Published on Jan 19, 2019 - 3 min read
Most of the time, parents present their child before the pediatrician for the smallest breathing problem, which is a good thing. But sometimes, especially at the second or third episode, the parents miss out some earliest possible signs to pick up pneumonia. So, public awareness is necessary to alert every parent as when is the cut off to avoid a midnight rush to the pediatrics casualty and act earlier.
Act According to the Kid's Age
Always remember that a slight difference in the breathing sound of a baby less than 2 months should alert every parent. Those babies are obligate nasal breathers. A viral infection in their nostrils may not start as a fever. So, always observe for fast breathing in them. If he or she takes more than 60 breaths per minute, it is a danger sign. And this will need admission, which should be managed by intensive care. For an older child, the criteria for danger signs are different. In the following article, we will be dealing with the breathing difficulty of children from 2 months to 5 years.
Symptoms of Acute Respiratory Infections
Danger signs (Best picked up by the doctor):
How to Pick up Early Cases
Never wait for the danger signs to set in. Whenever the parent feels that the child is not well, always count the breaths per minute. If it is more than 60 for a child less than 2 months, or more than 50 for a child of 2 to 12 months, or more than 40 for a child from 1 to 5 years, the parent should definitely take him or her to the doctor. Fever and cough may not set in, as the viral causes may be late pyrogens.
A mother should always know that a child not feeding well is an emergency. Especially, when breastmilk is the only feed, the baby is getting. As always, the mothers are alerted early, and it helps the pediatrician to carry out early interventions. Problem arises when some alternate caretakers try to reassure an alerted mother, which causes disaster. So, mothers should always discuss with each other about the classical combination of feeding difficulty with pneumonia.
Should the Baby Be Admitted?
Not all breathing difficulties need admission. A cough or cold will cause difficulty breathing but will need antibiotics that can be given at home. The government of India has published a treatment protocol on all childhood respiratory discomforts which is known to all general practitioners and other doctors. The antibiotics are given intravenously when the breathing rate is above the cutoff level, which demands admission. Whenever the baby shows danger signs, intensive care is needed.
Children of more than 5 years are more or less self alerters. They come to the parent for a fever prodrome a day earlier than it might set in especially when he realises that sickness means school absenteeism. But always take care of a child with fever as a potential candidate for any infection not confined to the respiratory system only. And the child now can take dissolved dispensible tablets which automatically escalate him out of the previously mentioned treatment algorithm. Take good care of the child, keep him or her hydrated and well fed, whenever fever or other symptom sets in, bring him to the doctor.
A Word on Secretions
Not all infections have secretion as a symptom. Clear and thick secretions may be normal or allergic, which can also cause breathing obstruction. This will require medical attention if the baby is less than 2 months old. The first antibiotic syrup or antipyretic syrup getting into the child's mouth may sometimes irritate the child's pharynx and cause secretions or may regurgitate the milk that was fed earlier. This might cause some breathing obstruction when it tries to get out through the nostrils. The syrups should be given in an erect posture than lying down. The mother should keep the baby in her arms and lap while sitting, which can easily take care of that problem. A regurgitant fluid reaching the nostrils might cause some of it to enter the eustachian tube which connects nose with the middle ear. This triggers a painful condition in the child called otitis media. The child may present with incessant crying and not feeding well. So better to carry out prevention rather than cure in such cases.
The child under 2 months always require prompt attention for the reasons said above. And older children can be managed with antibiotics based on the protocol corresponding to the age, weight, and presenting symptoms. Viral agents may require a different plan, which the pediatrician will decide accordingly. Never wait for the next symptom, and take action at the already available symptom.
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