Managing acute respiratory tract infections in children

Abstract

Respiratory tract infections (RTIs), including community-acquired pneumonia (CAP), bronchiolitis, viral-induced wheeze and croup, account for more primary care consultations than any other illness group and are the most likely reason for a parent or carer to contact a health professional. The majority of RTIs in fully immunised children are usually self-limiting. However, in a small percentage of children RTIs may become life threatening and it is crucial that all front-line health professionals are able to recognise and identify these children who are at risk of deterioration. To ensure this, fast recognition of symptoms is important, with care taken to exclude any 'red flag' features that may prompt a referral to secondary care. Nurses are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of a single antipyretic medication, how to avoid dehydration in children with RTIs, and the beneficial role of immunisation in preventing infection. It is also important to explain in cases of CAP where antibiotics are necessary about how soon to expect a response, any side effects from antibiotics, and to provide 'safety net advice' on when to consider reassessment for the child. An illustrative case study is included to highlight some of the challenges that are likely to be encountered in clinical practice.

The unmet needs of family caregivers in the management of childhood community-acquired pneumonia in Indonesia: a qualitative study

“…[13][14][15] The ability of caregivers to provide care is an important determinant in avoiding deterioration of symptoms in children. 16,17 In their discharge planning, healthcare professionals need to provide comprehensive information on the care of a child with CAP at home, the scheduling of follow-up appointments, and the prevention of recurrence.…”

Croup

“…3 Parainfluenza is the most common triggering pathogen, but croup can also be caused by Influenza A, Influenza B, adenovirus, respiratory syncytial virus, rhinovirus, and enterovirus. 4,5 During COVID-19, infection with the Omicron variant has been implicated as an additional pathologic agent for croup. 6,7 Less commonly, croup can be caused by bacteria such as Mycoplasma pneumoniae and Corynebacterium diphtheriae.…”

“…This leads to a partial airway obstruction and respiratory distress. 4 Edema of the larynx (voice box) and trachea lead to the symptoms of a…”

“…5 Avoid oral examinations with a tongue depressor because painful or agitating experiences can exacerbate laryngeal edema. 4 Similarly, avoid oral suctioning unless necessary. Cluster care to minimize stress-inducing interactions for the child and focus your physical assessment on the respiratory system: respiratory rate, breath sounds, work of breathing, and mental status.…”

Codetecção de vírus respiratórios endêmicos no contexto pandêmico da covid-19: uma revisão sistemática

“…As infecções respiratórias, em geral, podem cursar desde quadros clínicos assintomáticos ou leves, tal como síndrome gripal (SG), até apresentações mais complexas que podem resultar em síndrome respiratória aguda grave (SRAGS) e em seus potenciais desfechos como admissão em unidades de terapia intensiva, necessidade de suporte ventilatório e óbito (BRUCE et al, 2017). Um dos grandes desafios relacionado às infecções respiratórias agudas configura-se a sua apresentação clínica não exclusiva, ou seja, o diagnóstico molecular acaba sendo uma medida muito importante para que se possa gerir o controle da infecção bem como subsidiar decisões terapêuticas farmacológicas, quando as mesmas se aplicam (HUANG et al, 2018).…”