Assessment of severity and clinical features of CAP in children 2 months or older

Typical clinical features of community-acquired pneumonia (CAP) in children 2 months or older include cough, tachypnoea, tachycardia and increased work of breathing. Fever is usually, but not always, present.

Clinical features help to determine severity of CAP in children:

• Low-severity CAP – minimal tachypnoea, absence of tachycardia and oxygen saturation 95% or higher on room air.
• Moderate-severity CAP – increased work of breathing, tachypnoea, tachycardia and oxygen saturation 95% or lower on room air. These children require close clinical review so are usually managed in hospital.
• High-severity CAP – severe increase in work of breathing, grunting or nasal flaring, marked tachypnoea and tachycardia, and oxygen saturation 90% or lower on room air. These children have the highest risk of mortality and are usually managed in an intensive care unit because they are more likely to require intensive respiratory or vasopressor support. This includes children with sepsis or septic shock – see Definition of sepsis and septic shock in neonates and children.