Chest and lungs

Whooping Cough: What Parents Need to Know

​Pertussis, or whooping cough, is caused by bacteria that attack the lining of the breathing passages.  Severe coughing is one of the major symptoms.

Because a child is short of breath, they inhale deeply and quickly between coughs. The breaths often make a “whooping” sounds, which is how this illness got its common name. The intense coughing scatters the pertussis bacteria into the air, and can spread the disease to others.

Pertussis on the rise

Many years ago, there were several hundred thousand cases of whooping cough each year in the United States. With the development of a vaccine for pertussis, that number dropped. But in recent years, U.S. cases have gone up. Because of this, giving the pertussis vaccine to children and their caregivers is more important than ever.Infants under one year of age are at greatest risk of developing severe breathing problems and life-threatening illness from whooping cough.

Symptoms of pertussis

Pertussis often acts like a common cold for a week or two. Then the cough gets worse (rather than better, as usually happens with a cold), and older children may start to have the characteristic “whoop.” During this phase, which can last two weeks or more, your child may often be short of breath. They may look bluish around the mouth. In addition, they may tear, drool, and vomit.

Young infants with pertussis may have episodes where they appear to stop breathing or have vomiting after a long bout of coughs. Infants with pertussis become exhausted and develop complications, becoming more vulnerable to other infections, pneumonia, and seizures. Pertussis can be fatal in some infants, but the usual course is for recovery to begin after two to four more weeks.The cough of pertussis, which has also been called the “100 day cough,” may not disappear for months, and may return with future respiratory infections.

When to call the pediatrician

Pertussis infection starts out acting like a cold. You should consider the possibility of whooping cough if:

  • Your child is a very young infant who has not been fully immunized and/or has had exposure to someone with a chronic cough or the disease.
  • Their cough becomes more severe and frequent, or their lips and fingertips become dark or blue.
  • They become exhausted after coughing episodes, eat poorly, vomit after coughing, and look “sick.”

When your child needs hospital care

Most infants who are less than six months old with whooping cough need to be initially treated in the hospital. Slightly less than half of older babies with the disease are initially treated in the hospital, too. This more intensive care can decrease the chances of complications. These complications can include pneumonia, which occurs in slightly less than one fourth of children under one year old who have whooping cough. If your child is older, they are more likely to be treated only at home.

While in the hospital, your child may need to have the thick respiratory secretions suctioned. Their breathing will be monitored, and they may need to be given oxygen. Your child will be isolated from other patients to keep the infection from spreading to them.

Treatment for pertussis

Whooping cough is treated with an antibiotic that is most effective when given in the first stage of illness, before the coughing spells begin. Although antibiotics can stop the spread of the whooping cough infection, they cannot prevent or treat the cough itself. Because cough medicines do not relieve the coughing spells, your pediatrician probably will recommend other forms of home treatment to help manage the cough.Let your child rest in bed and use a cool-mist vaporizer to help soothe their irritated lungs and breathing passages. A vaporizer also will help loosen secretions in the respiratory tract.

Ask your pediatrician for instructions on the best position for your child to help drain those secretions and improve breathing. Also ask whether antibiotics or vaccine boosters need to be given to others in your household to prevent them from developing the disease. Your child should stay home from child care until finishing five days of antibiotics.

How to protect your baby against pertussis

The best way to protect your child against pertussis is with DTaP vaccination (immunizations at two months, four months, and six months of age, and booster shots at twelve to eighteen months and at four or five years of age or prior to starting school).

Parents or family members who will be in close contact with babies younger than one year old should also receive the Tdap booster. This lowers the risk of passing the infection to the infant.

In addition, all women who are pregnant should get the Tdap vaccine during each pregnancy. This allows mothers to pass on protection against pertussis to their newborns.

Chest and lungs

Tuberculosis in Children and Teens

​Each year in the United States, there are about 9,000 new cases of tuberculosis (TB). TB is a rare but contagious disease caused by a bacterium called Mycobacterium tuberculosis. It primarily affects the lungs, but can also target parts of the body.

While the disease is less common than it once was, some groups of children and teens have a high risk of getting this germ. Here’s what parents should know.

Who is at risk for TB infection?

Children and teens at higher risk include those who:

  • Are living in a household with an adult who has active tuberculosis
  • Were born in a country that has a high prevalence of TB
  • Are visiting a country where TB is endemic and who have extended contact with people who live there

Some groups of children have a high risk of severe disease if they become infected. These include:

  • Children who are younger than 4 years old, or teenagers who have started puberty
  • Children who have a problem with their immune system (including those who are infected with HIV, or take medications that will decrease their body’s immune system)

How does TB spread?

Tuberculosis usually is spread when an infected adult coughs the bacteria into the air. These germs are inhaled by the child or teen, who then becomes infected.

Children younger than about 12 years old with TB of the lungs rarely infect other people. This is because young children tend to have very few bacteria in their mucus secretions. Also, their coughs typically do not spread germs as effectively as when adults coughs.

Symptoms of TB

Fortunately, most children and adolescents exposed to tuberculosis don’t become ill. When the bacteria reach their lungs, the body’s immune system attacks the germs and prevents further spread. This symptom-free infection can only be identified by a positive blood test or skin test. However, even if your child has a symptom-free infection, they still must treated. This is to reduce the risk that, in the future, the infection will worsen into disease.

Occasionally, in a small number of children or teens without proper treatment, the infection does progress. It can cause fever, fatigue, irritability, a persistent cough, weakness, heavy and fast breathing, night sweats, swollen glands, weight loss, and poor growth.

In an even smaller number of those infected with TB–mostly those less than four years old, adolescents who have started puberty, or anyone with a weakened immune system–the TB germ spreads through the bloodstream. When this happens, it can affect virtually any organ in the body. This type of TB illness requires complicated treatment. The earlier it is found and the treatment is started, the better the outcome.

How is TB diagnosed?

If your child is at risk for getting TB or having severe disease, they should be tested. The type of test depends on the age of the person:

  • If younger than 2 years old, they should receive a tuberculin skin test (usually called a TST, and also called the TB skin test).
  • If 2 years of age or older, they can have blood drawn for a test called an interferon-gamma release assay (usually called an IGRA, and also called the TB blood test). A skin test can be done on older children, but the blood test is preferred.

Your child may need a TB blood test or TB skin test if you answer yes to at least one of the following questions:

  • Has a family member or contact had tuberculosis disease?
  • Has a family member had a positive TB blood test or TB skin test?
  • Was your child or teenager born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)?
  • Has your child or teenager traveled (had contact with resident populations) to a high-risk country for more than one week?
  • Does your child or teenager have a weakened immune system?

The IGRA test is done by having blood drawn into a tube, which is then sent to a laboratory. The laboratory will test the blood for the IGRA, and results will be sent to your pediatrician.

The TST is performed in your pediatrician’s office by injecting purified, inactive pieces of the TB germ into the skin of the forearm. If there has been an infection, your child’s skin will swell and redden at the injection site. Your pediatrician will check the skin forty-eight to seventy-two hours after the injection, and measure the diameter of the reaction.

Both the IGRA (TB blood test) and TST (TB skin test) means that your child’s body has experienced the bacteria, even if the child has had no symptoms and even if their body has fought the disease successfully. Neither of the TB blood test nor the TB skin test will actually cause or worsen a TB infection.

Treatment for TB

  • If your child’s TB blood test or TB skin test is positive: A chest X-ray will be ordered to determine if there is evidence of active or past infection in the lungs. If the X-ray does indicate the possibility of active infection, your pediatrician also will search for the TB bacteria in your child’s cough secretions or in their stomach. This is done in order to determine the type of treatment needed.
  • If your child’s TB blood test or TB skin test is positive, but they do not have symptoms or signs of active tuberculosis infection: They are still infected. Your pediatrician will prescribe medications to reduce the risk of the infection getting worse. The type of medication is based on what is best suited for your child’s age, ability to swallow pills, and whether the medication is taken at home or at the pediatrician’s office.
  • For an active tuberculosis infection: Your pediatrician will prescribe three or four medications. You will have to give these to your child for 6 to 12 months. Your child or teenager may have to be hospitalized at first to get treatment is started, although most of it can be carried out at home.

It is very important that children or anyone being treated for tuberculosis finish the medicine and take the drugs exactly as instructed.

Controlling the spread of TB

If your child has been infected with TB, regardless of whether they develop symptoms, it’s very important to try to identify the person they caught it from. Usually this is done by looking for symptoms of TB in everyone who came in close contact with your child. The most common symptom in adults is a persistent cough, especially one that is associated with coughing up blood.

A TB blood or TB skin test may be recommended for all family members, babysitters, and housekeepers. Anyone who has a positive TB blood test or TB skin test should be examined by a medical provider, get a chest X-ray, and start treatment.

When an active infection is found in an adult: The adult should be isolated as much as possible–especially from young children–until treatment is under way. All family members who have been in contact with that person usually are also treated with INH, regardless of the results of their own TB blood test or TB skin test. Anyone who becomes ill or develops an abnormality on a chest X-ray should be treated as an active case of tuberculosis.

If an adult with an active infection is untreated: Tuberculosis can be controlled by the immune system for many years, only to break free during adolescence, pregnancy, or later adulthood. At that time, not only can the individual become quite ill, but they also can spread the infection to those around them. That’s why it is very important to have your child or teenager to be tested for TB if they come in close contact with any adult who has the disease. This helps ensure they can get get prompt, appropriate treatment if their TB blood test or TB skin test is positive.


Talk with your pediatrician if you have any questions about TB or other infectious diseases.

Chest and lungs

Bronchiolitis: What Parents Should Know

Bronchiolitis is a common respiratory infection among infants. One of its symptoms is trouble breathing, which can be scary. Read on for more information about bronchiolitis, its causes, signs and symptoms, how to treat it and how to prevent it.

What happens if a baby has bronchiolitis?

Bronchiolitis causes the small breathing tubes of the lungs (bronchioles) to swell. This blocks airflow through the lungs, making it hard to breathe. It occurs most often in infants because their airways are smaller and more easily blocked than in older children.

What is the difference between bronchiolitis and bronchitis?

Bronchiolitis is not the same as bronchitis, which is an infection of the larger, more central airways that typically causes problems in adults.

What causes bronchiolitis?

Bronchiolitis is caused by one of several respiratory viruses such as influenza, respiratory syncytial virus (RSV), parainfluenza, and human metapneumovirus. Other viruses can also cause bronchiolitis.

Infants with RSV infection are more likely to get bronchiolitis with wheezing and difficulty breathing. Most adults and many older children with RSV infection only get a cold.

RSV is spread by contact with an infected person’s mucus or saliva (respiratory droplets produced during coughing or wheezing). It often spreads through families and child care centers.

What are the signs and ­symptoms of bronchiolitis?

Bronchiolitis often starts with signs of a cold, such as a runny nose, mild cough, and fever. After 1 or 2 days, the cough may get worse and an infant will begin to breathe faster. Your child may become dehydrated if he cannot comfortably drink fluids.

If your child shows any signs of troubled breathing or dehydration, call your child’s doctor.

The following signs may mean that your baby is having trouble breathing:

  • They may widen their nostrils and squeeze the ­muscles under their rib cage to try to get more air into and out of his lungs.
  • When they breathe, they may grunt and tighten their stomach muscles.
  • They will make a high-pitched whistling sound, called a wheeze, when they breathes out.
  • They may have trouble drinking because they may have trouble sucking and swallowing.
  • If it gets very hard for your baby to breathe, you may notice a bluish tint around their lips and fingertips. This tells you the airways are so blocked that there is not enough oxygen getting into their blood.

Your child may become dehydrated if he cannot comfortably drink fluids. Call your child’s doctor if your baby develops any of the following signs of dehydration:

  • Drinking less than normal
  • Dry mouth
  • Crying without tears
  • Urinating less often than normal

Can bronchiolitis be treated at home?

There is no specific treatment for RSV or other viruses that cause bronchiolitis. Antibiotics are not helpful because they treat illnesses caused by bacteria, not viruses. However, you can try to ease your child’s symptoms.

To relieve a stuffy nose

  • Thin the mucus using saline nose drops recommended by your child’s doctor. Never use nonprescription nose drops that contain medicine.
  • Clear your baby’s nose with a suction bulb. Squeeze the bulb first. Gently put the rubber tip into one nostril, and slowly release the bulb. This suction will draw the clogged mucus out of the nose. This works best when your baby is younger than 6 months.

To relieve fever

  • Give your baby acetaminophen. (Follow the recommended dosage for your baby’s age.) Do not give your baby aspirin because it has been associated with Reye syndrome, a disease that affects the liver and brain. Check with your child’s doctor first before giving any other cold medicines.

To prevent dehydration

  • Make sure your baby drinks lots of fluid. They may want clear liquids rather than milk or formula. Your baby may feed more slowly or not feel like eating because they are having trouble breathing.

Bronchiolitis and ­severe chronic illness

Bronchiolitis may cause more severe illness in ­children who have a chronic illness.

If you think your child has bronchiolitis and they have any of the following conditions, be sure to call their doctor:

  • Cystic fibrosis
  • Congenital heart disease
  • Chronic lung disease (seen in some infants who were on breathing machines or respirators as newborns)
  • Immune deficiency disease such as acquired ­immunodeficiency syndrome (AIDS)
  • Organ or bone marrow transplant
  • A cancer for which she is receiving ­chemotherapy

How will your child’s doctor treat bronchiolitis?

Your child’s doctor will evaluate your child and advise you on nasal suctioning, fever control, and observation, as well as when to call back.

Some children with bronchiolitis need to be treated in a hospital for breathing problems or dehydration. Breathing problems may need to be treated with oxygen and medicine. Dehydration is treated with a special liquid diet or intravenous (IV) fluids.

In very rare cases when these treatments aren’t working, an infant might have to be put on a respirator. This is usually only temporary until the infection is gone.

How can you prevent your baby from getting bronchiolitis?

The best steps you can follow to reduce the risk that your baby becomes infected with RSV or other viruses that cause bronchiolitis include

  • Make sure everyone washes their hands before touching your baby.
  • Keep your baby away from anyone who has a cold, fever, or runny nose.
  • Avoid sharing eating utensils and drinking cups with anyone who has a cold, fever, or runny nose.


If you have questions about treating ­bronchiolitis, call your child’s doctor.

Chest and lungs

Severe Cases of Croup: When Your Child Needs Hospital Care

​​Most cases of croup can be treated successfully at home. However, children with severe cases of croup may need to be treated in the hospital.

Call 911 or an ambulance right away if your child: 

  • Makes a whistling sound (called stridor) that gets louder with each breath.
  • Cannot speak because of a lack of breath.
  • Seems to struggle to get a breath.
  • Has a bluish color of the lips, mouth, or fingernails.
  • Drools or has trouble swallowing.

Care of Your Child at the Hospital:

At the hospital, your child’s doctor will decide the best way to treat your child. Treatments may include the following: 

  • Epinephrine. This medicine can help reduce swelling in the upper airways so that your child can breathe better. Epinephrine is given through a nebulizer. A nebulizer is a machine that turns liquid medicine into a fine mist. The mist is breathed in through a mouthpiece or face mask. Often, when this medicine is used, doctors prefer to continue to watch a child for several hours after it is given. This sometimes requires a stay in the hospital.
  • Corticosteroids. These medicines can be useful in reducing inflammation in the body. They work in 2 ways. Systemic corticosteroids must go through the body to treat the inflammation in the upper airway. Inhaled or intranasal corticosteroids go directly to where the inflammation is.
  • Oxygen. Sometimes when breathing is very difficult for a child, the body may not get enough oxygen and the work of breathing increases. Oxygen given through a mask or a small tube near the nose will make it easier to breathe.

When Can My Child Go Home?

As soon as your child’s breathing improves, usually within a few hours, he will be allowed to go home. Sometimes a child with croup will stay in the hospital overnight for observation. 

Chest and lungs

Pneumonia in Children


​​The word pneumonia means “infection of the lung.” While pneumonia was extremely dangerous in past generations, today most children can recover from it easily if they receive proper medical attention.

Most cases of pneumonia follow a viral upper respiratory tract infection. Pneumonia also can be caused by bacterial infections. Also, if a viral infection has irritated the airway enough or weakened a child’s immune system, bacteria may begin to grow in the lung, adding a second infection to the original one.

Certain children whose immune defenses or lungs are weakened by other illnesses, such as cystic fibrosis, asthma, or cancer may be more likely to develop pneumonia. Children whose airways or lungs are abnormal in other ways may have a higher risk.

Because most forms of pneumonia are linked to viral or bacterial infections that spread from person to person, they’re most common during the fall, winter, and early spring, when children spend more time indoors in close contact with others. The chance that a child will develop pneumonia is not affected by how she is dressed or by air temperature on cold days.

Signs & symptoms of pneumonia in children

Like many infections, pneumonia usually produces a fever, which in turn may cause sweating, chills, flushed skin, and general discomfort. The child also may lose her appetite and seem less energetic than normal. Babies and toddlers may seem pale and limp, and cry more than usual.

​​Because pneumonia can cause breathing difficulties, you may notice these other, more specific symptoms, too:Cough
Fast, labored breathingDrawing in of the skin between and around the ribs and breastboneFlaring (widening) of the nostrils
Pain in the chest, particularly with coughing or ​deep breathing
Bluish tint to the lips or nails, caused by decreased oxygen in the bloodstreamAlthough the diagnosis of pneumonia usually can be made on the basis of the signs, symptoms and examination, a chest X-ray sometimes is necessary to make certain and to determine the extent of lung involvement.

Pneumonia treatment

When pneumonia is caused by a virus, usually there is no specific treatment other than rest and the usual measures for fever control. Cough suppressants containing codeine or dextromethorphan should not be used, because coughing is helpful in clearing the excessive secretions caused by the infection. Viral pneumonia usually improves after a few days, although the cough may linger for several weeks.

Because it is often difficult to tell whether the pneumonia is caused by a virus or by a bacteria, your pediatrician may prescribe an antibiotic. All antibiotics should be taken for the full prescribed course and at the specific dosage recommended. You may be tempted to discontinue them early, but you should not do so—some bacteria may remain, and the infection might return unless the entire course is completed.

​​Check b​ack with the doctor if your child shows any of the following warning signs that the infection is worsening or spreading.​​Fever lasting mor​​e than a few days despite using antibioticsFever that goes away and then returns after a few days
Breathing difficulties
Increased lethargy and sleepinessEvidence of an infection elsewhere in the body: red, swollen joints, bone pain, neck stiffness, vomiting, or other new symptoms or signs

Prevention: the pneumonia vaccine

Your child can be vaccinated against pneumococcal infections, a bacterial cause of pneumonia. The American Academy of Pediatrics recommends that all children starting at 2 months of age receive this immunization (called pneumococcal conjugate or PCV13). A series of doses needs to be given at 2, 4, 6, and 12 to 15 months of age, at the same time that children receive other childhood vaccines.

If your child did not receive the first doses at the recommended times, talk to your pediatrician about a catch-up schedule. One dose of PCV13 should be given to all healthy children who are aged 2 through 5 years who have not previously received their recommended doses before the age of 2 years and to children aged 2 years through 18 years with certain underlying medical conditions who have not previously received a dose of PCV13.

Another pneumococcal vaccine (pneumococcal polysaccharide or PPV23) also is recommended for older children (2 through 5 years of age) who have a high risk of developing an invasive pneumococcal infection. These include children with:

  • Sickle cell anemia
  • Heart disease
  • Lung disease
  • Kidney failure
  • Damaged or no spleen
  • Organ transplant
  • HIV (human immunodeficiency virus) infection

It’s also recommended for children taking medications or who have diseases that weaken their immune system. Some children with certain underlying medical conditions may need a second dose of pneumococcal vaccine given at lease 8 weeks later.

Chest and lungs

Parainfluenza Viral Infections

Human parainfluenza viruses (HPIVs) are a group of organisms, types 1 through 4, that cause several different respiratory infections. For example, they are the major cause of croup, which is an inflammation of the voice box (larynx) and windpipe (trachea) that makes breathing more difficult.

They also cause some cases of lower respiratory tract diseases, including pneumonia (a lung infection) and bronchiolitis (an infection of the lung’s small breathing tubes). They can make the symptoms of chronic lung disease worse in children.

Parainfluenza viruses have an incubation period of 2 to 6 days. They are spread from person to person by direct contact or exposure to contaminated secretions from the nose or throat. Children are usually exposed to most types of parainfluenza by 5 years of age.

Signs and Symptoms

The following symptoms occur in many types of parainfluenza infections, although they may be different from child to child or one kind of infection to another:

  • A rough, barking cough
  • Rapid, noisy, or labored breathing
  • Hoarseness and wheezing
  • Redness of the eye
  • A runny nose
  • Cough
  • Fever
  • A decline in appetite
  • Vomiting
  • Diarrhea

How Is the Diagnosis Made?

The diagnosis of HPIVs may be made by testing the secretions collected from a sick child’s nose and throat. Viral cultures or tests are taken to look for parts of the virus. An increase in antibodies to parainfluenza may be found in the blood of infected children. As with most infections, it can take several weeks for the antibodies to appear.


The treatment of viral illnesses, including those caused by parainfluenza viruses, should not involve the use of antibacterials, which are not effective against viruses. Most parainfluenza infections do not require specific treatment other than soothing the symptoms and making your child more comfortable until she feels better. The illness goes away on its own. Antibacterials should only be used if a secondary bacterial infection develops.

Talk to your pediatrician about whether your child with a fever should be given acetaminophen to lower her body temperature. Make sure she drinks lots of liquids.

Some supportive therapies are unique to the specific infection that is present. For croup, which is characterized by a barking cough, your child may feel better if you take her into the bathroom, turn on the hot water in the shower, and let the bathroom fill with steam. The warm, moist air should allow her to breathe easier. Breathing in steam is usually helpful, but if it isn’t, take your child outdoors for a few minutes. Inhaling the moist, cool night air may loosen up her airway, and she will be able to breathe easier.

Your pediatrician may prescribe a dose of corticosteroids for croup. Usually a single dose is all that is needed.


In the first few months of life, infants have protection against some parainfluenza types because of antibodies from their mothers.

Keep your child away from youngsters who have viral infections, particularly in the early and most contagious stages. Regular and thorough hand washing is an important way to lower the chances of spreading most viral infections. Your child should not share eating utensils and glasses with a sick youngster.

A vaccine against parainfluenza viruses is not available, although vaccines against viral types 1 and 3 are in development.

Chest and lungs

Mycoplasma pneumoniae Infections

Some lung infections, including many cases of mild pneumonia (also referred to as walking pneumonia), are caused by an organism called Mycoplasma pneumoniae. It is spread from person to person in secretions such as phlegm from the respiratory passages and has an incubation period of 2 to 3 weeks. Transmission of this organism usually takes place through close contact. Outbreaks have occurred and are common in summer camps and colleges, as well as within households among family members.

While M pneumoniae infections are uncommon in children younger than 5 years, they are a leading cause of pneumonia in school-aged children and young adults. Community-wide epidemics of this illness occur every 4 to 7 years.

Signs and Symptoms

M pneumoniae infections cause symptoms that are usually mild. They can get worse over time in some children. The most common symptoms are

  • Bronchitis
  • Upper respiratory tract infections, including sore throats and, at times, ear infections

Children with this infection may also have a high fever, long-lasting weakness, and in some cases, headaches and a rash. Their cough can change from a dry cough to a phlegmy one. On rare occasions, youngsters may develop croup and a sinus infection (sinusitis).

When to Call Your Pediatrician

If these symptoms, including a fever, last for more than a few days, contact your pediatrician.

How Is the Diagnosis Made?

Your pediatrician will give your child a physical examination. The doctor may order blood tests for antibodies to M pneumoniae or cold agglutinins, which are a special type of antibody. Special tests are being developed to identify the organism in throat and respiratory samples, but these are not generally available yet.


In most cases, the bronchitis and upper respiratory tract illnesses associated with M pneumoniae infections are mild and get better on their own without antibiotic treatment. However, antibiotics such as erythromycin, azithromycin, or doxycycline may be given for more serious symptoms associated with pneumonia and ear infections.

What Is the Prognosis?

This infection often causes wheezing in children with asthma or reactive airways. Most people fully recover from this infection, even when antibiotics are not used. The death rate is quite low.

Chest and lungs

Legionnaires Disease

Legionnaires disease, also called legionellosis, is caused by the bacteria Legionella pneumophila and related species. These organisms have been found in water delivery systems. The infection can be caught by inhaling mists from water contaminated with the germs. Outbreaks have been traced to contaminated whirlpool spas, humidifiers, and air conditioning cooling towers and have occurred in hospitals, hotels, and cruise ships. The incubation period for legionnaires disease is 2 to 10 days.

The disease and the organism that causes legionnaires disease were identified and got their names from the first known outbreak, at an American Legion convention held at a Philadelphia, PA, hotel in 1976.

A related disease called Pontiac fever is caused by the same Legionella species. It is a milder, less serious infection with an incubation period of 1 to 2 days.

Signs and Symptoms

The symptoms of legionnaires disease can range from mild to severe. A form of pneumonia is a key component of the disease and may have symptoms that include

  • Fever
  • Cough
  • Chills
  • Muscle aches
  • Progressive breathing difficulties

These symptoms can get worse for the first few days of the infection before the patient begins to get better. People at greatest risk of contracting legionnaires disease are the elderly and those with suppressed immune systems.

Children rarely get the infection and when they do, their illness is usually mild or they may have no symptoms at all. Pontiac fever causes flu-like symptoms such as muscle aches and a fever, but there are no signs of pneumonia.

When To Call Your Pediatrician

Call your pediatrician if your child develops breathing problems.

How Is the Diagnosis Made?

Your pediatrician can collect a sample of the secretions from your child’s respiratory tract and send it to the laboratory for analysis. Urine tests can also be performed to look for the bacteria, as well as antibody tests that can be conducted on blood samples.


Antibiotics such as azithromycin are used to treat legionnaires disease.

No treatment is needed for Pontiac fever, which goes away on its own in 2 to 5 days.

What Is the Prognosis?

The most serious cases of legionnaires disease lead to respiratory failure and death, especially in the elderly or people with weak immune systems. These deaths occur in 5% to 15% of cases.

Chest and lungs

Hantavirus Pulmonary Syndrome


Hantavirus pulmonary syndrome (HPS) was first identified in 1993 when an outbreak of this infectious lung disease took place in the southwestern United States. The viruses that cause HPS come from a group of organisms known as hantaviruses. These germs are carried by particular kinds of mice. People get the infection by direct contact with infected rodents or their droppings, urine, or saliva or breathing in air contaminated with the virus. On rare occasions, the infection is passed to humans by a mouse bite. There is no evidence that it can be spread from person to person. The incubation period (the time after contact with an infected mouse to the beginning of symptoms) may be 1 to 6 weeks, though that period has not been established definitively.

The majority of cases of HPS occur during the spring and summer, mostly in rural areas. Although it is a relatively uncommon infection, it can be deadly.

Signs and Symptoms

In the first 3 to 7 days of HPS, many of its symptoms resemble those of a severe cold, the flu, or a gastrointestinal disease.

  • Fever
  • Chills
  • Headaches
  • Nausea
  • Vomiting
  • Diarrhea
  • Dizziness
  • Fatigue
  • Muscle aches in the large muscle groups (ie, back, thighs, shoulders)

After the first few days, respiratory difficulties begin abruptly and can progress rapidly. People with the infection will develop a condition called adult respiratory distress syndrome (ARDS), in which the lungs lose their ability to move oxygen to the blood. Patients may develop a cough and shortness of the breath. Very quickly every organ of the body is affected.

When to Call Your Pediatrician

If your child has the symptoms of a severe cold or the flu and then develops shortness of breath or other respiratory problems, contact your doctor at once or take your youngster to the emergency department.

How Is the Diagnosis Made?

Blood tests can be done at specialized laboratories to identify the hantavirus.


No specific therapy is available to directly treat HPS. There are studies taking place on an antiviral medication called ribavirin. This drug may someday be an effective treatment for HPS.

Children with HPS need to be hospitalized in an intensive care unit. They may require oxygen therapy and get help breathing with a ventilator for about 2 to 4 days to combat ARDS.

What Is the Prognosis?

About 45% of patients with HPS die from the infection. However, early identification and supportive care in the hospital will help the majority of infected people recover from this dangerous syndrome.


Take steps to reduce the likelihood of rodents in your home and other areas where your child spends time. Seal all holes through which rodents may enter your home. Exterminate rodents in the area with spring-loaded traps and other measures. Wear rubber gloves when touching dead rodents, and disinfect the gloves after you use them.

Remove brush and grass away from your home’s foundation to prevent rodents from nesting. When entering an area where rodents may have lived, avoid stirring up or breathing potentially contaminated dust. Consider using a mask when cleaning areas contaminated with rodent droppings. Use tightfitting lids on garbage cans to prevent rodents from getting into the trash.

Chest and lungs

Croup and Your Young Child

​Croup is a common illness in young children. It can be scary for parents as well as children. Read on for more information about croup, including types, causes, symptoms, and treatments.

What is croup?

Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). The swelling causes the airway below the vocal cords to become narrow and makes breathing noisy and difficult. It is most commonly caused by an infection.

Children are most likely to get croup between 3 months and 5 years of age. As they get older, it is not as common because the windpipe is larger and swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common in the fall and winter months.

Types of croup

Viral croup

  • This is the most common type of croup. It is caused by a viral infection of the voice box and windpipe. It often starts out just like a cold, but then it slowly turns into a barky cough. Your child’s voice will become hoarse and their breathing will get noisier. They may make a coarse musical sound each time they breathe in, called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F (40°C).

Spasmodic croup

  • This type of croup is thought to be caused by an allergy or by reflux from the stomach. It can be scary because it comes on suddenly, often in the middle of the night. Your child may go to bed well and wake up in a few hours, gasping for breath. They will be hoarse and have stridor when they breathe in. They may also have a barky cough. Most children with spasmodic croup do not have a fever. This type of croup can recur. It is similar to asthma and often responds to allergy or reflux medicines.

Croup with stridor

  • Stridor is common with mild croup, especially when a child is crying or active. But if your child has stridor while resting, it can be a sign of more severe croup. As your child’s effort to breathe increases, they may stop eating and drinking. They may become too tired to cough, and you may hear the stridor more with each breath.
  • The danger of croup with stridor is that sometimes the airway may swell so much that your child may barely be able to breathe. In the most severe cases, your child will not be getting enough oxygen into their blood. If this happens, they need to go to the hospital. Luckily, these most severe cases of croup do not occur very often.

Home treatment for croup

If your child wakes up in the middle of the night with croup, try to keep them calm. Keeping them breathe better.

Ways to comfort your child may include:

  • Giving your child a hug or a back rub
  • Singing a favorite bedtime song
  • Offering reassuring words such as, “Mommy’s here, you will be OK”
  • Offering a favorite toy

If your child has a fever (a temperature of 100.4°F [38°C] or higher):

Treat it with acetaminophen or ibuprofen (for children older than 6 months), as needed. Make sure they are drinking fluids to avoid dehydration.

What about steam treatment or night air?

In the past, parents may have been advised to try steam treatment in the bathroom. Though some parents may find that this helps improve breathing, there are no studies to prove that inhaling steam in a bathroom is effective. There are also no studies to prove that breathing in moist, cool night airs helps improve breathing.

When to call the doctor

If you are concerned that your child’s croup is not improving, contact your child’s doctor, local emergency department, or emergency medical services (911) even if it is the middle of the night. Consider calling if your child:

  • Makes a whistling sound that gets louder with each breath
  • Cannot speak or make verbal sounds for lack of breath
  • Seems to be struggling to catch their breath
  • Has bluish lips or fingernails
  • Has stridor when resting
  • Drools or has extreme difficulty swallowing saliva

Treating croup with medicine

If your child has viral croup, your child’s doctor or the emergency department doctor may give them a breathing treatment with epinephrine (adrenaline) to decrease the swelling. After epinephrine is given, your child should be observed for 3 to 4 hours to confirm that croup symptoms do not return.

A steroid medicine may also be prescribed to reduce the swelling. Steroids can be inhaled, taken by mouth, or given by injection. Treatment with a few doses of steroids should do no harm. Steroids may decrease the intensity of symptoms, the need for other medications, and time spent in the hospital and emergency department. For spasmodic croup, your child’s doctor may recommend allergy or reflux medicines to help your child’s breathing.

Antibiotics, which treat bacteria, are not helpful for treating croup because they are almost always caused by a virus or by allergy or reflux. Cough syrups are not useful and may do harm.

Other infections

Another cause of stridor and serious breathing problems is acute supraglottitis (also called epiglottitis). This is a dangerous infection, usually caused by bacteria, with symptoms that can resemble croup. Luckily, this infection is much less common now because of the Haemophilus influenzae type b (Hib) vaccine. Rarely, supraglottitis is caused by other bacteria.

Acute supraglottitis usually affects children 2 to 5 years of age and comes on suddenly with a high fever. Your child may seem very sick. They may have a muffled voice and prefer to sit upright with their neck extended and face tilted upward in a “sniffing” position to make breathing easier. They also may drool because they cannot swallow the saliva in their mouth. If not treated, this disease could rapidly lead to complete blockage of your child’s airway.

If your child’s doctor suspects acute supraglottitis:

Your child must go to the hospital right away. If they have supraglottitis, they will need antibiotics, and may also need a tube in their windpipe to help them breathe. Call your child’s doctor right away if you think your child may have supraglottitis.

To protect against acute supraglottitis:

Your child should get the first dose of the Hib vaccine when he is 2 months of age. This vaccine will also protect against meningitis (a swelling in the covering of the brain). Since the Hib vaccine has been available, the number of cases of acute supraglottitis and meningitis has dramatically decreased.

Recurrent or persistent croup

When croup persists or recurs frequently, it may be a sign that your child has some narrowing of the airway that is not related to an infection. This may be a problem that was present when your child was born or one that developed later. If your child has persistent or recurrent croup, their doctor may refer you to a specialist such as an otolaryngologist (ear, nose, and throat specialist) or pulmonologist (breathing and lung disease specialist) for further evaluation.

Although most cases of croup are mild, this common childhood illness can become serious and prevent your child from breathing normally. Contact your child’s pediatrician if your child’s croup is not improving or if you have other concerns. The doctor will make sure your child is evaluated and treated properly.