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Cough is the most common symptom of pneumonia in infants, along with tachypnea, retractions, and hypoxemia. These may be accompanied by congestion, fever, irritability, and decreased feeding. Streptococcus pneumoniae is by far the most common bacterial pathogen in infants aged 1-3 months.

Adolescents experience similar symptoms to younger children. They may have other constitutional symptoms, such as headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are also common in this age group. Mycoplasma pneumoniae is the most frequent cause of pneumonia among older children and adolescents.

See Clinical Presentation for more detail.

The signs and symptoms of pneumonia are often nonspecific and widely vary based on the patient’s age and the infectious organisms involved.

Observing the child’s respiratory effort during a physical exam is an important first step in diagnosing pneumonia. The World Health Organization (WHO) respiratory rate thresholds for identifying children with pneumonia are as follows:

Children younger than 2 months: Greater than or equal to 60 breaths/min

Children aged 2-11 months: Greater than or equal to 50 breaths/min

Children aged 12-59 months: Greater than or equal to 40 breaths/min

Assessment of oxygen saturation by pulse oximetry should be performed early in the evaluation when respiratory symptoms are present. Cyanosis may be present in severe cases. Capnography may be useful in the evaluation of children with potential respiratory compromise.

Other diagnostic tests may include the following:

Auscultation by stethoscope



Complete blood cell count (CBC)

Chest radiography


New data show that point-of-care ultrasonography accurately diagnoses most cases of pneumonia in children and young adults. Ultrasonography may eventually replace x-rays for diagnosis. [, ]

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Initial priorities in children with pneumonia include the identification and treatment of respiratory distress, hypoxemia, and hypercarbia. Grunting, flaring, severe tachypnea, and retractions should prompt immediate respiratory support. Children who are in severe respiratory distress should undergo tracheal intubation if they are unable to maintain oxygenation or have decreasing levels of consciousness. Increased respiratory support requirements such as increased inhaled oxygen concentration, positive pressure ventilation, or CPAP are commonly required before recovery begins.


The majority of children diagnosed with pneumonia in the outpatient setting are treated with oral antibiotics. High-dose amoxicillin is used as a first-line agent for children with uncomplicated community-acquired pneumonia. Second- or third-generation cephalosporins and macrolide antibiotics such as azithromycin are acceptable alternatives. Combination therapy (ampicillin and either gentamicin or cefotaxime) is typically used in the initial treatment of newborns and young infants.

World Health Organization. Handbook. IMCI integrated management of childhood illness. Available at . Accessed: November 5,2010.

Media Gallery
(Left) Gram stain demonstrating gram-positive cocci in pairs and chains and (right) culture positive for Streptococcus pneumoniae.
A breakdown of test results and recommended treatment for pneumonia with effusion. Gm = Gram; neg = negative; pos = positive; VATS = video-assisted thoracic surgery
(A) Anteroposterior radiograph from a child with presumptive viral pneumonia. (B) Lateral radiograph of the same child with presumptive viral pneumonia.
Radiograph from a patient with bacterial pneumonia (same patient as in the preceding image) a few days later. This radiograph reveals progression of pneumonia into the right middle lobe and the development of a large parapneumonic pleural effusion.
Right lower lobe consolidation in a patient with bacterial pneumonia.
(A) Anteroposterior radiograph from a child with a left lower lobe infiltrate. (B) Lateral radiograph of the same child with a left lower lobe infiltrate.
Anteroposterior radiograph from a child with a round pneumonia.
Table. Categorizing Patients Based on Symptoms, Which Assists in Differential Diagnosis of Those With Recurrent Pneumonias
Contributor Information and Disclosures

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP is a member of the following medical societies: Mens Dandelion Suede Venetian Loafers Christian Louboutin nxs4cwC
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Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha , American Academy of Pediatrics , sleeping bag dress Brown Rick Owens 3VMONDi
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Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Veronica, did you ever find the answer to your question? I have the same issues as you and have been on early intro GAPS diet unable to progress for almost 9 months now. (My daughter who is two also hasn’t been able to progress.) We can’t tolerate many of the healing foods like eggs, sauerkraut, yogurt etc. We eat liver but it doesn’t seem to help us. Were you able to find a source of folic acid that helped you metabolize b vitamins?

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Miriam Landau says


Go to: MTHFR.Net “Your Expert Resource on MTHFR Gene Mutation”

Dr Ben Lynch is a leading researcher and his site is one of the best resources about this genetically-based problem with folic acid metabolism. In addition, he has a store where he sells supplements SPECIFICALLY formulated for people with this genetic mutation! His prices are very fair and the product information is very detailed. I suggest you do this ASAP.

I’m a registered dietitian of over 30 years and a psychotherapist, and just heard him give a 1 hour webinar about THIS subject. He’s VERY knowledgeable, but, he is no longer accepting new clients. I suggest you go to his site and look around, but, mostly, be sure to look at the supplements for your disorder.

You can also refer your physician to his web site to help you figure out which one(s) might suit you best. I believe you can also inquire about what product would suit you, through the web site, but, Dr. Lynch won’t be the person to reply.

Hope this helps. Feel free to contact me through my website .

All the best. Miriam Landau


Thank you Miriam for your enthusiasm about the site. I have had a bit of a cruise around, and perhaps the best discussion that I have seen on MTHFR is actually at I didn’t realize that the problem was so associated with failure to get pregnant, miscarriage etc with pregnancy. After some encouragement from some of your readers I have put together a site with some of the chemistry and an explanation of it You will see that as far as folate supplementation goes, it is dependent upon whether or not you have the MTHFR mutation (s).


HI Jasmine,

Using sublingually 5mg sublingual can easily equal a 1mg injection, the typical size. However Greg makes agood point. More can help bring up up to a satisfactory level more quickly. However, the purpose is to get healing going and a more balanced approach with the other 3 essentials and awareness of the induced deficiencies that will happen. So do it intelligently, not like a party drug. Freddd

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Hi Fred,

– Does taking Metafolin raise Serum Folic Acid levels by any chance? Since i’ve started the protocol it seems like that my Folic Acid levels have increased! Should i be concerned about that? – My startup effects have been very minor and i’m worried about that, i get a slight tingling here and there, got headaches when i started to keep the Adb12 and Mb12 for 2 hrs, and muscle spasms. However now it feels like i’m not even getting that much effect from my 10mg Enzymatic, 10mg Adb12, 400mg Potassium and 1600-3200 MCG Metafolin (+ all essential vitamins). Seems like i’ve hit a plateau and i’m absolutely clueless how to get thinks start working again

Thank You


The headaches can be from not enough potassium. I have needed potassium between 1200 and 3000mg at various stages of healing. 400 4 times a day may get rid headches and muscle spasms. When you get these corrected then we can see what is next. My first clues are muscle spasms in my thight or occasionally calf or foot, screamingly intense in the middle of the night when relaxed. After all these thing get balanced out then we look at what isn’t being affected and take the next steps. A lot of healing happens over about a year and can continue for 5 or more years. It’s a matter of finding what else is needed. After the headaches amn spasms get taken care of then more healing can happen. Be In Good Health.


Hi Fredd,

I see ! thank you for the explanation, could you please let me know what you think about the increased blood folic acid level? Does it affect the B12 absorption?


Hi Jasmine, the energy boost that most people have is really following VB12 shots. In Europe and many parts of S. America they shoot up Adenosylcobalamin as an energy boost, almost like a party drug. The reason that you probably are not getting this is because oral tablets only get a tiny amount of VB12 across at any one time, so it is not enough to raise your serum levels by any significant amount once you are vitamin B12 deficient. They are OK if you have normal uptake to maintain levels but our calculations show that they are not enough to significantly raise your levels and certainly not enough to give you the energy boost. For that reason we have developed a rub-on lotion containing vitamin B12 in it. We have received wonderful responses from the few people that have tried it, who report getting the energy boost. The advantage with the rub-on lotion is that once the material has penetrated into the skin it persists for hours and hours and allows your body to start loading up on the vitamin B12. Preferably you should still keep applying the material daily until your levels reach normal (which should be above 300 pmol/L). You can find out further about deficiency states on a complementary web-site to that of Chris’ at I have worked on the uptake of VB12 for many many years, and our data definitely suggests that whilst you can maintain levels with oral supplements it is almost impossible to restore your levels to normal with them. Your situation with metformin makes it even harder. It is one of the diabolical problems with metformin use that is generally not told to patients who start taking the drug. There are so many serious problems with long term vitamin B12 deficiency that you should get it sorted out ASAP.


Deb Hickey says

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