Respiratory infections can develop into pneumonia in infants. Here’s how to keep them safe.

Irregular monsoons and frequent weather changes can play havoc with a child’s respiratory health. The number of children below the age five suffering from cough, cold and viral infections has increased significantly. Viral infections of the upper respiratory tract including influenza infections predispose a child to the development of pneumonia.

Take the case of eight-month-old Gourang who was brought with complaints of fast breathing and high-grade fever. A detailed case history showed that the symptoms had been present for four days but had worsened overnight. Others in the family were also suffering from fever and cold. The child was very irritable and the breathing rate was 80/minute (normal at this age would be <50/minute). Other tests also showed that the child was suffering from pneumonia. After treatment with antibiotics and nebulisation, there was partial recovery in three days but it took one week for the child to come back to normal.

What is pneumonia? Pneumonia is a respiratory infection that may be bacterial or viral. The infection causes inflammation of one or both lungs as the tiny air sacs within the lungs get filled with fluid, making it difficult for the lungs to function properly.

Who is at risk? Infants, neonates, premature babies and children between 24-59 months are most likely to suffer due to their low immunity. Getting wet in the rain will not trigger pneumonia but exposure to sudden temperature change can be a risk factor. Damp, heat, air pollution, smoking and overcrowding are conducive to the growth of bacteria, viruses or fungi. Other high-risk factors include malnutrition, deficiency of vitamin A&D and zinc, weakened immune systems, co-morbid pulmonary illness, other systemic illnesses and anticancer drugs.

Symptoms: In bacterial pneumonia, signs include high fever (more than 102° F), difficulty in breathing, fast respiratory rate, noisy breathing, severe chest pain, body ache, wheezing, severe weakness, inability to feed, excessive drowsiness, excessive sweating, coughing up blood and respiratory distress. A child with chest in-drawing and cyanosis (blue tinge to the skin) indicates severe pneumonia. Viral pneumonia, often called walking pneumonia, has less florid symptoms. Symptoms like high-grade fever (less than 102° F), preceding upper respiratory tract infection, coughing up small amounts of mucus, muscle ache and fatigue are common.

Treatment: If symptoms persist, the child must be taken to the doctor. Hospitalisation may be required to administer intravenous antibiotics or oxygen support. Viral pneumonia doesn’t require intensive care and treatment since viruses don’t respond to vaccines and antibiotics.

Complications: About half the number of children who survive pneumonia suffer some after-effect, which may be mild or temporary. But 22 per cent of survivors end up with a moderate or severe disability, according to the Centers for Disease Control and Prevention. The complications of untreated or neglected pneumonia can result in disabilities such as deafness, brain damage, seizures and, in severe cases, even death.

Prevention: Adequate breastfeeding for the first sixmonths helps improve an infant’s natural defences. All children should receive adequate nutrition, especially vitamin A & D and Zinc. Environmental factors such as pollution, smoking, overcrowding, sanitation and hygiene should be addressed to reduce the risk.

Bacterial pneumonia is the leading cause of pneumonia deaths in children and accounts for highest number of pediatric hospitalisations. There have been many instances when antibiotic treatments fail because of delay in treatment or administration of inappropriate antibiotics. Lately, the increasing number of disease-causing strains and antibiotic-resistant bacteria have been a matter of concern.

In such cases, prevention of pneumonia through vaccination (Hemophilus influenzae B vaccine and pneumococcal vaccine) is recommended. Pneumococcal Conjugate Vaccine (PCV), the latest pneumococcal vaccine, is highly effective against 13 serotypes of pneumococcus including serotype 19A, which is emerging as one of the important strains to cause pneumococcal disease in children less than five years of age. In addition, the vaccine is a potent tool for protection against the even more serious meningitis and blood infection (septicemia) caused by the same bacteria.