The document discusses acute respiratory infections (ARIs) in children, categorizing them into upper and lower respiratory infections, detailing their epidemiology, contributing factors, and treatment options. It highlights the common cold, tonsillitis, bronchiolitis, and pneumonia, emphasizing management techniques and preventative measures, particularly through integrated management strategies like IMNCI. The document aims to improve child health outcomes by addressing early diagnosis, treatment, and family education on health practices.

1. ACUTE
RESPIRATORY
INFECTION
PRSENTED BY- RISHABH
NAHAR
ROHIT
MAHESHWARI

2. CONTENT
 INTRODUCTION
 EPIDEMIOLOGY
 CLASSIFICATION
 FACTORS AFFECTING
 UPPER RESPIRATORY INFECTION
 COMMON COLD
 TONSILITIS
 LOWER RESPIRATORY INFECTION
 BRONCHI LITIS
 PNEUMONIA
 IMNCI
 OBJECTIVE IMNCI
 COMPONENT
 ADVANTAGE OF INTREGETED APPROACH
 REFERENCES

3. ACUTE RESPIRATORY
INFECTIONS
Infections of the respiratory tract are described in
a number of different ways according to the
general areas of involvement in the more
common infections.
The upper respiratory tract or upper airway
consists of primarily of the nose and pharynx.
The lower respiratory tract consists of bronchi
and bronchioles.

4. CHILDREN WITH ARI PRESENTING
IN OPD
Place % of children
London (UK) 35.0
Herston (Australia) 34
Ethiopia (Whole country) 25.5
Sau aulo (Brazil) 41.8
India 38.9
Nepal 37.6

5. EPIDEMIOLOGY
 Varied agents – Bacteria and viruses
 Clinical picture may vary with etiological
agent
 May be present in normal people but
may cause disease in only few.

6. Factors Affecting Acute Respiratory
Infections:
 Nature of infectious agent: The respiratory tract subjected
to a wide variety of infectious agents.
 Age of child: Children of preschool and school age are more
often exposed to infectious agents generally after 3 months of
age infants have less resistance to infections.
 Size of child: Airways are smaller in young children and more
subjected to considerable narrowing from edema.
 Ability to resist invading organisms: School age children
have greater resistance to infection than infants and young
children.

7.  Presence of great conditions:Malnutrition, anemia,
fatigue, chilling of the body and immune deficiencies
decrease normal resistance to infection.
 Presence of disorders affecting respiratory tract:
Allergies, cardiac abnormalities and cystic fibrosis
weaken respiratory defense mechanism.
 Seasons: The most common respiratory tract
pathogens appear in epidemics during winter and
spring months.

8. ARI IS CLASSIFIED
AS-
AURI – Acute Upper Respiratory Infection
(common cold, pharyngitis, epiglottitis, & otitis
media etc.)
ALRI – Acute Lower Respiratory Infection
(laryngitis, bronchitis/ bronchiolitis & pneumonia)

9. UPPER RESPIRATORY TRACT
INFECTIONS;
THE COMMON COLD
 Children average 8 episodes per year, adults 3 episodes per
year
 Etiologies : Rhinoviruses 30 to 35%
Coronaviruses about 10%
Miscellaneous known viruses about 20%
Influenza and adenovirus-30%
Presumed undiscovered viruses up to 35%
Group A streptococci 5% to 10%

10. THE COMMON COLD
 Common symptoms are sore throat, runny
nose, nasal congestion, sneezing.
 Sometimes accompanied by conjunctivitis,
fatigue.
 Sinusitis often present by CT scan;
“rhinosinusitis” might be a better term

11. THE COMMON COLD

12. THE COMMON COLD
CLINICAL FEATURES:-
 Incubation period 12-72 hours
 Nasal obstruction, drainage, sneezing,
scratchy throat
 Median duration 1 week but 25% can last 2
weeks
 Pharyngeal erythema is commoner with
adenovirus than with rhino or coronavirus

13. TREATMENT
• Rapid antigen tests for group A
streptococcus.
• Rapid techniques for influenza,
RSV, para influenza.
• Treat with NSAIDs.
•And prevent from cold atmosphere.

15. UPPER RESPIRATORY TRACT
INFECTIONS :TONSILLITIS
 Tonsillitis is a viral or bacterial infection in the throat that
causes inflammation of the tonsils.
 In the first six months of life tonsils provide a useful
defense against infections. Tonsillitis is one of the most
common ailments in pre-school children, but it can also
occur at any age.
 Children are most often affected from around the age of
three or four, when they start nursery or school and come
into contact with many new infections.
 A child may have tonsillitis if he/she has a sore throat, a
fever and is off food.

16. PALATINE TONSILS
(Visible during oral
examination)

17. CAUSES OF TONSILITIS
 Tonsillitis is caused by a variety of
contagious viral and bacterial infections.
 It is spread by close contact with other
individuals and occurs more during winter
periods.
 The most common bacterium causing
tonsillitis is streptococcus.

18. ADVICE AND TREATMENT:
 Encourage bed rest.
 Introduce soft liquid diet according to the child’s preferences.
 Provide cool mist atmosphere to keep the mucous membranes
moist during periods of mouth breathing.
 Warm saline gargles & paracetamol are useful to promote
comfort.
 If antibiotics are prescribed, counsel the child’s parents
regarding the necessity of completing the treatment period

19. Surgical removal of chronic tonsillitis
(tonsillectomy) is controversial. Generally,
tonsils should not
removed before 3 or 4 yrs of age,
because of the problem of excessive blood
loss & the possibility of
re-growth or hypertrophy of lymphoid
tissue, in young children.
MANAGEMENT

21. LOWER RESPIRATORY
TRACT INFECTIONS
 BRONCHITIS/BRONCHIOLITIS
 PNEUMONIA

22. LOWER RESPIRATORY
TRACT INFECTIONS:BRONCHIOLITIS
 Inflammatory disease of the
bronchioles
 Peak age of onset : 6 months
 Male : female :- 2:1
 Occurs mostly in winter/spring

23. BRONCHIOLITIS :
CLINICAL FEATURES
 Coryza with cough followed by worsening
breathlessness
 Vomiting
 Irritability
 Wheeze
 Feeding difficulty
 Episodes of apnoea

24. A chest X-ray demonstrating lung hyperinflation with a
flattened diaphragm and bilateral atelectasis in the right
apical and left basal regions in a 16-day-old infant with
severe bronchiolitis

25. MANAGEMENT
• TREATMENT
• Mainly supportive
• Prop up (30 – 40 degrees)
• Oxygen inhalation (achieve o2 >92%)
• If tachypneic, limit the oral feeds and use a nasogastic tube
for feeding
• Parenteral fluids to limit dehydration
• Correct resp. acidosis and electrolyte imbalance
• Bronchodilators for wheeze (nebulized adrenaline)
• Mechanical ventilation (severe resp. distress )

26. PREVENTION

27. LOWER RESPIRATORY
TRACT INFECTIONS:PNEUMONIA
-Inflammation of the lung parenchyma and is associated with the consolidation of
the alveolar spaces
-Developed world
-Viral infections
- Low morbidity and mortality
-Developing world
-Common cause of death
-Bacteria and PCP in 65%
-ARI case management WHO
-84% reduction in mortality
-Respiratory rate, recession, ability to drink
-Cheap, oral and effective antibiotics, Co-trimoxazole
-Maternal education

28. PNEUMONIA:
ETIOLOGY
•Vary according to-
Age, immune status, where contracted
•Developing countries
S. pneumoniae, H. influenzae, S aureus
Viruses 40%
Other: Mycoplasma, Chlamydia, Moraxella
•Developed countries
Viruses: RSV, Adenovirus, Parainfluenza, Influenza
Mycoplasma pneumoniae and Chlamydia
Pneumoniae Bacteria: 5-10%

29. PNEUMONIA:
HIGH RISK CHILDREN FOR
PNEUMONIA
•Significant risk factors are younger age (2-6 months), low parental
education, smoking at home, prematurity, low birth weight,
weaning from breast milk at < 6 months, a negative history of
diphtheria, pertussis and tetanus vaccination, anemia,
malnutrition and overcrowding.
•Infection rate higher in siblings of school children who introduce
infection in the household.
•Other risk factors
Immunodeficiency
Cystic fibrosis
Sickle cell disease
Tracheostomy in situ

30. PNEUMONIA:
DANGER SIGNS
•Sign of respiratory distress; nasal flaring & chest
Indrawing
•Younger than 2 months
•Decreased level of consciousness
•Stridor when calm
•Severe malnutrition
•Associated symptomatic HIV/AIDS

31. PNEUMONIA:
SIGNS OF RESPIRATORY DISTRESS

32. PNEUMONIA:
SIGNS OF RESPIRATORY DISTRESS

33. PNEUMONIA:RADIOLOGY
Bacterial
– Poorly demarcated
alveolar opacities with
air bronchograms
– Lobar or segmental
opacification

34. PNEUMONIA:RADIOLOGY
Viral
– Perihilar streaking,
Interstitial changes,
air trapping

35. COMPLICATIONS OF
PNEUMONIA
Empyema
 Lung abscess
 Pneumothorax
 Pleural effusion
 Delayed resolution
 Respiratory failure
 Metastatic septic lesions
 Meningitis
 Otitis media
 Sinusitis

36. PNEUMONIA:TREATMENT
Antibiotics
Under 5 yrs
-First line treatment :- amoxicillin
-Alternatives : coamoxiclav, cefaclor,(for typical)
macrolides (for atypical)
Over 5 yrs
-First line treatment :- Erythromycin 6 hourly daily/ doxacyclin 12 hourly
-Alternatives :-macrolide or flucloxacillin + amoxicillin
-Modrately :-ceftriaxone IV or erythromycin
-severely :-ceftriaxone IV and azithromycin IV ones day

37. PNEUMONIA:TREATMENT
CONT..
•Oxygen
- intranasaly
•Hydration
-50 – 80ml/kg/day
•Temperature control
•Airway obstruction management
•Chest drain :- for fluid or pus collection in chest
(empyema)

38. PNEUMONIA:PROGNOSIS
 Most children recover without residual damage
Incorrect treatment leads to tissue destruction and
Bronchiectasis
Half of children with pneumonia secondary to
measles or adenovirus have persistent airway
obstruction

39. PNEUMONIA:PREVENTION AND CONTROL
OF ARIs
Early diagnosis of pneumonia and the warning signs of
severe disease and prompt management – key factors
which determine the outcome of disease
Guidelines have been given by WHO regarding
management and use of antibiotics.
Recent changes – Management as per the
IMNCI protocol

41. PNEUMONIA:VACCINATION
 MEASLES
 HIB VACCINE
 PNEUMOCOCCAL
PNEUMONIA

42. THE INTEGRATYED
MANAGEMENT OF
NEONATAL AND
CHILDHOOD ILLNESS
(IMNCI)

43. INTRODUCTION
- 10 million children/ year- die in developing
countries due to acute respiratory infections,
diarrhoea, malaria, malnutrition
- 1990-WHO+UNICEF +other agencies- (IMCI)
- India adopted as (IMNCI).
- According to PSM(park)- NFHS.III report highlight that
ARI 17%, Diarrhoea 13%, malnutrition 43%

44. IMNCI HAVE TWO GROUPS OF CHILDREN
0-2 months Young
infants.
2 months to 5 years
Children

45. OBJECTIVE
IMPROVE
GROWTH AND
DEVELOPMENT
DURING THE
FIRST 5 YEARS
OF A CHILD'S
LIFE
REDUCE
FREQUENCY
AND SEVERITY
OF ILLNESS
AND
DISABILITY
REDUCE
MORTALITY

46. Improvement
in the overall
Health System.
Improvement in family
and
community health care
practices.
Health worker
component-
Improved
health in case
management
COMPONENTS IMNCI

47. Principle of IMNCI
1. All sick children under 5 years of age must be
examined for conditions which indicate immediate
referral or hospitalization.
2. Children must be routinely assessed for major
symptoms, nutritional and immunization status,
feeding problems and other potential problems.
3. Based on the presence of selected clinical signs,
the child is placed in a ‘classifications’.
Referral
Treatment in
health facility
Management
at home

48. 4. A limited number of essential drugs are used.
5. Counseling of caretakers about home care
including feeding, fluids and when to return to
health facility
6. IMNCI guidelines address most common but
not all pediatric problems.

49. Care of Newborns and Young Infants
(infants under 2 months)
1. Keeping the child warm.
2. Initiation of breastfeeding immediately after
birth and counseling for exclusive
breastfeeding and non-use of pre lacteal feeds.
3. Cord, skin and eye care.
4. Recognition of illness in newborn and
management and/or referral).
5. Immunization
6. Home visits in the postnatal period.

50. Care of Infants (2 months to 5 years)
1. Management of diarrhea, acute respiratory
infections, malaria, measles, acute ear infection,
malnutrition and anemia.
2. Recognition of illness and at risk conditions and
management/referral)
3. Prevention and management of Iron and Vitamin A
deficiency.
4. Counseling on feeding for all children below 2 years
5. Counseling on feeding for malnourished children
between 2 to 5 years.
6. Immunization

51. IMNCI CASE MANAGEMENT PROCESS
Steps of case management process are the
following:
1. Asses the young infant/ child.
2. Classify the illness.
3. Identify the treatment.
4. Treat the young infant/child.
5. Counsel the mother./ Provide follow up care.

53. ADVANTAGE OF INTEGRATED
APPROACH

54. • Speeds up the urgent treatment and treatment
seeking practices.
• Prompt recognition of serious condition, hence
prompt referral.
• Involves parents in effective care of baby at
home.
• Partial Success of Individual disease control
program.
ADVANTAGES OF
INTEGRATED
APPROACH

55. CONT…
• Involves prevention of diseases by active
immunization, Improved nutrition and
exclusive Breastfeeding practices.
• Highly cost effective.
• It avoids wastages of resources by using
most appropriate medicines and treatment.
• It reduces duplication of effort.

57. REFERENCES
Community medicine and recent advances.- AH
Suryakanta.
Global recommendation on physical health activity for
health.- www.who.int
en.wikipedia.org/wiki/ARI
Textbook of medicine – Davidson
Review of Pharmacology
Medicine text book – review Mathew
www. who.nic.child.imnci