Pneumonia in Children

Pneumonia in Children

Pneumonia is the major cause of death in children and also major cause of concern in the developing countries. About one-third of hospital outpatients suffer from acute respiratory infections and almost 30 percent of them are for pneumonia. Majority of the children of developing countries now-a-days die due to pneumonia and its complication.

Pneumonia is the inflammation of lung parenchyma. It is caused by various viruses, bacteria and other organisms. 

S. pneumoniae, H. influenzae and Staphylococcus are the pyogenic bacteria that most commonly cause pneumonia in children.

Pathogenesis

When viral infections disturb the defense mechanism of the lungs there is the alteration of the secretory properties of the lungs and the phagocytic capability is also hampered. In this favorable condition normal bacterial flora is modified and causing disruption of the respiratory tract epithelium. Then bacteria and other organisms invade the respiratory tract and causing inflammation of the lung parenchyma. Microorganisms reaches either via respiratory process or via blood.

Clinical Features

The clinical features of pneumonia are as follows-

1.  Increased respiratory rate.

2. Fever.

3.  Cough.

4.  Chest indrawing.

5.  Cyanosis.

 6.  Difficulty in feeding.

 

Presence of rapid respiratory rate has acceptable sensitivity for clinical diagnosis of pneumonia .

AGE                             RESPIRATORY RATE

Below 2 months               more than 60 breaths/minute

2 to 12 months                 more than 50 breaths/minute

1 to 5 years                      more than 40 breaths/minute

In root level or at your home for diagnosing pneumonia the only realistic feature is rapid respiratory rate.

 

Diagnosis

For diagnosing pneumonia presence of cough and rapid respiration in a previously normal child is sufficient. We can diagnose simply by seeing those features. Additional diagnostic tools doctors usually apply are following:

  • CBC (complete blood count) to find out the evidence of sepsis.
  • Nasopharyngeal aspirate for viral antigen (CMV, Adenovirus, etc.).
  • X-ray of respiratory tract.

 

Treatment of Pneumonia

Treatment can be done at home or at hospital. There are some indications for hospitalization. First we should know when to take our children to hospital:

1.  When the baby is hypoxic i.e. Restlessness, anxiety, cyanosis, Inability to sleep, talk, walk, unconsciousness, seizures –all these symptoms are present.

2.  Features of dehydration (reduced urine output, shunken eye, lethargy etc. )

3.  Poor intake, vomiting.

4.  No improvement/Progressive deterioration in spite of outpatient Treatment.

5.  Presence of high risk factors.

 

Outpatient Management in case of Pneumonia in Children

When we see that the child is not sick and the etiology is viral withhold antibiotics, give only supportive care and follow-up the child. If the clinical features are suggestive of atypical pneumonia start erythromycin or azithromycin i.e. macrolides. In case of other children with suspected pneumonia the preferred antibiotics are oral cotrimoxazole or amoxicillin or cephalexin.

DIET: normal oral diet is advised.

EDUCATION OF PARENTS: About Warning signs of pneumonia.

FOLLOW-UP: The child should be reassessed after 48 hours.

If child shows improvement then continue current treatment , if any deterioration then hospitalize your baby without any delay.

Supportive Care (Pneumonia in Children)

Fever should be treated with paracetamol (10–15 mg/kg/dose) every 4 to 6 hourly. Oxygen should be administered by nasal catheter, nasopharyngeal catheter, oxygen hood or oxygen mask if there is the presence of tachypnea,cyanosis,or chest indrawing. Intravenous fluids should be administered if child is not drinking milk/water or is dehydrated. Oral feeds should be started as soon as possible.

By proper treatment complications like empyema, lung abscess,pyopneumothorax,osteomyelitis,pericardial effusion and sepsis can be avoided. By knowing about pneumonia we can prevent death of our children from pneumonia.

 

Previous Chikungunia Fever and its Signs and Symptoms

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