Upper Respiratory Tract Infections among Children

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23/09/19 Medical Reference this

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Upper Respiratory Tract Infections among Children

 

Annotated Bibliography

“Duration of symptoms of respiratory tract infections in children: a systematic review” by Thompson et al., (2013) describes the duration of symptoms of respiratory tract infections that commonly occur in children in settings of primary care. It was a systematic review using PubMed, CINAHL. The population involved children suffering from acute respiratory tract infections (RTIs)  in high-income regions and the methodology involved the test of study quality. The findings and conclusions of the study were that common cold and earaches lasted longer as compared to symptoms like a sore throat and bronchiolitis. This article is relevant to the topic of upper respiratory tract infections (URTIs) among children and the information obtained can be extrapolated to most of the population across the US and UK.

 “Respiratory tract infections among children younger than five years: current management in Australian general practice” by Biezen et al., (2015) is a study exploring how the Australian general practice is currently managing common URTIs among children of less than five years. It was a cross-sectional survey involving a sample of 4522 healthcare practitioners, where the results indicated that the management of URTIs was sufficiently higher than conditions like acute tonsillitis, bronchitis, and pneumonia. The treatment involved significant use of antibiotics, and it varied according to the clinical presentation of the disease, the age of the patient and their sex.

Management of respiratory tract infections in young children—a qualitative study of primary care providers’ perspectives” by Biezen et al., (2017) is a study that used a cross-sectional qualitative design to underscore how the multidisciplinary teams in healthcare manage this. The population was 30 primary care providers who were interviewed, and the findings indicated that they did not follow the standard recommendations given for treating URTIs. The study is relevant in this topic since it expounds on the possible complex interactions that involve psychological components during the decision making process while caring for children with URTIs.

Alexandrino et al. did a study. (2016) on “Risk factors for respiratory infections among children attending day care centers” aimed to characterize the risk factors for URTIs,  acute otitis media (AOM)  and  lower respiratory tract infection (LRTI) among children in a daycare center. The study’s population was 152 where the inclusion criteria were up to 3yeras old. It was established that the risk factors at the daycare were linked with URTI while the LRTI was associated with risk factors related to household and mothers. This study has been chosen to help underscore the possible risk factors and etiology of URTIs among the children.

McDonagh et al., (2016), while performing a study on “Improving antibiotic prescribing for uncomplicated acute respiratory tract infections.” Established that the best evidence is in support of educating the parent of the sick children on the appropriate use of antibiotics through rational prescription. The aim was to assess the relative effectiveness of advocating for reasonable use of antibiotics in cases of acute respiratory infections and both children and adults. The method included a meta-analysis of studies covering interventions of proper antibiotic use. It is imperative to consider such studies since it aids in understanding the current practice with medication use. 

“Acute otitis media and other complications of viral respiratory infection,” by Chonmaitree et al., (2016) is a study done to determine the prevalence of viral URTIs and the common complications that usually occur, including acute otitis media, bacterial sinusitis, and lower respiratory tract infections among others. The population of the study was 367 infants who were followed for AOM until 12months old. The methodology involved specimen collection from the nasopharynx every month for culturing. The conclusions indicated that nearly half of the infants suffer from AOM by the first year.

The article by the Committee on Infectious Diseases (2014), on “Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection” underscores the recent guidelines released from the literature on the effectiveness of using palivizumab for prophylaxis against respiratory virus syncytial (RSV) among predisposed children. The data provide more instructions on the use of this preventive measure against RSV which is a common cause of URTI.

  “Clinical features, virus identification, and sinusitis as a complication of upper respiratory tract illness in children ages 4-7 years,” by DeMuri, et al., (2016) is a study conducted to determine the incidence of sinusitis that complicates URTI illness among children by identifying the epidemiologic traits. The methodology was a cohort study involving observation in primary care settings. The findings indicated that 8.8% of URTIs had sinusitis. This study is essential in the understanding of the nature of complications that accompany URTIs among children.

Recommendations for prevention and control of influenza in children,” by Committee on Infectious Diseases (2017) provides recent updates on the use of influenza vaccines and medications targeting viruses to prevent and treat influenza among children. It suggests annual immunization against the infection from 6 months and above. The article is an essential item in this topic since it provides the relevant guidelines on minimizing incidences of URTIs across the United States.

Taylor, et al., (2017), in the study “Respiratory viruses and influenza-like illness: Epidemiology and outcomes in children aged six months to 10 years in a multi-country population sample” underscores the epidemiology of the respiratory viruses in children who are healthy and aged 6 months to less than 10 years. The purpose was to obtain better data on the population from tropical and southern hemispheres. The design involved active surveillance for a year in a population sample in a vaccine trial across 17 settings in 8 different countries. The findings indicated a high prevalence of rhinovirus and enteroviruses, then influenza, RSV, adenovirus, and coronavirus among others.

Review of Literature Themes Synthesis

Introduction

Upper respiratory tract infection is one of the most frequent infections among children in the United States and across the industrialized world. Statistics indicate that nearly ten episodes of common cold infection occur to a preschool child every year, resulting in frequent visits to the pediatricians (Thompson et al., 2013). The infection is caused by several viruses, and the disease shows varied forms of manifestations, including the mild symptoms like sneezing, obstruction, and congestion of the nose, rhinorrhea, coughing, and postnasal drip. Severe symptoms also emerge, and these include a sore throat, discomfort in the GIT, low-grade fever, clear discharge from the eyes and malaise among others. Examples of the known viruses that cause upper respiratory tract infections (URTIs) include coronavirus, influenza virus, rhinovirus, respiratory syncytial virus (RSV), adenovirus and the parainfluenza virus (Biezen et al., 2017). These infections are prevalent among children, and they often result in various complications like acute otitis media as demonstrated by the literature.

Themes from Literature

a)    Prevalence and Medication Use

One of the main issues from the research is the prevalence of URTIs and the use of antibiotics in its management. It is evident from the study that the incidence of upper respiratory tract infections among children is very high (McDonagh, et al., 2016).  However, the majority of the cases are self-limiting, prompting for self-care and symptom treatment as a recommended management strategy. Despite the protocol, these infections have dominated the pediatric population and data indicates that more than a third of the consultations with pediatricians both in the United States and the United Kingdom involve cases of upper respiratory tract infections (McDonagh et al., 2016). This has led to an emerging trend of increasing use and prescription of antibiotics for managing the conditions despite the limited evidence regarding the effectiveness of these medications in such diseases.

The pathophysiology of the disease starts with the entry of the virus into host cells by use of surface proteins. The virus then undergoes fusion with plasma membranes causing the release of the replication machinery of the virus into the cytoplasm of the host cells (DeMuri et al., 2016). This results in the injury of the tissues causing the clinical disease. The response of the host to the virus is the determinant of the pathogenesis of the disease and its severity. The infected cells then respond by releasing mediators of the inflammatory process, including the cytokines. Studies also indicate that there can be simultaneous infections by more than one virus, and there can be an associated bacterial infection, resulting in the observed complications among sure children who are affected by the disease (DeMuri et al., 2016). This pathophysiology indicates that the virus can be resistant to the known standards of treatment owing to the possible multifactorial etiology. It, therefore, follows that management should be individually designed to meet the specific health needs of the patient. The administration thus varies according to the clinical presentation, the sex, and age of the child (Biezen et al., 2015).

The literature chosen for theme synthesis finds relevance as they address areas of possible misuse of antibiotics in the management of upper respiratory tract infections in pediatrics (McDonagh et al., 2016). Antibiotics serve as treatment options for URTIs, but the utilization patterns of these drugs may show aberrant deviation, resulting in the emergence of resistance. Literature has demonstrated that penicillin’s have been widely used in these scenarios together with antipyretics and analgesics (Biezen et al., 2017). Rational use of antibiotics is, therefore, an essential consideration among healthcare professionals. It is agreeable to employ the technique of delayed prescription of antibiotics, especially after observing the symptoms for 10 to 14 days. Documented studies have revealed the effectiveness of this intervention, and it has reduced the use of these drugs by half, and it is also a strategy that is agreeable to both the parents and the healthcare providers. The concept of delayed antibiotic prescription has proven useful since it involves the parent of the child in the decision-making process. Thus they feel empowered and that there is an ongoing therapeutic action for their sick children (Biezen et al., 2017). Also, active involvement of the parents through education is an efficient way of overcoming the barriers to effective management of URTIs among children across the globe.

b)    Complications

Frequent viral infections affecting the upper respiratory tract are a significant risk factor for acute otitis media and acute bacterial sinusitis (Chonmaitree et al., 2016). These infections, especially acute otitis media, are one of the leading causes of hospital visits by children, with a subsequent hospitalization, surgery and increased consumption of antibiotics. The observed prevalence of viral URTIs among children has caused significant infant mortality by the first year of life (Chonmaitree et al., 2016). One can conclude that nearly half of the infants suffer from AOM before the end of the first year of life. The interactions between the bacteria and the viruses can play an essential role in the pathophysiology of acute otitis media, prompting for more research (Alexandrino et al., 2016).  Sinusitis is a lower respiratory tract infection which occurs as a complication of URTI. Literature has shown that this “occurs within 28 days of URI onset…and clinical sinusitis was recorded after 41 episodes of URTI in 37 participants in a study.” (Taylor et al., 2017).

Several risk factors can be attached to the etiology of acute otitis media among children who have suffered episodes of upper respiratory tract infection. One of these determinants could be the bacterial colonization of the nasopharyngeal area, causing the observed pathology (Alexandrino et al., 2016). Secondly, the various viruses that cause URTI can lead to AOM as discussed above. The third factor is the interaction between the virus and the bacteria during the occurrence of the URTI and AOM respectively. Additionally, the genetic and environmental factors can significantly contribute to the pathogenesis of AOM and further bacterial complications (Taylor et al., 2017). Research has revealed that the incidences of AOM are increased among children below the age of 3 months and those who are not exclusively breastfed (Alexandrino et al., 2016). From the studies, the theme of complications due to URTIs is succinctly brought out and captured in the statistics and data. For example, there is a high prevalence of URTIs during infancy, and this significantly contributes to the various complications including bacterial sinusitis, acute otitis media, mastoiditis, meningitis, and lower respiratory tract infections. The complexities have adverse consequences in children (DeMuri et al., 2016).

Other bacteria co-infect with the viruses that cause URTIs. For example, Streptococcus pneumoniae and Moraxella catarrhalis are some of the main co-infecting pathogens that occur during URI among infants (Committee on Infectious Diseases 2014). It is also agreeable to conclude that the manifestations of the disease can be aggravated by the interaction between the virus and the bacteria as discussed herein. The complexity of these interactions may prompt further studies geared at revealing more information on the pathophysiology to enable effective treatment of the complications. It, therefore, follows that the most effective way of treatment is by prevention (Committee on Infectious Diseases 2014). This can be achieved by educating the parents and other members of the family on aspects of hygiene like hand washing, cleaning of surfaces, infant and children isolation for those who are infected, and by avoiding places that are crowded like a daycare center that is busy. Also, prophylactic prevention is also necessary to cover against agents like RSV by administering vaccines like RSV-IGIV (Committee on Infectious Diseases 2017).

Conclusion

The prevalence of URTIs among children is high, and the various studies done on the subject reveal substantial information on the statistics. The manifestation of the disease varies from mild symptoms to severe complications as discussed in the essay. The high prevalence shows a global trend as suggested by the data from the United States and the United Kingdom as discussed herein. The use of antibiotics has helped significantly in managing the complications. However, there has been the misuse of these drugs, prompting for delayed prescription as the best option after a period of observation. Rational use of these drugs aids in preventing the emergence of antibiotic resistance. The complications that come with URTIs include bacterial sinusitis, acute otitis media and lower respiratory tract infections among others. The described pathophysiology and the risk factors should be well understood for proper management of the disease and the possible complications.

Path Chart

The pathophysiology of the disease starts with the entry of the virus into host cells by the use of surface proteins (Taylor et al., 2017). The virus then undergoes fusion with plasma membranes causing the release of the replication machinery of the virus into the cytoplasm of the host cells. This results in the injury of the tissues causing the clinical disease. The response of the host to the virus is the determinant of the pathogenesis of the disease and its severity. The infected cells then respond by releasing mediators of the inflammatory process, including the cytokines. There can also be simultaneous infections by more than one virus, and there can be an associated bacterial infection, resulting in the observed complications among sure children who are affected by the disease.

Risk factors

  • Malnutrition
  • Overcrowding in homes
  • Incomplete immunization
  • Air pollution while indoors
  • The socio-economic status
  • A large number of children in daycare centers
  • Social and anatomical behavioral characteristics (Alexandrino, et al., 2016)

Clinical manifestations

  • Rhinorrhea
  • Sneezing
  • Nasal congestion
  • Coughing
  • Postnasal drip
  • A sore throat
  • GI discomfort
  • Low-grade fever
  • Clear discharge from the eyes
  • Malaise among others

Treatment Plan

      reassurance

      parent education

      symptomatic home treatment – fluid intake and rest

      acetaminophen for fever

      nasal decongestants

      antibiotics e.g. penicillin

      antivirals

References

  • Alexandrino, A. S., Santos, R., Melo, C., & Bastos, J. M. (2016). Risk factors for respiratory infections among children attending daycare centers. Family practice, 33(2), 161-166.
  • Biezen, R., Brijnath, B., Grando, D., & Mazza, D. (2017). Management of respiratory tract infections in young children—a qualitative study of primary care providers’ perspectives. NPJ primary care respiratory medicine, 27(1), 15.
  • Biezen, R., Pollack, A. J., Harrison, C., Brijnath, B., Grando, D., Britt, H. C., & Mazza, D. (2015). Respiratory tract infections among children younger than 5 years: current management in Australian general practice. Medical Journal of Australia, 202(5), 262-265.
  • Chonmaitree, T., Trujillo, R., Jennings, K., Alvarez-Fernandez, P., Patel, J. A., Loeffelholz, M. J., … & McCormick, D. P. (2016). Acute otitis media and other complications of viral respiratory infection. Pediatrics, e20153555.
  • Committee on Infectious Diseases. (2014). Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, peds-2014.
  • Committee on Infectious Diseases. (2017). Recommendations for prevention and control of influenza in children, 2017–2018. Pediatrics, 140(4), e20172550.
  • DeMuri, G. P., Gern, J. E., Moyer, S. C., Lindstrom, M. J., Lynch, S. V., & Wald, E. R. (2016). Clinical features, virus identification, and sinusitis as a complication of upper respiratory tract illness in children ages 4-7 years. The Journal of Pediatrics, 171, 133-139.
  • McDonagh, M., Peterson, K., Winthrop, K., Cantor, A., Holzhammer, B., & Buckley, D. I. (2016). Improving antibiotic prescribing for uncomplicated acute respiratory tract infections.
  • Taylor, S., Lopez, P., Weckx, L., Borja-Tabora, C., Ulloa-Gutierrez, R., Lazcano-Ponce, E., … & Safadi, M. A. P. (2017). Respiratory viruses and influenza-like illness: Epidemiology and outcomes in children aged 6 months to 10 years in a multi-country population sample. Journal of Infection, 74(1), 29-41.
  • Thompson, M., Vodicka, T. A., Blair, P. S., Buckley, D. I., Heneghan, C., & Hay, A. D. (2013). Duration of symptoms of respiratory tract infections in children: a systematic review. BMj, 347, f7027.

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