By Dr Arvind Shenoi and Dr Meghna Manocha
Breathing problems in children are the single most important reason for children to be hospitalised, including sometimes in the intensive care unit. The causes are many, including infections, allergies, and in newborns, related to deficiency of surfactants or malformations of the respiratory tract.
Causes of breathing problems in children
- Common colds and viral infections.
- Exposure to outdoor pollution, indoor allergens.
- Deficiency of surfactant in newborn.
- Swallowing of fecal material and lung malformations in newborns.
Breathing problems in newborns
Newborn babies suffer from respiratory problems of the most severe nature and often need admission to the neonatal intensive care unit (NICU). The common reasons are deficiency of a substance known as surfactant, lung infections, aspiration of fecal matter into the lung and malformations of the lung. These are serious illnesses and require expert care in a NICU.
Breathing problems in children
Children suffer from infections and allergies, both of which lead to breathing problems. Respiratory infections are divided into upper respiratory infections (URI) and lower respiratory infection (LRTI). Most colds and coughs are caused by URIs that last seven to 15 days, are self-limiting and do not need any medications. That is why they are called the ‘common cold’. Children under two years have about six URIs in a year and more if they are in daycare settings.
Simple home remedies like cleaning nostrils of babies with saline and nasal aspirator, helping older kids blow their nose, offering plenty of warm liquids to soothe and comfort their throats and keeping them well hydrated and rested is all that is needed to cure a common cold. We generally discourage the use of cold medicines as they can have serious side-effects in babies less than six months of age. Cough suppressants, in particular, may cause harm in children less than four years of age.
Older children require hardly any therapy and may even continue on with normal school. However, some common colds can turn into painful ear infections, sinus infections and chest congestions. Hence, it is prudent to follow up with your paediatrician if fever does not settle down in three days, sputum turns yellow green in colour, cold lasts more than 10 to 15 days or a child seems unusually uncomfortable or cranky.
Lower respiratory tract infections like pneumonia can be life-threatening. These may start off like the innocuous common cold but rapidly progress with high fever and fast breathing. They need to be seen by a doctor who would probably diagnose them after a physical examination and chest X-ray, if needed. Treatment can be complex with intravenous antibiotics, oxygen therapy and ICU care. Worldwide, pneumonia is the second most common cause of deaths in children less than five years. These can be prevented by exclusive breastfeeding till six months of age, and use of vaccines like the pneumococcal and HiB vaccines. Good cough hygiene and hand hygiene can help prevent spread of infection among children.
Avoid exposure to allergens like cigarette smoke, dust mites, furry pets and soft toys
Wheezing is a sign that the airways taking air into the lungs are inflamed. This is characterised by a wet cough and in some cases a musical sound heard through the chest called a wheeze. Infections and allergies both trigger wheezing. Most wheezing in small children is triggered by viral infections. Persistent or recurrent wheezing is known as asthma. Wheezing and asthma are treated by inhaled medications given via a nebuliser or through metered dose inhalers.
The medications are divided into bronchodilators — medicines which relax muscles that line the air passages — and preventers, those which reduce the inflammation of the air passages. Both need to be given till the inflammation in the air passages subsides. There are many misconceptions about the use of these medicines, which are actually very effective.
The treatment also includes prevention of the allergen exposure. This entails avoiding smoke, including passive smoking, dust control measures in the child’s immediate environment, and avoiding precipitating events or stimuli. In severe cases, seeing an allergy specialist may help identify and reduce or modify the allergy. Some children have associated skin allergy (atopic dermatitis), nasal allergy (allergic rhinitis) and eye allergy (allergic conjunctivitis). Some of the severely affected children may even need a multi-disciplinary team to look after various allergies.
A parents’ guide
Breathing problems in a newborn are always severe and need to be evaluated urgently, preferably in a NICU setting. In young children, the commonest breathing problem is a common cold and requires rest, fluids and fever control. If the child has high fever, fast breathing, is not feeding well, it may be a lower respiratory infection, so please see a doctor right away. If the child has wheezing, see a doctor to sort out whether it is an allergy, infection or both. Inhaled medications are safe and can effectively treat and prevent wheezing.
(Dr Arvind Shenoi is Consultant Neonatologist and Pediatrician, and Dr Meghna Manocha is Consultant Pediatrician, Cloudnine Group of Hospitals, Bangalore.)