Paediatric Respiratory Tract Infections

Respiratory tract infections in children are generally grouped according to the part of the airway they affect.

• Upper respiratory tract infections (URTIs) involve the nose, throat, and upper air passages. Common examples include the cold and pharyngitis.
• Lower respiratory tract infections (LRTIs) affect the lung and lower airways. They include conditions such as pneumonia and broncholith, which are often more serious.
• Systemic symptoms are seen in severe cases of LRTIs like pneumonia in children, especially infants, leading to general unwellness.

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

• Runny nose
• Cough
• Fever
• Sore throat
• Nasal congestion
• Persistent high fever
• Wheezing
• Difficulty breathing
• Rapid breathing
• Cyanosis (bluish discoloration of the skin due to lack of oxygen)
• Hypoxia (insufficient oxygen in tissues), are also observed in severe cases.

RTIs in children are caused by different germs, and certain factors can make children more likely to catch them:

• Viral infections are the most common causes of RTIs in children. Viruses such as respiratory syncytial virus (RSV), influenza viruses, rhinoviruses, and adenoviruses often spread widely in the community.
• Bacterial infections, including those caused by Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae, are more often linked with severe LRTIs such as pneumonia.
• Underdeveloped immune system in children make them more prone to infections because their natural defences are still developing.
• Communal exposure, for example in schools and daycare centres, increases the risk of spreading infection.
• Seasonal variation plays a role, with viral infections peaking in colder months, resulting in higher incidences of RTIs during winter.
• Underlying conditions such as asthma or congenital heart disease can worsen the severity of RTIs.

Accurate diagnosis of RTIs in children is important for proper treatment and care: 

• Clinical evaluation involves physically examining the child, including listening to the lungs, to detect abnormal breath sounds, such as crackles and wheezing that may suggest chest infection.
• Laboratory tests include blood tests and blood cultures to help differentiate between viral and bacterial causes, while specific viral tests confirm the virus type.
• Radiological imaging, such as chest X-rays, is used to check for signs of lung infection, for example areas of pneumonia.
• Pulse oximetry is a simple, non-invasive test that measures oxygen levels in the blood and helps assess respiratory function in children with suspected serious infections.

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

• Supportive care includes giving plenty of fluids, controlling fever and pain with medicines, maintaining oxygenation, and providing breathing support if the child has breathing difficulties. Humidified air and nasal saline drops can help relieve nasal congestion.
• Antibiotic therapy is used only for bacterial infections. Antibiotics do not work against viruses, so it is important to identify the cause before starting treatment.
• Antiviral medications such as oseltamivir may be used in some cases of severe flu, although most viral infections are treated with supportive care alone.
• Oxygen therapy and ventilation are required in severe cases where children develop serious breathing problems or low oxygen levels. In such cases, hospital care may be needed, including advanced support in a paediatric (PICU) or neonatal intensive care unit (NICU), where mechanical ventilation if required.

Parents should seek medical help if a child with a respiratory infection:

• Has fast, difficult, or noisy breathing.
• Shows bluish lips, face, or fingertips (a sign of low oxygen).
• Has a high fever that does not improve with treatment.
• Refuses to eat or drink or shows signs of dehydration (such as very little urine, dry mouth, or sunken eyes).
• Becomes unusually sleepy, irritable, or unresponsive.
• Has repeated vomiting or seizures.
• Shows no improvement or gets worse after a few days.

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

• Immunisation helps protect children against common infections such as influenza, pneumococcus, and Haemophilus influenzae type b (Hib).
• Hand hygiene and respiratory etiquette, though regular handwashing with soap, use of hand sanitisers, and covering the mouth and nose when coughing or sneezing, reduce the spread of infection.
• Limiting exposure, by keeping children away from infected individuals and avoiding crowded places during peak seasons of infection, can help prevent RTIs.
• Breastfeeding provides infants with important antibodies that strengthen their immune system and protect against respiratory infections.

Children with suspected or confirmed respiratory tract infections should first be examined by a paediatrician, who can assess the severity and decide on further care. In complicated or severe cases, especially when hospitalisation is required, a paediatric pulmonologist (lung specialist for children) or an infectious disease specialist may also be involved.