OVERVIEW
Repeated respiratory tract infections are a common clinical condition in pediatrics, with an incidence rate of about 20%. It is a respiratory tract infection in which the number of upper respiratory tract infections or lower respiratory tract infections in a year is frequent and exceeds a certain range. The diagnostic criteria are different at different ages. Recurrent upper respiratory tract infections are more than 7 times/year in infants and young children under 2 years old, more than 6 times/year in children aged 3-5 years old and more than 5 times/year in children over 6 years old; recurrent lower respiratory tract infections are more than 3 times/year in infants and young children under 2 years old, more than 2 times/year in children aged 3-5 years old and more than 2 times/year in children over 6 years old, which can be diagnosed as recurrent respiratory tract infections.
Etiology
Recurrent respiratory tract infections are formed by complex factors. Most of them are the result of a combination of congenital factors or low immune function or lack of trace elements and vitamins, or improper feeding, as well as heredity, nursing, living environment and other factors. Young children have relatively low immune function and are prone to respiratory diseases. In addition, long-term partiality, picky eating, as well as poor cold tolerance of the children susceptible to respiratory infections, atmospheric pollution on susceptibility to respiratory disease also has an impact.
Questions you may be concerned about
What are the causes of recurrent respiratory infections in babies?
Recurrent respiratory tract infections in babies may be caused by imperfect development of autoimmune functions, environmental factors, and combination of underlying diseases.
1. Imperfect development of autoimmunity and other functions: the anatomical and physiological characteristics of the respiratory system and immune function of the pediatric period is immature, easy to be attacked by the pathology of recurrent respiratory tract infections.
2. Environmental factors: environmental pollution, passive smoking, chronic tonsillitis and adenoid hypertrophy can increase the chance of recurrent respiratory infections.
3. Combined underlying conditions: such as immunodeficiency diseases (including primary immunodeficiency diseases), congenital lung parenchyma and pulmonary vascular development abnormalities (such as pulmonary cysts, pulmonary vascular development abnormalities), congenital weather tract development abnormalities (such as tracheobronchial softening) or congenital heart disease (such as tetralogy of Fallot), etc., can lead to susceptible to recurrent respiratory tract infections.
Recurrent respiratory infections in babies may also have other causes, and it is recommended that babies go to the hospital in time for a complete examination to clarify the cause of the disease and then give targeted treatment or therapy.
Symptoms
Respiratory tract infection is a common disease in children, the onset of fever, runny nose, nasal congestion, sneezing with mild cough and other symptoms. Some may have vomiting and diarrhea. Symptoms vary by age. In addition to being several times more susceptible to respiratory disease than healthy children, those susceptible to recurrent respiratory infections often suffer from loss of appetite, night sweats, lack of weight gain, and a yellowish complexion. Improper treatment can lead to asthma, myocarditis, nephritis and other diseases, seriously affecting the growth and health of children.
Examination
1. Blood test
The total number of white blood cells, the percentage of neutrophils and lymphocytes can help determine whether the respiratory tract infection is caused by bacteria or viruses. Generally, the total number of white blood cells and the percentage of neutrophils are elevated in bacterial infections, whereas in viral infections, the white blood cell count is normal or low and the percentage of lymphocytes is high.
2. Pharyngeal swab culture
For children suspected of having recurrent respiratory tract infections caused by bacteria, pharyngeal swab culture, that is, the culture of pharyngeal secretions and drug sensitivity test should be performed in order to find out which kind of bacteria causes the infection and which kind of antibiotics is effective. The specific method is; in the early morning without food, water, or brushing teeth and gargling, gently smear the pharynx with a sterilized cotton swab several times, and then put it into the bacterial culture solution. It should also be noted that it is best to do this test before taking antibiotics, because taking antibiotics will inhibit or kill the bacteria, and it is difficult to get satisfactory culture results.
3. Radiologic examination
Children with recurrent pneumonia must undergo X-ray or radiographic examination of the lungs, because the duration of the disease, the severity of the disease and the infecting pathogenic microorganisms are different, the performance of radiographic images will also be different. The change of the image is very important to guide the diagnosis and treatment of the child.
4.Immune function examination
For children with recurrent respiratory tract infections, this test should be performed if possible to observe whether the immune function is normal. Because the main symptom of children with congenital immunodeficiency disease is also recurrent respiratory tract infection, and the immune function of these children is obviously abnormal, through the examination of immune function can distinguish these children, which is conducive to guiding the treatment. The immune function examination includes two aspects:
(1) Humoral immune function is closely related to the body’s resistance to bacterial infection. The main test is serum immunoglobulin (IgG, IgA, IgM, IgD and IgE). If this test is not available, plasma protein quantification and serum protein electrophoresis can also be performed to initially determine the humoral immune status of the child. Some children with recurrent respiratory tract infections may have serum IgG or IgA levels lower than those of normal people, but not at the level required for the diagnosis of immunodeficiency diseases.
(2) Cellular immunity mainly refers to the body’s ability to resist viral invasion. Including T cell subclasses (CD cell classification) and delayed hypersensitivity skin test (PPD, PHA skin test). Some children, especially when combined with malnutrition, often show a decrease in the number of peripheral blood helper T-cells (CD4 cells) and a low skin test response. These mild abnormalities in immune function may be caused by repeated stimulation of the immune system by microorganisms such as bacteria or viruses, which leave immunoreactive cells in a state of exhaustion.
As a parent of a child with recurrent respiratory infections, it is important to note that the child must undergo an immune function test to determine if the recurrent respiratory infections are due to an immunodeficiency disease, as the treatment and prognosis of the two are very different.
Diagnosis
Diagnosis can be made on the basis of clinical manifestations and examination findings.
Treatment
The aim of clinical treatment is to reduce the number of respiratory tract infections.
1. Pathogenetic treatment
The most common pathogenic factor during the infectious phase of recurrent upper respiratory tract infections in pediatric patients is the invasion of pathogens, most commonly viruses, bacteria and atypical pathogenic microorganisms. Anti-infective treatment for pathogens is routine.
2. Immunomodulator therapy
The use of immunomodulators can enhance the immune function of the respiratory tract and effectively reduce the frequency of recurrent respiratory tract infections and the use of antibacterial drugs.
3. Traditional Chinese Medicine (TCM)
Chinese medicine has unique advantages in improving symptoms, eliminating evils and fixing the root cause, conditioning the body and controlling recurrent attacks.
Prevention
Modern medicine on pediatric recurrent respiratory tract infections prevention and treatment means are not yet many, long-term efficacy to be observed, in addition, recurrent respiratory tract infections and the pediatric body’s ability to defend, nutritional status, environmental factors have a close connection, and with the pediatric respiratory tract anatomical characteristics. Preventive measures must first start from increasing the pediatric body resistance and preventing the invasion of pathogens, for example, through appropriate outdoor activities, more sunshine, strengthen physical exercise, nutritional supplementation to enhance the physical fitness of children. During the influenza epidemic season, do not take your child to public places and do not let your child have more contact with infected children and adults. Weather change season, strengthen the care, the child dressed in warm and cold clothes should be appropriate, indoor air circulation. Children who are really weak can take medicines to strengthen their immunity.