ACUTE RESPIRATORY TRACT

INFECTIONS IN CHILDREN UNDER

FIVE YEARS
Dr. Imran Shaikh
Revised 03/3/16
Revised 21/6/17
Revised 1/8/18

Ref:
1. Management of child with serious infections and malnutrition, chp. 2who.int/child-
adolescent-health/publications/referral_care/chap2/chap2fr.htm
2. Mannual for Child survival management guidelines
 Tender swelling behind the Pus draing from ear less than 2 wks Pus draining for 2 wks or
Earache
ear more
Red immomobile ear drum on
otoscopy

Mastoiditis Acute ear infection Chronic Ear infection

Dry ear by wicking Remove the wick when wet

To dry the ear: Roll clean absorbent cloth/cotton into a wick and Replace it with clean one and repeat the process till ear is dry
place it in the ear
Not able to drink Tender enlarged LN on the Pain on drinking
neck or
White exudate on the throat

Throat Absess Streptococcal ST Viral ST

ARI guidelines in Pakistan reduced child
pneumonia deaths in hospital by 50%
 Seasonal Variation in children under 5 years of age, PHC Centre

70.0

60.0

50.0
Percentage

40.0

30.0

20.0

10.0

0.0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year 2001

Res.Inf Diarr Fever Rash Otitis M

 Pneumonia
 Pneumonia, an infection of the lungs, is usually caused
by viruses or bacteria. Most serious episodes are caused
by bacteria

 Pneumonia is classified as very severe disease, severe

pneumonia or non-severe, based on the clinical features,
with specific treatment for each of them.
 Fast breathing:
 age <2 months: =>60/minute

 age 2-12 months: =>50/minute

 age 12 months to 5 years: =>40/minute

 Nasal flaring

 Grunting
Nasal flaring: with inspiration, the side of the
nostrils flares outwards
 Lower chest wall in-drawing (lower chest wall

goes in when the child breathes in; if only the

soft tissue between the ribs or above the clavicle

goes in when the child breathes, this is not lower

chest wall in-drawing)

 Lower chest wall in-drawing: with inspiration,
the lower chest wall moves in

 Chest auscultation signs of pneumonia:

 Decreased breath sounds

 Bronchial breath sounds

 Crackles
Lower chest wall in-drawing: with inspiration,
the lower chest wall moves in
 CASE STUDY
A five months old child was brought to the PHC center with
complaints of:

 Fever for 2 days

 Cough for 2 days

 Difficulty in breathing for 1 day

On examination:

 Fever 102.4 0 F

 Chest in-drawing & wheezing present

 Respiratory Rate 55 / min

 Severe pneumonia
Diagnosis:

 Cough or difficult breathing plus at least one of the

following signs:

 Lower chest wall in-drawing

 Nasal flaring

 Grunting (in young infants).

 Respiratory rate
Check that there are no signs of very
severe disease, such as:

Central cyanosis
 Inability to breastfeed or drink
 Vomits everything
 Convulsions
 Lethargy
Unconsciousness
 Severe respiratory distress
 hypothermia / hyperthermia
In addition, some or all of the other signs of
pneumonia may also be present:

 Fast breathing:
 age 2-12 months: =>50/minute

 Chest auscultation signs of pneumonia:

decreased breath sounds
 Bronchial breath sounds
 Crackles
Abnormal vocal resonance (decreased
over a pleural effusion, increased over
lobar consolidation
Pleural rub.
 Treatment
• Admit or refer the child to hospital
 CASE STUDY
An eight month old baby was brought to the PHC
center with complaints of:

 Fever for 1 day

 Fast breathing for 1 day
 Cough for 2 days

On examination:
 Respiratory rate 56 / min
 Temp 1000 F
 Chest clear
 Chest in-drawing - ve
 Pneumonia (non-severe)

Diagnosis:
On examination, the child has cough or
difficult breathing and fast breathing:
Age 2-12 months: =>50/minute

Check that the child has none of the signs of

severe or very severe disease (pneumonia)
In addition, other signs of pneumonia (on
auscultation) may be present:
Crackles,
Reduced breath sounds
or
 An area of bronchial breathing.
 Treatment

 Treat the child as an outpatient.

 Give cotrimoxazole (4 mg/kg trimethoprim/20 mg/kg

sulfamethoxazole twice a day) for 5 days or

amoxicillin (15 mg/kg 3 times a day) for 5 days.

 Give the first dose at the clinic and teach the mother

how to give the other doses at home

 Follow-up
 Encourage the mother to feed the child. Advise her to
bring the child back after 2 days, or earlier if the child
becomes more sick or is not able to drink or breastfeed
 When the child returns:

 If the breathing has improved (slower), there is less

fever, and the child is eating better, complete the 5
days of antibiotic treatment
 If the breathing rate, fever and eating have not
improved, change to the second-line antibiotic and
advise the mother to return again in 2 days.

 If there are signs of severe or very severe

pneumonia, admit the child to hospital and treat
according to the guidelines
 CASE STUDY

A child aged 6 months was brought to the PHC

center with complaints of:
Fever for 1 day
Runny nose for 1 day
On examination:
Temp 990 F
Chest Clear
Resp. Rate 46 / min

HOW WOULD YOU CLASSIFY THIS CHILD

ACCORDING TO W.H.O CRITERIA FOR A.R.I ?
 Cough or cold
 These are common, self-limited viral infections that
require only supportive care.
 Antibiotics should not be given
Wheeze or stridor occur in some children,
especially infants.
Most episodes end within 14 days.
Cough lasting 30 days or more may be caused by
tuberculosis, asthma, pertussis
 Diagnosis

Common features:
Cough
Nasal discharge
Mouth breathing
Fever
The following are absent:
 Fast breathing
 Lower chest wall in-drawing
 Stridor when the child is calm
 General danger signs.
 Treatment
Treat the child as an outpatient.
Soothe the throat and relieve the cough with a
safe remedy, such as a warm, sweet drink.
Relieve high fever of =>39oC (=>102.2oF) with
paracetamol, if this is causing distress to the child.
Clear secretions from the child's nose before feeds
using a cloth soaked in water, which has been
twisted to form a pointed wick.
 TAKE CARE:
 Do not give any of the following:
 An antibiotic (they are not effective and

do not prevent pneumonia)

 Remedies containing atropine, codeine or

codeine derivatives, or alcohol (these may

be harmful)
 Medicated nose drops
Clearing child’s blocked nose with cotton wick
or normal saline
 Follow-up
Advise the mother to:
 Feed the child
 Watch for fast or difficult breathing and
return, if either develops

 Return if the child becomes more sick, or is

not able to drink or breastfeed.