Pneumonia in Children and the Elderly: Warning Signs Families Miss
Reviewed by Dr. Farhan Rashid Abbasi, Pharmacist, Medicine Online. For general information only; it does not replace advice from your own doctor.
World Pneumonia Day is marked on 12 November. Pneumonia is an infection that inflames the air sacs in the lungs, filling them with fluid so that breathing becomes hard work. It remains one of the leading causes of death in young children worldwide, and it is a serious risk for older adults too. Winter, smog and crowded homes all make it more common in Pakistan. The good news is that much of it is preventable, and early treatment saves lives.
Why children and older adults are most at risk
Young children have immune systems that are still developing and small airways that block easily. Older adults often have weaker immunity and long-term conditions such as diabetes, heart disease or COPD. In both groups, pneumonia can worsen quickly, and the early signs are easy to mistake for an ordinary cold.
Warning signs in children
The most important sign in a child is fast breathing. Count breaths for a full minute while the child is calm or asleep, watching the chest or tummy rise and fall. Breathing is considered fast if it is:
- 60 or more breaths a minute in babies under 2 months
- 50 or more in babies aged 2 to 12 months
- 40 or more in children aged 1 to 5 years
Other signs to watch for:
- Chest indrawing: the lower chest sucks in when the child breathes in
- Grunting, wheezing or noisy breathing
- Fever with cough, or in young babies a low temperature instead of fever
- Refusing feeds or unable to drink
- Unusual sleepiness or difficulty waking
- Bluish lips or tongue
Warning signs in older adults
Pneumonia in older people often does not look like a chest infection at first. Fever may be mild or absent. Watch for:
- New confusion, or a sudden change in behaviour
- A fall, or becoming suddenly weak and unsteady
- Loss of appetite and drinking much less
- Breathlessness, or breathing faster than usual
- Cough, with or without phlegm
- Worsening of an existing condition, such as blood sugar going out of control
Go to a hospital or doctor immediately if someone:
- Is struggling to breathe, has chest indrawing or is breathing very fast
- Has bluish lips, tongue or fingertips
- Cannot drink or keep fluids down
- Is very drowsy, confused or hard to wake
- Has a seizure
How pneumonia is treated
A doctor diagnoses pneumonia by examining the chest and sometimes with an X-ray, oxygen level check or blood tests. Bacterial pneumonia is treated with antibiotics, which must be prescribed by a doctor and taken for the full course, even when the person starts feeling better. Viral pneumonia does not respond to antibiotics, and treatment focuses on rest, fluids, fever control and, if needed, oxygen in hospital.
Never give leftover antibiotics or ones bought without a prescription. The wrong antibiotic or dose can delay proper treatment and adds to antibiotic resistance.
A nebuliser can help children and adults with asthma or wheezing, but it is not a treatment for pneumonia on its own. Use one only as your doctor advises. See our steamers and nebulisers and respiratory care range.
Recovering at home
- Give plenty of fluids and small, frequent meals.
- Control fever with paracetamol at the correct dose for age and weight.
- Keep the home smoke-free, and avoid outdoor air on high-smog days.
- Keep counting breaths in children; return to the doctor if breathing gets faster or other danger signs appear.
- Older adults may feel tired for several weeks; help them stay active gently and eat well.
Preventing pneumonia
- Keep children's vaccines up to date. Pakistan's routine immunisation programme (EPI) includes vaccines against pneumococcus, Hib, measles and whooping cough, all of which protect against pneumonia. Check your child's card and catch up on any missed doses at your nearest EPI centre.
- Vaccines for older adults. Pneumococcal and yearly flu vaccines are recommended for adults over 65 and for people with long-term illnesses. Ask your doctor.
- Breastfeed babies, ideally exclusively for the first 6 months, to strengthen their defences.
- Reduce indoor smoke from cooking fires, heaters and smoking.
- Wash hands with soap, and keep sick family members away from newborns.
- Good nutrition, including enough vitamin A and zinc for children, supports immunity.
A digital thermometer at home makes it easier to track fever accurately. For more on winter illness, read Flu or Cold? When to Treat at Home and our asthma and allergy guide.
Frequently asked questions
What is the first sign of pneumonia in a child?
Fast breathing is often the earliest and most reliable sign, together with cough or fever. Chest indrawing and difficulty feeding are signs of more serious illness.
Can pneumonia happen without fever?
Yes, especially in older adults and young babies. Confusion, weakness or poor feeding may be the main signs.
Is pneumonia contagious?
The germs that cause pneumonia can spread through coughs and sneezes, but not everyone who catches them develops pneumonia.
Does the pneumonia vaccine protect fully?
Pneumococcal vaccines protect against the most common bacterial causes, greatly reducing serious pneumonia, but no vaccine prevents every type.
How long does recovery from pneumonia take?
Most healthy people feel better within 1 to 2 weeks of treatment, but tiredness and cough can last a month or more, especially in older adults.
