Acute Respiratory Infections (ARI)
– It is an acute infection of the ear ,nose, throat, larynx, trachea, bronchi, bronchioles or lung.
1- Acute upper respiratory tract infection :-acute infection of the nose,
pharynx(throat) and middle ear.
2- Acute lower respiratory tract infection:-acute infection of the epiglottis ,larynx,
trachea ,bronchi ,bronchioles or lung.
– ARI is the commonest cause of death in developing countries in children mainly
– Pneumonia is responsible for almost all ARI deaths particularly in young infants.
– Most cases of severe pneumonia are bacterial usually Streptococcal pneumonia.
It is an acute infection of the lungs, it is classified according to the severity based on clinical signs.
1- In the child age( 2 months-5 years):
a – Severe pneumonia :-cough or difficult breathing with chest indrawing.
B – Pneumonia :-cough or difficult breathing with fast breathing but no chest
2- Age( less than 2months):
Any of these clinical signs can mean severe pneumonia or very severe disease in young infant less than 2 months:
1- stopped feeding well.
2- Stridor in calm child.
4- Abnormaly sleepy or difficult to wake.
6- Fever or low body temperature.
7- Severe chest indrawing .
8- Fast breathing.
Stridor: A harsh noise when the child breaths in ,it occurs when there is narrowing of the larynx,trachea or epiglottis, it can be due to a croup or a foreign body.
Wheeze: A soft musical noise when the child breaths out ,it may be caused by a swelling and narrowing of the small airways of the lungs or by a contraction of the smooth muscles surrounding the airways in the lung.
Croup: Narrowing of the larynx,trachea or epiglottis which interferes with air entering the lungs, it can be caused by a viral or bacterial infection.
Risk factors in ARI :
1- lack of immunization.
3- Vit A deficiency.
4- Low birth weight.
5- Young age.
7- Cold weather.
8- Exposure to pollution.
9- High incidence of nasopharyngeal carrier of pathological bacteria.
Proper management of ARI is important for these reasons :
1- Relieve suffering.
2- Reduce the incidence of sequelae such as deafness.
3- Help the mother care for the child during illness.
4- Reduce the inappropriate use of antibiotics so will reduce the incidence of antibiotic resistance.
– Advice the mother to give home care :
– Home care is very important for the child with ARI,and most children you
manage will be treated with it. Good home care means the mother will :
1- Feed the child to avoid weight loss. weight loss can contribute to malnutrition.
2- Increase fluids to avoid dehydration. dehydration can weaken the child and
make the child even sicker.
3- Relieve the child’s sore throat and cough.
4- Most important, watch for signs that the child is getting sicker so she knows
when to bring the child to health worker.
Treatment : assess initial response to a rapid acting bronchodilator such as nebulized salbutamol and assess response after 15 minutes you can repeat it if respiratory distress persist.
Signs of improvement :
1- Less respiratory distress.
2- Less chest indrawing.
3- improved air entry.
If the condition is not improved after 30 minutes:
1- Admit to hospital.
2- Continue nebulized salbutamol every 4 hours.
3- Add aminophyllin if bronchospasm is not adequately controlled with nebulized
4- As the severity of attack decrease change to oral salbutamol,observe the child for at least 8 hours before discharge.