this topic about respiratory dysfunctions in children..definition, etiology, sign symptoms, and treatment

1. Respiratory Dysfunctions in
Children

2. Anatomy and physiology of
respiratory system

3. Upper and lower respiratory tract
infections

4. ACUTE RESPIRATORY INFECTIONS (ARI)
• ARI is leading cause of illness
& death of children < 5 years of
age.
• 30 – 60 % patients come in
OPD ,80 % of these patients
have AURTI.
• Most of these required
symptomatic treatment except
middle ear or streptococcal
sore throat .

5. Etiology
 Bacterial pneumonia is more common in PK but in
developed countries mostly is viral.
 Bacterial infections of acute lower respiratory infections
in children are as under.
 Streptococcus Pneumoniae.
 Haemophilus Influenza.
 Staphylococcus Aureus.
 Group A Streptococci.

7. Clinical Features
 WHO studied that two signs are most critical and
sensitive to make diagnosis of pneumonia
 Fast breathing , Nazal flaring ( Nostrils widen while a
person is breathing.)
 Lower chest indrawing

8. If the child is Than he has fast breathing if you count
< 2 months 60 breath /Minutes or more
2 months to 11 months 50 breaths / Minutes or more
12 months up to 5 years 40 breaths / minutes or more

9. Treatment
 > 80 % cases have cough or cold or AURI , These patient
don’t need Antibiotics.
 Varity of simple non sedative cough syrup/ Mixture or
home remedy can be used .
 Recommended home remedies :
 Green Tea with honey
 Qahwa
 Joshanda

10. Acute Pharyngitis And Tonsillitis
 Common uper respiratory tract infections in
which Streptococcal Pharyngitis and tonsillitis is
one of the most common respiratory infections of
the childhood.
 It may be viral or Bactarial .
 Significant bacteria for pharyngitis and tonsillitis
is group A Beta hemolytic streptococcus .
 Uncommon < 1 year of age , peak incidence
occur > 5 to < 15 years of age , younger than 2
year is often viral , higher in winter and early
spring.

11. Stages and ages
Stages Ages
Prenatal Before delivery
Baby 0- 12 month
Toddler 1 – 3 Years
Preschool 3 – 5 Years
Gradeschool
er
5- 12 Years
Teen 12 – 18 Years
© Copyright 2016 American Academy of Pediatrics.
All rights reserved.
Category Age
Premature Newborns < 38 weeks
gestational age
Term Newborns > 38 weeks
gestational age
Neonate 0 – 30 days of age
Infant 1 month – 2 years
Young Child 2 – 6 years
Child 6 – 12 years
Adolescent 12 – 18 years
World Health Organization.

12. Clinical Features
 Vary from child to child .
 Older children : abrupt cough , fever , sore throat
with headache , wt loss and malaise .
 Younger with cough , Nausea , vomiting and
abdominal pain.
 Swallowing is painful , solid food refused and fluid
may be accepted but in severe cases there may
be dysphagia for fluids or even from saliva.
 Temp is higher > 101f (38.4C)
 Tonsillar enlargement with , edema , erythema
(redness of the skin) and lymphoid hyperplasia
(increase number of lymphoid cell) .

13.  Conjunctivitis , flu , cough ,
hoarseness (abnormal voice
changes), and diarrhea
suggested viral rather than
streptoccoccal infection.

14. How to diagnose:
 White blood cell (WBC) count will be raised.
 Throat culture is primary methods for making
diagnose streptococcus pharyngitis and tonsillitis.
 WBCs also called leukocytes are the cells of
the immune system that are involved in protecting
the body against both infectious disease and
foreign invaders.

15. Differential diagnoses
 Acute pharyngitis and tonsillitis may be caused by
other organisms e.g., Adenovirus , Rhinovirus ,
Entervirus , Influenza Virus , Parainfluenza Virus ,
Herpes Simplex Virus , Epstain Bar Virus ,
Mycoplazma Pneumoniae , Coryne Bacterium ,
Diptheriae , and Beta hemolytic streptococci (e . g,
group C and group G ).

16. Complications
 Acute Rhematic Fever
 Acute Glomerulonephritis

17. Treatment
 The treatment of choice for streptococcal pharyngitis or
tonsillitis is oral penicillin V (25o mg) given 3 times daily
for 10 days.
 Inj Benzathine Penicillin G (Provide adequate pencilline
level for 10days ) 600,000 unit < 25 kg children &
1200,000 units > 25 kg children .
 If the patient has had three or more documented
infections in 6 months , consider daily penicillin
prophylaxis during the winter season.
 Frequent episode required tonsillectomy when enlarge
tonsils cause upper air way obstruction.

18. Pencilline allergic patients may be
given at any one of several
alternative antibiotics
 Oral Erythromycin -50mg/kg/day in three divided
dose for 10 days .
 Cephalosporins such is cephradin 50-100mg/kg/day
in three devided dose for 10 days .
 Oral clarithromycin 15 mg/ kg / day in two divided
dose for 10 days .

19. Otitis Media
 Otitis media is one of the most common infections of
childhood , especial between the ages of 6 months to 3
years.
 Acute Otitis media is defined as inflammation of the
middle ear presenting with rapid on set of symptoms.
 Three episodes within 6 month or 4 episode during 4 years
is marked as Acute Otitis Media.
 Persistent discharge from the ear longer than 6 weeks is
labled as Chronic Otitis Media.

20. Etiology:
Bacteria are common agents , the most common
organism are:
 Streptococcus Pneumoniae (25-40% )
 Haemophillus Influenzae (15-25 % ) , It causes
recurrent Otitis media.
 Moraxella Catarrhalis (12-20%)
 Group A streptococcus
 Staphylococcus Aureus (acute and chronic Otitis
media )
 Pseudomonas Aeruginosa (Chronic Otitis Media )

21.  Virus are not important direct causes otitis media
but viral upper respiratory infections commonly
obstruct Eustachian tube which allows bacteria to
multiple in the middle ear space .
middle ear to the pharynx

22. Pathogenesis
 Bacteria gain access to the middle ear when the
normal patency of the eustachian tube is blocked
by local infections , pharyngitis .
 Obstruction of the flow of secretions from the
middle ear to the pharynx , results in a middle ear
effusion (Gas/Fluid) that become infected by
bacteria.

23. Clinical Features
 Neonate and infant may be asymptomatic , only non
specific manifestation such as irritability , fever ,
diarrhea , vomiting or may pull at their ears .
 None specific sign and symptoms in children are
fever , irritability , mild upper respiratory symptoms
vomiting and diarrhea .
 Classic sign and symptoms of acute otitismedia are
pain in one or both ear and hearing loss , discharge
may be present .
 Chronic otitismedia present with hearing impairment
perforation of the tympanic membrane and a fouling
smelling discharge form the ear canal .

24. Diagnosis criteria
 Abnormal contour (shape) of tympanic
membrane , like fullness or bulging or extreme
retraction.
 Erythema of tympanic membrane or presence of
liquid in middle ear or cavity show pale yellow
color .
 Opacification (Opaque) of tympanic membrane .
 Structural changes of tympanic membrane
include scare or perforation .
 Tympanic membrane mobility impaired , mobility
is more sensitive and specific to determine
presence or absence of effusion .

25. Continue….
 Culture of ear discharge.
 Needle aspiration and culture
of middle ear content (where
there is no discharge ) is most
reliable methode for
confirming the presence of
infection and indentifying the
causative agent .
 Otoscopy (view) and
tympanometry (mobility)
An otoscope or auriscope is a medical
device which is used to look into the ears

29. Complications
 Mastoiditis.(inflammation of the mastoid process.)
 Meningitis (inflammation of the meninges)
 Hearing Loss

30. Treatment
 Dry moping of ear
 Analgesics for pain
 Antipyretics for fever .
 Intial treatment is directed against the most
common organisms (S . Pneumoniae and H.
Influenzae )
 Antibiotic are changed according to the culture
and sensitivity report . The drug of choice is
amoxilline 80-90mg/kg/day in three divided
doses for 10 days . Which is usually effective
against both of these organisms.
Acute Otitis Media.

31. Continue..
 Alternative antibiotics are Amoxicillin Clavulanic
Acid , Erthromycin , Sulfisoxazole , Cefaclor ,
Cefuroxime , Trimethoprim Sulfamethoxazole and
Cefixime . The duration of therapy is 7-10 days .
 For pencilline resistant pneumococci , option
include cefriaxone 50 mg / kg /day IM once a
day for total 1-3 doses or Macrolide Antibiotic
(Azithromycin , Clarithromycin )
 Patient who are not cured after a second course
of antibiotics or who become severely ill may be
considered for tympanocentesis to identify the
causative pathogen so that appropriate antibiotic
can be used.

32. Recurrent Otitis Media
 Patient with recurrent Otitis Media may be
placed on daily doses of an antibiotic such as
Sulfisoxazole or Amoxicillin prophylaxis for 3
-8 months after acute infection has cleared

33. Chronic Otitis Media
 The pathogen are usually mixed and commonly
includes s . Aureus , Pseudomonas
Aeuroginosa or both . Intial therapy with an oral
antibiotic that is effective against staphylococcus
is tried but optimal therapy is based on middle
ear cultures and may require intravenous anti-
pseudomonal therapy (a beta-lactam antibiotic
(Amoxicillin) with an
aminoglycoside(Amikacin)).

34. Chronic otitis media with effusion
 May be due to infection , allergy or immunologic
disorders . 2 – 4 weeks cours of oral antibiotic
may be effective.
 In resistant cases , placement of typmpanostomy
tubes is recommended for more than 2-3 months
.

35. Thanks