Acute respiratory infections in children

Basic facts

• About 20% of all deaths in children under 5 years are due to Acute
Lower Respiratory Infections (ALRIs - pneumonia, bronchiolitis and
bronchitis); 90% of these deaths are due to pneumonia. Early
recognition and prompt treatment of pneumonia is life saving.
• Causative organisms may be bacterial (most commonly Streptococcus
pneumoniae and Haemophilus influenzae) or viral. However, it is not
possible to differentiate between bacterial and viral ARIs based on
clinical signs or radiology.
• Low birth weight, malnourished and non-breastfed children and those
living in overcrowded conditions are at higher risk of getting
pneumonia. These children are also at a higher risk of death from
pneumonia

Case management of ARI in children 2 month to 5 years

• Assessment, classification and treatment of ARI are summarized on

the attached charts. All children presenting with cough or difficult
breathing should be assessed according to these charts.
• All children should also be assessed for signs of severe malnutrition -
visible severe wasting and oedema of both feet. Children with any of
these signs must be referred to a hospital as they are at a very high
risk of death from pneumonia.
• Children with danger signs should be referred to a hospital after a
single dose of IM chloramphenicol. In situations where referral is not
possible, twice daily injections of IM chloramphenicol should be
continued for 5 days, followed by oral antibiotic therapy for another 5
days.
• Children with severe pneumonia should be referred to a hospital for
treatment with IM ampicillin/penicillin. In situations where referral is
not possible, these children can be treated with oral amoxicillin given
thrice daily for 7 days. Oral amoxicillin has recently been shown to be
effective in treatment of severe pneumonia.
• Children with non-severe pneumonia should be given antibiotics for 5
days. The new Emergency Health kits contain co-trimoxazole, which is
a low-cost broad spectrum antimicrobial. An alternative is oral
amoxicillin.
• Supportive measures include increased oral fluids to prevent
dehydration, continued feeding to avoid malnutrition and anti-pyretics
to reduce high fever.
Case management of ARI in young infants 0-2 months

• Signs of pneumonia, sepsis and meningitis are difficult to differentiate

in a young infant less than 2 months of age.
• Young infants with fast breathing or chest indrawing should be
suspected to have serious bacterial infection. These infants should be
referred to a hospital and treated with IM ampicillin/penicillin and
gentamicin for 10 days. In situations where referral is not possible,
oral amoxicillin or co-trimoxazole twice daily with IM gentamicin once
daily should be given for 10 days.

PNEUMONIA

Pneumonia
RELATED DIAGNOSTIC TESTS:

Crackles are heard when listening to the

chest with a stethoscope (auscultation).
DEFINITION:
Tests include: chest X-ray, sputum gram
stain, CBC, arterial blood gases. This
An inflammation of the lungs caused by an
disease may also alter the results of the
infection.
following tests: thoracic CT, routine
sputum culture, pulmonary
ventilation/perfusion scan, pleural fluid
culture, lung needle biopsy .
ETIOLOGY:

Pneumonia is a very common, serious The goal of treatment is to cure the

illness and affects about 1 out of 100 infection with antibiotics. If the
people each year. It is caused by many pneumonia is caused by a virus,
different organisms and can range in antibiotics will not be effective.
seriousness from mild to life-threatening Supportive therapy includes oxygen and
illness. There are different categories of respiratory treatments to remove
pneumonia. secretions.

PATHOPHYSIOLOGY: NURSING MANAGEMENT:

 Ø Pt will need to have breath sounds

monitored q 4° to determine if
There are different categories of pneumonia is progressing.
pneumonia. Two of these types are
hospital-acquired and community-acquired. Ø O2 sats should be done regularly (
Common types of community-acquired at least q4°during acute phase) to make
pneumonia are pneumococcal pneumonia sure that patient is getting adequate
and Mycoplasma pneumonia. In some perfusion.
people, particularly the elderly and those
who are debilitated, pneumonia may follow
influenza. Hospital-acquired pneumonia  Ø Make sure to give all scheduled
tends to be more serious because defense antibiotics on schedule so that
mechanisms against infection are often therapeutic ranges are maintained.
impaired. Some of the specific pneumonia-
related disorders include:  Ø Any s/s of infection must be
monitored and reported to MD.
aspiration pneumonia, pneumonia in
immunocompromised host and viral
pneumonia

SIGNS & SYMPTOMS: HEALTH DEVIATION SELF-CARE

REQUISITES:
 Cough (with mucus-like, greenish, or pus-  ü Pt will need to continue on
like sputum scheduled antibiotics after discharge.
Teaching may be necessary to inform
chills with shaking ), fever, easy fatigue, patient of therapeutic ranges and need to
take all of meds, even if they are feeling
chest pain (sharp or stabbing better.
increased by deep breathing or increased by
 ü Pt will need to get a
coughing), headache, loss of appetite, PneumonoVax (if does not all ready
nausea and vomiting, general discomfort, have0 to help prevent future outbreaks
uneasiness, or ill feeling (malaise), joint of pneumonia.
stiffness (rare), muscular stiffness (rare),
rales  ü Pt will need to be taught S/S of
infection and when to report to MD.
Additional symptoms that may be
associated with this disease: shortness of
breath, clammy skin, nasal flaring,
coughing up blood, tacypnea, apnea,
anxiety, stress, and tension, abdominal pain
.

. How does a child get pneumonia?

A child may get it if:

i. he has not been vaccinated, especially against measles and whooping cough;
ii. he is not breast-fed during the first six months;
iii. he is being brought up in a dirty environment;
iv. he stays in a crowded place, especially where there are people with air passage and
lung infections;
v. people sneeze or cough without covering their mouth;
vi. people spit on the ground;
vii. he is not kept warm when the weather is cold;
viii. he breathes in dust or smoke.
3. What should we do to prevent a child from having pneumonia?
i. Make sure he gets all the vaccinations, especially those against measles and whooping
cough. from the health centre.
ii. Give him breast milk in the first 6 months of life.
 iii. If he is more than 6 months old, in addtion to breast milk, feed him well with
nutrient-rich and energy-rich foods, such as milk, cereals, vegetables, beans, fish, meat, egg
and fresh fruit juices.
iv. Keep him warm when the weather is cold.
v. Don't expose him to smoke or dust.
vi. Don't let him sleep in a crowded room, especially if there are people with infections
there.
vii. Make sure people around him cover their mouth and nose when they cough or sneeze;
and
viii. Tell them not to spit on the ground.
ix. Mothers should keep their babies and themselves clean always.