Pediatric Respiratory Disease

Pediatric Respiratory Disease

Pediatric respiratory diseases are common and can range from mild to severe, affecting children of all ages. Common causes include viral and bacterial infections, as well as allergic reactions and asthma. 

Common Pediatric Respiratory Diseases

• Asthma: A chronic inflammatory condition of the airways, causing symptoms like wheezing, coughing, and shortness of breath. 
• Bronchiolitis: Inflammation of the smaller airways (bronchioles), often caused by a virus like RSV. 
• Pneumonia: An infection of the lungs, which can be caused by bacteria, viruses, or fungi. 
• Croup: Inflammation of the larynx and trachea, causing a barking cough. 
• Pertussis (Whooping Cough): A highly contagious respiratory infection caused by bacteria. 
• Acute Respiratory Infections: Common colds, flu, and other viral infections that can lead to respiratory symptoms. 
• Chronic Respiratory Conditions: Conditions like cystic fibrosis and pulmonary hypertension that require long-term management. 

Symptoms of Respiratory Diseases in Children

• Coughing: Can be mild or severe, and may be dry or produce mucus. 
• Wheezing: A high-pitched sound during exhalation, indicating airway obstruction. 
• Shortness of breath or rapid breathing: Indicates difficulty breathing. 
• Chest congestion or tightness: Feeling of tightness or pressure in the chest. 
• Fever: A common symptom of many respiratory infections. 
• Runny or stuffy nose: A common symptom of upper respiratory infections. 
• Sore throat: Can be a symptom of various respiratory illnesses. 

Treatment and Management of Pediatric Respiratory Disease

• Viral infections: Often treated with supportive care, such as rest, fluids, and fever reducers. 
• Asthma: Managed with inhaled bronchodilators, anti-inflammatory medications, and potentially other therapies. 
• Bronchiolitis: Often requires supportive care, such as oxygen and intravenous fluids. 
• Pneumonia: Treated with antibiotics if bacterial, and antiviral medications if viral. 
• Croup: May require inhaled corticosteroids, nebulizers, or hospitalization for more severe cases. 
• Chronic respiratory conditions: Require ongoing medical management and therapy. 

Prevention of Pediatric Respiratory Disease

• Vaccination:Staying up-to-date on vaccinations, such as the flu vaccine and pertussis vaccine, can help prevent respiratory infections. 
• Good hygiene:Washing hands frequently and avoiding contact with sick individuals can help prevent the spread of respiratory viruses. 
• Avoiding smoke and allergens:Reducing exposure to smoke, allergens, and irritants can help prevent respiratory symptoms. 
• Early intervention:If a child has a respiratory illness, it is important to seek medical attention promptly to prevent complications. 

Pediatric Asthma

Pediatric asthma is a respiratory condition in children characterized by variable expiratory airway limitation and persistent respiratory symptoms like wheezing, coughing, and shortness of breath.  It often begins in childhood, with nearly half of infants wheezing in their first year, and most developing persistent asthma by age 6. 

Symptoms of Pediatric Asthma

• Infants and toddlers:Cough may be the only symptom, and symptoms can vary widely. Some may cough only at night, while others experience frequent chest colds. 
• School-age children and teens:May experience shortness of breath, chest tightness or pain, wheezing, waking at night due to asthma symptoms, a drop in peak flow meter reading (if used), and exercise intolerance. 
• Severe asthma attacks:May involve difficulty breathing, wheezing, rapid breathing, rib retractions, and even gasping for breath. 

Diagnosis of Pediatric Asthma

• Physical exam: A doctor will perform a physical exam and take a detailed medical history, asking about symptoms, triggers, and family history.
• Lung function tests: Spirometry, a test where the child blows forcefully into a device, can measure air flow and volume.
• Chest X-rays: May be used to rule out other conditions causing the symptoms. 

Treatment of Pediatric Asthma

• Long-term control medications:Often include inhaled corticosteroids (ICS) to reduce inflammation in the airways and prevent asthma attacks. 
• Quick-relief medications:Such as short-acting beta-agonists, are used to treat asthma attacks when they occur. 
• Trigger avoidance:Identifying and avoiding triggers like allergens, irritants, and infections is crucial. 
• Education and action plans:Children and their families need to understand asthma and how to manage it effectively. 

Asthma is a complex disease with varying degrees of severity, from intermittent symptoms to potentially life-threatening airway compromise. Therefore, a comprehensive approach to diagnosis and treatment is crucial for managing pediatric asthma successfully. 

Pediatric Bronchiolitis

Bronchiolitis is a common lung infection in young children and infants. It causes swelling and irritation and a buildup of mucus in the small airways of the lung. These small airways are called bronchioles. Bronchiolitis is almost always caused by a virus.

Bronchiolitis starts out with symptoms much like a common cold. But then it gets worse, causing coughing and a high-pitched whistling sound when breathing out called wheezing. Sometimes children have trouble breathing. Symptoms of bronchiolitis can last for 1 to 2 weeks but occasionally can last longer.

Most children get better with care at home. A small number of children need a stay in the hospital.

Symptoms of Pediatric Bronchiolitis

For the first few days, the symptoms of bronchiolitis are much like a cold:

• Runny nose.
• Stuffy nose.
• Cough.
• Sometimes a slight fever.

Later, your child may have a week or more of working harder than usual to breathe, which may include wheezing.

Many infants with bronchiolitis also have an ear infection called otitis media.

When to see a Child Specialist

If symptoms become serious, call your child’s health care provider. This is especially important if your child is younger than 12 weeks old or has other risk factors for bronchiolitis — for example, being born too early, also called premature, or having a heart condition.

Get medical attention right away if your child has any of these symptoms:

• Has blue or gray skin, lips and fingernails due to low oxygen levels.
• Struggles to breathe and can’t speak or cry.
• Refuses to drink enough, or breathes too fast to eat or drink.
• Breathes very fast — in infants this can be more than 60 breaths a minute — with short, shallow breaths.
• Can’t breathe easily and the ribs seem to suck inward when breathing in.
• Makes wheezing sounds when breathing.
• Makes grunting noises with each breath.
• Appears slow moving, weak or very tired.

Causes of Pediatric Bronchiolitis

Bronchiolitis happens when a virus infects the bronchioles, which are the smallest airways in the lungs. The infection makes the bronchioles swollen and irritated. Mucus collects in these airways, which makes it difficult for air to flow freely in and out of the lungs.

Bronchiolitis is usually caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by 2 years of age. Outbreaks of RSV infection often happen during the colder months of the year in some locations or the rainy season in others. A person can get it more than once. Bronchiolitis also can be caused by other viruses, including those that cause the flu or the common cold.

The viruses that cause bronchiolitis are easily spread. You can get them through droplets in the air when someone who is sick coughs, sneezes or talks. You also can get them by touching shared items — such as dishes, doorknobs, towels or toys — and then touching your eyes, nose or mouth.

Risk factors of Pediatric Bronchiolitis

Bronchiolitis usually affects children under the age of 2 years. Infants younger than 3 months have the highest risk of getting bronchiolitis because their lungs and their ability to fight infections aren’t yet fully developed. Rarely, adults can get bronchiolitis.

Other factors that increase the risk of bronchiolitis in infants and young children include:

• Being born too early.
• Having a heart or lung condition.
• Having a weakened immune system. This makes it hard to fight infections.
• Being around tobacco smoke.
• Contact with lots of other children, such as in a child care setting.
• Spending time in crowded places.
• Having siblings who go to school or get child care services and bring home the infection.

Complications of Bronchiolitis

• Low oxygen in the body.
• Pauses in breathing, which is most likely to happen in babies born too early and in babies under 2 months old.
• Not being able to drink enough liquids. This can cause dehydration, when too much body fluid is lost.
• Not being able to get the amount of oxygen needed. This is called respiratory failure.

If any of these happen, your child may need to be in the hospital. Severe respiratory failure may require that a tube be guided into the windpipe. This helps your child breathe until the infection improves.

Prevention of pediatric Bronchiolitis

Because the viruses that cause bronchiolitis spread from person to person, one of the best ways to prevent infection is to wash your hands often. This is especially important before touching your baby when you have a cold, flu or other illness that can be spread. If you have any of these illnesses, wear a face mask.

If your child has bronchiolitis, keep your child at home until the illness is past to avoid spreading it to others.

To help prevent infection:

• Limit contact with people who have a fever or cold. If your child is a newborn, especially a premature newborn, avoid being around people with colds. This is especially important in the first two months of life.
• Clean and disinfect surfaces. Clean and disinfect surfaces and items that people often touch, such as toys and doorknobs. This is especially important if a family member is sick.
• Wash hands often. Frequently wash your own hands and those of your child. Wash with soap and water for at least 20 seconds. Keep an alcohol-based hand sanitizer handy to use when you’re away from home. Make sure it contains at least 60% alcohol.
• Cover coughs and sneezes. Cover your mouth and nose with a tissue. Throw away the tissue. Then wash your hands. If soap and water aren’t available, use a hand sanitizer. If you don’t have a tissue, cough or sneeze into your elbow, not your hands.
• Use your own drinking glass. Don’t share glasses with others, especially if someone in your family is ill.
• Breastfeed, when possible. Respiratory infections are less common in breastfed babies.

Immunizations and medicines

In the U.S., respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in children who are less than a year old. Two options for immunization can help prevent young infants from getting severe RSV. Both are recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and others.

• Antibody product called nirsevimab (Beyfortus). This antibody product is a single-dose shot given in the month before or during RSV season. It’s for newborn babies and those younger than 8 months born during or entering their first RSV season. In the U.S., the RSV season typically is November through March, but it varies in Florida, Alaska, Hawaii, Puerto Rico, Guam and other U.S. Pacific Island territories.
• Nirsevimab also should be given to children 8 months through 19 months old who are at higher risk of severe RSV disease through their second RSV season. Higher risk conditions include:
  • Children with active chronic lung disease from being born too soon (prematurely).
  • Children with a severely weakened immune system.
  • Children with severe cystic fibrosis.
  • American Indian or Alaska Native children.
• Vaccine for pregnant people. The FDA approved an RSV vaccine called Abrysvo for pregnant people to prevent RSV in infants from birth through 6 months of age. A single-dose shot of Abrysvo can be given sometime from 32 weeks through 36 weeks of pregnancy during September through January in the U.S. Abrysvo is not recommended for infants or children.

Diagnosis of Pediatric Bronchiolitis

Your child’s health care provider can usually diagnose bronchiolitis by the symptoms and listening to your child’s lungs with a stethoscope.

Tests and X-rays are not usually needed to diagnose bronchiolitis. But your child’s provider may recommend tests if your child is at risk of severe bronchiolitis, if symptoms are getting worse or if the provider thinks there may be another problem.

Tests may include:

• Chest X-ray. A chest X-ray can show if there are signs of pneumonia.
• Viral testing. A sample of mucus from your child’s nose can be used to test for the virus causing bronchiolitis. This is done using a swab that’s gently inserted into the nose.
• Blood tests. Occasionally, blood tests might be used to check your child’s white blood cell count. An increase in white blood cells is usually a sign that the body is fighting an infection. A blood test also can show if the level of oxygen in your child’s bloodstream is low.

Your child’s provider may look for symptoms of dehydration, especially if your child has been refusing to drink or eat or has been vomiting. Signs of dehydration include dry mouth and skin, extreme tiredness, and making little or no urine.

Treatment of Pediatric Bronchiolitis

Bronchiolitis usually lasts for 1 to 2 weeks but symptoms occasionally last longer. Most children with bronchiolitis can be cared for at home with comfort measures. It’s important to be alert for problems with breathing that are getting worse. For example, struggling for each breath, not being able to speak or cry because of struggling to breathe, or making grunting noises with each breath.

Because viruses cause bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — don’t work against viruses. Bacterial infections such as pneumonia or an ear infection can happen along with bronchiolitis. In this case, your child’s health care provider may give an antibiotic for the bacterial infection.

Medicines called bronchodilators that open the airways don’t seem to help bronchiolitis, so they usually aren’t given. In severe cases, your child’s health care provider may try a nebulized albuterol treatment to see if it helps. During this treatment, a machine creates a fine mist of medicine that your child breathes into the lungs.

Oral corticosteroid medicines and pounding on the chest to loosen mucus, a treatment called chest physiotherapy, have not been shown to be effective for bronchiolitis and are not recommended.