This document provides an overview of lower respiratory tract infections (LRTI) in children. It covers the epidemiology, pathophysiology, clinical presentation, diagnosis, and management. The most common causes of LRTI in children are viral infections like respiratory syncytial virus (RSV) and bacterial infections such as Streptococcus pneumoniae. Clinical features vary by age but may include fever, cough, tachypnea, grunting, and hypoxia. Diagnosis is usually based on symptoms and physical exam. Most children can be treated as outpatients with supportive care and antibiotics when indicated. Severe cases requiring hospital admission include those with hypoxia, respiratory distress, or comorbidities. Complications are rare but may include
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
THESE SLIDES ARE PREPAREED TO UNDERSTAND CHILD HEALTH DISORDERS IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #HEALTH,#NEW,#BORN,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICER
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
THESE SLIDES ARE PREPAREED TO UNDERSTAND CHILD HEALTH DISORDERS IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #HEALTH,#NEW,#BORN,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICER
Clinical features, mechanism of development of cow milk protein allergy.
Diagnostic algorithm and review of available data about cow milk protein allergy.
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
1. Dr.Osama Felemban MBBS DCH CABP AFSA CPPF
Consultant Pediatric Pulmonology
Clinical Assistant Professor
Pediatric Department
King Abdulaziz University Hospital
Faculty of Medicine
KAU
3. 1- Over view
LRTI : infection below the level of larynx
Larynogotracheobronchitis
Bronchitis
Bronchiolitis
Pneumonia
4. 2- Epidemiology
The estimated incidence of LRTI is 30 per 1,000 children
per year in the UK.
Boys affected > than girls, (children born between 24-28
weeks compared to born at term.)
Haemophilus influenzae infection is uncomon because of
immunization.
5. 3 - Pathophysiology
Essentially, it is inflammation of the airways/pulmonary
tissue, due to viral or bacterial infection, below the level
of the larynx.
Gastro-oesophageal reflux may cause a chemical
pneumonitis.
Smoke and chemical inhalation may cause pulmonary
inflammation
10. Bacterial infection :
Streptococcus pneumoniae (the majority of bacterial
pneumonias)
H. influenzae
Staphylococcus aureus
Klebsiella pneumoniae
Enterobacteria - eg, Escherichia coli
Anaerobes
11. Atypical organisms
Mycoplasma pneumoniae
Legionella pneumophila,
Chlamydophila pneumoniae
Secondary bacterial infection
relatively common following viral upper respiratory tract infection (URTI)
or LRTI.
12. 4 - Clinical Presentation
typical viral URTI
Fever
Bacterial pneumonia :++ in children (persistent or repetitive
fever > 38.5°C) with chest recession and a raised resp.rate
Audible wheezing is not seen very often in LRTI (common
with more diffuse infections ; M. pneumoniae and
bronchiolitis).
Stridor or croup suggests URTI, epiglottitis or foreign body
inhalation.
13. 5 – Clinical Approach
History :symptoms of LRTI is variable with age
Newborn and neonates present with:
Grunting
Poor feeding
Irritability or lethargy
Tachypnoea ±
Fever (±Hypothermia)
Cyanosis (in severe infection)
Cough (±)
In this age group beware:
Particularly of streptococcal sepsis and pneumonia in the first 24 hours
of life
Chlamydial pneumonia, which may be accompanied by chlamydial
conjunctivitis (presents in the second or third week)
14. History
Infants present with:
Cough (the most common symptom after the first four weeks)
Tachypneic (according to severity)
Grunting
Chest indrawing
Feeding difficulties
Irritability and poor sleep
Breathing, which may be described as 'wheezy' (but usually upper
airway noise)
History of preceding URTI (very common)
Atypical and viral infections (especially pneumonia) may have
only low-grade fever or no fever
15. Toddlers/pre-school children:
Preceding URTI is common
Cough is the most common symptom
Fever occurs most noticeably with bacterial organisms
Pain (chest and abdominal)
Vomiting with coughing is common (post-tussive vomiting)
Lower lobe pneumonias can cause abdominal pain
16. Older children:
There will be additional symptoms to those above
More expressive and articulate children will report a wider
range of symptoms
Constitutional symptoms may be variable described
Atypical organisms are more likely in older children
17. Physical Examination
General points:
Examination can be difficult in young children
(particularly auscultation)
A careful routine of observation is essential to identify
respiratory distress
Pulse oximetry can be very useful in evaluation.
High fever over 38.5°C may occur often
18. signs of respiratory distress:
Cyanosis in severe cases
Grunting
Nasal flaring. In children aged under 12 months this can
be a useful indicator of pneumonia
Marked tachypnoea
Chest indrawing (intercostal and suprasternal recession)
Other signs ;subcostal recession, abdominal 'see-saw'
breathing and tripod positioning
Reduced oxygen saturation (less than 95%)
19. Observation:
In good light, with the chest and abdomen uncovered, is essential
Count respirations and note the respiratory rate (RR)
Newborn 30-60/minute
Infant 20-30/minute
Toddler 20-30/minute
Child 15- 20/ minute
Observe the infant's feeding (to uncover decompensation during
feeding)
Observe the chest movements (for example, looking for splinting of
the diaphragm)
20. Auscultation:
Examine with warm hands and a stethoscope
Take the opportunity to examine a quiet sleeping child
Upper respiratory noises can be identified by listening at
the nose and chest
Crepitations in the chest may indicate pneumonia, +
when accompanied by fever
21. Percussion:
Identifies consolidation
Consolidation is a later and less common finding than
the crepitation of a pneumonia
Later in older children there may be dullness to
percussion over zones of pneumonic consolidation
Bronchial breathing and signs of effusion occur late in
children and localization of consolidation can be difficult
to diagnose
23. 7 - Investigations
CBC:
White cell count is often elevated.
Microbiological studies:
Blood cultures are seldom positive in pneumonia (fewer
than 10% are bacteraemic in pneumococcal disease).
Sputum culture
Imaging:
Chest radiography (CXR) is not routinely indicated in
outpatient management.
CXR cannot differentiate reliably between bacterial and
viral infections.
24. Other tests:
Tuberculin skin testing if tuberculosis is
suspected.
Cold agglutinins when mycoplasmal infection
is suspected (50% sensitive and specific).
ESR , CRP
Diagnostic procedures:
Drainage and culture of pleural effusions may
relieve symptoms and identify the infection.
25. 8 - Management
Most children with lower respiratory tract infection
(LRTI) and pneumonia can be treated as outpatients,
with oral antibiotics.
Older children can be managed with close observation
at home if they are not distressed or significantly
dyspnoeic and parents can cope with the illness.
Viral bronchitis and croup do not require antibiotics
and mild cases can be treated at home
26. Admission of severe LRTI :
Oxygen saturation <92%
Respiratory rate >70 breaths/minute (≥50 breaths/minute in an older
child)
Significant tachycardia for level of fever
Prolonged central capillary refill time >2 seconds
Difficulty in breathing as shown by intermittent apnea, grunting and
not feeding
27. Presence of comorbidity :
congenital heart disease,
chronic lung disease of prematurity,
chronic respiratory conditions such as
- cystic fibrosis,
- bronchiectasis or
- immune deficiency
28. Admission should also be considered for:
All children under the age of 6 months
Children in whom treatment with antibiotics has failed (most
children improve after 48 hours of oral, outpatient antibiotics)
Patients with troublesome pleuritic pain
29. Be sure to offer the patient and parents general support,
explanation and reassurance.
Respiratory support as required, including oxygen
Pulse oximetry to guide management
Severe respiratory distress with ↓level of consciousness
and failure to maintain oxygenation indicates a need for
intubation
31. 9 - Complication & prognosis
Complete resolution after treatment should be expected in
the vast majority of cases.
Bacterial invasion of the lung tissue can cause pneumonic
consolidation, septicemia, empyema, lung abscess
(especially S. aureus) and pleural effusion.
Respiratory failure, hypoxia and death are rare unless
there is previous lung disease or the patient is
immunocompromised.
32. 10 - Prevention
Prevention of pneumococcal pneumonia and influenza by
vaccination, for high-risk individuals with pre-existing
heart or lung disease.
Smoking in the home is a major risk factor for all
childhood respiratory infection.
33. 11 - Take Home massages
Understanding the pathophysiology of LRTI
Conducting proper History
Performing careful physical Examination
Comprehension the Impact of the disease on the family
Close follow up after discharge
Avoidance of bad Habit : Smoking
34. 12 - References
Guidelines for the management of community acquired pneumonia in children;
British Thoracic Society (2011)
Pediatric Essntial Nelsom 2011
van Woensel JB, van Aalderen WM, Kimpen JL; Viral lower respiratory tract
infection in infants and young children. BMJ. 2003 Jul 5;327(7405):36-40.
Michelow IC, Olsen K, Lozano J, et al; Epidemiology and clinical
characteristics of community-acquired pneumonia in hospitalized children.
Pediatrics. 2004 Apr;113(4):701-7.
Krilov LR; Respiratory syncytial virus disease: update on treatment and
prevention. Expert Rev Anti Infect Ther. 2011 Jan;9(1):27-32.
Feverish illness in children - Assessment and initial management in children
younger than 5 years; NICE Guideline (May 2013)
Mahabee-Gittens EM, Grupp-Phelan J, Brody AS, et al; Identifying children
with pneumonia in the emergency department. Clin Pediatr (Phila). 2005
Jun;44(5):427-35.
Haider BA, Saeed MA, Bhutta ZA; Short-course versus long-course antibiotic
therapy for non-severe Cochrane Database Syst Rev. 2008 Apr
16;(2):CD005976.