Walking pneumonia in kids is on the rise

This cold and flu season, another villain has returned: walking pneumonia.

Diagnoses of this bacterial infection – caused by Mycoplasma pneumoniae – have increased in the United States since late spring and have remained high, according to the U.S. Centers for Disease Control. Mycoplasma infections are often mild and affect the upper respiratory system. But about 5 to 10 percent of them turn into pneumonia, an infection of the lower respiratory tract, according to the National Institutes of Health. Walking pneumonia is most common in school-age children, although this year, there has been an uptick in cases among preschoolers.

Mycoplasma is one of the infections making a comeback after the isolation caused by the COVID-19 pandemic, said Geoffrey Schreiner, MD, MPH, a Boston Children’s Hospital pediatric hospitalist who works at Cape Cod Hospital. Pneumonia refers to any infection of the lower respiratory tract, including the bronchi, as opposed to the common cold, for example, which targets upper areas like the nose and sinuses. In most cases, however, walking pneumonia is not a serious risk, he said.

“It often is more of a mild infection and people are able to still walk and do things, and yet they have pneumonia,” he said. “It's a very common bacteria that's out there. And most kids, when they have it, they recover without needing treatment.”

In fact, some studies say up to 20 percent of children that get walking pneumonia are asymptomatic carriers, he said. But, it can be a risk for those with breathing issues or asthma, and can morph into complications such as encephalitis, according to the CDC. Any child suspected of having pneumonia should be evaluated by a physician, Dr. Schreiner said.

Symptoms and Treatment

Pneumonia symptoms include prolonged cough, fever, shallow breathing, and extreme fatigue. In younger children, symptoms can include diarrhea, vomiting and skin issues, Dr. Schreiner said. The ribs may be “retracting” as a child pulls in their ribs, struggling to breathe. They may not be eating or drinking enough fluids, risking dehydration, he said. If your child has a persistent cough, a fever that lasts a few days and looks to be having trouble breathing, that’s the time to call the pediatrician or head to urgent care or the emergency department, he said.

Doctors may test for the cause of the infection, check the child’s oxygen level and see if they are dehydrated. While waiting on test results – which can take a few days – doctors may start a course of antibiotics, such as amoxicillin, that can knock out some classic pneumonia bacteria. If the child does not improve within 24 to 48 hours, doctors may switch to a different antibiotic, such as azithromycin, which is better at fighting mycoplasma infections, he said. But not all children with walking pneumonia will even require treatment, he said.

“We have to be careful and use our antibiotics judiciously, because there certainly can be side effects from the antibiotics," he said.

Walking pneumonia spreads via respiratory droplets produced when an infected person coughs or sneezes. The incubation period is one to four weeks, Dr. Schreiner said. “If you do have it in your system, you’re going to be contagious at some point,” he said.

It can be tough to discriminate between walking pneumonia and other respiratory infections, such as RSV (respiratory syncytial virus), which can also produce a lingering cough, he said. “But it’s in those cases where they have that persistent cough, develop that fever for a few days, and start breathing faster or look like they are in distress that you really should have them seen,” he said.