Acute infections of the respiratory tract-nose, throat, larynx, trachea, bronchi and alveoli are a common cause of morbidity in children. Though deaths due to acute respiratory infections have become rare due to availability of powerful antimicrobials and good supportive care many children do suffer from severe diseases requiring hospitalization. Air enters the body through the nose where filtration and humidification take place, into the lungs via the wind pipe (trachea). The trachea divides into two branches each entering a lung in the cavity of chest. The bronchi go on dividing and subdividing till they end up in small sac like structures called alveoli where gas exchange-absorption of oxygen and carbon dioxide elimination-takes place.

Infections of airways result in swelling of the wall of the airways. As the airways are narrow in children even slight swelling can cause significant narrowing of airways and difficulty in breathing. Infections of respiratory tract are classified as upper and lower respiratory infections. Upper respiratory infections are more common but less serious and include infections of nose, throat and ear. The usual manifestations one cough, cold and fever. Sometimes nasal block can be quite troublesome.

Viral infections are more common than bacterial. Antibiotics are unnecessary if there is no evidence of bacterial infection. Fever may be controlled with paracetamol which can be given every six hours if necessary. Antitussives (drugs for suppressing cough) may be given if the cough is dry in older children. Nasal decongestants may be given for watery nasal discharge. Medicated steam inhalation is very useful if there is nasal block. Capsules containing liquid medication are available. A capsule can be punctured and the medicine squeezed on the pillow or dress of young children. The vapor from the medicine will have a soothing effect. Infection of the middle ear is very painful and babies go on crying continuously while older children complain of ear ache. If it is not treated promptly the tympanic membrane can rupture due to increased pressure resulting in discharge of pus from the ear.

Lower respiratory infections involve epiglottis (a lid like structures which prevents food from entering the wind pipe), trachea (wind pipe) its divisions and alveoli. They are more dangerous and even life threatening. Epiglottitis (infection of epiglottis) is a serious and potentially fatal disease because the swelling can result in obstruction to flow of air into lungs. The condition manifests as fever, drooling of saliva and a noise when the child breathes in (stridor). The condition requires hospitalization and intravenous medication. Sometimes it may be necessary to put a tube inside the trachea (endotracheal intubation) so that the child can breathe.

The term pneumonia refers to infection within the lung affecting a considerable portion of the lung. On x-ray the affected part is seen as a white patch whereas the normal lung appears dark. This is also a serious condition but fortunately deaths have become rare due to the availability of powerful antibiotics. Children with pneumonia usually need hospitalization and intravenous administration of antibiotics. They may also require oxygen, intravenous fluids if they are not able to take orally and drugs to liquefy the thick secretion inside the lungs so that it can be coughed up easily. Medicines to suppress cough should not be given to children with pneumonia as the infected secretion stays in the lungs instead of getting eliminated and can even cause an abscess (collection of pus).

Indications for immediate consultation
Young infants below three months in whom infection of the respiratory tract can progress rapidly causing serious disease

High fever of 39 degree centigrade or more

Rapid breathing and difficulty in feeding-the rate of breathing is more in infants and young children and if the child appears to breathe faster than usual it indicates significant disease. If the breathing becomes faster the baby will find it difficult to take feeds.

Chest retraction in infants and young children-If the lungs are not expanding normally due to disease the chest is drawn in when the child takes a breath because the negative pressure inside the chest causes the soft and pliant chest wall of young children to cave in.

Frequent vomiting-Any illness causes vomiting in children. If vomiting is frequent the child will not be able to take anything orally and becomes dehydrated which causes drying up of secretions inside the lungs and worsening of the disease.

Arun Kumar Suri is a pediatrician by profession. His website Family Life and Home Based Business is dedicated to various family issues with particular attention to child and adolescent health. The articles on the site look at the common problems in a family from different angles. It stresses the need to lead a balanced life giving equal importance to materialistic and spiritual aspects of life. You can visit his website at http://www.homebusinessandfamilylife.com

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