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If your child has been battling a flu-like illness, you may be concerned if it suddenly gets worse when you thought it was getting better. Pneumonia, which is a serious infection of the lungs, often begins after an upper respiratory infection such as a cold or the flu 12. The symptoms are similar, so it’s often hard to tell them apart, but there are some things to watch for that signal that the flu has turned into pneumonia 12. Call your doctor immediately if you see these symptoms.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Fever and Chills

Both the flu and pneumonia can come with high fever or chills, and it usually happens suddenly in both cases 12. However, with pneumonia, chills are more severe, with chattering teeth, and fever is slightly higher: up to 105 degrees Fahrenheit, as opposed to the 102 to 104 temperature that’s typical for the flu 12. Fever with the flu should last only three or four days, but with pneumonia, the fever lingers 12. If your child has had the flu, then starts feeling better for a day or two before being hit with another wave of fever, that might be pneumonia 12.**

Rapid or Labored Breathing

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If she has pneumonia, your child will probably have trouble breathing, or feel like she can’t get enough air, and it will happen suddenly 12. Often this is the only symptom of pneumonia that you’ll notice, so it’s the most important in determining whether your child might have it 12. Signs can include grunting or wheezing sounds while she’s breathing, an unusually rapid pace of breathing or labored breathing. With the latter, you may even notice her rib muscles retract, drawing inward with every breath. A rapid pulse is also common with pneumonia 12.**

Cough

Your child may have been coughing a lot with the flu, but with pneumonia it’s almost guaranteed 12. The cough will be severe, dry and hacking, and often accompanied by chest pain or tightness.** These symptoms usually become worse after the first 12 to 36 hours.

Chest or Abdominal Pain

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The flu often brings severe aches and pains in the head or body, but pneumonia’s pain is usually concentrated in a couple of areas 12.** Your child may feel a sharp stabbing pain or tightness in his chest, or if the infection is lower in the lungs, it may cause abdominal pain.

Vomiting or Appetite Loss

Children sometimes vomit or have diarrhea when they get the flu. With pneumonia, however, vomiting is highly likely, as is a loss of appetite 1. Older kids will be extremely picky about their food or refuse to eat, and infants will suddenly start feeding poorly. It’s not a good idea to force your child to eat, but do encourage him to drink plenty of fluids, especially if he has a fever.**

  • Children sometimes vomit or have diarrhea when they get the flu.
  • Older kids will be extremely picky about their food or refuse to eat, and infants will suddenly start feeding poorly.

Decreased Activity

While the flu likely made your child feel extremely weak or fatigued, pneumonia affects her energy only slightly or moderately 12.** Expect less than her usual level of activity, but it may be increased somewhat from what she was able to do when she had the flu.

Bluish or Gray Lips and Nails

If your child gets a serious case of pneumonia, his lips or fingernails might turn bluish or gray because of a lack of oxygen in the lungs 12.**

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