What is the treatment for a 12-month-old child with mild pneumonitis?

Treatment of Mild Pneumonitis in a 12-Month-Old

For a 12-month-old with mild pneumonitis, antimicrobial therapy is not routinely required because viral pathogens are responsible for the great majority of clinical disease in this age group, and supportive care alone is the appropriate management. 1, 2

Initial Assessment and Decision for Outpatient Management

Confirm the child meets criteria for outpatient management by ensuring they do NOT have any of the following indicators for hospitalization: 1, 2

• Oxygen saturation <92%
• Respiratory rate >70 breaths/min (for infants)
• Difficulty breathing, grunting, or intermittent apnea
• Not feeding
• Family unable to provide appropriate observation

If all these criteria are absent and the child appears mildly ill, outpatient management is safe and appropriate. 1

Supportive Care (Primary Treatment)

The mainstay of treatment for mild pneumonitis in this age group is supportive care: 2, 3

• Maintain adequate hydration through oral fluids 2
• Use antipyretics (acetaminophen or ibuprofen) to control fever and keep the child comfortable 1, 2
• Ensure adequate rest 2
• Nasal suctioning if significant nasal congestion is present 3
• Do NOT use chest physiotherapy as it is not beneficial 1, 2

When to Consider Antibiotics

Antibiotics should only be prescribed if there is strong clinical suspicion of bacterial pneumonia, which is less common in this age group. 1, 2, 3 If bacterial pneumonia is suspected based on clinical features (high fever, focal consolidation, elevated inflammatory markers), then:

• Amoxicillin 90 mg/kg/day divided in 2 doses is the first-line antibiotic 1, 2, 4
• This provides appropriate coverage for Streptococcus pneumoniae, the most prominent invasive bacterial pathogen 1, 4
• Treatment duration should be 5 days in areas with low HIV prevalence 2

However, young children presenting with mild symptoms of lower respiratory tract infection need not be treated with antibiotics. 1, 4

Parental Education and Follow-Up

Provide clear instructions to parents: 1, 2

• Educate on managing fever and preventing dehydration
• Teach recognition of signs of deterioration (increased work of breathing, poor feeding, lethargy)
• Schedule re-evaluation if the child is deteriorating or not improving after 48 hours 1, 2, 4

Common Pitfalls to Avoid

• Do not prescribe antibiotics reflexively – most cases in preschool-aged children are viral and antibiotics provide no benefit while contributing to antimicrobial resistance 1, 2, 3
• Do not use over-the-counter cough and cold medications in children under 4-5 years due to lack of efficacy and potential for serious harm 5
• Do not give honey to infants under 12 months due to risk of infant botulism 5
• Do not fail to reassess – children who remain febrile or unwell after 48 hours require re-evaluation for possible complications or alternative diagnoses 2

When to Escalate Care

Hospitalization and intravenous antibiotics become necessary if: 1, 2

• Oxygen saturation drops to ≤92%
• Respiratory rate exceeds 70 breaths/min
• Signs of respiratory distress develop (grunting, retractions)
• Child stops feeding or shows signs of dehydration
• Clinical deterioration occurs despite appropriate outpatient management