Paediatric Respiratory Infections
Respiratory infections are the most common infections of childhood, and the most common cause of death across the world. 50% of acute paediatric presentations to GPs arise from respiratory infections, and account for 25% of admissions to hospital.
- 1 Overview
- 2 Infections
- Viruses are the main pathogens causing childhood respiratory infections, responsible for approx 80-90%. The main ones are: **Respiratory Syncitial Virus (RSV)
- Bacteria also cause respiratory infections. The main ones are:
- Streptococcus pneumonia
- Haemophilus influenza
- Bordatella pertussis
- Mycoplasma pneumonia
Dual bacterial and viral infections can occur.
Factors increasing risk of respiratory infection in children:
- Parental smoking
- Poor nutrition
- Low socio-economic status
- Males> Females
- Underlying lung disease
- Congenital heart disease
Crib sheets (Print off and use!)
Coryza (Common cold)
This presents with clear, or purulent nasal discharge.
Self limiting- offer reassurance, paracetomol / ibuprofen if needed.
Croup (acute laryngotracheobronchitis)
Croup is an URTI which commonly affects children aged 6 months to 6 years.There is inflammation of mucosa which can occur at any point from the nose to lower airways, along with increased secretions, affecting the airway. In severe cases, oedema of the subglottis can lead to obstruction of the trachea.
- 6 months to 6 years old
- Commonest in autumn
Croup presents initially with coryzal symptoms and fever over a period of days then progression to:
- Barking Cough
- Hoarse voice
Often worse at night
It is important to differentiate from acute epiglottitis (which is characterised by slight or no cough, acute onset, drooling saliva with mouth open, fever)
In 95% of cases: Parainfluenza infection of all the upper airways.
In mild cases croup is:
- Self limiting
- Managed conservatively through observation and good hydration
- May be treated with humidified air, nebulised budesonide and oral dexamethasone to reduce symptom severity
In severe cases:
- There are signs of an increased work of breathing, restlessness and cyanosis
- May require treatment with nebulised adrenaline along with oxygen and in some cases intubation and ventilation may be required
Bronchiolitis is a LRTI which is the most common serious respiratory infection affecting babies and infants under 1 year old, usually those aged 3 to 6 months. Outbreaks typically occur during the winter months. There is increased mucus production, with inflammation and obstruction of bronchioles.
Bronchiolitis presents with:
- Dry, persistent cough
Hyperinflation of chest, subcostal and intercostal recession, tachypnoea, tachycardia, downward displacement of liver, high pitched wheeze, prolonged expiration, fine end inspiratory crackles, pallor, cyanosis
Caused by: In 80% of cases- Respiratory Syncitial Virus (RSV).
In mild cases Bronchiolitis:
- Is self limiting
- Is managed conservatively through observation and good hydration
- May be treated with paracetamol or ibuprofen to reduce temperature
In severe cases:
- Poor feeding is main reason for hospital admission; also signs of lethargy, severe recession and cyanosis
- It is managed with supportive measures including oxygen, bronchodilators and in severe respiratory distress mechanical ventilation may be required.
Pneumonia is a LRTI that commonly affects babies and infants under 1 year old, usually those aged 3 to 6 months. It causes consolidation in lower respiratory tract.
Pneumonia presents with:
- Productive cough
- Chest or Abdominal pain
O/E: Intercostal recession, use of accessories, tachypnoea, cyanosis, percussion dullness, reduced air entry, bronchial breathing, increased vocal fremitus, crackles
- Viral (accounts for 14-35% of CAP): RSV, influenza, parainfluenza, adenovirus, coxsackie virus
- Bacterial - Streptococcus pneumonia (most common in under 5’s), Haemophilus influenza type B, Staphylococcus, Mycoplasma pneumonia (most common in over 5’s), and Group B beta haemolytic streptococcus (in newborns)
- In those with underlying respiratory disease- Psedomonas aeruginosa and Staphylococcus aureus
- Abnormality of bronchi
- Foreign body inhalation
- Recurrent aspiration
- Cystic Fibrosis
- Amoxacillin is first line treatment
- May also require anti-pyretics, fluids, oxygen
- In severe cases, co-amoxiclav, cefotaxime, cefuroxime