The diagnosis of pneumonia in children is established based on a medical history, physical examination, and supporting tests.

In the medical history, complaints experienced by the patient can be identified, including: fever, cough, restlessness, irritability, and shortness of breath. In infants, symptoms are often nonspecific, often without fever and cough. Older children may sometimes complain of headaches, abdominal pain, and vomiting. During the physical examination, a number of pathological physical signs can be found, especially rapid breathing (tachypnea) and difficulty breathing (dyspnea). Fever can reach a temperature of over 38.5°C, sometimes accompanied by chills. Pulmonary symptoms appear a few days after the infection process is not well-compensated.

Laboratory tests performed in children with pneumonia include Complete Blood Count (CBC), Arterial Blood Gas (ABG) analysis, CRP, serological tests, PCR, and Microbiological examination.

In a Complete Blood Count examination, leukocytosis may be found, with white blood cell counts generally around 15,000 - 30,000/mm3, predominantly polymorphonuclear (PMN) cells. The number of white blood cells and the differential count can help determine the choice of antibiotics. In some cases, anemia and an elevated erythrocyte sedimentation rate (ESR) may be observed.

Children with severe respiratory distress, hypercapnia should be evaluated with ABG examination, as oxygen levels must be maintained. An increased CRP level indicates inflammation in the body.

Microbiological examinations that can be performed include mycoplasma culture. Culture examination is recommended for severe pneumonia symptoms and complications, pneumonia that is unresponsive to therapy, in children under 6 years of age, and in individuals who have not been vaccinated. Bacteria can be found in at least 10 - 30% of blood cultures in febrile children.

A chest X-ray is performed to assess the extent of pathological changes in lung tissue. The presence of infiltrates in the lobar, interstitial, unilateral, or bilateral areas provides clues to the affected part of the lung. Generally, alveolar infiltrates strongly indicate pneumonia in children.

Clinical and laboratory manifestations, along with a positive chest X-ray result, are the gold standard for diagnosing pneumonia.

References:

1. Mani, CS,. & Muray, DL. (2018). Acute Pneumonia and Its Complications. 238-249.
2. Jannah, M., Abdullah, A. & Melania, H. Analysis of Risk Factors Associated with Pneumonia Incidence in Toddlers in the Work Area of UPTD Puskesmas Banda Aceh. JUKEMA 2019; 69-73.
3. Opovsky, EY,. & Florin, TA. Community-Acquired Pneumonia In Childhood. 2020.
4. Howie S, Murdoch D, Global Childhood Pneumonia. 2019.
5. World Health Organization. Pneumonia. 2019. Available from: https://www.who.int/news-room/fact-sheet/detail/pneumonia.