pleurisy in children

Overview

Pleurisy (also called pleuritis) is irritation and swelling of the pleura — the thin, two-layer membrane that wraps around the lungs and lines the inside of the chest. When these layers rub together during breathing, it can cause sharp chest pain. In children, pleurisy is usually a complication of a chest infection.

Pleurisy is not very common in children, but it can happen. When it does, it is most often linked to a cold, flu, or pneumonia. Most children who get pleurisy recover completely with care and treatment.

It can affect children of any age, from babies to teenagers. Children with weakened immune systems or long-term lung conditions may be more at risk.

Symptoms

Common symptoms

• Sharp chest pain that worsens with deep breaths, coughing, or movement
• Breathlessness or rapid breathing
• Dry cough
• Fever or chills
• Feeling tired or unwell

Symptoms in children

• Babies and younger children may not be able to say they have chest pain. Instead, they may be fussy, cry more, or breathe faster than usual.
• They may favor one side by lying still to avoid pain.
• Poor feeding or loss of appetite
• Sometimes a grunting sound when breathing out

Symptoms in older adults

• In older adults, the pain may be less sharp and more like a dull ache.
• Breathlessness may be more noticeable than pain.
• Some older adults may feel confused or very weak.

Causes

Main causes

• Viral infections, such as colds, influenza, or other respiratory viruses
• Bacterial infections, especially pneumonia
• Lung infections like tuberculosis (more common in some parts of the world)
• Injury to the chest
• Autoimmune conditions (when the body's immune system attacks healthy tissue)
• Blood clot in the lung (very rare in children)

Risk factors

• Having a respiratory infection like a cold or pneumonia
• A weakened immune system
• Autoimmune diseases like lupus
• A family history of autoimmune disease
• Certain medicines or treatments that affect the immune system

When to see a doctor

See a doctor urgently if:

• Your child has chest pain that is not getting better after a day
• Your child is breathing faster than usual or seems short of breath
• Your child has a fever and chest pain
• Your child cannot drink or eat properly and shows signs of dehydration

Book a routine appointment if:

• If your child has a cough or mild chest pain that lasts more than a week
• If your child seems more tired than usual after an infection
• If you have concerns about any symptoms, you can speak to your family doctor or pediatrician

Diagnosis

To diagnose pleurisy, a doctor will ask about your child's symptoms, listen to their chest with a stethoscope, and examine them. The doctor will look for the specific sound the inflamed pleura makes when it rubs against the lung. They may also order tests to look for the cause and rule out other conditions.

Tests that may be done

• Chest X-ray to look at the lungs and the space between the lungs and chest wall
• Ultrasound of the chest to see if there is fluid build-up
• Blood tests to check for infection or inflammation
• Pulse oximetry to measure oxygen levels in the blood
• Sometimes a CT scan if more detail is needed

What to expect at your appointment

The doctor may ask your child to take a deep breath or cough. This is normal. Some tests, like blood tests, may involve a small needle and may feel uncomfortable for a moment. The doctor will explain each step so you and your child know what to expect. After the visit, you will receive guidance about next steps.

Treatment

Treatment for pleurisy in children depends on what is causing it. The most important steps are to ease the chest pain, help your child breathe comfortably, and treat the underlying infection or condition. In most cases, pleurisy can be managed at home with rest and supportive care.

Self-care at home

• Let your child rest and take it easy. Sleep and calm help the body heal.
• Encourage fluids like water, clear soups, or warm drinks to keep the body hydrated.
• Use a cool mist humidifier or sit with your child in a steamy bathroom to help ease coughing.
• Make sure the child is comfortable — lying on the side that hurts may sometimes help reduce irritation, but let them find their comfortable position.
• Follow the doctor's advice about fever and pain relief. Do not give over-the-counter medicines without checking with a healthcare provider first.

Medical treatments

Medical treatment depends on the cause. If a bacterial infection is found, a doctor may prescribe antibiotics. Pleurisy from a virus is usually managed with rest and pain relief. Anti-inflammatory medicines may also be used to reduce swelling, but these should only be given under a doctor's guidance. If another condition such as an autoimmune disease is causing the pleurisy, a specialist will recommend an appropriate treatment plan.

When is surgery considered?

In rare cases, if fluid builds up in the space around the lungs (a pleural effusion) and becomes infected, doctors may drain it using a needle or a small tube. This is not major surgery, but it is done in a hospital. If the fluid does not drain easily, a small keyhole surgery may be needed to clean out the area.

Living with this condition

While your child is recovering, expect them to tire quickly. Keep activities gentle and let them nap. It may take a few weeks before they have their full energy back. Gradual return to normal activity is fine, but avoid strenuous play until the pain and breathing have improved.

Lifestyle tips

• Create a calm, smoke-free home environment. Avoid exposure to secondhand smoke and strong fumes.
• Keep up with regular hygiene, like handwashing, to reduce spread of infections.
• If your child uses a rescue inhaler or other breathing medicine, make sure they take it exactly as prescribed.
• Stay in contact with school or nursery so they understand your child is recovering and may need time off.

Diet and exercise

There is no special diet that treats pleurisy, but eating well helps the body heal. Offer small, nutrient-rich meals. Let your child guide their appetite. Gentle exercise, like short walks, can be restarted when the doctor says it is safe. Avoid sports or running until your child is pain-free and breathing normally.

Mental health and emotional wellbeing

Being sick can be stressful for a child, especially if they are in pain or have to stay home from school. Let them know it is okay to feel frustrated or upset. Talk about their feelings in simple words and reassure them that they are on the mend. If you notice ongoing anxiety, sadness, or changes in behavior, speak to your doctor.

Prevention

Pleurisy itself is not always preventable, because it often happens after an infection. But lowering the chance of respiratory infections can help. This includes good hand hygiene, avoiding contact with people who are unwell, and keeping your child up to date with recommended vaccines.

Vaccines

Vaccines that protect against flu and pneumonia may help prevent some infections that can lead to pleurisy. Make sure your child's immunisation schedule is up to date. Ask your doctor or nurse about what is recommended for your child.

Screening programmes

There is no routine screening for pleurisy. Diagnosis happens when a child has symptoms, and tests are done as needed.

Complications

If left untreated

• Fluid build-up in the chest (pleural effusion), which can press on the lungs and make breathing harder
• Infection spreading to the fluid that forms around the lungs
• The pleura becoming thicker or scarred, which can make it harder for the lungs to expand
• Pneumonia or worsening lung infection
• Collapsed lung (when air leaks out of the lung), though this is very rare

Long-term outlook

The vast majority of children with pleurisy recover fully with appropriate care. Once the cause is treated, the inflammation settles down, and the pain disappears. Some children may feel tired for a few weeks, but long-term lung damage is uncommon. With good follow-up and support, children usually return to normal life and play.

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