My 4-year-old daughter has allergies and occasional mild bouts of asthma. It’s not unusual for her to wake up coughing, so my husband and I weren’t alarmed when she coughed a little more than usual last Tuesday night. We even sent her to school Wednesday morning.By Wednesday evening we were at urgent care doing breathing treatments to try to get her oxygen saturation levels up. By midnight, we were settled into the hospital room where we’d live for the next three days while our daughter received oxygen and antibiotics to recover from pneumonia.Pneumonia?! But she didn’t even have a runny nose or a fever.Yes, pneumonia. I was shocked.Even her cough wasn’t what I imagined a pneumonia cough to sound like – it wasn’t wet or hacking. My daughter didn’t complain about finding it hard to breathe. If I didn’t happen to be texting with a friend who told me the signs of breathing distress, I probably would have waited even longer to take my girl to the doctor, and it probably would have gotten a lot worse.It can be so hard to tell when a cough is something to be concerned about. Here are some signs that your child is having breathing distress and it’s time to get to urgent care or an ER right away:
Now let’s talk about the symptoms of pneumonia versus the symptoms of bronchitis or of asthma in kids. All three conditions are common during cold and flu season and can cause coughing, chest pain or tightness, and shortness of breath. So what’s the difference?
Pneumonia
What is it? It’s an infection that inflames the air sacs of one or both lungs.What causes it? It can be caused by a virus or bacteria. It can start as the flu or a respiratory infection and develop into pneumonia.Do antibiotics treat it? Yes, but only if it’s a bacterial infection. Viral pneumonia will not be affected by an antibiotic, but it is possible to get viral pneumonia and have it develop into bacterial pneumonia.Does it require hospitalization? Sometimes it does, especially if oxygen is needed to keep oxygen blood saturation levels up, or if an IV is needed to deliver fluids, antibiotics or steroids. (My daughter was able to avoid an IV because she was able to drink plenty of fluids and take oral medications.) But it can also be treated at home in many cases.What are some indications that a cough may be caused by pneumonia (understanding that symptoms will manifest differently in every child)? Other than the coughing and tight chest that come with other illnesses, pneumonia may cause vomiting, fever, coughing up colorful mucus, wheezing, or fast breathing. My daughter did have some faint wheezing and fast breathing, but none of the rest.Fun fact #1: Coughing is good, so don’t reach for that cough suppressant without talking to a doctor. In the hospital, they encouraged my daughter to make herself cough to get things moving out of her lungs.Fun fact #2: Pneumonia is sometimes a complication of another illness, so it’s possible that you and I both get the flu but only one of us develops pneumonia.
Bronchitis
What is it? It’s an inflammation of the lining of the bronchial tubes (those things that bring air to and from the lungs). We’ll be talking about acute bronchitis, which is a temporary condition caused by illness.What causes it? It develops from a cold or other respiratory illness. It’s most often caused by a virus.Will antibiotics help? Not usually, because it’s viral.Does it require hospitalization? Not usually.What are some indications that a cough may be caused by bronchitis (understanding that symptoms will manifest differently in every child)? Bronchitis may be to blame if the cough developed soon after a cold, flu, or other illness, and it’s annoying but not causing distress.Fun fact: Bronchitis can lead to pneumonia.
Asthma
What is it? Asthma is a condition that causes the lungs and airways to be easily inflamed by certain triggers.What causes it? The condition can be present due to a variety of factors, including genetics. Triggers include air irritants like smoke, pollution or pollen, allergies, and respiratory illnesses.Will antibiotics help? Antibiotics won’t treat asthma directly, but because asthma can be triggered by an illness, it’s important to treat bacterial infections with antibiotics.Does it require hospitalization? It can. It’s important to stay on top of your child’s asthma (as I learned last week), because kids with asthma are more susceptible to conditions like bronchitis and pneumonia. Asthma is one of the leading causes of school absences.What are some indications that a cough may be caused by asthma (understanding that symptoms will manifest differently in every child)? If your child has recurring colds that settle in the chest, tends to cough while trying to sleep, or coughs while exercising, laughing, or when emotional, she might have asthma.Fun fact: Asthma and allergies go hand in hand and sometimes what you think is a symptom of allergies (like a cough during sleep) is actually a sign of asthma.An asthma attack looks a lot like the symptoms of breathing distress from pneumonia. Of course, pneumonia can also cause an asthma attack; so can bronchitis.Any way around it, I was fooled last week. I thought my daughter was having asthma problems (maybe triggered by bronchitis), but never guessed it was because she had pneumonia. I was shocked when the x-ray showed a lung infection.
It truly can be so hard to tell the difference. I encourage you to call your pediatrician if you have any concerns, and take your child to urgent care or the ER (make sure you know which urgent cares take pediatric patients and which hospitals have pediatric floors), if she shows any signs of breathing distress or uncharacteristic behavior. My daughter didn’t verbalize that she was in distress, but her behavior was off.Another friend of mine ended up in the hospital with her daughter with pneumonia exactly one week after I was there with mine. Neither of us was certain it was an emergency, but we both felt like we’d rather go to urgent care and regret it than not go to urgent care and regret it. And it turned out that it was an emergency (or would have been shortly) for both of our kids.When it comes to our kids, it’s always better to be safe than sorry.