For three long nights last week, Alexis Geddes sat by her daughter’s hospital bed, staring at the monitors tracking the amount of oxygen in little Alma’s bloodstream.

Doctors at Greater Baltimore Medical Center in Towson had warned Geddes they would need to transfer the 3-year-old to the pediatric intensive care unit if her lungs did not improve.

For weeks, Geddes had heard stories swirling around their Rodgers Forge neighborhood of children with pneumonia. Her eldest son, 9-year-old Felix, had missed 16 days of school last spring due to the illness. Now pneumonia had hit her baby.

“It’s very scary when your kid can’t breathe,” said Geddes. “And the whole place was just full of kids just trying to breathe.”

An outbreak of bacterial pneumonia is hitting an unexpected population in the Baltimore area and around the world — young children.

“This year we’ve seen a ton of it,” said Dr. Aaron Milstone, a Johns Hopkins epidemiologist and pediatrics professor. “There’s been a dramatic rise locally, nationally and internationally.”

The bacteria infecting many children right now, Mycoplasma pneumoniae, typically triggers a spike in pneumonia cases in children every 3-7 years. However, like so many other things, the COVID pandemic disrupted the cycle. The precautions that prevented COVID transmission — masking, social distancing and hand hygiene — suppressed mycoplasma as well.

But now the pathogen has returned with a vengeance.

The pediatric pneumonia outbreak first erupted in northern China last year and worked its way through Europe before spreading through this country. And unlike previous outbreaks of mycoplasma, which usually hit school-age children and teens hardest, this one is going after preschoolers.

“This year we have been seeing younger children coming in ... which has been surprising,” said Dr. Elizabeth Duque Hammershaimb, a pediatric infectious disease specialist at the University of Maryland Medical Center.

Between April and the end of August, the Centers for Disease Control and Prevention recorded a sevenfold increase in children of the ages 2 to 4 visiting emergency rooms for mycoplasma. Emergency room visits for kids 5 to 17 with mycoplasma more than doubled during the same period. More recent data have not yet been published.

Locally, infectious disease experts and pediatricians say the surge in pneumonia started in midsummer and intensified as children squeezed back into school buildings. Cases have further increased in the past few weeks as temperatures have cooled.

“I have not seen this kind of cluster of cases in such a short amount of time,” said Dr. Theresa Nguyen, chair of pediatrics at the Greater Baltimore Medical Center in Towson. About 10-20 children are being diagnosed with pneumonia each week at the GBMC Pediatric Group in Towson, she said.

Dr. Melissa Denham, medical director of Patient First in Towson and Owings Mills, said she diagnosed three or four children with pneumonia during a recent 12-hour shift.

Schools are urging parents to closely monitor children’s symptoms. “We have seen an uptick in cases of pneumonia throughout both the Lower School and Middle School,” officials at North Baltimore’s Calvert School wrote in an email to parents. “If your child has a fever and cough, please contact your pediatrician.”

The good news about mycoplasma pneumonia is that most cases are mild and are easily treated with antibiotics and rest. The bad news is that symptoms can linger for days or weeks, and some children experience severe complications.

“Mycoplasma pneumonia is called ‘walking pneumonia,’ because you can drag yourself around with it,” said Dr. Susan Lipton, the head of pediatric infectious diseases at Sinai Hospital in Northwest Baltimore. “But it also drags on for a long time.”

The most noticeable symptom of mycoplasma pneumonia is, of course, “a lot of coughing,” said Nguyen. A fever that comes and goes, lethargy and fatigue, are also typical. Most — but not all — mycoplasma pneumonia patients have lung congestion that can be heard with a stethoscope, she said. Other symptoms include a headache, sore throat and, less commonly, a rash.

Some children are being hospitalized with complications such as dehydration and low oxygen levels, said Milstone at Hopkins. Occasionally, children develop more serious issues such as encephalitis or meningitis, he said.

Children with sickle cell disease or heart or lung conditions are most at risk for complications and should be monitored closely, said Lipton at Sinai.

The surge of pneumonia is occurring amid a typical autumn increase in respiratory infections. But it’s also converging with another alarming trend — a spike in whooping cough cases. While most people are vaccinated against whooping cough in infancy, babies too young for the vaccine, and children whose parents choose not to vaccinate, are at risk.

“We have seen several babies with whooping cough, including one who was in the pediatric ICU for quite a while with complications,” said Hammerschaimb at UMMS.

Other pathogens can cause pneumonia, too. Viruses and, more rarely, fungi, can infect the lungs. Several bacteria can cause pneumonia, including Streptococcus pneumoniae, which young children and people over 65 can be vaccinated against.

Parents who suspect their children have pneumonia should take them to the doctor. But if symptoms are mild, there is no need to rush them to the emergency room, Nguyen said. “If your child has had a cough for more than a week or a fever for more than five days, that’s the time to call the doctor,” she said.

Mycoplasma infections are typically treated with azithromycin, also known as a z-pack, or doxycycline, doctors said.

If children are struggling to breathe or are dehydrated, parents should call their pediatrician or seek medical care right away. But for most children the recovery involves a course of antibiotics, lots of liquids and some quiet days at home.

For 6-year-old Iyla Davis, that meant getting out glue and scissors to make Halloween crafts with her mom in their Cockeysville home last week. Alex Tamberino of Ruxton spent a couple days cuddled up on the couch at home, “coughing so hard he was having a hard time catching his breath,” said his mom, Jill Tamberino. And Louis Galloway-Williams of Wyman Park played dozens of rounds of Uno and read animal books with his dad while being treated with two different antibiotics.

Of course, while young children often struggle to share toys, they have no qualms about sharing germs. And as the mycoplasma pathogen bounces around classrooms and playgrounds, it’s also spreading to parents and teachers.

Joanna Bower, 40, of Lutherville, who teaches music and movement classes for young children, is still catching her breath after a bout of pneumonia that began in early October.

“One day I was fine, and the next I woke up with a high fever and cough,” she said. Bower has completed her course of antibiotics, but said she has occasional coughing fits and gets winded easily.

Back in Rodgers Forge, Alma Geddes is finally back home after spending three nights and four days in the hospital. The girl started with a virus earlier in the month, but grew progressively more ill until she hospitalized last week and eventually diagnosed with pneumonia.

At GBMC, Alma was given azithromycin by IV and oxygen through a tube in her nose. Respiratory therapists administered a nebulizer treatment every four hours, her mother said.

The 3-year-old would eat nothing but bacon and strawberries, so her grandfather and his husband would bring her some each morning, her mother said.

Alma, already tiny, lost weight, her big blue eyes growing even rounder in her thin cheeks. Her preschool teachers brought a card that had been decorated by her classmates. Neighbors delivered a basket of toys to entertain her. But mostly the little girl just wanted to go home.

“Every evening when the sun would go down she would get wimpery and sad,” her mother said. The illness was hard on the whole family— Alexis Geddes, an art restorer, and her husband, Andrew Geddes, an art teacher, had to take off work and postpone projects. The grandfathers stepped in to care for the couple’s two older boys.

Finally, Alma’s lungs began to rebound. The GBMC staff weaned her off oxygen and on Friday released the girl, who was happy to rejoin her brothers and beloved dog, Cybele.

But Alma, who has to be awakened every four hours for a nebulizer treatment, is still very tired. So is her mother.

Said Alexis Geddes, “I think we both still feel like we were hit by a bus.”