Pediatric Pneumonia Detection from Chest X-Rays:A Comparative Study of Transfer Learning and Custom CNNs

Pneumonia is a leading cause of mortality in children under five, with over 700,000 deaths annually. Accurate diagnosis from chest X-rays is limited by radiologist availability and variability. Objective: This study compares custom CNNs trained from scratch with transfer learning (ResNet50, DenseNet121, EfficientNet-B0) for pediatric pneumonia detection, evaluating frozen-backbone and fine-tuning regimes. Methods: A dataset of 5,216 pediatric chest X-rays was split 80/10/10 for training, validation, and testing. Seven models were trained and assessed using accuracy, F1-score, and AUC. Grad-CAM visualizations provided explainability. Results: Fine-tuned ResNet50 achieved the best performance: 99.43% accuracy, 99.61% F1-score, and 99.93% AUC, with only 3 misclassifications. Fine-tuning outperformed frozen-backbone models by 5.5 percentage points on average. Grad-CAM confirmed clinically relevant lung regions guided predictions. Conclusions: Transfer learning with fine-tuning substantially outperforms CNNs trained from scratch for pediatric pneumonia detection, showing near-perfect accuracy. This system has strong potential as a screening tool in resource-limited settings. Future work should validate these findings on multi-center and adult datasets. Keywords: Pneumonia detection, deep learning, transfer learning, CNN, chest X-ray, pediatric diagnosis, ResNet, DenseNet, EfficientNet, Grad-CAM.