Why is my child having Recurrent Chest Infections?

Acute respiratory infections are the most common reason for consultation with a paediatrician. In addition, acute respiratory infections constitute the most important reason for hospital admission for children. Some children get repeated respiratory infections, which leads to significant concern to parents. In this article we shall discuss the causes of repeated respiratory infections in children, red flag signs when the parents should be worried and how do we evaluate such cases.

Why is my child having Recurrent Chest Infections?

What are the causes of repeated respiratory tract infections in children?
Children who have repeated respiratory infections can be divided into 3 groups. The first and the most common is children having repeated upper respiratory tract viral infections. The second group of children are those having repeated episodes of wheezing or asthma like symptoms. The third group of patients are those having true episodes of pneumonia. It is extremely important to distinguish between these three groups of patients since the plan of evaluation, investigation and treatment is completely different.

Children who get repeated episodes of pneumonia can have many causes. These cases could be immune deficiency disorders, suppurative lung disease, bronchiectasis, cystic fibrosis, primary ciliary dyskinesia, gastroesophageal reflux disease and aspiration syndromes.

What are the red flags signs in children who are having repeated episodes of respiratory infections?
Most children who have repeated respiratory tract viral upper respiratory infections or have asthma like episodes are usually well and do not have any other problems. In children who have additional signs and symptoms, such as those mentioned below can be an indicator of an underlying serious problem.

These red flag signs or markers of an underlying serious disease could failure to thrive or poor weight gain, repeated hospital admissions, serious infections, pneumonias since very early infancy, persistent wet cough for more than 4-8 weeks, persistent changes on xray chest, history of aspiration of a foreign body and history of choking.

What investigations are needed?
Children who get repeated upper respiratory tract viral infections usually do not require any testing. A good clinical history and examination is enough to make a diagnosis. Usually, these infections are self limiting, mild in severity, and worse in winter. Children are usually well in between the episodes and recovery from the episodes is usually complete. These children have normal growth parameters and a normal physical examination. These kids have no other problem in addition to these viral respiratory infections.

Children who have repeated episodes of wheezing or asthma-like symptoms require minimal investigations. These investigations are usually in the form of a chest X-ray, X-ray of sinuses and a lung function test for assessing the degree of obstruction.

Children who have repeated episodes of pneumonia are a heterogeneous group of patients. Investigations into these children are based on a case to case basis. Investigation that might be required in such children CT scan of the chest, bronchoscopy, sweat chloride, test for evaluation of aspiration and tests for immunodeficiency.

How do we manage children who are getting repeated respiratory infections?
Children who are having repeated episodes of upper respiratory infections usually do not require many medicines. It is important to understand that these respiratory infections are viral in nature and are self-limiting. Avoiding extra medicines, including antibiotics and nebulization is important. Children who have repeated episodes of wheezing or asthma-like symptoms require preventive medicines in the form of inhaled corticosteroids given with the inhaler and spacer, with or without a mask. This can lead to significant improvement in symptoms, reduce the number of flares or exacerbations and significantly improves the quality of life. Treatment of children who have repeated episodes of pneumonia are treated based on a particular diagnosis on a case to case basis.

In case your child is having repeated respiratory infections, you need to get in touch with the child pulmonologist for a proper evaluation and management.

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