Managing upper respiratory tract infections in children – Part 2

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 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.

How can it be treated?
Treatment can be non-medical, medical and surgical.

Non-medical treatment
Rest, adequate fluid intake, including warm drinks such as tea or soup and humidified air can improve symptoms of nasal congestion and runny nose. Honey may be helpful for night time cough in children older than 12 months, nasal suction, saline nasal drops for infants or saline nasal spray/irrigation for older children can modestly improve symptoms, decrease use of other therapies, decrease recurrence of symptoms, and decrease school absence.

Medical treatment
Symptomatic treatment using NSAIDs (Non-steroidal anti-inflammatory drugs) to relieve fever, headache and malaise.

Over the counter decongestant drugs may provide symptomatic relief of nasal symptoms in adolescents older than12 years. Over the counter medications containing antihistamines, decongestants, antitussives, expectorants and mucolytics should be avoided in infants and young children, who are particularly sensitive to the side effects of decongestants and may experience agitation, confusion, hallucinations, lethargy, and rapid heart rate.

Antibiotics are to be given only when there is bacterial infection.

Surgical treatment
Surgery will be needed for some cases such as sinusitis and tonsillitis that are not responding to medical treatment.

When to seek help when a child has common cold
Parents should take a child with common cold to hospital immediately, if the following are noticed:
• Refusal to drink anything or breastfeed for a prolonged period of time.
• Behavioural changes, including irritability or lethargy (decreased responsiveness)
• Difficult breathing (grunting), working hard to breathe (chest in-drawing), or breathing rapidly.
• Colour of tongue, lips or nails turn blue
• Fever lasts more than three days.
• Nasal congestion does not improve or worsens over the course of 14 days.
• The eyes become red or develop yellow discharge.
There are signs or symptoms of an ear infection such as pain, ear pulling and fussiness.

Concluded.