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Pneumonia in Children

The biggest infectious killer of young children, and Pakistan ranks third in the world. Know the fast-breathing signs.

Dr. Sana Fatima Updated 8 November 2026 8 min read Draft · awaiting Dr. Sana's medical review

At a glance

  • Pneumonia killed 740,180 children under 5 in 2019, which was 14% of all under-5 deaths 1.
  • Newer Global Burden of Disease (GBD) estimates put the toll at about 610,000 under-5 deaths in 2023 2.
  • Pakistan had about 31,000 under-5 pneumonia deaths in 2023, the third-highest number in the world 2.
  • Fast breathing means 60 or more breaths a minute under 2 months, 50 or more at 2–12 months, and 40 or more at 1–5 years 3.
  • Pneumococcus is the leading cause of under-5 pneumonia deaths, with about 197,000 in 2023 2.
  • Pakistan's EPI gives pneumococcal (PCV) and pentavalent (including Hib and whooping cough) vaccines free at 6, 10 and 14 weeks 5.

What it is

Pneumonia is a lung infection in which the tiny air sacs fill with fluid, so breathing gets hard and oxygen levels drop. It is usually caused by bacteria (such as pneumococcus or Hib) or viruses (such as RSV). Bacterial pneumonia needs antibiotics and viral pneumonia usually does not, but they look alike, so a doctor decides 11Pneumonia in children — WHO, 2022. who.int77Pneumonia — AAP HealthyChildren.org, 2024. healthychildren.org.

Symptoms

  • Cough or difficult breathing, often with fever 1.
  • Fast breathing, counted for one full minute while the child is calm: 60 or more breaths under 2 months, 50 or more at 2–12 months, 40 or more at 1–5 years 33IMNCI Chart Booklet — Ministry of NHSR&C Pakistan/WHO, 2019. sites.pitt.edu.
  • Chest indrawing. The lower chest sucks in when the child breathes in 13.
  • Wheezing, grunting or flaring nostrils 166Pneumonia — NHS, 2026. nhs.uk7.
  • Poor feeding and tiredness 7.

See a doctor urgently if

  • The child cannot drink or breastfeed, or vomits everything 344Guideline on pneumonia and diarrhoea in children up to 10 years — WHO, 2024. who.int.
  • The child has a fit, or is very sleepy, floppy or hard to wake 36.
  • There is a harsh noise when breathing in while calm (stridor) 3.
  • The lips look blue or grey, or the oxygen level is below 90% 36.
  • A baby under 2 months breathes fast, has severe chest indrawing, a temperature of 38 °C+ or below 35.5 °C, or moves only when touched 3.
  • The child gets sicker, or the fever continues after a few days of treatment 37.

Who is most at risk

  • Babies and children under 5 16.
  • Children who are malnourished, or babies who are not exclusively breastfed 1.
  • Homes with smoke from wood or dung fires, parents who smoke, or crowding 1.
  • Children with measles, HIV, asthma or long-term heart or lung disease 17.
  • Children with missed vaccines 1.

How it is diagnosed

Doctors usually diagnose pneumonia by examining the child: counting breaths, looking for chest indrawing and listening to the chest 388Pneumonia: diagnosis and management (NG250) — NICE, 2025. nice.org.uk. A pulse oximeter (a small finger or toe clip) measures oxygen, and a reading below 90% means hospital care 34. X-rays and blood tests are mainly for children in hospital 68.

Treatment

  • Bacterial pneumonia needs antibiotics; oral amoxicillin is first choice 1. Your doctor decides the medicine, the dose and how long to give it. Finish the course 6.
  • Most children recover at home, including those with chest indrawing but no danger signs 4.
  • Viral pneumonia does not improve with antibiotics; care means rest, fluids and fever control 7.
  • Hospital care is for danger signs, low oxygen or a sick young baby, and may include oxygen, injected antibiotics or bubble CPAP 341717Ijaz N et al. bCPAP for severe pneumonia — PLOS Glob Public Health, 2026. pubmed.ncbi.nlm.nih.gov.
  • Go back for a check-up after 3 days 3.

Prevention

  • Vaccines are the most effective protection 1. Pakistan's EPI gives them free 55Immunization schedule — Federal EPI Pakistan, 2023. epi.gov.pk:
  • PCV at 6, 10 and 14 weeks
  • Pentavalent vaccine (including whooping cough and Hib) at 6, 10 and 14 weeks
  • Measles-rubella vaccine at 9 and 15 months
  • Give only breast milk for the first 6 months 1.
  • Keep cooking smoke away from children, and never smoke indoors 1.
  • Wash hands and cover coughs 2121About Mycoplasma pneumoniae infection — CDC, 2026. cdc.gov.
  • Make sure your child eats well 1.
  • Ask your doctor about RSV protection: a vaccine in pregnancy (from 28 weeks) or an injection for the newborn 1414Recommendations to protect infants against RSV — WHO, 2025. who.int.

The situation now (2025–2026)

  • Global: WHO (fact sheet, November 2022) reports 740,180 under-5 deaths in 2019 1. GBD 2023 (reported November 2025) estimates about 610,000 in 2023 (UN estimate for 2021: 726,000; methods differ) 22World Pneumonia Day release (GBD 2023 data) — FIRS, 2025. firsnet.org.
  • Progress: Under-5 deaths from lower respiratory infections fell 33.4% from 2010 to 2023, but only 129 of 204 countries met the global target (GBD, December 2025) 99GBD 2023 LRI Collaborators. Lower respiratory infections 1990–2023 — Lancet Infect Dis, 2026. doi.org.
  • Pakistan: About 31,000 under-5 deaths in 2023, behind only India and Nigeria (reported November 2025) 2. A November 2025 national dialogue heard of gaps in IMCI practice, equipment and referrals 1010Urgent action to combat childhood pneumonia stressed — Dawn, 2025. dawn.com. Punjab reported 234 child deaths in January 2024, amid smog and cold 1111Pneumonia claims 234 child lives in Punjab — Arab News, 2024. arabnews.pk.
  • Mycoplasma: Cases rose worldwide in 2023–2024 1212de Groot RCA et al. Mycoplasma resurgence in children — Curr Opin Infect Dis, 2025. pmc.ncbi.nlm.nih.gov. In the US they peaked in August 2024 and have fallen since early 2025 (CDC, as of May 2026) 1313Mycoplasma pneumoniae surveillance and trends — CDC, 2026. cdc.gov.
  • RSV: RSV causes about 100,000 deaths and more than 3.6 million hospital admissions in under-5s each year (WHO, May 2025) 14.

What the research says

  • Suhag ZH et al., J Glob Health 2025prospective cohort, n=456 (Sindh)
    Children with chest-indrawing pneumonia treated with oral antibiotics at primary care: 96.3% cured, 0.4% died 15. Read the study
  • Mahmood H et al., J Glob Health 2026prospective cohort, n=373 (Islamabad and Rawalpindi)
    Chest-indrawing pneumonia treated as outpatients, mostly with oral amoxicillin: 89.3% cured, 0.6% died 16. Read the study
  • Ijaz N et al., PLOS Glob Public Health 2026prospective cohort, n=165 (Karachi)
    53% of children with severe pneumonia got bubble CPAP; monitoring and safe feeding needed improvement 17. Read the study
  • Jehan F et al., N Engl J Med 2020randomised controlled trial, n=4,002 (Karachi)
    For pneumonia with fast breathing only, treatment failed in 4.9% of children on placebo and 2.6% on amoxicillin 18. Read the study
  • Klapas A et al., Eur J Pediatr 2026meta-analysis, 10 trials, n=8,970
    In non-severe pneumonia, short courses failed no more often than long ones and were more often completed 19. Read the study
  • Drysdale SB et al., N Engl J Med 2023randomised controlled trial, n=8,058
    One nirsevimab injection cut infant hospital admissions for RSV chest infection by 83.2% 20. Read the study

Questions parents ask

Is pneumonia contagious?

The germs that cause it spread through coughs and sneezes 721. The same germ may give one child a cold and another pneumonia. Handwashing and vaccines reduce spread.

How long does recovery take?

Fever and breathing difficulty usually settle within 3–4 days of starting treatment. A cough can last up to 4 weeks 8.

What is "walking pneumonia"?

A mild pneumonia, often caused by Mycoplasma pneumoniae. The child may seem well enough to be up and about, but symptoms can last weeks 21.

Can pneumonia come back?

Yes. Many germs cause it, so a child can get it again. A cough lasting over 14 days, or repeated wheezing, should be checked for TB or asthma 3.

Does my child need an X-ray?

Usually not; the examination is often enough 8. An X-ray helps if a child is very unwell or not improving.

What can I do at home?

Breastfeed more often, give extra fluids and give medicines exactly as prescribed 3. Avoid cough medicines with codeine or dextromethorphan 7.

Myth vs fact

  • MythCold weather causes pneumonia.
    FactGerms cause it. Winter brings more cases because children crowd indoors, and cold and smog can add to the risk 1711.
  • MythPneumonia always needs injections or a hospital stay.
    FactMost children, including many with chest indrawing, recover at home with antibiotics by mouth 415.
  • MythA vaccinated child cannot get pneumonia.
    FactVaccines prevent the deadliest causes, but RSV and Mycoplasma can still cause it 11421.

Sources

  1. 1.Pneumonia in children — WHO, 2022. https://www.who.int/news-room/fact-sheets/detail/pneumonia
  2. 2.World Pneumonia Day release (GBD 2023 data) — FIRS, 2025. https://firsnet.org/on-world-pneumonia-day-experts-demand-action-to-save-children/
  3. 3.IMNCI Chart Booklet — Ministry of NHSR&C Pakistan/WHO, 2019. https://sites.pitt.edu/~super1/Pirzado/Chartbooklet%202019%20Pakistan.pdf
  4. 4.Guideline on pneumonia and diarrhoea in children up to 10 years — WHO, 2024. https://www.who.int/publications/i/item/9789240103412
  5. 5.Immunization schedule — Federal EPI Pakistan, 2023. https://www.epi.gov.pk/immunization-schedule/
  6. 6.Pneumonia — NHS, 2026. https://www.nhs.uk/conditions/pneumonia/
  7. 7.Pneumonia — AAP HealthyChildren.org, 2024. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Pneumonia.aspx
  8. 8.Pneumonia: diagnosis and management (NG250) — NICE, 2025. https://www.nice.org.uk/guidance/ng250
  9. 9.GBD 2023 LRI Collaborators. Lower respiratory infections 1990–2023 — Lancet Infect Dis, 2026. https://doi.org/10.1016/S1473-3099(25)00689-9
  10. 10.Urgent action to combat childhood pneumonia stressed — Dawn, 2025. https://www.dawn.com/news/1957447/urgent-action-to-combat-childhood-pneumonia-stressed
  11. 11.Pneumonia claims 234 child lives in Punjab — Arab News, 2024. https://www.arabnews.pk/node/2448646
  12. 12.de Groot RCA et al. Mycoplasma resurgence in children — Curr Opin Infect Dis, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12404625/
  13. 13.Mycoplasma pneumoniae surveillance and trends — CDC, 2026. https://www.cdc.gov/mycoplasma/php/surveillance/index.html
  14. 14.Recommendations to protect infants against RSV — WHO, 2025. https://www.who.int/news/item/30-05-2025-who-outlines-recommendations-to-protect-infants-against-rsv-respiratory-syncytial-virus
  15. 15.Suhag ZH et al. Chest indrawing pneumonia in Pakistan — J Glob Health, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11952181/
  16. 16.Mahmood H et al. Pneumonia in Islamabad and Rawalpindi — J Glob Health, 2026. https://pubmed.ncbi.nlm.nih.gov/42171395/
  17. 17.Ijaz N et al. bCPAP for severe pneumonia — PLOS Glob Public Health, 2026. https://pubmed.ncbi.nlm.nih.gov/42296103/
  18. 18.Jehan F et al. Amoxicillin for pneumonia in Pakistan — N Engl J Med, 2020. https://pubmed.ncbi.nlm.nih.gov/32609980/
  19. 19.Klapas A et al. Short- vs long-course antibiotics in CAP — Eur J Pediatr, 2026. https://pubmed.ncbi.nlm.nih.gov/42844453/
  20. 20.Drysdale SB et al. Nirsevimab for RSV in infants — N Engl J Med, 2023. https://pubmed.ncbi.nlm.nih.gov/38157500/
  21. 21.About Mycoplasma pneumoniae infection — CDC, 2026. https://www.cdc.gov/mycoplasma/about/index.html

This page summarises published research for education. It is not a diagnosis or a treatment plan. Always speak to your child's doctor, and go to the nearest hospital in an emergency.

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