCH says no one should smoke in the home or around your child.
10. Tell grandparents, your helper or infant care teachers the plan. Share the medicine the doctor gave, how much your child should drink, and the signs that mean a return visit.

Signs of pneumonia in a toddler

KKH lists a fever with or without chills, and a cough that starts dry and may turn phlegmy. Other signs are fast or hard breathing, and chest pain when your child coughs or breathes. Some children vomit after coughing, or have diarrhoea. RCH says pneumonia often comes after a cold.

Toddlers can't always tell you their chest hurts, so watch what they do. RCH says most children refuse food when they have pneumonia. The NHS says babies may make grunting noises. For the other bugs that go round preschools, see our guide to common childhood illnesses.

NICE gives these lines for fast breathing in a child with a fever: more than 60 breaths a minute up to 5 months, more than 50 from 6 to 12 months, and more than 40 after 12 months. NUH says 40 to 50 breaths a minute is fast for a child under 2. The table shows where to go for what you see.

Viral or bacterial pneumonia

KKH names the usual germs: RSV, the flu virus, a bacterium called Streptococcus pneumoniae, and Mycoplasma. Antibiotics don't work on viruses. So KKH says doctors prescribe them only for bacterial pneumonia, or when they suspect bacteria on top of a virus.

RCH says viral pneumonia is usually milder, but recovery can be slower, up to four weeks. With antibiotics for bacterial pneumonia, KKH says the fever usually starts to ease within two to three days. The cough can take up to two weeks to settle. Our baby cough remedies guide covers soothing it at home.

How doctors check for pneumonia

KKH says doctors diagnose pneumonia from your child's history and an examination. Sometimes they need a chest X-ray or blood tests. RCH says most children need no tests. NICE advises against a routine chest X-ray for a child who isn't admitted to hospital.

If a test is needed, KKH says many polyclinics and family doctors offer X-rays and lab tests. Tell the doctor the breath count you took, how long the fever has lasted, and how much your child has drunk. Bring a list of any medicines and allergies. To find a children's doctor near you, use our paediatrician map.

When a toddler needs hospital care

In severe cases, KKH says children are admitted for closer watching, antibiotics and oxygen. RCH says some get antibiotics through a drip in a vein, and some need extra fluids.

KKH says illnesses such as chronic lung disease or a weak immune system raise a child's risk of pneumonia. If your child has a long-term condition and gets worse, KKH lists that as a reason to go to Children's Emergency.

How to lower the risk in Singapore

The pneumococcal vaccine is part of the National Childhood Immunisation Schedule (NCIS). KKH says it can prevent serious infections, including pneumonia, caused by some strains of pneumococcus. If your child hasn't had all three doses, KKH says to get them done. Check the ages in our vaccination schedule tool, and see our NCIS guide for where to go.

A yearly flu jab helps too. KKH says the flu vaccine can prevent flu pneumonia. HealthHub recommends the jab especially for groups at higher risk of flu complications, and children aged 6 to 59 months are one of them. KKH adds that children with some high-risk conditions may benefit from it each year. If your child has asthma, see our asthma guide. RSV, one of the common causes, has its own protection for babies, set out in our RSV guide.

Day to day, KKH advises regular hand washing or an alcohol-based hand sanitiser, and no smoke around your child. RCH suggests teaching children not to share food, drinks or spoons. It says that's hard at child care, where children put shared toys in their mouths. Our guide to why kids fall sick at childcare has more.

Walking pneumonia (mycoplasma)

Walking pneumonia is pneumonia caused by Mycoplasma, one of the germs KKH lists. HealthXchange says its symptoms tend to be milder than other types. Anyone can get it, but it mostly affects people aged 5 to 20. It spreads through close, prolonged contact, which is why it's common in schools and among siblings.

HealthXchange says Singapore has no season for it, and the flu jab doesn't protect against it. Many people get better with rest and fluids. Doctors may prescribe antibiotics if symptoms are more severe.

When to see a doctor

Go back to your GP or polyclinic if the fever hasn't started to ease within two to three days of antibiotics. That's when KKH says it usually improves. RCH also says to go back whenever you're worried.

Go to KKH Children's Emergency or NUH Children's Emergency if you see any of these:

• Breathless to talk, drink or play, or wheezing or noisy breathing (KKH)
• Breathing that gets harder, or a grunt with each breath (RCH)
• Vomiting, so your child can't keep fluids down (KKH, RCH)
• More drowsy than usual, hard to wake, very irritable or confused (KKH, RCH)
• Looking pale or ashen (KKH)
• Any fever or illness in a baby under 3 months (KKH)
• A long-term illness, such as a lung condition, that suddenly gets worse (KKH)

Call 995 if your child's lips, tongue or skin look blue or grey, they're struggling to breathe, they have a seizure, or you can't wake them. For the first three, the NHS says to call an ambulance or go to A&E. KKH lists seizures for Children's Emergency, and says to call 995 in an emergency.

For milder problems, KKH says a family doctor or polyclinic is faster and cheaper. Children's Emergency sees the sickest children first. If a fever is your main worry, try our fever checker or read when a fever needs a doctor.

Frequently asked questions

Is pneumonia in toddlers contagious?

The germs behind it pass from child to child. RCH says to teach your child not to share food, drinks or spoons, and to wash hands after coughing or sneezing. HealthXchange says walking pneumonia spreads through close, prolonged contact.

How long does pneumonia last in a toddler?

With antibiotics for bacterial pneumonia, KKH says the fever usually eases within two to three days, and the cough can take up to two weeks. RCH says a cough can carry on for up to three weeks after treatment, which is fine if your child is otherwise getting better. Viral pneumonia can take up to four weeks to clear.

Can my toddler go to infant care or preschool with pneumonia?

Your doctor decides when your child is well enough to go back, so ask at the visit. Keep your child home while they need rest and close watching. Tell the centre the diagnosis so staff can watch for the warning signs too.

What's the difference between pneumonia and bronchiolitis?

KKH says pneumonia is an infection of the lung, from viruses or bacteria. NUH says bronchiolitis is an infection of the small airways, mostly in children under 2. It's caused by viruses, so antibiotics generally don't help. Our baby blocked nose and noisy breathing guide covers bronchiolitis care at home.

Does the pneumococcal vaccine stop pneumonia?

KKH says it prevents serious infections, including pneumonia, from some strains of pneumococcus. Other germs, such as RSV, flu and Mycoplasma, also cause pneumonia, so a vaccinated child can still catch it. The flu jab and hand washing add more protection.

Can I give my toddler cough medicine for pneumonia?

Ask the doctor first. KKH says cough suppressants and phlegm medicines aren't routinely used for children with pneumonia. RCH goes further and says cough medicines don't help children with pneumonia.