Walking pneumonia in children

According to the Centers for Disease Control and Prevention (CDC), the number of walking pneumonia cases among children of all ages has been significantly rising since the start of the 2024-25 school year.

"Many kids spent years not being exposed to illnesses during the pandemic, and now they're being exposed again. The increase in walking pneumonia cases is part of what experts are calling an 'immune debt,' a situation where children's immune systems are less prepared to fight off infections because they weren't exposed to as many illnesses earlier on," says Preeti Sharma, M.D., Pediatric Pulmonologist at Children's Health℠ and Associate Professor of Pediatrics at UT Southwestern.

Dr. Sharma helps parents and caregivers understand how to prevent the spread of walking pneumonia, recognize its symptoms and know when it's time to take a child to the doctor.

What is walking pneumonia?

Walking pneumonia is a common form of pneumonia caused by the bacteria mycoplasma pneumoniae. The bacteria cause a respiratory illness that affects the throat, windpipe and lungs.

Walking pneumonia got its name because its symptoms are usually milder than other types of pneumonia. But there are some cases of walking pneumonia that require medical attention and treatment.

What are the symptoms of walking pneumonia?

Walking pneumonia can start just like the common cold or flu. But with walking pneumonia, a child's symptoms generally don't always go away or get better after about a week.

"For many kids, walking pneumonia makes them feel kind of yucky for a while, like they have a bad cold," says Dr. Sharma. "But, unlike a cold, they may continue to have a deep cough that just doesn't seem to be getting better."

Symptoms of walking pneumonia in children can include:

• Frequent, lingering cough
• Runny or stuffy nose
• Sneezing
• Fever
• Headache or sinus pressure
• Fatigue
• Sore throat

Additional symptoms that are usually more common in young kids include:

• A rash around the mouth that looks like small bumps
• A rash around the eyes (which can look like pink eye)

Learn more about causes of cough in children.

"I tell parents to keep track of a child's symptoms, especially if a cough is lingering or your child is having trouble eating or drinking," says Dr. Sharma. "If they aren't getting better after 5 to 7 days, or are getting worse, it's a good idea to see a doctor."

Dr. Sharma also warns parents of children who have asthma that walking pneumonia is likely to make a child's asthma worse and cause them to use their inhaler more often.

How is walking pneumonia diagnosed?

Walking pneumonia is usually diagnosed by a doctor who performs an exam to assess a child's symptoms, check their breathing and listen for a crackling or rattling sound in their lungs. A blood test or nasal swab may be done to confirm the presence of mycoplasma. If needed, a doctor may perform a chest x-ray.

Is walking pneumonia contagious?

Yes, walking pneumonia is a contagious illness. It spreads by breathing in droplets from someone who has walking pneumonia – after that person coughs or sneezes. It's common for children to get walking pneumonia at a daycare or school, where they spend a lot of time in close contact with other children.

Any child can get walking pneumonia. But, like other respiratory illnesses, children who have a weakened immune system or underlying lung problems may be more likely to get it and have more severe symptoms.

How can you prevent the spread of walking pneumonia?

You can help prevent the spread of walking pneumonia if you:

• Make sure your child frequently washes their hands. Modeling and practicing proper hand washing is the number one way to prevent the spread of all kinds of germs.
• Teach your child to cover their mouth when they cough or sneeze. Show them how to cough or sneeze into their sleeve or elbow.
• Use masks. If your child has a lingering cough, consider having them wear a mask at school. Masks can also help protect others in close contact with an infected child – at home or school.

Learn more about how to prevent common illnesses kids get at school.

Treating walking pneumonia in kids

Not every child will need antibiotics for walking pneumonia. Some children feel better with home remedies, including:

• Drinking lots of fluids
• Medication, such as acetaminophen, to reduce fever
• Rest

After about a week, many kids will start to feel better, although it may take up to 6 weeks for their cough to go away.

"And if a child is not showing signs of improvement after 5 to 7 days, we have antibiotics for walking pneumonia that work quickly," Dr. Sharma says

When to see a doctor if you think a child may have walking pneumonia

Dr. Sharma encourages parents to take their child to see a doctor if their child has:

• A deep cough that hasn't improved (or has gotten worse) after 5 to 7 days
• A fever for more than 5 days
• Trouble eating or drinking due to severe cough
• Trouble breathing (wheezing) or chest pain
• Much less energy than usual

When can a child with walking pneumonia return to school?

Dr. Sharma tells parents and caregivers that a child with walking pneumonia can return to school when they:

• Have been fever-free for more than 24 hours (without any medications that lower fever)
• Have enough energy to be at school

It can be a challenge to know when to send a kid with walking pneumonia back to school. And that's because they may no longer have a fever but they're still coughing a lot, which is how the bacteria can spread.

Find care for your child

Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality care with evidence-based practice to meet your child's medical needs. Learn more and find a pediatrician.

You can also videoconference with a health care provider 24 hours a day, 7 days a week with Virtual Visit by Children's Health Virtual Care. Download the Virtual Visit app today.