1. Acute respiratory infections (ARI)

2. Instructional Objectives: At the end of the lecture the student would be able to: 1-Define ARI in children. 2-Point out the occurrence of the disease. 3-Define the methods of risk assessment. 4-List the management plan according to age and the result of clinical evaluation.

3. (Acute Respiratory Infections)
ARI
(Acute Respiratory Infections)
Acute infections of Ear lasting <14 days &/or Nose ,Epiglottis, Larynx, Trachea, Bronchi, bronchioles ,&/or Lungs with cough lasting <30 days.

4. Control of acute respiratory infections (ARI) program .
ARI is a world wide problem &is the third child killer after diarrhea &Malnutrition.
ARI forms the main cause of mortality &morbidity among children in developing countries & contribute to 30-60% of all attendance to outpatient departments of child health facilities

5. 70% of which are upper R.T.I
The incidence of pneumonia is 3-4%in children <5 years in developing countries.
The majority of ARI are mild &can be treated at home without antibiotics

6. The most important objective of ARI program is to be able to identify the serious cases .
Common causes: viruses followed by bacteria

7. Standard case management :
Assessment ,classification &management
I Assessment :
Ask:
How old is the child ?
2 months-5years :is he able to drink?
<2 months :has the child stopped B.F. well
Is he coughing ? Duration ?
(<30 days :acute ,>30 days chronic)
Does the child have fever? duration?
Did the child have convulsion during the current illness?

8. Look &listen :(calm child)
Count: Respiratory rate /minute Tachypnea is considered a danger sign if:
Age RR/minute
<2months
2- <12 months
>=12 – 5 years
Chest indrawing:
During child breathing look for the indrawing in the lower chest wall
Stridor: it indicates URT obstruction
Wheeze: it indicates LRT obstruction

10. Look: Measure the Temp. The child is abnormally sleepy or drawsy
sings of Malnutrition
Measure the Temp.
Fever (38c) or low body temperature (35.5c)

11. Management related classification:
Cough or cold (no pneumonia )
Cough
No fast breathing
No chest indrawing
Pneumonia
Fast breathing

12. Sever pneumonia Cough Fast breathing Chest indrawing
Very sever disease
Danger signs are:
Convulsion
Sleepy child
Stopped feeding well
Not able to drink
Stridor
Under nutrition

13. Group(1): 2 months-5 years

14. Very sever disease : Sever pneumonia: Refer urgently hospital
Give 1st dose of antibiotic
Treat wheezing if present
If cerebral malaria is suspected give antimalarial
Sever pneumonia:
Refer urgently hospital
Give first dose of antibiotics
Treat fever if present
Treat wheezing if present

15. Pneumonia : Advice mothers to give home care Give an antibiotics
Treat fever if present
Treat wheezing if present
Advise mother to return with child in 2 days
for reassessment ,or earlier if child get worsen

16. No pneumonia (cough or cold)
If coughing more than 30 days refer for assessment
Assess &treat ear problems & or sore throat
Advice mother to give home care
Treat fever &wheezing

17. Reassess in 2 days a child who is taking an antibiotics for pneumonia :
If he gets worse:
Not able to drink, has chest indrawing, has other dangerous signs
(Refer urgently to hospital)
If he remains the same:
Change the antibiotics or refer
If he improves:
Breathing slower, no fever, Eating better
(Finish the 5 days of antibiotics)

18. Group (2): age <2 months

19. Very sever disease: Refer urgently to hospital Keep infant warm
Stopped feeding well
Convulsion
Sleepy or difficult to wake
Stridor
Wheezing
Fever or low body temperature
Refer urgently to hospital
Keep infant warm
Give first dose of antibiotic

20. Sever pneumonia: Severe chest indrawing or Fast breathing
Refer urgently
Keep infant warm
Give first dose of antibiotic
If referral is not feasible ,treat with antibiotic &follow closely

21. no pneumonia (cough or cold):
No chest indrawing, No fast breathing
Advice on home care:
Keep infant warm
Breast feeding frequently
Clean nose if interferes with feeding
Give extra fluid & sooth throat & relieve cough with a safe remedy

22. (This child may have Pneumonia)
Advice the parents to return quickly if:
Breathing becomes difficult
Breathing becomes fast
feeding becomes a problem
The young infant becomes sicker
The child is not able to drink
(This child may have Pneumonia)

23. Antibiotics which can be used:
Cotrimoxazol, Amoxicillin,
Ampicillin, procaine penicillin.
Antipyretic for fever: use Paracetamol
Wheezing is treated with nebulized B agonists or oral salbutamol in mild cases