1. Respiratory Infections in Children
Dr. S. Benson
GPSTI

2. Infections URTI Croup Epiglottitis Whooping Cough Bronchiolitis
Pneumonia TB

3. URTI Coryza – Usually rhinovirus, coronavirus, RSV
Pharyngitis – viral or Group A beta-haemolytic strep
Tonsillitis – Group A beta-haemolytic strep and EBV
Acute Otitis Media – viruses, pneumococcus, strep, haemophilus, moraxella catarrhalis
Sinusitis – viral or bacterial

4. URTI Children often present with: Sore throat
Fever (inc febrile convulsions)
Blocked Nose
Nasal Discharge
Earache
Wheeze

5. URTI Thorough examination is needed Exclude serious infections
Address feeding and hydration
Consider possible bacterial causes for:
Otitis Media (discharge, ruptured drum, red and bulge)
Tonsillitis (exudative with pus)
Mainstay of treatment is paracetamol and ibuprofen

6. URTI Antibiotics – to prescribe or not to prescribe?
Recommend if tonsilitis or acute OM
Tonsilitis – Give Penecillin V (avoid amoxicillin as maybe caused by EBV – rash)
Acute OM – Coamoxiclav is a suitable choice
Take throat swabs before treatment
Most URTI are viral

7. Croup Viral laryngotracheobronchitis
Mucosal inflammation of respiratory tract
Usually caused by RSV, parainfluenza and influenza
Usually children are 6 months to 6 years old
Presents as stridor and difficulty breathing

8. Croup Can be managed at home if mild Give humidified air
Give steroids (reduces severity and duration of croup)
oral prednisolone (2mg/kg) for 3 days
nebulised budesonide (2mg stat)
Nebulised adrenaline provides transient relief
If severe or desaturating will need admission

9. Acute Epiglottitis Life threatening swelling of the epiglottis
Can cause septicaemia
Caused by haemophilus influenza type B
Mostly in children 1-6yo
DO NOT examine the throat
Keep the child calm

10. Acute Epiglottitis Management is in ITU ET intubation often required
7-10 days of 3rd gen cephalosporin
Rifampicin prophylaxis for close contacts

11. Croup vs Epiglottitis Croup Epiglottitis Time Course Days Hours
Prodrome
Coryza
None
Cough
Barking
Feeding
Can drink
Mouth
Closed
Drooling
Toxic No
Yes
Fever
<38.5
>38.5
Stridor
Rasping
Soft
Voice
Hoarse
Weak / Silent

12. Whooping Cough Caused by bordatella pertussis Three stages of illness
Catarrhal (1-2 weeks) – fever, cough, coryza
Paroxysmal (2-6 weeks) – barking cough
Convalescent (2-4 weeks) – lesser symptoms which resolve
The barking cough has a characteristic paroxysmal nature with an inspiratory whoop

13. Whooping Cough Investigations:
Eyes – Subconjunctival haemorrhages are indicated
CXR
FBC – Leucocytosis and lymphocytosis
Nasal swab for pertussis
As part of the work up, we need to ensure this is not pneumonia.
Treatment is with erythromycin / clarythromycin
These have limited effect on cough

14. Whooping Cough Admission required if:
Apnoeas
Cyanosis
Paroxysms
Risk of seizures
Patients should isolated for 5 days
Immunize close contacts under the age of 7
Only 90% effective and wanes as child ages
Prophylactic antibiotics to close contacts

15. Bronchiolitis Most commonly due to RSV
Also can be caused by influenza, parainfluenza, adenovirus, rhinovirus and C and M Pneumoniae
Causes problems by:
Invading nasal and pharyngeal epithelium
Spreading to lower airways
Increasing mucus production, desquamation and obstruction
Net effect is hyperinflation and atelectasis

16. Bronchiolitis History Winter months Coryzal illness Dry cough
Worsening SOB
Wheeze
Feeding problems
Apnoeic episodes

17. Bronchiolitis Examination findings Cyanosis or pallor Dry cough
Tachypnoea
Subcostal and intercostal recession
Chest hyperinflation
Prolonged expiration
Respiratory pauses
Wheeze
Crackles

18. Bronchiolitis Treatment mainly supportive
Keep oxygen saturations above 92%
If tachypnoeic when feeding consider NG tube
Bronchodilators (salbutamol, atrovent, adrenaline)
Mechanical ventilation if severe
Reserve antivirals for immunodeficient patients
Prophylaxis is available for preterm or babies with chronic lung problems

19. Pneumonia Lower respiratory tract infection Mostly bacterial
Common pathogens shown below
Age
Pathogen
Neonate
Group B strep
E. Coli
Klebsiella
Listeria
Infants
Strep pneumoniae
Chlamydia
School age
Staph aureus
Group A strep
Bordatella
Mycoplasma pneumoniae

20. Pneumonia Symptoms and Signs High temp Productive cough
Tachypnoea (>50)
Grunting
Recession
Cyanosis
Lethargy
Focal signs / bronchial breathing

21. Pneumonia Investigations NPA FBC Microbiology
CXR (not of mild and uncomplicated)
Pleural fluid if effusion may be indicated

22. Pneumonia Follow local guidelines for treatment
Recommended treatments are
Amoxicillin
Coamoxiclav
Cefuroxime
Antipyretics can also be helpful
IV fluids
Oxygen as required
Physiotherapy is not all that helpful in children

23. Tuberculosis Consider in at risk groups Mantoux test CXR
Specialist referral

24. Summary URTI Croup Epiglottitis Whooping Cough Bronchiolitis PneumoniaTB