Paeds · respiratory-sleep-and-airway
Community-acquired pneumonia
Also known as Childhood pneumonia · Paediatric CAP · Lower respiratory tract infection with consolidation · Bacterial pneumonia in children · Bronchopneumonia
Fellowship guide to community-acquired pneumonia in children: the febrile, coughing, fast-breathing child with alveolar consolidation acquired outside hospital; the age-dependent shift from viruses and pneumococcus in the young child to Mycoplasma in the school-age child; grading severity by WHO respiratory-rate thresholds, chest indrawing, oxygenation and feeding; the differential from bronchiolitis, viral wheeze, foreign body and tuberculosis; clinical diagnosis with restrained imaging; first-line oral amoxicillin with the SAFER and CAP-IT evidence for short-course standard-dose therapy; oxygen and intravenous care for severe disease; recognising parapneumonic effusion and empyema; and the ANZ, UK and North American guideline differences.
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Target exams
Red flags
- Oxygen saturation persistently below 92 percent, grunting, severe chest indrawing or nasal flaring — this child needs oxygen, admission and reassessment, not discharge on oral antibiotics
- A child who is not feeding or drinking, is dehydrated, or is too breathless to complete sentences or feeds — a marker of severe disease needing admission and intravenous support
- Cyanosis, apnoea, altered conscious level or an infant under about three months with pneumonia — very severe disease demanding urgent oxygen, senior review and broad early treatment
- Persistent high fever beyond about 48 to 72 hours of appropriate antibiotics, worsening respiratory distress, or a dull, quiet hemithorax — think parapneumonic effusion, empyema or necrotising pneumonia
- A sudden choking onset, focal persistent signs or recurrent same-site pneumonia — think inhaled foreign body or a structural or immune cause rather than simple community-acquired pneumonia
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Acute respiratory illness
- Lower respiratory tract infection in childhood
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Acute and critical care
- Paediatric respiratory infection and antimicrobial stewardship competencies
- Clinical Applications
- Acute paediatrics and the lower respiratory tract
- Long Cases
- Short Cases
- Acute assessment scenarios
- 4. Professional skills and knowledge: Patient management
- 6. Acute and emergency care
- General Paediatrics: Recognises and manages acute lower respiratory tract infection
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Acute respiratory illness; community-acquired pneumonia
- Clinical
- History and management planning
- Acute respiratory assessment in childhood
- General Pediatrics Content Outline — Domain 2: Emergency Medicine
- General Pediatrics Content Outline — Domain 17: Respiratory System
- General Pediatrics Content Outline — Domain 12: Infectious Diseases
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Emergency and acute care
- Medical Knowledge 1: Clinical Knowledge
- Systems-Based Practice: high-value care and antimicrobial stewardship
- Medical Expert
- Communicator
- Health Advocate
- Scholar
- Pediatrics: Core EPA — Assess and manage the acutely ill child with a respiratory infection
Overview & Definition
Picture the three-year-old brought in on the third day of a fever: he is flushed and breathing fast, his lower ribs draw in with each breath, he has a wet cough and has gone off his food, and over the right base you hear fine crackles with quieter breath sounds than on the left. That scene — a febrile child breathing hard with focal chest signs — is community-acquired pneumonia, and recognising it lets you start simple antibiotics and supportive care with confidence rather than reaching first for scans and blood tests. [1] [8]
Community-acquired pneumonia is an acute infection of the lung parenchyma acquired outside hospital, in which the alveoli and small airways fill with inflammatory exudate. The name places the problem in the air sacs themselves rather than in the conducting airways, and that is why the child develops focal consolidation, hypoxaemia and increased work of breathing rather than the diffuse wheeze of bronchiolitis. [8] [3]
Why this matters at fellowship level is that pneumonia is one of the commonest serious infections of childhood and, worldwide, a leading infective cause of death in young children, yet most cases in well-resourced settings are mild and respond to oral antibiotics. The skill being examined is disciplined severity assessment, high-value care that avoids needless imaging and intravenous therapy, and the alertness to spot the child who is genuinely severe or who is developing a complication. [3] [8]
References11ShowHide
- [1]Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis, 2011.PMID 21880587
- [2]Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax, 2011.PMID 21903691
- [3]Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med, 2015.PMID 25714161
- [4]Pernica JM, Harman S, Kam AJ, et al. Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial. JAMA Pediatr, 2021.PMID 33683325
- [5]Bielicki JA, Stöhr W, Barratt S, et al. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA, 2021.PMID 34726708
- [6]Lodha R, Kabra SK, Pandey RM. Antibiotics for community-acquired pneumonia in children. Cochrane Database Syst Rev, 2013.PMID 23733365
- [7]Griffin MR, Zhu Y, Moore MR, et al. U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med, 2013.PMID 23841730
- [8]le Roux DM, Zar HJ. Community-acquired pneumonia in children - a changing spectrum of disease. Pediatr Radiol, 2017.PMID 29043417
- [9]Long AM, Smith-Williams J, Mayell S, et al. 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center. J Pediatr Surg, 2016.PMID 26382287
- [10]Swingler GH, Hussey GD, Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet, 1998.PMID 9482294
- [11]Omaggio L, Franzetti L, Caiazzo R, et al. Utility of C-reactive protein and procalcitonin in community-acquired pneumonia in children: a narrative review. Curr Med Res Opin, 2024.PMID 39494704