Pneumonia- how long to expect this

[febbabies2023]

Little girl is 20 months old

Backstory for health

• perfectly fine as a baby
• hospitalised in June for 4 days for sepsis and tonsillitis
• ambulance trip 3 weeks ago and treated for viral wheeze with nebuliser, inhaler, steroids
• 2 weeks ago came down with chicken pox. All scabbed over by this Wednesday

2 days after scabbing, got an awful cough again. Fine, children do and she attends nursery 5 days a week. 3am this morning I go in and she's breathing rapidly and has a clear temp. Sucking in at ribs and neck. Call 111 who sends ambulance for breathing. Taken to hospital

Oxygen was at 97% on arrival
Temp was at 38.9
Breathing at 180bpm

Treated with nebuliser, inhalers, steroids. Given a chest xray and blood gas. Advised that it was likely early pneumonia following from the chicken pox. Wheeze seemed okay but crackling on right side of lungs.

Sent home with dextramethosone one dose for tonight. Back on the wheeze plan with inhaler, and antibiotics as well. When we left, oxygen was at 93%

Little one is EXHAUSTED. No wonder. She's just been sick because shes still coughing so much. About 20 mins after first lot of antibiotics and neurofen as temp was creeping up again.

What should I expect from here? When should I then be worried again? She still has some retraction, still coughing constantly. I'm not sure what else I can do to help her. I'm so worried to even sleep in case her breathing gets worse again.

But after 2 nights of bare minimum sleep I will have to sleep at some point. Any advice or tips for this?

Cough can unfortunately stick around for weeks and weeks if you're unlucky (though most do clear a bit sooner than that). If still significant high temperatures and breathing difficulties 48-72h after starting treatment, sensible to get them checked again, either at GP or back to your hospital based paediatrics depending on how it's organised locally to you and what advice was given. Getting better from illness is exhausting especially for children, so if just knackered but not too much else likely just need to wait it out.

Was she definitely at 93% sats? DS and DH were both kept in until sats were consistently over 97 and kept on high flow, then normal flow, then ambient as a reduction plan.

What did the hospital advise? usually safety netting is provided eg signs to look out for, worsening symptoms, when to go back. Can you monitor o2 at home?

92 and above is what is classed as acceptable without o2 in the hospitals i’ve worked in ( for children btw ) I’ve never known children to be kept in till 97 tbh. We would have children hospitalised for days waiting for that!

Oxygen levels are often lower at night so sometimes they drop in deep sleep and children are kept in for that reason.

Thank you all - helpful and reassuring

@Unseenentity hospital just said to monitor really and if she doesn't improve then to take her back or to gp. I guess my issue is how much worse will she get without it being a real problem given that she's already being sick / a temp / breathing still not where it is for normal

@ShowOfHands yes definitely 93%. They did her observations just before we left and still there but heart rate had come down to 153 when it was 180

@Musiclover234 thank you, good to know. No I can't monitor at home unfortunately. I'd like to think that given how her health seems to have been recently that I've become fairly good at gauging when she's struggling / her oxygen may have dipped lower than it was I guess by looking out for the chest and neck retractions, and flaring of her nostrils etc

I guess I'll just see how the next couple of days go and hope she starts to feel better soon. Poor girl can't catch a break at the moment 😭

Her respiration rate is really important. Kids are great at compensating for low oxygen saturation, right up until they aren't. So if she's having to work really hard and breathe really fast then that's much more concerning than her maintaining her oxygen levels with less effort. I'd check how fast she's breathing every couple of hours at least and take her back if her resp rate increases and she's sucking in.

Gosh. She sounds really poorly, poor thing. When my son has been really bad I have slept in the room with him and set an alarm for every 2 hours to monitor breathing and temp. Phone 111 if any concerns.
I didn't have a pulse oximeter when DS was little and don't know if they work on toddlers but might be worth checking out if they're suitable and if so getting one delivered on prime tomorrow. I found one invaluable when DS had covid and was really poorly with it.
Might be worth speaking to nursery to see if there's any more they can do to reduce spread of infections there. Better ventilation/HEPA filters? Asking any adults in the building who have respiratory symptoms to wear a mask? Etc.
Really hope she feels better soon

With a few goes I can get a decent reading on our pulse oximeter on my 16 month old, so I'd recommend the same. It's been invaluable for my three year old.

I haven't read the full thread but when my oldest dd was around 15 months she had pneumonia. Was very sick but initially sent home from a&e to recover. Within a couple of days we were back in as like you I felt concerned that she was still recessing with breaths and very weak. The second time they kept her in several nights; she had in fact been getting worse and was more seriously ill. Please go back if you are worried.