Inflammation of the lungs (pneumonia) – a serious infectious disease that affects people of all ages. And children are no exception. Recently, there has been an increase in the number of acute infectious diseases of the respiratory organs, and pneumonia is the most dangerous of them. Therefore, parents should understand what it is – pneumonia, how to recognize this disease, and what to do if it appears in a child.
The danger of the disease is associated with the important role that the lungs play in the human body. After all, the lungs perform the function of delivering oxygen to the tissues of the body and, therefore, the defeat of such an important organ can have serious consequences.
Oxygen is supplied to the lungs from the upper respiratory tract during inhalation. In the special vesicles of the lungs – the alveoli, the process of blood enrichment with oxygen takes place. At the same time, carbon dioxide enters the alveoli from the blood and is released to the outside during exhalation. The inner surface of the lungs has a mucous membrane, the purpose of which is to protect the lungs from negative external influences.
Each lung consists of 10 segments, which are grouped into lobes — there are three of them in the right lung, and two in the left. In pneumonia, the infectious process affects the internal structures of the lungs, which greatly complicates the process of respiration and gas exchange. And it can affect other organs, especially the heart.
Gas exchange does not exhaust the lung function in the body. They also participate in the following processes:
- body temperature regulation,
- filtering harmful substances
- regulation of the amount of liquids and salts
- blood purification,
- toxin elimination
- synthesis and neutralization of proteins and fats.
With infectious diseases of the gastrointestinal tract, poisoning, injuries and burns, the load on the lungs increases many times, and they can not cope with the removal of toxins from the body. This can trigger an infection in the lungs.
Varieties of pneumonia
Unlike other respiratory diseases, the proportion of cases that have a purely viral etiology is small. In about 80% of cases we are talking about lung damage by various strains of bacteria. In childhood, the majority of pneumonia diseases are associated with three types of bacteria – pneumococcus, mycoplasma, and pulmonary chlamydia. However, other types of bacteria can also be a source of disease.
These include staphylococci, streptococci, Klebsiella, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, Mycobacterium tuberculosis and some others. Much less often, the lungs suffer from exposure to pathogenic fungi, and even more rarely, pneumonia caused by worms can be observed.
Pathogens are also unevenly distributed by age group. Pneumonia in infants and preschool children is most often caused by pneumococci. At the early school age, children are more likely to have mycoplasma pneumonia. Teens often suffer from chlamydia pneumonia.
By the size and shape of the area of inflammation, pneumonia is divided into:
- left side
- right sided.
With focal pneumonia, there are only separate foci of inflammation about 1 cm in size, and with confluent pneumonia, these foci merge together. When segmental pneumonia affects one of the segments of the lungs. In the croupous type of pneumonia, the whole process is covered by the pathological process.
When bronchopneumonia affects not only the lung tissue, but also the bronchial mucosa. Usually, bronchopneumonia is a consequence of bronchitis.
Less common is pure viral pneumonia. The causative agents of this form of the disease may be influenza viruses, parainfluenza, adenoviruses. Bilateral pneumonia is most often caused by pneumococci and a hemophilic rod. Atypical pneumonia in a child is most often caused by mycoplasmas and chlamydia. This type of pneumonia can last longer and is difficult to treat with antibiotics.
Hospital pneumonia is most often caused by staphylococcus, Pseudomonas aeruginosa, and Klebsiella.
Pulmonary inflammation in childhood
Left-sided pneumonia in a child is often more severe than right-sided. This is due to the fact that the lungs have an asymmetric structure, and on the left side the airways are narrower than on the right side. This circumstance complicates the removal of mucus and contributes to the establishment of infection.
It is well known that children are more prone to pneumonia than adults. There are several reasons for this. First of all, young children have a rather weak immunity compared to adults. And the second reason is that the child’s respiratory system is not as developed as in an adult. In addition, the narrowness of the respiratory passages in children causes stagnation of mucus in them and makes it difficult to excrete.
Also, babies usually breathe through movements of the diaphragm, which are affected by the condition of the gastrointestinal tract. Violation of his work, expressed, for example, in abdominal distension, is immediately reflected in the lungs – they develop stagnation, leading to an increase in the number of pathogens. Infants also have relatively weak respiratory muscles, which do not allow them to effectively cough up sputum.
Symptoms of pneumonia in a child
How does pneumonia manifest? Symptoms of pneumonia in children of different ages are somewhat different. However, it is worth noting that in all types of pneumonia there is such a symptom as respiratory failure. It is expressed primarily in the acceleration of respiration in pneumonia, which usually does not happen with infectious diseases of the upper respiratory tract. Normally, the ratio of pulse and respiration rate is 3 to 1. However, with pneumonia, the ratio can reach 2 to 1 and 1 to 1. That is, if the child has a pulse of 100, then the breathing rate can be more than 50 breaths per minute. Despite the increased respiratory rate, it is usually superficial, shallow.
How else can you determine respiratory failure? There are a number of other signs testifying to it, for example, blue skin, especially in the area of the nasolabial triangle. Sometimes paleness of the skin can be observed.
Secondly, with pneumonia, there is another characteristic symptom – high temperature. The level of hyperthermia in pneumonia is usually significantly higher than for other respiratory diseases and can reach 102-104ºF (+ 39-40ºС). However, this symptom may not occur with all types of pneumonia. Signs of atypical pneumonia in a child include subfebral temperature or the temperature is slightly above 100ºF (+ 38ºС). Sometimes there may be such a scenario of the disease, when the temperature in the first days rises to high values, and then decreases. In addition, in children under one year old, due to the imperfection of the immune system, the temperature can also remain within subfebrile, even in the most severe forms of pneumonia.
Signs of pneumonia in a child include other respiratory symptoms. First of all, it is a cough. As a rule, it can occur if the infection affects not only the lungs, but also the bronchi, which most often happens in practice, as well as if pneumonia is a complication of acute respiratory infections. Cough can be varied, but as a rule, it is not completely dry, but is associated with sputum discharge. Or, in the first days of the disease, a dry cough appears, and then it goes into a cough with expectoration of sputum. A variety of manifestations differs bilateral lobar pneumonia. In children, the symptoms of this form of the disease include not only cough, but “rusty” sputum, including red blood cells from damaged small capillaries.
With the development of pneumonia in a child, the symptoms will include signs of intoxication – headaches, nausea, dizziness. In some types of pneumonia in children, symptoms may include chest pain, sometimes in the hypochondrium.
Symptoms of pneumonia in an infant may not be as severe as in older children. Often, symptoms of pneumonia in infants include only low-grade fever and cough (in some cases it may be absent). Therefore, the recognition of the disease at the age of one year is difficult. Attention should be paid to indirect symptoms – low muscle tone, lethargy, chest failure, anxiety, frequent regurgitation.
Causes of pneumonia
For the causes of pneumonia is divided into primary and secondary. Primary pneumonia includes cases of the disease that arise directly from infection with pathogens. Secondary pneumonia includes cases of disease that are complications of other respiratory diseases – ARVI, bronchitis , flu, sore throat, etc.
In most cases we are talking about secondary diseases. It should be noted that viral respiratory diseases very often provoke the occurrence of pneumonia and prepare the soil for them by weakening the immune system and lowering the protective properties of bactericidal sputum produced in the lungs.
Rarely, pneumonia is transmitted from person to person by airborne droplets. Typically, the causative agents of the disease already live in the body, long before it starts, and just wait in the wings to begin their advance on the lungs. The trigger, which can trigger the activation of pathogenic microflora, can be an infectious disease of the upper respiratory tract, influenza, weakening of the immune system, for example, as a result of hypothermia of the body.
A special group of cases of pneumonia diseases includes the so-called hospital infections. They occur in hospitals, in the event that patients are treated for other diseases. Hospital pneumonia is caused by special, hospital strains of bacteria that have an increased resistance to traditional antibiotics.
Thus, pneumonia can also be caused by congestion in the lungs associated with long bed rest. In young children, congestion in the lungs can also be caused by intestinal infectious diseases, in which abdominal distention occurs and normal ventilation of the lungs is disturbed. Also, the occurrence of pneumonia can be facilitated by the frequent regurgitation of food by a child, in which the vomitus with the intestinal pathogens contained in them can partially enter the lungs.
If pneumonia occurs in newborns, then there may be two main reasons – either the child was infected directly in the maternity hospital, or was already infected in the womb.
Other factors contributing to the disease:
- passive smoking of others.
In a child, acute pneumonia can only be diagnosed by a doctor. At the first signs of pneumonia in a child should call a therapist. An experienced doctor can determine the focus of inflammation by listening to noises and wheezing in the lungs and tapping the chest. Also, other diagnostic signs are used to recognize the disease: respiratory failure, the nature of hyperthermia, damage to the upper respiratory tract.
However, in order to unambiguously make a diagnosis and determine the location of the nidus of the disease, in most cases radiography is required. The degree of lung lesion and the area of distribution of the pathological process are clearly visible on the X-ray. This symptom is the most important in the diagnosis.
However, X-rays do not always allow to determine the causative agent of the disease. But the treatment strategy largely depends on this information. For this purpose bacteriological analyzes are used – the isolation of antibodies to the pathogen or the pathogens themselves from blood and sputum droplets. However, it is not always possible to unambiguously identify the pathogen, since several potentially pathogenic microorganisms can be contained in the sputum at once. In addition, a violation of leukocyte formula, an increase in the ESR level (20 mm / h or more), a decrease in hemoglobin are taken into account. However, a significant increase in the number of leukocytes accompanies not all types of pneumonia. The maximum increase in the number of leukocytes is observed with chlamydial infections (30 000 per μL).
In most cases of pneumonia in children, subject to timely access to a doctor, the prognosis is favorable. Pneumonia in newborns and infants, especially premature infants, is a serious life-threatening condition. It is also dangerous for its severe complications of pneumonia caused by staphylococci and streptococci, as well as with the pyocyanic stick. In most cases, with proper treatment, the likelihood of complications is low.
Inflammation of the lungs in a child aged 2 years can be severe and spread to other organs.
The most common complications include lung abscess, lung tissue destruction, pleurisy, air entering the pleura.
Complications of pneumonia in children that affect other organs:
- heart failure,
- sepsis and septic shock,
- bleeding disorder.
Treatment of pneumonia in children
Treatment of acute pneumonia in a child can be carried out both in the hospital and at home. The choice of a particular option is made by a doctor, based on these factors:
- child’s age,
- patient’s condition
- estimated type of disease
- the ability of parents to provide proper care for the child,
- the presence of smokers in the family.
If you do not cure acute pneumonia, it can turn into chronic, lasting up to six months.
Treatment of bacterial pneumonia in a child is carried out mainly with antibiotics. Of course, during the first examination, the doctor often does not have the opportunity to accurately determine the type of pathogen. Therefore, general antibiotics are prescribed first, or an antibiotic is selected based on approximate assumptions. Subsequently, as the diagnostic data accumulates, this appointment can either be canceled or confirmed. The effectiveness of the antibiotic is assessed in the first days after administration, usually after 2-3 days. How do you know if the drug has worked? If the patient’s condition improves – a decrease in temperature, a weakening of symptoms indicating pulmonary insufficiency, then drug therapy with this drug continues. Otherwise, another medication is used. By this time, the doctor may already have at his disposal data on the nature of the infection, which can help him make the right choice.
Not everyone antibacterial drug can be used in the treatment of pneumonia in children. Among the drugs that are effective in pneumonia and resolved in pediatric practice, the most common antibiotics are the group of cephalosporins and macrolides. However, it is possible to choose other drugs – penicillins, sulfonamides, amoxicillins. Fluoroquinolones and tetracyclines are less commonly used only in the case of severe complications and the ineffectiveness of other drugs. It is necessary to take into account the age of the child, for example, in 3 years some drugs may come up, and in 1 year – not anymore.
The choice of the drug is not a simple matter, and it should not be carried out at random by people who do not have knowledge of the properties of antibiotics, but by a qualified specialist with extensive practical experience and able to take into account all factors, such as contraindications, effectiveness and side effects of the drug, but also the condition of the patient, his age, features of the disease. Otherwise, the use of antibiotics can only harm.
If a child has pneumonia, then, as a rule, oral antibiotics are prescribed. However, in the event of a severe illness, or in the event that the administration of antibiotics causes nausea or vomiting in a child, parenteral administration of drugs is prescribed.
It is necessary to strictly follow the dosage indicated by the doctor. Irregular intake can negate the entire therapeutic effect of drugs, due to the fact that there is not enough concentration of the substance in the blood. Also, if a patient has signs of improvement, you should not stop taking the drug, you must complete the treatment.
Among the negative factors associated with taking antibiotics, we should highlight the fact that they negatively affect the body’s beneficial microflora, especially the intestinal. Therefore, in parallel with taking antibiotics, probiotic preparations should also be taken.
Should one use antipyretic and anti-inflammatory drugs for pneumonia in a child? This can be done in some cases, but only with the permission of a doctor. It is not recommended to bring down the temperature with the help of antipyretics for pneumonia due to the fact that hyperthermia is a protective reaction of the body and is designed to mobilize all its forces to fight infection. Of course, a lot depends on how high the temperature is. If it exceeds 102,2° F (+39° C), then such overheating of the body can negatively affect the patient’s condition. In young children, high fever can even lead to seizures. In such cases, it is worth giving the child an antipyretic even when the thermometer reaches 99,5° F (+37,5° C). Otherwise, if the child tolerates the temperature well, and he does not have any concomitant diseases in which a high temperature can be dangerous, then it is better not to reduce the temperature artificially. The most commonly used antipyretic drugs are paracetamol and other non-steroidal drugs.
It is also necessary to give the patient as much as possible to drink. With pneumonia in the child, the body loses a lot of fluid – this is primarily due to the abundant sweating. In addition, drinking plenty of water allows you to quickly remove toxins from the body. However, with signs of pulmonary edema, fluid intake is limited.
As a rule, pneumonia in a child is combined with the formation of mucus in the bronchi and cough, in which this mucus is removed from the respiratory system. Therefore, an important category of funds are drugs to relieve cough. They are divided into three main groups – mucolytic, expectorant and bronchodilator. Mucolytic agents reduce the viscosity of bronchial mucus, and expectorant drugs facilitate its withdrawal. Among expectorant and mucolytic drugs most commonly used are bromhexine, ambrohexal, acetylcysteine. Among bronchodilator drugs designed to relieve bronchospasm, euphylline is most commonly used.
Cold preparations that suppress the activity of the cough center are contraindicated because they lead to stagnation of sputum in the lungs.
Can I use folk remedies?
Is it necessary to use traditional medicine for pneumonia detected in a child, and can they replace antibiotics? As you know, many parents are wary of antibiotics. And this concern is understandable – because antibiotics can have side effects, for example, dysbacteriosis and can cause allergic reactions. Therefore, they are trying to replace antibiotics in the treatment of infectious diseases with some alternative means. It is worth saying straight out that such an approach in the case of bacterial pneumonia is an irresponsible levity.
Pneumonia in a child is not sore throat, which takes seven days in the case of treatment, and a week in the absence of treatment This is a severe and life-threatening disease that has no other effective treatment methods other than antibiotics. This is due to the fact that the focus of inflammation is very deep, sometimes in the lower part of the lungs, and no gargling with infusions of herbs or even inhalation can affect it. Those who wish to treat their child with folk methods should remember that before the invention of antibiotics, the survival rate of young children in the case of pneumonia was about 30%. These statistics clearly show the effectiveness of folk remedies compared with modern antibiotic therapy. Of course, if a child does not tolerate any kind of antibiotic, then the doctor should be told about this and he will surely be able to find a replacement.
Additional measures for treatment
Massage and physiotherapy can be prescribed as ancillary measures. They are carried out with pneumonia, when the child has started to decrease the temperature.
It goes without saying that when treating at home, the patient must comply with bed rest. The air in the room where it is located should not be either too warm or too cold. The optimum temperature is 66-68 F (19-20 C). You should also monitor sufficient humidity, because dry air irritates the mucous membranes of the respiratory tract. In addition to abundant drinking, you should also pay attention to the diet. Of course, the patient should not be forced to feed, if there is no appetite at high temperature. However, it is worth noting that with the disease the body should receive an increased amount of proteins, vitamins and microelements, so that nutrition should be complete. Food should be easily digestible and hypoallergenic.
In stationary conditions in severe condition oxygen therapy (artificial ventilation of the lungs) is carried out.
With the proper observance of all the doctor’s prescriptions, full recovery can occur in 10-14 days. However, even after recovery, a child attending school for several months (from 1.5 to 3) should be released from physical education and physical activity. Emotional and physical overwork of children who have had pneumonia should be avoided. They are put on dispensary registration for a period of up to one and a half years. At this time, additional tests and X-rays may be prescribed. During rehabilitation, it is recommended to use breathing exercises.
After recovery, residual symptoms of the disease, such as a dry cough, are associated with inadequate recovery of the mucous membrane. For the speedy restoration of lung functionality, sanatorium-resort treatment, inhalation of sea air is recommended.
Pneumonia in a child in most cases is a disease of low immunity. Therefore, the prevention of the disease in children includes measures to improve immunity – hardening, the correct daily routine, physical activity, good nutrition, taking vitamin complexes. At the same time, care should be taken that the child would not get hypothermia, cleanliness and sufficient humidity in the apartment.
And, of course, it is necessary to treat respiratory diseases, which can be the direct cause of pneumonia – ARVI, pharyngitis, laryngitis, tonsillitis, and first of all, bronchitis.
Universal vaccinations against pneumonia at the moment does not exist, but you can be vaccinated against some pathogens of pneumonia, for example, pneumococcus and hemophilus bacilli. These vaccinations are not mandatory and are carried out at the request of the parents.
The tendency to pneumonia in childhood is a reason for in-depth examination and identifying the causes of the situation. It is possible that the child has hereditary pathologies of the lungs and bronchi and chronic diseases such as muscoviscidosis. This condition requires constant monitoring and treatment.