Respiratory Tract Infections in Children

Be Wary of Pneumonia

July in this part of the world is always synonyms with cold weather. This year, the cold weather did not wait for July to start. By mid-June, the temperatures were dipping very low, a phenomenon that is unusual in the tropics. With this kind of weather, colds, flu and coughs are very common, especially among children below five years of age. It is skeptical because flu and coughs are cardinal signs of the COVID-19 infection raising eyebrows with every sneeze and cough! What may not be known is the number of children who end up with pneumonia, a complication of respiratory tract infection and its consequences.

Today, we shall explore respiratory diseases in children, in particular, pneumonia. Worldwide, respiratory tract infection is the leading cause of unfair illness and death of children under five years. Pneumonia a lower respiratory tracts infection accounts for the majority of the ill-health and deaths. Yet, scientific evidence opines that pneumonia is preventable with cost-effective measures. With this background, let us dive in and explore how we can bridge the health gap and prevent pneumonia in children.

The extents of respiratory disease

Respiratory tract infections encompasses a group of illnesses affecting the upper and lower respiratory tracts.

Upper respiratory tract infections (URTI)

URTI is the most common acute illness seen in children affecting the nostrils, sinuses, pharynx, larynx, and windpipe.  Infections range from mild form of a common cold and sore throats that are self-limiting to the most life-threatening epiglottitis (inflammation of tissues surrounding the windpipe) that blocks the airflow to the lungs.

Lower respiratory tract infections (LRTI) 

On the other hand, LRTI, refers to any infection affecting the lungs. The most common forms of LRTI are pneumonia, bronchitis, and tuberculosis. The diseases of the lower respiratory tracts can affect either the airways in the case of bronchitis or the air pockets as seen in pneumonia.

Pneumonia infection

Pneumonia is the most common and deadliest lower respiratory tract infection with a higher incidence of disease occurrence and fatality. Pneumonia can result from infection by viruses, bacteria, or fungi. Pneumonia infection affects the air sacs by filling them with fluid and mucus leading to difficulty   breathing. A cough or chest pain may be the first indication of sudden onset pneumonia infection.

Transmission of pneumonia

Pneumonia infection can occur when viruses and bacteria harbored in the nasal tract are transported to the lower respiratory tract through inhalation into the lungs causing an infection. Alternatively, pneumonia can be transmitted through droplets from one person to another by sneezing or coughing in overcrowded dwellings.

Features of pneumonia infection

Pneumonia caused by viruses or bacteria has similar clinical features. Manifestation of pneumonia presents with difficulty breathing, cough, high fever, chest pain, lower chest wall in drawing during inhalation, and wheezing. The child is dull, inactive, and does not feed. Poor feeding coupled with high fever can easily lead to loss of body fluids and dehydration. When pneumonia is severe, the child may present with low body temperature (hypothermia), can be unresponsive, has a bluish to gray fingertips and lips, and may have convulsions.

Factors that increase the risk of pneumonia

1. Children with compromised immune system are more prone to pneumonia infection. A Low nutrient diet can lead to malnutrition, a known immune depressant.
2. Children with pre-existing chronic conditions. Pre-existing illnesses like heart disease compromises the immune system rendering the child susceptible to more infections.
3. Children with a compromised immune system due to symptomatic HIV infection. Respiratory tract infections like pneumonia are known opportunistic infections.
4. The living environment of a child can determine their health status and well-being. Poor sanitation coupled with overcrowding increase the risk of pneumonia infection. 
5. Indoor air pollution from biomass sources of cooking fuel (firewood or cow dung) increases the risk of respiratory tracts infections like pneumonia, especially in very young children.
6. Exposure to secondhand tobacco smoking. These are forms of silent smoking where the child inhales fumes and particles of tobacco harbored indoor increasing their risk of respiratory infections.  
7. Children born premature have an under developed respiratory system increasing their risk of respiratory tracts related infections.

Prevention of pneumonia

Prevention of pneumonia is the most cost-effective strategy in controlling respiratory diseases and associated complications. Listed are actionable measures that can significantly reduce the prevalence of pneumonia in children; 

1. Give the child a nutrient-dense diet to meet the demand of a growing infant, strengthen the immunity system, and protect against infections. 
2. Observe personal hygiene by washing hands with soap and water. Young children tend to touch their faces as well, putting their fingers in their mouths. This behavior is likely to introduce pathogenic microorganisms through the mouth leading to infections. 
3.  Cough etiquette is an essential lesson for children. Teach children to cough into the crook of their elbow (cough pocket) whenever they cough or sneeze. This practice helps reduce the contamination of surfaces with micro-organisms.
4. Use of improved cooking stove to reduce indoor air pollution. Women and children are at an increased risk of indoor air pollution through their proximity to the kitchen. 
5. Reduce indoor air pollution through smoking. Tobacco smoke through secondhand and third hand increases the risk of pneumonia. Secondhand tobacco smoking occurs when a child lives in the same house as a smoker and inhales the smoke directly from the person smoking. On the other hand, third hand tobacco smoking occurs when a baby gets in touch with particles of tobacco smoke left in vehicles or rooms used by smokers.
6. Follow a routine immunization schedule for children. Vaccination against measles, pneumonia, and influenza are associated with reduced incidences and severity of pneumonia.
7. Adhere to Prevention of Mother to Child Transmission of HIV (PMTCT) guidelines. Get counseling and testing during pregnancy, practicing safe hospital delivery, closely monitor HIV exposed baby, follow prophylactic protocol, and seek medical attention whenever an infection presents. 
8. Give zinc supplementation to a child with diarrhea. Zinc is known to reduce the severity, duration, frequency, and amount of diarrhea per episode.
9. Practice prompt treatment of children with pneumonia.

When to seek Medical care

Pneumonia is a life-threatening disease that requires adequate and prompt treatment from a qualified health professional. Seek immediate health care when you observe any of the following signs and symptoms;

1. Flaring of the nostril is a dangerous sign signifying difficulty breathing that needs urgent medical attention. 
2. The in-drawing of the chest muscles during inhalation. This is a breathing complication due to compromised lung efficiency.
3. The child has a high fever, restless, and is irritable.
4. The skin color of the child’s lips and fingertips turns blue or gray, a sign of poor oxygenation.