RESPIRATORY TRACT INFECTIONS IN CHILDREN

A few definitions

Common cold or rhinopharyngitis: inflammation of the nose and pharynx. The symptoms last generally 5 to 10 days. The throat is red and swollen, with aqueous or purulent nasal discharge and often high fever. Swallowing is painful and the lymph glands of the neck are swollen and painful. Diarrhoea and vomiting can also occur. It is very common in children aged 1 to 6 years. Complications such as sinusitis, middle ear infection or bronchitis can occur.

Sore throat or tonsillitis: inflammation of the tonsils. The tonsils become swollen and red, with or without white, grey or yellow spots or smears. The affected child has a sore throat, fever, swollen glands in the neck and trouble in swallowing. It is most common in children aged 4 to 7 years. Recurrences may lead to tonsil removal.

Sinusitis: inflammation of cavities called sinuses. It is characterized by a stuffy or runny nose, slight fever, as well as cough, worsening congestion of the sinuses, dental pain, ear pain, tenderness in the face, lack of appetite and poor general condition. It is more common in children over 2 years. It may become chronic and accompanied by polyps.

Middle ear infection or acute otitis media: inflammation in the middle ear area. It is characterized by the presence of fluid - pus - in the middle ear with redness of the eardrum, pain, often acute, and possibly fever, vomiting and reduction of hearing. It is very common in younger children up to 7 years.

Frequency of respiratory tract infections in children

Nearly 50% of all paediatric consultations in industrialized countries are caused by respiratory tract infections (RTIs). Acute RTIs are among the leading causes of childhood mortality, especially in developing countries. In 1998, the World Health Organization considered acute RTIs to be “the forgotten pandemic” because of the burden these diseases on children’s health.
Their annual incidence per child decreases with age:

6.1 in children less than 1 year
5.7 in children aged 1-2
4.7 in children aged 3-4
3.5 in children aged 5-9
2.7 in children aged 10-14
2.4 in children aged 15-19.

The vast majority of RTIs are caused by viruses (80-90%), but bacterial superinfections do often occur.

Risk factors for RTIs

Increased exposure to respiratory pathogens by siblings and in childcare, as crowded conditions favour colonization and spread of pathogens causing RTIs
Environmental factors such as passive smoking and exposure to pollutants
Familial predisposition with immunological defects or anatomical and/or physiological features
Male gender
Lack of breast-feeding.

Consequences of RTIs

Acute RTIs are the leading cause of sickness in developed countries, responsible for most sickdays among school children and parental absenteeism from work. Mortality is also very high, especially in Africa and South-East Asia. Uncomplicated upper viral RTIs are usually self-limiting and do not require antibiotics. However bacterial complications are not infrequent, such as middle ear infection, sinusitis, laryngitis, bronchitis or pulmonary infections.

Costs of RTIs

The economic burden of non-influenza-related viral RTIs is very high. In USA alone, the results of a survey performed on several thousands households and extrapolated to the entire US population showed that the cost of these infections approached 40 billion $ annually with the direct costs (doctors, medications and other treatments, as well as hospitalisations, etc) reaching 17 billion $ and the indirect costs (expenses for absence from work, caregivers, etc) reaching 22.5 billion $.

Prevention and management of RTIs

Several different approaches are available.

Non specific preventive measures:

Immunostimulants of bacterial origin or other sources (synthetic, thymic extracts) to reinforce the body’s defences mechanisms against infections
Oligosaccharides
Herbal extracts
Nutritional supplements such as vitamin A and C, as well as trace elements
Parent education on risk factor modification, in particular avoiding smoking indoors
General hygiene methods for children attending day care centres.

Specific preventive measures:

Influenza vaccination
Pneumococcal vaccination.

General management measures:

Rest
Plenty of nourishment. If swallowing is painful, try liquids and soft foods (soups, milkshakes, ice cream)
Lot of fluid intake.

Medical managements measures

Nasal wash with hypertonic salt water or saline helps to remove mucus and bacteria from the nose and sinuses
Decongestants to unblock the opening of sinuses and reduce symptoms of nasal congestion
Steroid nasal spray to decrease nasal inflammation and mucus production
Pain relievers
Antibiotics to treat the bacterial infection but they won’t help an infection caused by a virus.

Any medical information on this website is not intended as a substitute for informed medical advice. No action should be taken before consulting with a healthcare professional.

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