Acute respiratory infection (ARI) in children

Written by Dr.Md.Redwanul Huq (Masum)
Monday, 16 January 2012 12:50

Risk factors of ARI:

* Low birth weight
* Poor breast feeding practice
* Vitamin A deficiency
* Malnutrition
* Lack of immunization
* Overcrowded leaving
* Air pollution
* Passive smoking.

Anatomical classification of ARI:

1. Upper (above the vocal cord)

a) Common cold
b) Pharyngitis
c) Tonsillitis
d) Otitis media

2. Lower(below the vocal cord)

a) Epiglottitis
b) Laryngitis
c) Bronchitis/Bronchiolitis
d) Pneumonia.

Causes of ARI:

I) Bacterial:

* Streptococcus pneumonae
* Haemophilus influenzae
* Staphylococcus aureus.

II) Viral:

* Respiratory syncytial virus
* Influenza A and B viruses
* Parainfluenza viruses
* Adenoviruses
* Rhinoviruses.

Signs and Symptoms of ARI:

Signs and Symptoms of ARI in children are-

* Fever
* Cough
* Difficult breathing
* Blocked/ runny nose
* Sore throat
* Discharge from ear(s)

Management of child with cough and/or difficult breathing:

I) Assessment :

a) Ask-

* Age of the child
* About coughing of the child
* Duration of coughing (if there is cough)
* If age of the child is 2 months-5 years: about drinking ability of the child
* If age of the child is less than 2 months(i.e. in case of young infant): About feeding of the child- either it is stopped or not
* About fever of the child
* Duration of fever (if there is fever)
* About convulsion of the child.

b) Look/Listen (child must be calm)-

* Counting breath for 1 minute
* Looking for chest indrawing
* Looking and listening for striador
* Seeing the child either the child is abnormally sleepy or in difficulty to wake
* Feeling the child for fever or low body temperature
* Looking for severe malnutrition.

Classification of ARI:

Child having the age 2 month- 5 years-

i) Very severe disease– if danger signs are present
ii) Severe pneumonia– if chest indrawing is present
iii) Pneumonia– There is no chest indrawing but fast breathing
iv) No pneumonia, cough or cold- No chest indrawing and fast breathing.

Child having the age less than 2 months (i.e. in case of young infant)-

i) Very severe disease– if danger signs are present
ii) Severe pneumonia– Severe chest indrawing or fast breathing
iii) No pneumonia, cough or cold- No chest indrawing and fast breathing.

For young infants all pneumonias are severe pneumonia.

Very severe disease includes- Severe pneumonia, septicemia, meningitis and cerebral malaria.

* Fast breathing–

* Age less than 2 months: 60 or more breaths per minute
* Age 2 months upto 1 year: 50 or more breaths per minute
* Age 1 year upto 5 years: 40 or more breaths per minute

* Chest indrawing–

Lower chest wall goes in while the child breath in which is definite and persistent.

* Danger signs–

Child having the age 2 month- 5 years:-

1. Not able o drink
2. Convulsion
3. Abnormally sleepy or difficult to walk
4. Striador in calm child
5. Severe malnutrition

Child having the age less than 2 months:-

  1. Stopped feeding well
  2. Abnormally sleepy
  3. Striador in calm child
  4. Wheeze
  5. Fever or hypothermia.

Management of ARI:

I) Management in out patient or primary health centre:

a) Child having the age 2 month- 5 years:-

1. Very severe disease and severe pneumonia-

* Urgent referral to hospital with a referral note
* 1st dose of antibiotic
* Paracetamol for fever
* Salbutamol for wheeze.

2. Pneumonia-

* Antibiotic for 5 days
* Home care advice-
* Advice to the mother to come after 2 days for re-assessment
(If improving – same antibiotic should be continued
If the condition is same- antibiotic should be changed
If the child is deteriorating- the child should be referred)

3. No pneumonia-

Home care advice-

  1. More fluid to the child
  2. Frequent feeding
  3. Soothing of throat with safe cough remedy (e.g. honey, warm lemon juice, lemon tea)

Teaching the referral knowledge. Return quickly if-

  1. Breathing becomes faster and difficult
  2. Feeding becomes a problem
  3. The child gets sicker.

Recommended antibiotics:

* Co-trimoxazole – 10 mg/Kg/day in 2 divided doses
* Amoxicillin – 10-40 mg/Kg/day in 3 divided doses
* Ampicillin – 100 mg/Kg/day in 4 divided doses
* Inj. Procaine penicillin – 50000 IU/Kg IM daily.

b) Child having the age less than 2 months:-

1. Very severe disease /severe pneumonia-

* Urgent referral
* First dose of antibiotic
* The baby should be kept warm
* If referral is not possible, then treatment should be continued with antibiotic and follow up
of the child is needed.

2. No pneumonia, cough or cold-

Home care advice-

  1. The baby should be kept warm
  2. Frequent breast feeding
  3. If nasal obstruction hampers feeding, it should be cleared by normal saline drop or salt in water

Teaching the referral knowledge.Return quickly if-

  1. Breathing becomes faster and difficult
  2. Feeding becomes a problem
  3. The child gets sicker.

II) Management in hospital:

Investigations:

  • CBC
  • Chest X-ray
  • Blood for C/S
  • Throat swab C/S.

Treatment:

a) Child having the age 2 month- 5 years:-

1. Very severe disease-

* Antibiotics-

[Inj. Ampicillin – 50 mg/Kg/dose 6 hourly for 5 days
+
Inj. Gentamycin – 2.5 mg/Kg/dose 8-12 hourly for 5 days]

OR,
[Inj. C-penicillin – 50000 IU/Kg/dose 6 hourly for 5 days
+
Inj. Gentamycin – 2.5 mg/Kg/dose 8-12 hourly for 5 days]

OR,
Inj. Ceftriaxone.

* Paracetamol for fever
* Salbutamol for wheeze
* Oxygen inhalation if respiratory rate is more than 70 breaths / minute

2. Severe pneumonia-

* Antibiotic–

Inj. Ampicillin or Inj. C-penicillin

* Paracetamol for fever
* Salbutamol for wheeze.

b) Child having the age less than 2 months:-

In both very severe disease and severe pneumonia–

[Inj. Ampicillin –  50 mg/Kg/dose 6 hourly for 5 days
+
Inj. Gentamycin –  2.5 mg/Kg/dose 8-12 hourly for 5 days]

OR,
Inj. Ceftriaxone.


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