Mycoplasma pneumonia in kids
We are seeing a LOT of mycoplasma pneumonia nationwide right now.
If your child has been coughing for weeks, this is an article worth reading.
Most parents hear pneumonia and panic. After all, pneumonia sounds serious. And it should be taken seriously, but keep in mind also that bacterial pneumonia is treatable with antibiotics and most healthy children recover without complications. If you want to know more about pneumonia in general, check out my previous article.
It may also be helpful to check out my article on managing coughs in kids.
TL;DR
Mycoplasma pneumonia is a common cause of pneumonia in kids over 5 years. We’re seeing a lot right now.
It causes an ongoing prolonged cough, sometimes fever, and fatigue along with other symptoms. It can be challenging to diagnose (often diagnosed clinically, rather than with testing) but once diagnosed, it is treatable with an antibiotic like a Z-pack (Azithromycin).
What is it?
Mycoplasma is a bacteria that causes pneumonia, most commonly in kids over 5 years. We are seeing so much right now that we’re seeing it in other age groups too. It can cause other non-lung symptoms and illnesses as well but for today we are focusing on pneumonia.
The Pediatrician Mom Tip: Mycoplasma pneumonia is sometimes called “atypical” or “walking” pneumonia, or even “white lung” pneumonia.
Symptoms:
The most common story for Mycoplasma is: “My child has been coughing for weeks and they seem really tired.” They may or may not have fever. Often, the child has been seen by their healthcare provider already and diagnosed with a viral illness, but is simply not getting better.
Early stages (first 1-2 weeks)
Dry Cough (almost everyone)
Fever (80-90%)
Low energy, fatigue (80%)
Sore throat (10-50%)
Shortness of breath (60-70%)
Sometimes: weird rash, ear pain, abdominal pain, vomiting, diarrhea
RARE: brain and heart symptoms
Later stages (2-6 weeks)
Cough can linger for weeks even with treatment
The Pediatrician Mom Tip: If your child has been seen by their pediatrician and diagnosed with a viral cough, this really should be improved in most cases within 10 days. If it is on-going, they may need another visit.
How does it spread? How quickly do you see symptoms?
Transmission occurs via:
respiratory droplets (eg via coughing, sneezing)
usually requires prolonged close contact, eg household member
Does not survive for long periods without a “host” (so not likely to be transmitted on surfaces, for example)
Incubation period can be quite long, unfortunately. After exposure, symptoms can take up to 3-4 weeks to develop.
How is it diagnosed?
Diagnosis is often made clinically, based on symptoms and a physical exam. What makes it tough is that symptoms overlap closely with many other viral respiratory germs.
Sometimes we order PCR testing from nasal or throat swabs. Most other tests (eg antigen, antibody) aren’t as useful because they can take awhile for results to be helpful.
Chest X-ray can be helpful as well, but changes on X-ray images can be subtle — and sometimes there are no obvious abnormalities.
The Pediatrician Mom Tip: Diagnosing mycoplasma can be difficult and does take some clinical judgment and experience. This is why I recommend trusting your gut and getting a second evaluation if you need to.
Treatment:
Most children will have mild infection that will go away without intervention. However, the cough can be annoying and disruptive: it tends to interfere with good sleep, with school and activities, and with comfort.
Mycoplasma pneumonia can be treated with specific antibiotics, but these are not the same antibiotics that are used for other types of pneumonia. This is because the structure of the bacteria is a little unique.
We treat with Azithromycin in children, although there other antibiotics may be used in specific circumstances.
How quickly do they improve?
In most cases, a child will feel better within 48-72h after starting the right antibiotic. However, the cough can continue to linger for a few weeks even with treatment.
In the meantime, focus on hydration, fever management, rest and TLC.
Check out my cough management article for more.
Complications:
Although we typically see mild illness, this is not always the case - even in otherwise health kids.
This year alone, I’ve seen several otherwise healthy children require hospitalization for oxygen and respiratory support.
Prevention
We do not know how long mycoplasma is contagious. We know that it can linger in the throat and nose for long periods but most experts think that it is less likely to be contagious about 2 wks after start of symptoms.
The best way to prevent mycoplasma is to use common sense infection control measures: The best way to prevent transmission is to focus on the same things we always focus on.
Frequent handwashing for 20 seconds using soap and water
Face masks - these can work to minimize transmission
Distancing from others who are sick (I know… easier said than done)
When to call the pediatrician
This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!
If your child is not improving within a few days, or if they seem to be getting worse, call your pediatrician. Other concerning symptoms include:
Breathing difficulty (see my video on instagram with more details).
Rapid breathing (see the free download in the guides section that covers how to count respiratory rate as well as what is normal at different ages).
Retractions: when the skin pulls in between the ribs or at the base of the throat with each breath
Pauses/irregular breathing
Nasal flaring
Grunting with each breath
Wheezing
Feeding difficulty or dehydration
Change in color (blue OR pale)
Excessive fatigue
Poor feeding
Dehydration - here are some signs to look for.
Fever persistent beyond 3-5 days
Lack of improvement 24-48h after starting antibiotics
Anything else tickling your spidey sense!!
FAQs
Can you get it more than once?
Yes.
Is there anything I should avoid?
Stay tuned for a post on this, but in general we do not recommend nasal decongestants, cough suppressants, or essential oils in children because of potential side effects. In particular, certain essential oils can release VOCs and cause bronchospasm (spasming of the airways) which can worsen respiratory symptoms. Some of the biggest culprits here are lavender, eucalyptus and tea tree oil.
Does my child need to stay home from school?
Yes. Keep them home until they have been on antibiotics for at least 24 hours, are feeling better (able to stay hydrated, acting more like themselves) and fever free without medications for >24 hours. Talk to your pediatrician for more guidance.
