Version July 2025
| Indication | Comment |
| Most children <3 to 6 months of age | Exception: a viral etiology or Chlamydia trachomatis is suspected and the child is relatively asymptomatic without hypoxia |
| Inability to care for at home | Any child whose caregiver(s) cannot provide appropriate care or follow the management instructions |
| Hypoxia | SpO2 <90% on room air |
| Dehydration | Inability to maintain oral hydration or inability to feed an infant |
| Moderate to severe respiratory distress | Examples: RR >70 breaths per minute for infants <12 months of age, RR >50 breaths per minute for children ≥12 months of age, retractions, nasal flaring, difficulty breathing, apnea, grunting |
| Toxic appearance | Toxic appearance is more common in bacterial pneumonia and may suggest more severe illness |
| Underlying conditions that predispose to a more severe course | Examples: cardiopulmonary disease, genetic syndromes, neurocognitive disorders |
| Underlying conditions that may be exacerbated by pneumonia | Example: metabolic disorder |
| Underlying conditions that may adversely affect response to treatment | Example: immunocompromised host |
| Complications of pneumonia present | Examples: effusion/empyema, necrotizing process, lung abscess |
| Suspicion or confirmation of a pathogen that has increased virulence | Examples: Staphylococcus aureus, group A Streptococcus |
| Failure of outpatient therapy | Continued lack of response within 48 to 72 hours of antibiotic change |
