Severity of community-acquired pneumonia in infants and children

Clinical features of mild pneumonia	Clinical features of severe pneumonia
Mild or absent respiratory distress: Increased RR, but less than the age-specific RR that defines moderate to severe respiratory distress Mild or absent retractions No grunting No nasal flaring No apnea Mild shortness of breath	Moderate to severe respiratory distress: RR >70 breaths/minute for infants; RR >50 breaths/minute for older children Moderate/severe suprasternal, intercostal, or subcostal retractions (<12 months) Severe difficulty breathing (≥12 months) Grunting Nasal flaring Apnea Significant shortness of breath
Normal color	Cyanosis
Normal mental status	Altered mental status
Normoxic (oxygen saturation ≥92% in room air)	Hypoxic (sustained oxygen saturation <90% in room air at sea level)
Normal feeding (infants); no vomiting	Not feeding (infants) or signs of dehydration (older children)
Normal heart rate	Tachycardia
Capillary refill <2 seconds	Capillary refill ≥2 seconds

RR: respiratory rate.

References:

Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25.
Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: Update 2011. Thorax 2011; 66:ii1.

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