Diagnosis of pneumonia in children is aimed at assessing the state of the respiratory system, the quality of ventilation. The final diagnosis is established on the basis of laboratory and instrumental research data, as well as on the objective status of the patient and the complaints presented.
Pneumonia in children is characterized by an acute infectious process, predominantly of a bacterial nature. The mechanism of the inflammatory process is due to the defeat of the respiratory parts of the lung structures, the formation of infiltrates of various localization.
When diagnostics are needed
Diagnostics is required when symptoms characteristic of acute respiratory viral infections, bronchitis, flu are manifested. Diagnostic measures are shown and are required for the following symptoms in a child:
- febrile syndrome and persistent febrile condition (in infants, pneumonia can occur without high fever);
- nausea, vomiting, regurgitation in infants;
- general malaise, apathy and lethargy (in newborns, these signs may be absent):
- overlapping of the tongue with a gray or white bloom;
- pallor of the skin (blue nasolabial triangle in babies of the first year of life);
A characteristic symptom for the diagnosis of pneumonia is the appearance of respiratory failure with shortness of breath. The deficiency is compensated by the active participation of the auxiliary muscles. Pay attention to the inflation of the wings of the nose, retraction of the intercostal spaces, supraclavicular dimples.
Infants and children under 1 year of age are characterized by the appearance of “croaking” breathing with a constant increase in the frequency of breaths, often with cyanosis of the nasolabial region. When these symptoms appear, you need to call an ambulance.
Features of children’s examinations
If pneumonia is suspected, the child is hospitalized in specialized children’s hospitals for adequate diagnosis and treatment. Diagnostic examinations are aimed at determining the nature of the inflammatory process, its localization, excluding concomitant or other diseases with a similar course. The main research methods are:
- physical examination of the child, auscultation of the lungs, listening to heart sounds;
- examination of the pharynx;
- determination of reactions to light, noise.
Be sure to take blood tests for the level of leukocytes, ESR and other indicators. A slight increase or decrease in leukocytes may indicate pneumonia of a viral nature. Urine is examined for sediment, protein, leukocytes, density.
In children over 4 years old, sputum is taken to determine the type of pathogen. In young children, this procedure is carried out by the aspiration method using probing. Analysis is important for long-term chronic pneumonia (for example, atypical or hospital-acquired).
An obligatory method for diagnosing pneumonia in children is a chest x-ray. The accuracy of the method reaches 94%. The following signs indicate pneumonia:
- foci of infiltration and their prevalence;
- morphological and destructive changes in the parenchymal layer of the lungs;
- pleural effusion.
Given the widespread prevalence of focal pneumonia in children, experts immediately distinguish the nonspecific course of the inflammatory process. The following criteria indicate focal classical bronchopulmonary pneumonia:
- the appearance of irregular shadows;
- merging fuzzy contours;
- strengthening of the outlines of the pulmonary pattern;
- significant expansion of the roots of the lungs;
- swelling of the lung tissue.
In severe forms of pneumonia, darkening is determined in the entire part or in the lobe of the lung. It is possible to diagnose pneumonia only in stationary conditions. A second x-ray is performed 4-5 weeks after the onset of the disease. With a clear positive trend against the background of adequate therapy, there is no need for a second X-ray.
Symptomatic manifestations differ somewhat not only in connection with the age of the child, but also with the type of inflammatory process. Specialists identify several types of pneumonia with a specific symptomatic classification:
- Bronchopneumonia or focal inflammation. Respiratory symptoms worsen by the 6th day of illness. In children under 12 months of age, this period is significantly shortened.
- Segmental. It often occurs in children from 4 to 7 years old, characterized by a lesion of one pulmonary segment. With adequate therapy, recovery occurs within 21 days.
- Lobar or lobar pneumonia. The disease is provoked by a pneumococcal infection, rarely occurs in pediatric practice. The inflammatory process covers the pleura and the lobe of the lungs. Correct therapy ensures complete recovery as early as 14 days after the illness.
- Interstitial. Inflammation is caused by the pathogenic activity of staphylococcal infection, pneumocysts, viruses, mycoplasmas, fungi. It is more common in premature babies against the background of diathesis, dystrophic syndrome, HIV. The most dangerous form of the disease, in which the vessels of the lung tissues are damaged, complications quickly occur in the form of bronchiectasis, pneumofibrosis.
- Destructive form. Destructive pneumonia is usually diagnosed in babies up to 12 months old with a burdened heredity, a complex clinical history. It is characterized by a violent and protracted course, strong intoxication of the body. Several episodes of exacerbation of pneumonia can lead to the death of a child.
- Atypical or community-acquired. This form of inflammation is due to the defeat of the body by Klebsiella, Proteus, Pseudomonas aeruginosa. Treatment is difficult due to resistance to many antibiotics.
Pneumonia of any form requires compulsory treatment in stationary conditions with antibacterial drugs, inhalation, physiotherapy. Despite the effectiveness of modern medicine, pneumonia is still a deadly threat to children. Only early diagnosis and adequate therapy can avoid serious consequences.
The difference between pneumonia and other pathologies of the respiratory system
Differential diagnosis of pneumonia in children largely determines further treatment and prognosis. Pneumonia should be distinguished from other diseases that have similar symptoms:
- Bronchitis of any origin. Pneumonia is characterized by severe intoxication, the presence of shadows on x-rays. With bronchial obstruction, the child’s condition changes slightly, a cough appears.
- Pulmonary tuberculosis. When listening to the chest, characteristic wheezing is typical. Against the background of tuberculosis, listening to wheezing is rare. Positive results of Mantoux tests indicate tuberculosis. If papules are more than 5 mm, the presence of tuberculosis can be suspected. Additionally, blood and sputum tests are performed. The first signs of tuberculosis are in many ways similar to focal pneumonia.
- Lungs’ cancer. Oncology rarely affects the child’s body, but it can occur with congenital lung pathologies. Diagnostic tests – biopsy, CBC, X-ray.
- Meningitis. Meningeal infection is characterized by the appearance of characteristic symptoms: photophobia, tonic cramps, muscle tension, headaches, indomitable vomiting.
The prognosis for pneumonia is favorable only against the background of adequate and timely therapy. It is important to follow the recommendations of doctors, to carry out treatment in inpatient conditions. If the child’s condition improves, outpatient or home treatment is possible. Lack of qualified assistance leads to serious complications, up to and including death.