Pneumonia kills more children than any other illness – more than AIDS, malaria and measles combined. Over 2 million children die from pneumonia each year, accounting for almost 1 in 5 under five deaths worldwide. Yet, little attention is paid to this disease. This joint UNICEF/WHO report examines the epidemiological evidence on the burden and distribution of pneumonia and assesses current levels of treatment and prevention. It is a call to action to reduce pneumonia mortality, a key step towards the achievement of the millennium development goal on child mortality.

Key facts

  • Pneumonia accounts for 16% of all deaths of children under 5 years old, killing 920 136 children in 2015.
  • Pneumonia can be caused by viruses, bacteria, or fungi.
  • Pneumonia can be prevented by immunization, adequate nutrition, and by addressing environmental factors.
  • Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed 920 136 children under the age of 5 in 2015, accounting for 16% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.


Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

  • Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
  • Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;
  • respiratory syncytial virus is the most common viral cause of pneumonia;
  • in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.


Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child’s nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.

Presenting features

The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.

Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

Risk factors

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child’s immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child’s risk of contracting pneumonia.

The following environmental factors also increase a child’s susceptibility to pneumonia:

  • indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
  • living in crowded homes
  • parental smoking.


Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia.


Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children’s natural defenses, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

Pneumonia Prevention and How to Care for Your Child

  • Keep your child away from children (and adults) who are sick. If you child is sick with upper or lower respiratory tract symptoms (e.g. runny nose, cough and sneezing), it is best to keep them away from healthy children.
  • Make sure your child is vaccinated. The Hib and Pneumococcal vaccines (PVC13) will help protect your child against bacterial pneumonias.
  • Make sure your child gets a flu shot. Did you know the influenza (flu) virus could turn into pneumonia?
  • Frequent hand washing with warm water and soap is very important to prevent viruses or bacteria from entering the body when hands come in contact with your child’s nose or mouth. When you’re on the go, use hand sanitizer.
  • Don’t let your child share eating utensils, cups or straws with others. Same goes for facial tissue and handkerchiefs.

Caring for a Child Battling Pneumonia

If you think your child has pneumonia, schedule an appointment with their pediatrician promptly. In most cases, pneumonia can be treated at home after your child sees their doctor, but in more serious cases children require hospitalization.

Tips for caring for your child at home:

  • If your child’s pediatrician prescribes antibiotics, give them to your child at the correct time each day and for the entire duration prescribed. Don’t stop the antibiotic after a few days even if your child is feeling better. Address any concerns about the medication or side effects with the pediatrician.
  • Check with your child’s pediatrician before giving over the counter cough and cold medications (Many of these are NOT recommended for children under six years of age).
  • Check your child’s temperature with a thermometer. Anything greater than 100.4 F is considered a fever. Do not attempt to guess if your child has a fever by simply feeling if their body seems hot.
  •  Keep your child well hydrated. This is a golden rule for almost any type of illness to prevent dehydration.
  • Allow your child to get plenty of rest—naps, quiet play and lounging on the couch work the best.
  • A humidifier helps moisten the air and may help your child breathe better.
  • If you notice your child is having difficulty breathing (rapid chest rise, tummy moving in and out fast, sucking in at or under the ribs with breathing or nasal flaring), take them immediately to the emergency room for evaluation.
  • Your child’s lips and nail beds should be rosy pink, not blue or gray, which is a sign your child may not be getting enough oxygen.  If this happens, your child needs to be seen by a doctor immediately.
  • If your child is treated at home for pneumonia and is not getting better or looks worse, take them back to the doctor for evaluation. They may require hospitalization.