Pneumonia—Child Care and Schools

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What is pneumonia?

An inflammation of the lungs primarily caused by a viral or, less commonly, bacterial infection. Infection of the lungs often is secondary to an infection that starts in the nose and throat area (ie, the upper portion of the respiratory tract) and then spreads to the lungs (ie, the lower portion of the respiratory tract).

What are the signs or symptoms?

  • Cough

  • Fast, difficult breathing

  • Fever

  • Muscle aches

  • Loss of appetite

  • Lethargy

What are the incubation and contagious periods?

  • Incubation period: Pneumonia is a condition caused by a variety of types of germs; therefore, incubation periods will vary depending on the germ causing the pneumonia.

  • Contagious period: Depends on the germ causing the pneumonia.

How is it spread?

Pneumonia does not spread. The germ that causes pneumonia can spread if the person is still infectious at the time the pneumonia develops. Most of the germs that cause pneumonia spread by direct or close contact with mouth and nose secretions and touching contaminated objects.

How do you control it?

  • Good hand-hygiene techniques and reducing crowding by ensuring space and ventilation meet the requirements in national standards.

  • Prevent contact with respiratory secretions. Teach children and teachers/caregivers to cover their noses and mouths when sneezing or coughing with a disposable facial tissue, if possible, or with an upper sleeve or elbow if no facial tissue is available in time. Teach everyone to remove any mucus or debris on skin or other surfaces and perform hand hygiene right after using facial tissues or having contact with mucus to prevent the spread of disease by contaminated hands. Change or cover clothing that has mucus on it.

  • Dispose of facial tissues that contain nasal secretions after each use.

  • Sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8.

What are the roles of the teacher/caregiver and the family?

  • Immunizations against Haemophilus influenzae type b, Streptococcus pneumoniae (pneumococcus), and pertussis prevent some of the bacterial infections that cause pneumonia. Influenza vaccine may prevent pneumonia that sometimes occurs as a complication of influenza infection.

  • Ensure all immunizations are up-to-date, including annual influenza immunization for all people older than 6 months. See the most recent immunization schedule at www.cdc.gov/vaccines.

Exclude from group setting?

No, unless

  • The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

  • The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4).

Readmit to group setting?

Yes, when all the following criteria have been met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group


  • Most forms of pneumonia are most common during the fall, winter, and early spring, when children spend more time indoors in close contact with others.

  • Although most pneumonias are caused by viruses, health professionals can't tell the difference between viral and bacterial pneumonia at the time of diagnosis. Therefore, all children with pneumonia are treated with antibiotics even though antibiotics are not effective against viruses.

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.