Dr. Ekanem Ekure is Associate Professor/Honorary Consultant Cardiology/Infectious Disease Unit, Department of Paediatrics at the University of Lagos and Lagos University Teaching Hospital (LUTH). She told GERALDINE AKUTU, she talks about Upper Respiratory Tract Infection (URTI) in children, its causes and how to deal with it.

What is Upper Respiratory Tract Infection (URTI) and what are the symptoms?
It refers to infection of the upper respiratory tract, which includes nasal passages, pharynx, larynx, trachea and sinuses. The illnesses involved are common cold, tonsillitis, pharyngitis, laryngitis, sinusitis and epiglottitis. Otitis media can occur as a complication of URTI because inflammation of the upper airway extends from the nasopharynx to the ear through a connecting tube called the Eustachian tube.

The symptoms will depend on the part of the tract affected, but generally will include fever, cough, catarrh, headache, sneezing, nasal congestion, mouth breathing, dry mouth, itchy or sore throat, photophobia (light sensitivity), irritability and difficulty in sleeping at night. There could be a general feeling of illness (malaise).

The lining of the nose may become red and swollen, and the lymph nodes (glands) in the neck may become slightly enlarged. Pain and pressure of the ear caused by a middle ear infection (otitis media) and the reddening of the eye caused by viral conjunctivitis are often associated with upper respiratory infections.

Symptoms of the digestive system like vomiting diarrhoea, nausea and decreased appetite may be present in some cases. Infants and young children are usually unable to communicate their specific symptoms and are just uncomfortable and cry a lot.

What are the circumstances that give rise to the infection?
Viruses mostly cause URTI in children. Bacterial organisms and occasionally fungal organisms can also cause URTI. The following conditions increase the risk of developing URTI:
• Close contact with someone infected with URTI e.g. in day care or with infected family members.
• Poor hand washing after contact with an individual with upper respiratory infection
• Crowded living conditions
• Contact with groups of people in a closed setting such as travelling long distances in a bus or airplane etc.
• Weak immune system as seen in people with HIV, prolonged steroid use or those receiving drugs for cancer or who just had organ transplant done.
• Active and passive smoking (e.g. child being in the same room with a smoking adult) will alter mucosa resistance to respiratory tract infection.
• URTI can occur at any time, but commoner in cold or rainy seasons. During cold seasons, there is overcrowding because people are huddled together in-doors for long periods.
• Allergy and nasal injury
• Carrier state: Here, some people are chronic carriers of organisms that cause URTI and hence are at risk of passing the infection to people around them.
At what age can it occur in children?
This infection can occur in any age group, but is highest in children below five years. Children are said to have three to eight viral illnesses per year and in adults it is less; two to four episodes.

What preventive measures can parents take to protect children from URTI?
For the newborn, it is breastfeeding, as the protective antibodies in breastmilk give passive immunity.
• Hand hygiene: Hand washing is of great importance in prevention. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. It is not necessary to use antibacterial hand soap. Children should be taught how to wash their hands before and after eating and after coughing or sneezing. All household members should be taught to imbibe the habit of washing hands regularly.

• Alcohol-based hand rubs are a good alternative to hand washing for disinfecting hands. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry, and may be used several times without fear of skin irritation or loss of effectiveness. Avoid and treat infected contacts. Immunisations such as Haemophilus influenza type b (Hib), pneumococcal conjugate vaccine (PCV); diphtheria and pertussis vaccines are of great benefit.

To also protect other children, parents should ensure that affected children stay home from school or childcare until the fever is gone and they feel well enough to attend. Children should be encouraged to cover their mouth, when sneezing and to use a tissue when blowing their nose. Parents can use household cleaners that kill viruses such as phenol/alcohol. This may help reduce viral transmission.