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Childhood Respiratory Tract Infections: When Should you be Concerned?

Childhood Respiratory Tract Infections: When Should you be Concerned?

The new year is already in full swing and before we know it, the change of season from summer to autumn will be underway. According to health experts, a change in temperature can divert the immune system from its task of protecting our health[1] and this is when children become prone to illness.

Children develop an average of six viral respiratory tract infections each year[2]. These can affect either the upper respiratory system, which includes the nose, sinuses, pharynx and larynx, or the lower respiratory system, which includes the trachea, bronchial tubes, bronchioles and lungs.[3]

Says Allison Vienings, Executive Director of the Self-Medication Manufacturers Association of South Africa (SMASA), “While upper respiratory tract infections leave children feeling congested and tend to result in a cough and runny nose, lower respiratory infections in children under five often show more serious symptoms such as shortness of breath, wheezing and rapid breathing, and usually require a visit to a doctor.”[4]

What are common upper respiratory tract infections?

Upper respiratory tract infections occur most often in autumn and winter. Unless a bacterial infection is suspected, antibiotics are seldom used to treat this type of infection. [5]

The common cold is a viral infection. Symptoms include a runny nose, sore throat, cough, watery eyes, sneezing, and congestion.[6]

Influenza or flu is a viral infection affecting the nose, throat and lungs.[7] Symptoms include a temperature over 38° C, sore muscles, chills and sweats, a headache, dry cough, and nasal congestion.[8]

Tonsillitis is inflammation of the tonsils caused by a viral or bacterial infection. Symptoms include swollen tonsils, a sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. Appropriate treatment depends on the cause, so it is important to get an accurate diagnosis.[9]

Pharyngitis is the inflammation of the throat (pharynx). The primary symptom is a sore throat, which can include scratchiness or irritation that worsens when you swallow.[10]

Croup is an infection of the upper airway. The associated barking cough is the result of inflammation around the vocal cords, windpipe and bronchial tubes. Children suffering from croup often produce a high-pitched whistling sound (stridor) when they inhale.[11]

What are common lower respiratory tract infections?

Lower respiratory tract infections occur below the level of the larynx[12] and include pneumonia, bronchitis and bronchiolitis.

Pneumonia causes inflammation of the air sacs in one or both lungs. These may fill with fluid or pus, causing a cough with phlegm or pus, fever, chills and difficulty breathing. Pneumonia can be caused by bacteria, viruses and fungi.[13]

Bronchitis is an inflammation of the lining of the bronchial tubes. Children with bronchitis often cough up thick, discoloured mucus.[14]

Bronchiolitis causes congestion in the bronchioles in the lungs. Symptoms are similar to those of the common cold in the early stages, but can later include coughing, wheezing and sometimes difficulty breathing.[15]

Prevention is always better than cure and some of the most effective ways of preventing respiratory tract infections in children include practising good hygiene (washing their hands regularly), boosting their immune systems with daily doses of vitamin C and echinacea, and ensuring that they enjoy a healthy, balanced diet that includes at least five portions of fruit and vegetables a day and limits too much fat and sugar, which compromise the immune system.

“Unfortunately, despite our best efforts, preventative methods are not always enough to keep germs at bay,” says Vienings. “But, there are many effective ways to treat the symptoms of respiratory tract infections,” she continues. “Placing a wedge underneath your child’s pillow to elevate him or her to a 45-degree angle (elevate the bed for older children) will help him or her dispel the mucus and breathe more easily, pushing fluids like cooled boiled water or diluted fruit juice will prevent dehydration, while rehydration solutions from your pharmacy will make a big difference to your child’s energy levels and recovery. There are also some excellent over-the-counter medications that can help treat the symptoms of respiratory tract infections,” she concludes.

Over-the-counter treatments

Paracetamol or ibuprofen help with pain and fever, but avoid giving aspirin to children under the age of 16, and always follow the manufacturer’s instructions.

Saline nasal sprays or nasal drops work well for a blocked nose. However, avoid using a nasal spray for longer than 5–7 days as the nose can feel as though it is becoming more blocked. This is known as the rebound effect.[16 

A paediatric cough syrup can help loosen a tight chest, but is not recommended for infants under the age of three months.

When is it time to visit your doctor?

  • When your child has a temperature over 39° C.
  • If symptoms don’t improve within three to five days, last more than 10 to 14 days, or 
deteriorate suddenly.
  • If your child is experiencing severe pain or discomfort.
  • If your child displays signs of lethargy and ‘floppiness’.
  • If your child takes in less fluid and urinates less than three times a day – this is a sign of 
dehydration.
  • If your child displays respiratory distress or fast breathing and uses rib/tummy muscles to aid breathing.
  • If your child improves, but then develops a high fever again.
  • If your child’s nose produces lots of thick green/yellow fluid.