5 Signs Your Child Might Have Pneumonia

Your child has been coughing, sneezing and running a temperature. Is this the common cold, or could it be something more serious like pneumonia?

Dr. Jonathan Auth, a CHOC pediatrician, offers five signs your child might have pneumonia.

On the surface, symptoms can be similar. But Dr. Jonathan Auth, a CHOC pediatrician, says parents can look for five key signs that indicate their child may have developed bacterial pneumonia, an infection of the lungs:

1. Grunting

Listen to the child’s breathing. A consistent grunting noise associated with his breaths is typically a warning sign, Dr. Auth says.

2. Flaring

Pay attention to the child’s nostrils. Do they flare open and closed as she breathes? This can be a sign that breathing is impacted deeper in the lungs.

3. Retractions

Closely examine a child’s torso where the abdomen meets the rib cage. As he breathes, look for a sucking motion of the skin. Referred to as a retraction, this movement indicates that the child is having difficulty breathing.

4. Late onset fever

A fever that appears more than three days after cold symptoms first surfaced could be an indicator of pneumonia or another secondary infection, Dr. Auth says. Generally, if a fever accompanies a cold, it typically will arise at the beginning of the illness. A late fever is often a sign of trouble.

5. Increased respiratory rate

Look for more rapid breathing in your child. This varies by age, but Dr. Auth says a good rule of thumb is that an infant younger than 2 months taking more than 60 breaths per minute; a baby aged 2 to 11 months taking more than 50; and children older than 1 taking 40 or more breaths per minute should be evaluated by a pediatrician.

How to stop a cold from turning into pneumonia

There is no sure-fire way to ensure a pneumonia doesn’t follow a cold, but parents can take a few steps to minimize the possibility.

First, keep the child hydrated through liquid consumption and a humidifier, Dr. Auth says.

The goal is to ensure the body’s mucus secretions do not dry and thicken to create a breeding ground for the bacteria that causes pneumonia, he explains.

Hydration also keeps the tissue that lines the body’s cavities, like nostrils, from drying out. Dry mucosal lining can crack, which makes it easier for bacteria to enter and cause illness, Dr. Auth says.

Children with asthma and a history of allergies should also take steps to control inflammation and allergens in the home.

5 Questions to Ask When Your Child Has a Fever

The thermometer says your toddler has a 101-degree fever, but he’s acting like his usual self. Is a doctor’s appointment necessary? Answering these five questions can help caregivers decide if it’s time for a visit to the pediatrician.

Dr. Jonathan Auth, a CHOC pediatrician, encourages parents to ask these five questions when your child has a fever.
How old is the child?

Babies aged 3 months and younger with temperatures 100.4 degrees or higher should be evaluated by a physician immediately, says Dr. Jonathan Auth, a CHOC pediatrician.

How long has he had the fever?

If the child has a fever and typical cold symptoms, but is otherwise acting well, a fever can last for three to five days before parents ought to seek medical attention, Dr. Auth says.

“After more than five days, you should see a doctor because it increases the risk of other complications,” he says.

How high is the temperature?

A temperature hovering at 102 in a child might be alarming, but Dr. Auth says it’s common for children younger than 5 to spike high temperatures when ill.

In these cases, caregivers ought to work to make the child more comfortable by employing a fever reducer like acetaminophen, which is gentle on the stomach and safe for children of all ages.

When temperatures creep to 104 degrees, a parent should make an appointment with a pediatrician, Dr. Auth says. If a child has a 105-degree fever that doesn’t decrease abruptly with acetaminophen, go to urgent care, he says.

Where in the course of a child’s illness did the fever surface?

Generally, if a fever accompanies a cold, it will arise at the beginning of the illness, Dr. Auth says.

A fever that appears more than three days after cold symptoms first surfaced, however, could be an indicator of a secondary infection such as pneumonia, ear infection or sinus infection, he says.

In these cases, call the pediatrician.

Does the child also have body aches?

A high fever early in an illness that is accompanied by body aches or headaches can be an indicator of influenza, Dr. Auth says.

Parents who suspect their child has the influenza should seek medical attention early in the course of the illness. Specific anti-influenza medications can be used to shorten the duration of illness as well as reduce the risk of potential complications and minimize contagiousness.

A flu shot is the best way to protect children against the flu, and is recommended for all children older than 6 months.

Family Medicine Cabinet Essentials

In addition to a first-aid kit, a well-stocked family medicine cabinet can help families contend with a variety of ailments that children of all ages – and adults alike – might experience.

Here, Dr. Jonathan Auth, a CHOC Children’s pediatrician, lists the essential elements of a family’s medicine cabinet.

Family Medicine Cabinet Essentials
Dr. Jonathan Auth, a CHOC Children’s pediatrician, offers tips on family medicine cabinet essentials.

Oral medications

Acetaminophen – Frequently known as Tylenol, this common over-the-counter medication is a first-line defense against fever and pain. He recommends that families stock children’s acetaminophen rather than anything labeled as for infants. Though they used to differ in concentration, formulas are now the same, and children’s versions are typically less expensive than those marketed to infants, Dr. Auth says. Download a parent’s guide to acetaminophen for children to ensure you’re giving your child the right dose.

Ibuprofen – Known in stores as Motrin or Advil, this medication also combats fever and pain. It can also help soothe swelling and other complaints associated with an injury, thanks to its anti-inflammatory properties. Ibuprofen’s effects also last longer than acetaminophen, though it can irritate some children’s stomachs, especially if taken on an empty stomach. Dr. Auth does not recommend it for children younger than 6 months old.

Diphenhydramine – Commonly known as Benadryl, this medication can have multiple purposes, Dr. Auth says. It can help children with mild allergic reactions, as well as those who have seasonal allergies and some cold symptoms. Dr. Auth cautions that it frequently has sedative side effects, and should not be given to children younger than 2 without first consulting a pediatrician.

Calcium carbonate – Known as Tums, these chews can help soothe upset stomachs. Dr. Auth recommends consulting your pediatrician before using them in children younger than 6, however.

Dimenhydrinate – Commonly sold in stores as Dramamine, this medication is good to have on hand for travel with children who are prone to motion sickness.

Topical treatments

Multipurpose antibiotic ointments – Commonly known under the brand names Neosporin or Bacitracin, these topical medications help reduce the risk of possible infections from scrapes and mild skin abrasions, Dr. Auth says.

Hydrocortisone, 1 percent – This low-potency topical steroid cream can help soothe itchy rashes or irritated skin.

Antifungal cream, 1 percent – Commonly known under the brand name Lotrimin, this cream is good for treating yeast diaper rashes, ringworm, and athlete’s foot, Dr. Auth says.

Sunblock – Dr. Auth recommends families keep plenty of sunblock on hand: Barrier forms, which contain compounds like zinc oxide or titanium dioxide and block out the sun are safe at any age. UV A and UV B light absorbers containing PABAs can be used in children after age 6 months old. Dr. Auth also recommends families choose SPFs around 40 or 50. Anything marked higher than that shows minimal additional benefit.

Diaper cream – For families with newborns and young infants, having a diaper cream on hand is valuable, says Dr. Auth, who also recommends choosing a cream containing zinc oxide.

Petroleum-based ointments – These treatments can be helpful as a barrier, Dr. Auth says. For example, they can protect a cut against infection or can lock in moisture on chapped lips or dry hands.


Nasal saline solution – Dr. Auth recommends these products to help relieve infants’ stuffy noses or older children’s congestion.

Thermometer – Dr. Auth generally suggests families have a very basic and inexpensive digital thermometer that can be used orally for toddlers and children and rectally for infants.

Nail clippers and files – These are a necessity to keep children’s fingers groomed. When it comes to trimming infants’ nails however, files are safer and less intimidating for new parents, Dr. Auth says.

Bulb suction devices – These products are helpful in removing mucus from newborns, as well as in children who can’t yet blow their noses.

Humidifier – This can be helpful for children suffering colds, Dr. Auth says. However, he cautions families to properly maintain humidifiers to prevent mold production or limescale build-up, which can worsen problems. Also, whether to use a warm or cold mist is generally a matter of preference, Dr. Auth says.

A word of caution

Safely store medications so that they are inaccessible to children.

With any medication, parents should pay special attention and adhere strictly to dosing instructions.

Every household should have the phone number for poison control readily available: 800-222-1222.

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Is It a Cold, Sinus Infection or Allergies?

By Fionna Lam and Tran Nguyen, clinical pharmacists at CHOC and Dr. Jonathan Auth, CHOC pediatrician

With the winter season nearing the end and spring season already here, many of us are experiencing nasal symptoms related to the common cold, a sinus infection, or seasonal allergies. Since all these conditions share overlapping signs such as sneezing, nasal discharge and congestion, distinguishing between them may be the first step to selecting the proper over-the-counter remedy for symptomatic relief.

The common cold usually peaks during cold weather and is caused by a viral infection. While children may feel crummy for a few days, most cold symptoms can be managed with over-the-counter medications. Sinus infections, on the other hand, can bring about headaches and facial pain. It can happen after a prolonged common cold when the body is more vulnerable to bacterial or viral infections. Some children may be more susceptible to sinus infections than others due to structural abnormalities in the nose.

Sneezing, nasal congestion, and/or watery eyes are the hallmark symptoms of seasonal allergies. These are due to the body’s immunologic reaction to irritants in the air. This condition usually peaks during spring time when the highest amount of pollens from trees, grasses or weeds are present in the environment. Other common allergens include dust and mold.

The following table compares some common signs and symptoms of common cold, sinus infections and seasonal allergies:

SymptomCommon ColdSinus InfectionSeasonal Allergies
Fever/chills+/- *+/- 
Stuffy/runny nose+++
Color/consistency of sinus dischargeClear and watery, or thick and coloredThick, yellowish or greenishClear and watery
Sore/itchy throat+ +/-
Chest congestion+  
Headache/facial pain + 
Stiff neck + 
Watery eyes  +

+    present

+/-  may or may not be present

*Fever and/or chills are more common in children than adults

**Cough may present if post nasal drip present

It’s important to be aware of how long each symptom has been present. Cold symptoms usually start to show improvement in most children in 7-10 days. Sinus infections usually have longer lasting symptoms without treatment, around 10-14 days. Allergies are usually present for weeks or more.

When an infection or allergy occurs, the blood vessels in your child’s sinuses dilate and the tissues tend to swell up, which can lead to pain around the eyes, cheeks and forehead. Mucus production increases during an infection and can cause further discomfort. Small microscopic hairs in our nose called cilia help sweep bacteria and particles from our nose, but when dry air enters our nose, it can damage the cilia by drying them out.

Before resorting to medications, non-pharmacological strategies can be tried first such as introducing moist air with a humidifier, taking warm showers or drinking hot fluids like tea and soup. Keeping the air moist will help prevent drying out the nose passage and prevent mucus buildup.   Applying a warm compress to the face may also help alleviate congestion pain.

A variety of over-the-counter medications can provide targeted symptomatic relief. See the chart below for active ingredients and their role in cold and sinus infections. Learn what to look for when choosing the right over-the-counter medication for your child. While combination products offer the convenience of addressing many symptoms at once, they often contain more than one ingredient. When multiple over-the-counter remedies are taken together, the risk of toxicity increases due to duplication of active ingredients or doubling up on drugs in the same drug class. For example, acetaminophen (Tylenol) is commonly found in many over-the-counter cold and cough medications. Inadvertent overdoses have occurred when parents gave these medications along with Tylenol. To minimize this risk, single ingredient products are recommended whenever possible. Download this guide to acetaminophen for children.

Remember that over-the counter medications are not completely safe and do come with risk of side effects and toxicity if not taken correctly. Talk to your child’s pediatrician or pharmacist before starting a medication regimen.

Active ingredientPurposeSymptoms Treated     
  MucousCoughPainFeverRunny NoseStuffy Nose
AcetaminophenPain reliever  ++  
Ibuprofen, NaproxenPain reliever  ++  
Phenylephrine*, Pseudoephrine*To relieve nasal congestion    ++
Dextromethorphan**Cough suppressant +    
GuaifenesinTo loosen up phlegm++    
Saline sprayTo relieve nasal congestion    ++
Mentholated topical ointmentTo relieve nasal congestion    ++
Fluticasone, Triamcinolone (Nasal Spray)To relieve nasal congestion    ++
Oxymetazoline*, Phenylephrine*(Nasal Spray) To relieve nasal congestion     ++

+ present

*Do not use decongestant for more than 3 days as it might make you more congested.

**Discretion should be used when using dextromethorphan as a cough suppressant as high doses can cause hallucinogenic effects and be abused.

What Parents Need to Know About Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is a viral illness that usually affects infants and children younger than 10 years old, specifically those 1 to 5. We spoke to Dr. Jonathan Auth, a CHOC Children’s pediatrician on what to expect with this common condition.

hand foot and mouth disease
Dr. Jonathan Auth, a CHOC Children’s pediatrician, explains hand, foot and mouth disease

Q: Is HFM contagious?

A: Yes, it can be spread through contact with feces, saliva, or mucus. The virus is common year round but tends to cluster in the summer and fall.

Q: What are the symptoms?

A: A fever is usually the first sign of the virus, followed by a reduced appetite and sore throat, which can cause a child to feel achy and irritable. After a few days, painful sores (red-yellowish blisters) develop in the back of the roof of the mouth. A skin rash with red spots may appear in the palms of the hands and soles of the feet, as well as on the knees, elbows and buttocks area.

Q: What should a child with HFM eat?

A: Make sure your child drinks plenty of fluids, such as water or milk, to stay hydrated. How much water should your child drink? At CHOC Children’s, we recommend that children drink the amount of 8 ounce cups of water equal to their age, with a maximum of 64 ounces for children over the age of 8. Most children do not have much of an appetite during this time. Cold or soft foods, such as popsicles, ice cream, yogurt or jello, are the most soothing given the sores on the throat.

Q: How is HFM treated?  

A: HFM usually clears up within a week. While there is no medical cure or vaccination for HFM, your child’s pediatrician can recommend ways to make your child more comfortable while the illness runs its course. Acetaminophen or ibuprofen can be given to ease painful mouth sores or discomfort from the fever. Download a parent’s guide to acetaminophen for children.

Children with blisters on their hands, feet or rest of the body should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and gently pat dry.

Everyone in the family should wash their hands often, especially after using the toilet or changing a diaper, and before preparing food. Shared toys should be cleaned often, as viruses can live on objects for a few days.

Call your child’s pediatrician if your child is sluggish, can’t be comforted or seems to be getting worse.

Q: Are there any complications?

A: Complications are rare. Occasionally, some complications could arise, such as dehydration, due to a child not eating well, or not being able to swallow enough liquids because of painful mouth sores. Sometimes the rash or sores on the body can be infected if there are breaks in the skin.

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