This document discusses acute respiratory tract infections in children. It provides details on a case of a 15 month old boy presenting with rhinorrhea, cough, fever and breathing difficulty. It discusses the classification, signs, and management of acute respiratory tract infections according to the WHO IMNCI protocol. The key points are: acute respiratory infections are a leading cause of death in children under 5 worldwide. Clinical assessment involves checking breathing rate, chest indrawing, fever and other danger signs. Conditions are classified as no pneumonia, pneumonia, severe pneumonia or very severe disease depending on symptoms. Management ranges from home care to hospitalization and antibiotics depending on severity of illness.

2. ACUTE RESPIRATORY TRACT
INFECTIONS
IMNCI Protocol (WHO)
(Integrated Management Of Neonatal and
Childhood Illnesses)
Prep & Presented by Dr. Zujaja Baloch
Instructed by Lt Col Jawad Jalil

3. History
Name: XYZ (Male)
Age: 15 months
Address: Gujranwala
DOA: 10 dec 2014
DOD: 14 dec 2014
Source: OPD

4. History (Cont)
• Presenting compliants:
Rhinorrhea 7 days
Cough 6 days
Fever 4 days
Breathing Difficulty 2 days

5. History (Cont)
• Birth History :
Antenatal History: Booked Case.
Natal History: FTP & SVD, delivered in Hospital.
Post Natal: Cried after birth, no jaundice or cyanosis
• Feeding History :
Exclusively Breast fed for 6 months & weaning started.
• Vaccination History :
Vaccinated according to EPI Schedule

6. History (Cont)
• Developmental History:
Gross Motor, Fine Motor & Social Development was fine
• Family History:
Non consangious marriage.
No history of asthma, epilepsy, TB or congenital heart diseases.
• Socioeconomic history :
Middle class family.

7. Examination
• General physical examination :
Apprehensive, Irritable
Mildly dehydrated
Nasal flaring
Weight 10 kg
• Vital Signs :
Pulse : 150 / min
Respiratory Rate 64 / min
Temperature 102°F

8. Systemic examination
• Respiratory system examination :
R/R: 64 / min
Chest in drawing
Nasal flaring
Recessions
• CVS examination
• GIT examination Normal
• CNS examination

9. Investigation
• Complete Blood Picture:
Hb 11.4 g/dl
TLC 7 × 10 / L
• Chest X – Ray :
Normal findings
9

10. DIAGNOSIS
Acute Respiratory Tract Infection
(Bronchiolitis)

11. Treatment
• Anti pyretic :
Paracetamol 5 ml—(SOS)
• Nebulization:
Ipratropium (Atem) 6 hourly.
• Discharged on 3rd day

12. Case discussion

15. Epidemiology
•Each year, acute respiratory
infections cause approximately 2-3
million deaths among children <5
years old and are the leading cause of
death in this age group.

16. ARI
• ARI is the most common of the human
ailment.
• It runs a natural course and mostly settles
without treatment and complications.
• In young infants, children and elderly there is
increased morbidity and mortality.

17. TYPES
• Acute Upper Respiratory Infections.
Mild cough, cold, pharyngitis, otitis media, and
allergic rhinitis.
• Acute Lower Respiratory Infections.
Laryngotracheitis, bronchitis, bronchiolitis,
pneumonia.

19. RISK FACTORS
• Low Birth Weight
• Malnutrition
• Specific nutritional deficiencies
• Climatic conditions
• Housing (over crowding, poor housing
conditions)
• Level of Industrialization
• Socio-economic Level
• Pollution
• Smoking

21. CLINICAL ASSESSMENT
• 1.BREATHING RATE/MINUTE.
• 2.LOOK FOR CHEST INDRAWING.
• 3.LOOK AND LISTEN FOR STRIDOR.
• 4.LOOK FOR WHEEZE.
• 5.LOOK IF THE CHILD IS DROWSY.
• 6.FEEL FOR FEVER.
• 7.CHECK FOR SEVERE MALNUTRITION.
• 8. LOOK FOR CYANOSIS.

22. SIGNS OF RESPIRATORY DISTRESS

23. Nasal Flaring

24. SIGNS OF RESPIRATORY DISTRESS

25. Chest In drawing

26. CLASSIFICATION OF ILLNESS
• Child aged (0- 2 months)
→ Very severe disease.
→ Severe Pneumonia.
→ No Pneumonia: cough or cold.

27. CLASSIFICATION OF ILLNESS
• 2 months up to 5 years.
→Very severe disease.
→ Severe Pneumonia.
→ Pneumonia not Severe.
→ No Pneumonia: cough or cold.

28. O-2 Months
• PNEUMONIA :
Fast breathing without chest in drawing
• SEVERE PNEUMONIA :
Respiratory rate
60 or more/minute
Chest in drawing
Nasal flaring
Grunting
Cyanosis

29. 0-2 months
• VERY SEVERE DISEASE
→ Danger signs
Convulsions
Stridor
Stopped feeding well
Wheezing
Fever/ Low body temperatures

30. 2-5 yrs
• NO PNEUMONIA :
cough or cold
• PNEUMONIA NOT SEVERE :
Fast breathing without chest in drawing

31. 2-5 yrs
• SEVERE PNEUMONIA :
Chest in drawing
Nasal flaring
Grunting
Cyanosis
Fast breathing
• Age 2 -12 months R/R : 50 or more/ min
• Age 1- 5 years R/R : 40 or more/ min

32. 2-5 YRS
• VERY SEVERE PNEUMONIA :
Child is unable to drink
Convulsions
Strider in the calm child
Severe malnutrition

33. WHO Classification and management
NO PNEUMONIA COUGH
NO TACHYPNEA
-HOME CARE
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 5 DAYS IF NOT
IMPROVING
PNEUMONIA -COUGH
-TACHYPNEA
-NO RIB OR STERNAL RETRACTION
-ABLE TO DRINK
- NO CYANOSIS
-HOME CARE
-ANTIBIOTICS FOR 5 DAYS
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH
-TACHYPNEA
-RIB AND STERNAL RETRACTION
-ABLE TO DRINK
-NO CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
VERY SEVERE PNEUMONIA -COUGH
-TACHYPNOEA
-CHEST WALL RETRACTION
-UNABLE TO DRINK
-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-OXYGEN
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT

36. THANK
YOU