This document discusses acute respiratory infections (ARIs) in children. It begins by stating that ARIs are a leading cause of childhood morbidity and mortality, especially where medical care is unavailable. It then defines ARIs and classifies them as either upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs). Examples of common URIs are then provided, such as rhinitis, sinusitis, tonsillitis, and laryngitis. Examples of common LRIs in children, such as pneumonia and bronchiolitis, are also described. Finally, the document outlines signs and symptoms of ARIs, diagnostic tests, management approaches, and nursing care considerations for children with ARIs.

1. By – SURESH KUMAR ( Nursing Tutor )
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2. Acute Respiratory Infections
• ARIs in children take a heavy toll on life, especially where
medical care is not available or is not sought. ARI is a leading
cause of childhood morbidity and mortality.
• Acute respiratory infections (ARIs) are defined as acute
infections of any part of respiratory tract or adjuescent
structures. Theses are classified as upper respiratory tract
infections (URIs) or lower respiratory tract infections (LRIs).

3. Upper Respiratory
Tract Infections (URI)
• URIs are the most common infectious diseases. They
include rhinitis (common cold), sinusitis, ear
infections, tonsillitis, acute pharyngitis or tonsillo-
pharyngitis, epiglottitis, and laryngitis—of which ear
infections and pharyngitis cause the more severe
complications (deafness and acute rheumatic fever,
respectively).

4. Upper Respiratory
Tract Infections (URI)
• Rhinitis is inflammation and swelling
of the mucous membrane of the nose,
characterized by a runny nose and
stuffiness and usually caused by the
common cold or a seasonal allergy.
Colds and allergies are the most
common causes of rhinitis.

5. Upper Respiratory
Tract Infections (URI)
• Sinusitis is a common inflammation
of the paranasal sinuses, the cavities
that produce the mucus necessary
for the nasal passages to work
effectively. It can be acute or chronic,
and it can be caused by viruses,
bacteria, fungi & allergies.

6. Upper Respiratory
Tract Infections (URI)
• Acute ear infection is caused by swelling and infection of
the middle ear (otitis media) . The middle ear is located
just behind the eardrum. An acute ear infection starts
over a short period and is painful. Anything that causes
the eustachian tubes to become swollen or blocked makes
more fluid build up in the middle ear behind the eardrum
(middle ear).

7. Upper Respiratory
Tract Infections (URI)
• Tonsillitis is inflammation of the
tonsils, two oval-shaped pads of tissue at
the back of the throat — one tonsil on
each side. Signs and symptoms
of tonsillitis include swollen tonsils, sore
throat, difficulty swallowing and tender
lymph nodes on the sides of the neck

8. Upper Respiratory
Tract Infections (URI)
• Acute pharyngitis is an inflammatory syndrome of the
pharynx and/or tonsils caused by several different groups of
microorganisms. Pharyngitis can be part of a generalized
upper respiratory tract infection or a specific infection
localized in the pharynx.
• Most cases are caused by viruses and occur as part of
common colds and influenzal syndromes.

9. Upper Respiratory
Tract Infections (URI)
• Epiglottitis is inflammation of the epiglottis—the
flap at the base of the tongue that prevents food
entering the trachea (windpipe). Symptoms are usually
rapid in onset and include trouble swallowing which
can result in drooling, changes to the voice, fever, and
an increased breathing rate.

10. Upper Respiratory
Tract Infections (URI)
• Laryngitis is an inflammation of voice box (larynx)
from overuse, irritation or infection. With laryngitis,
the vocal cords become inflamed or irritated. This
makes the vocal cords swell, which distorts the sounds
produced by air passing over them. As a result, voice
sounds hoarse. In some cases of laryngitis, your voice
can become almost undetectable.

11. Lower Respiratory
Tract Infections (LRI)
• The common LRIs in children are pneumonia,
bronchiolitis and sometimes influenza. The respiratory
rate is a valuable clinical sign for diagnosing acute LRI
in children who are coughing and breathing rapidly.
The presence of lower chest wall indrawing identifies
more severe disease

12. Lower Respiratory
Tract Infections (LRI)
• Both bacteria and viruses can cause pneumonia. Bacterial
pneumonia is often caused by Streptococcus
pneumoniae (pneumococcus) or Haemophilus influenzae, mostly
type b (Hib), and occasionally by Staphylococcus aureus or other
streptococci. Other pathogens, such as Mycoplasma
pneumoniae and Chlamydia pneumoniae, cause atypical
pneumonias.

13. Lower Respiratory
Tract Infections (LRI)
• Bronchiolitis occurs predominantly in the first year of life
and with decreasing frequency in the second and third years.
The clinical features are rapid breathing and lower chest wall
indrawing, fever in one-third of cases, and wheezing.
Inflammatory obstruction of the small airways, which leads
to hyperinflation of the lungs, and collapse of segments of
the lung occur.

14. Lower Respiratory
Tract Infections (LRI)
• Even though influenza viruses usually cause URIs in
adults, they are increasingly being recognized as an
important cause of LRIs in children. For most people,
influenza resolves on its own. But sometimes,
influenza and its complications can be deadly such as
young children under age 5, and especially those under
12 months

15. Sign and Symptoms of ARI
• Common sign and symptoms of ARI are-
• congestion, either in the nasal sinuses or lungs
• runny nose
• cough
• sore throat
• body aches

16. Sign and Symptoms of ARI
• fatigue
• fever over 103˚F (39˚C) and chills
• difficulty breathing
• dizziness
• loss of consciousness

17. Diagnostic investigations
Main diagnostic examination for ARI includes-
• Auscultation
• Nasal swab examination
• Sputum examination
• X-ray Examination
• CBC blood test.

18. Management
• Almost all ARIs can be managed medically in OPD.
But in severe cases the child may need hospitalization.
• Bacterial cases may need antibiotics.
• Oxygen inhalation may be needed in severe cases.
• Antipyretics and antitussive bronchodilators may help
as supportive treatment.

19. Nursing Management -
-Observation of respiratory status is very important
nursing care in severe ARI.
-Breathing pattern should be noted for retractions,
nasal flaring use of accessory muscles etc.
- Steam inhalation may be ordered , it should be
provided with care to clear lungs.

20. Nursing Management -
- All the medications and Nebulization should be given as
per schedule. some times postural drainage may be
prescribed, so act accordingly.
- The baby is observed for cyanosis if it occur head end of
the bed should be raised and inform to pediatrician.
- Oxygen inhalation may be prescribed and should be
administered as per recommendation .

21. Nursing Management -
- Provide psychological support to parents to reduce
their anxiety.
- Signs and symptoms of dehydration should be
noted and iv fluids may be given to correct it .
- Nursing management of fever is done in case of
pyrexia which is often seen in severe ARI.

22. Nursing Management -
 Regular diet and more fluids should be given so that nutritional
status and water balance is maintained.
 Breathing exercises and habits should be explained and
encouraged to follow instructions.
Other Nursing interventions – includes all nursing care of
hospitalized child that we have discussed in previous lecture
under heading Nursing care of hospitalized child in the lecture
“Child Health Nursing”.

23. By – SURESH KUMAR ( Nursing Tutor )