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Respiratory tract infections in children

Overview

Respiratory tract infections (RTIs) in children are the leading causes of paediatric consultations, hospitalisations, and absence from school. These infections vary in severity, from mild upper respiratory tract infections (URTIs), like the common cold, to severe lower respiratory tract infections (LRTIs), such as pneumonia and bronchiolitis, which can lead to morbidity and mortality, especially in younger children and those with underlying health conditions.

RTIs in children are caused by various pathogens with certain factors increasing their susceptibility:

  • Viral infection: The most common causes of RTIs in children include respiratory syncytial virus (RSV), influenza viruses, rhinoviruses, and adenoviruses, which are often associated with widespread community outbreaks.
  • Bacterial infection: Bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae, are frequently associated with severe LRTIs like pneumonia.
  • Underdeveloped immune system: As children have underdeveloped immune systems, they are susceptible to infections.
  • Communal exposure: Increased exposure to settings like schools and daycare centres increases the risk of infection spread.
  • Seasonal variation: Viral infections peak in colder months, contributing to high incidences of RTIs during winter.
  • Underlying conditions: Chronic health issues like asthma or congenital heart disease can worsen the severity of RTIs.

The symptoms of RTIs in children vary based on the site and severity of the infection.

  • Upper respiratory tract infections (URTIs): Symptoms include runny nose, cough, fever, sore throat, and nasal congestion, which are commonly associated with cold and pharyngitis.
  • Lower respiratory tract infections (LRTIs): They are associated with severe symptoms, including persistent high fever, persistent cough, wheezing, difficulty breathing, rapid breathing, and, in severe cases, cyanosis (bluish discoloration of the skin due to lack of oxygen) and hypoxia (insufficient oxygen in tissues).
  • Systemic symptoms: In severe cases of LRTIs like pneumonia, children, especially infants, may exhibit lethargy, irritability, and poor feeding.

Accurate diagnosis of RTIs in children is crucial for appropriate management, often involving a combination of clinical and advanced diagnostic tools.

  • Clinical evaluation: Physical examination, including auscultation of the lungs, helps detect abnormal breath sounds, such as crackles and wheezing that are indicative of LRTIs.
  • Laboratory tests: Blood tests including complete blood counts and blood cultures help differentiate between viral and bacterial causes, while specific viral panels can be used to confirm viral infections.
  • Radiological imaging: Chest X-rays are commonly used to assess the extent of infection in LRTIs like pneumonia based on lung consolidation or other changes.
  • Pulse oximetry: This simple, non-invasive test measures oxygen saturation and is crucial for assessing respiratory function in children with suspected severe LRTIs.

Management of RTIs in children is dependent on the type and severity of infection with supportive care being the cornerstone of treatment in most cases.

  • Supportive care: This includes hydration, fever management with antipyretics and analgesics, maintaining oxygenation, and providing paediatric respiratory support in cases of respiratory distress. Humidified air and nasal saline drops can help relieve nasal congestion.
  • Antibiotic therapy: Antibiotics that are prescribed for bacterial infections are not useful for viral infections, highlighting the importance of accurate diagnosis.
  • Antiviral medications: Antiviral drugs, such as oseltamivir are used for severe cases of influenza, but most viral infections are managed with supportive care.
  • Oxygen therapy and ventilation: In severe cases where children develop respiratory distress or hypoxia, hospitalisation is required for advanced paediatric respiratory support. Our hospital has a paediatric intensive care unit (PICU) and a neonatal intensive care unit (NICU) where both paediatric and neonatal patients with respiratory distress can receive advanced respiratory support, including mechanical ventilation if required.

Preventing RTIs is a key strategy to reduce their adverse impact on health. Various public health measures to prevent RTIs include:

  • Immunisation: Vaccines against influenza, pneumococcus, and Haemophilus influenzae type b (Hib) have significantly decreased the prevalence and severity of RTIs.
  • Hand hygiene and respiratory etiquette: Regular handwashing with soap, using hand sanitisers, and covering the mouth and nose while coughing and sneezing are simple but effective preventive measures.
  • Limiting exposure: Reducing children’s exposure to infected individuals, particularly in communal settings, and avoiding crowded places during peak seasons of infection can help prevent RTIs.
  • Breastfeeding: For infants, breastfeeding provides essential antibodies that help strengthen their immune system and protect against respiratory infections.
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