Overview

Respiratory Tract Infections are a common condition with children in the age-group of 3 to 12 years. The Immune system of children are weaker compared to that of adults, so it’s easy to develop infections. While most infections are not very serious and can be easily managed, in some cases, they lead to complications or become fatal even. 

That is why, it’s important for parents and educators to be aware of them, so that timely action can be taken in the likelihood of infection.

Introduction

The respiratory system starts at the nasal cavities, followed by the trachea or wind-pipe, the bronchi and bronchioles (collectively called ‘airways”) terminating in the alveoli of the lungs. The sinuses and throat are also part of this complex body-system. Viral or bacterial infections can affect any part of this network, and they are called Respiratory Tract Infections (RTI). These are further divided into:

Upper RTI: These occur in the nose and throat, and examples of viral upper RTI are Common Cold and Influenza

Lower RTI: These occur in the trachea, windpipe and lungs. Examples of viral lower RTI include pneumonia, bronchiolitis and croup.

Children and RTIs

Children in the age-group of 2 to 12 are highly prone to RTIs. There are several reasons for this. To begin with, their immune systems are not as sturdy as that of adults. Secondly, they meet each other often at school and at play. Some of these infections spread through droplets in the air, so its easy to catch them. Further, when children come in contact with other infected children, and then touch their eyes, nose or mouth, the pathogens are easily ingested/inhaled into the body. Finally, children do not follow hand-washing routines as rigorously as adults do.

RTIs are quite common and create hassles for the child, parents, siblings, teachers and school-staff. Frequent bouts of RTI lead to missed days from school or play, and reduced performance. This in turn can affect their emotional health. Parents should be vigilant about signs and symptoms of RTIs, so that timely treatment can be provided.

Also Read: Complications arising out of Respiratory Disease

Symptoms of RTIs caused by viruses

• Runny nose
• Cough
• Fever
• Sore throat
• Hoarse voice
• Fatigue, weakness, lack of energy
• Red eyes/Pink eyes, with yellowish discharge from the eyes
• Swelling on the sides of the neck (due to swollen lymph nodes)

When to see a doctor

• Dizziness, fainting or loss of consciousness (called syncope)
• Fever that’s higher than 103 F
• Rapid, or heavy breathing and difficulty in breathing
• Frequent and severe cough accompanied by vomiting
• Wheezing and/or a high-pitched whistling sound while breathing out
• Retractions (a deep outline of the ribcage is visible) while breathing or coughing
• Stridor, which is a harsh and raspy vibration while breathing out (similar to sounds made by a seal)

How are RTIs diagnosed?

• Chest X-ray to look at the lungs
• CT scan of the lungs
• Lung function test to see how the lungs are working
• Sputum test, where phlegm coughed up from the lungs are examined under a microscope
• Throat swab
• Nasal swab

Common RTIs and their treatment

• Common Cold: There are over 200 different viruses that cause this condition, and most of them spread by phlegm, mucous or saliva. The condition lasts for nearly 10 days, and is marked by cough and fever in some cases. Complications like infections of the eye, ear and sinus, as well as pneumonia are possible in rare cases. Staying hydrated and taking rest is the best medicine, but in case of fever or body-aches, acetoaminophen can be given.
• Laryngitis: When there is viral infection of the upper airways, the larynx or voice-box gets inflamed. The child will experience sore throat, hoarse voice, low voice and inability to speak. Resting, drinking plenty of fluids, using cough medicines and doing steam inhalation forms the treatment.
• Pharyngitis: Also called sore throat, this condition is generally caused by a virus although a bacteria called streptococcus can cause a variation of this, called strep throat. The child experiences severe throat pain, swollen red tonsils, difficulty in swallowing, inability to speak and tender lymph nodes in the neck. OTC drugs such as NSAIDs are given, while in rare cases a steroidal drug may be given. Gargling with warm saline also helps.
• Sinus Infection: When the sinuses get infected by a virus, they get inflamed and the condition is called sinusitis. In rare cases, bacteria can cause the infection, which can make the condition severe. The child experiences a range of symptoms such as congestion, runny nose, green-coloured mucous from the nose, tender or painful face, fatigue, weakness, cough, headache, fever, cough and bad-breath. While OTCs can be taken for mild infections, in severe cases, antibiotics may be prescribed.
• Community-acquired Pneumonia (CAP): Children get easily infected within their community (friends, family and neighbours), from a range of viruses. CAP can be caused by influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus and rhinovirus. Bacteria can also cause CAP, and these include Streptococcus pneumoniae and Mycoplasma pneumoniae. The child experiences cough, recession of the chest wall and difficulty in breathing. Fluids, and anti-pyretic medication is the best form of treatment.
• Bronchiolitis: The trachea or wind-pipe branches into 2 bronchi, which in turn branches into smaller tubes called bronchioles. When these get infected by a virus, they get inflamed. The child will experience wheezing, coughing, fever and nasal discharge. Oral feeds, nasal drops (saline) and raising the pillow while sleeping are known to give relief when infection is mild. IV fluids, oxygen supplementation and airway pressure-support are done for moderate infection, while antibiotics are given for severe infection.

Also Read: RSV leading cause of respiratory infections in children

Croup: Also called laryngotracheobronchitis, this is marked by viral infection of the upper airways. The child experiences barking cough, hoarse voice and restlessness. Fluids and anti-pyretics are adequate when the infection is mild. When infection is severe, hospitalization will be required and a range of medicines prescribed for treatment.

Epiglottitis: The top part of the trachea or wind-pipe is called epiglottis. If this gets infected, it results in inflammation and swelling of the epiglottis, which causes the airways to get blocked. This is a medical emergency, requiring hospitalization. The child experiences difficulty in breathing, inability to swallow, sore throat and fever. At the hospital, doctors will provide antibiotics, steroids and IV fluids as part of the treatment.

Preschool (Viral wheeze): Intermittent airway obstruction, resulting in wheezing and coughing. Treatment includes hydration and bronchodilators.

Bacterial tracheitis: Similar to epiglottitis, and is marked by drooling of saliva, sickly appearance, high temperature and stridor. Will require hospitalization. Medication includes oral steroids, corticosteroids and nebulized adrenaline.

Chronic lung disease of prematurity: This affects infants born prematurely and having low birth-weight. Hospitalization, with oxygen supplementation is the mode of treatment.

Tonsillitis: The tonsils get inflamed due to viral infection, or bacteria such as Group-A streptococcus. The child will experience hoarseness, difficulty in swallowing, headache, cough and high fever. Fluids and anti-pyretics are adequate in most cases, while antibiotics may be required in a few cases.

Otitis media: This is marked by inflammation of the middle-ear, leading to accumulation of infected fluid in the middle ear. This in turn leads to bulging tympanic membrane and ear-ache. Anti-pyretics, antibiotics and a surgical procedure called grommet insertion are the preferred forms of treatment.

Protracted bacterial bronchitis: This is marked by chronic or long-term wet-cough, caused by a range of bacteria such as H. influenzae, S. pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. Antibiotics and bronchoscopy with broncho-alveolar lavage may be explored for treatment.

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.

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