Walking Pneumonia in Kids
Walking pneumonia, also called atypical pneumonia, is a milder form of lung infection that often allows children to go about their daily activities, even while having symptoms like a lingering cough or mild fever. According to the Centers for Disease Control and Prevention (CDC), cases of walking pneumonia caused by Mycoplasma pneumoniae have been rising across the United States since the spring of 2024, especially among young children.
“Walking pneumonia is less severe than typical pneumonia, but it still requires attention and treatment to ensure a full recovery,” says Vandana Madhavan, MD, MPH, a Mass General Brigham pediatric infectious disease specialist. “It’s important to know what to watch for and how to manage it effectively.”
Dr. Madhavan is the clinical director of pediatric infectious disease and a primary care pediatrician at Mass General for Children.
What causes walking pneumonia in kids?
Walking pneumonia is caused by atypical bacteria, with Mycoplasma pneumoniae being the most common in children. This bacterium spreads easily through droplets in the air, especially in crowded spaces like schools and daycare centers.
“Unlike severe bacterial pneumonia, which can cause dehydration or require hospitalization, walking pneumonia tends to be milder and often allows kids to continue their normal activities,” Madhavan explains.
While walking pneumonia can happen at any time of the year, clusters of cases often occur when one person spreads the bacteria to others nearby. Some children may only have mild cold-like symptoms, while others develop more serious respiratory problems.
Walking pneumonia symptoms in kids
Walking pneumonia can look a lot like a common cold or flu, making it harder to recognize. Below are common symptoms and warning signs to watch for. Some may require immediate medical attention.
Common signs of walking pneumonia
Cough that lingers longer than a typical cold
Mild fever (though it can be higher in some cases)
Runny or stuffy nose
Sore throat, headaches, and muscle aches
Rashes that may appear during or after the illness
Signs of walking pneumonia that need immediate medical care
Flared nostrils, grunting, or pulling in the skin around the ribs (retractions) that are signs of increased work of breathing
Trouble finishing sentences without coughing
Needing to sleep propped up to breathe comfortably
Blue lips or difficulty breathing
Fewer wet diapers or decreased urine output as a sign of dehydration
If you notice any of these symptoms in your child, seek medical care right away.
How to test for walking pneumonia
Doctors usually diagnose walking pneumonia by listening to a child’s lungs and asking about their symptoms. “In most outpatient cases, we don’t need special tests to diagnose walking pneumonia,” explains Dr. Madhavan. “If the symptoms and physical exam match, we often start treatment right away rather than waiting for a test.”
If a child is sicker or requires hospital care, doctors may use tests like:
Respiratory panels to detect viruses and bacteria, including Mycoplasma pneumoniae
Blood tests to check for antibodies
Chest x-rays to see lung inflammation
While these tests can help confirm the diagnosis, they are typically reserved for more severe cases.
How to treat walking pneumonia in kids
Treating walking pneumonia involves antibiotics that target atypical bacteria. Antibiotics that parents might be more familiar with like amoxicillin don’t work for these infections. Instead, doctors will prescribe:
Azithromycin (Zithromax): A common first-choice antibiotic
Doxycycline: Used when azithromycin isn’t effective
Levofloxacin: Sometimes given to older kids with more severe symptoms
“Parents may worry when they hear their child needs a different type of antibiotic, but these medications are effective and safe when used as prescribed,” says Dr. Madhavan. “It’s important to talk with your child’s doctor about how to give the medicine, possible side effects, and what to expect during treatment.”
How long does walking pneumonia last?
Recovery times for walking pneumonia can vary. Some children feel better in just a few days, while others may take weeks to recover fully. Even after the worst symptoms go away, a lingering cough can last for a while.
To ease a cough, Dr. Madhavan recommends honey for children over 12 months old. “Honey has been shown to be more effective than many over-the-counter cough medicines,” she says. You can give it directly or mix it with warm water or tea. However, parents shouldn’t give honey to babies younger than 12 months because it can cause a severe form of food poisoning called botulism. If your baby has a severe cough, consult their pediatrician for safe alternatives such as using a humidifier in the bedroom.
If symptoms don’t improve after a few days or seem to get worse, it’s important to check in with your child’s primary care provider (PCP).
Tips for preventing walking pneumonia in kids
While there’s no vaccine for walking pneumonia, Dr. Madhavan suggests these tips to help prevent illness:
Encourage good hygiene. Teach kids to wash their hands often and cover their mouths when coughing or sneezing.
Stay current on vaccines. Make sure kids are up to date on flu shots and COVID-19 vaccines, which can reduce the risk of having other respiratory illnesses.
Avoid crowded places during outbreaks. If you know walking pneumonia is spreading, consider limiting exposure to crowded indoor spaces, especially if there are people in your household who are at higher risk of severe lung or breathing complications.
Promote overall health. A healthy diet, regular sleep, and staying hydrated can help boost your child’s immune system.
Walking pneumonia is a common, but treatable illness in children. While it’s usually mild, recognizing symptoms early and seeking the right treatment can help your child recover quickly. If you’re unsure about your child’s symptoms, reach out to their PCP for guidance.
