Upper respiratory tract infection in children – 7 Interesting Facts

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How common are Upper respiratory tract infection in children

Interesting Facts

  • Upper respiratory tract infection is an acute, self-limiting viral illness associated with inflammation of the nasal and pharyngeal mucosa
  • Common symptoms in children include rhinorrhea, nasal congestion, sneezing, cough, and otalgia, sometimes accompanied by mild fever, sore throat, and headache
  • Transient, self-limited middle ear abnormalities are common in younger children; the majority require no specific treatment
  • History and physical examination are the only diagnostic tools necessary to confirm an upper respiratory tract infection
  • Treatment includes symptomatic care for patient (eg, acetaminophen or ibuprofen for general discomfort or fever, nasal saline for nasal congestion, honey for cough) and anticipatory guidance for caregivers; topical anticholinergics can help reduce nasal symptoms in children older than 5 years
  • Complications include acute otitis media, acute sinusitis, pneumonia, and asthma exacerbation in children with underlying asthma
  • Most important preventative measure is effective hand hygiene
  • Prognosis is very favorable in otherwise healthy children; often children show improvement in symptoms by 10 days without risk of mortality or severe morbidity 1

Pitfalls

  • School-aged children experience on average 7 to 12 episodes of upper respiratory tract infection yearly, and young children frequently experience prolonged symptoms; 2 lack of appropriate anticipatory guidance and education of parents can lead to increased parental anxiety associated with upper respiratory tract infections in young children and unnecessary physician office visits
  • Common OTC medications (eg, cough and cold preparations, antitussives, antihistamines) used to treat upper respiratory tract infection are discouraged owing to lack of proven efficacy and safety concerns in children; exceptions include ibuprofen and acetaminophen
  • Avoid use of dextromethorphan, narcotics, and codeine in children with upper respiratory tract infection owing to lack of efficacy and potential for harm 3
  • Avoid unnecessary and inappropriate use of antibiotics in children with upper respiratory tract infection 4 5
    • Infants and young children commonly experience prolonged symptoms (ie, 73% of patients are symptomatic 10 days after symptom onset 6) with upper respiratory tract infections
  • Upper respiratory tract infection can precipitate exacerbation of underlying comorbid disease (eg, asthma, cystic fibrosis, bronchopulmonary dysplasia, congenital heart disease); heightened management and monitoring of underlying disease is usually necessary during upper respiratory tract infection in children with underlying pulmonary or cardiac comorbidity

Urgent Action

  • Urgently evaluate in office all neonates with a reported fever before administering acetaminophen; a documented fever in a neonate is a medical emergency requiring evaluation for sepsis despite symptoms and signs of an upper respiratory tract infection
  • Urgently evaluate any child with an acute severe respiratory infection causing reported apnea or respiratory distress for alternate diagnosis requiring treatment modification

Terminology

Clinical Clarification

  • Upper respiratory tract infection is an acute, self-limiting viral illness associated with inflammation of the nasal and pharyngeal mucosa 2
  • Also known as nasopharyngitis 2
  • School-aged children experience on average 7 to 12 episodes of upper respiratory tract infection yearly, and young children frequently experience prolonged symptoms 2

Diagnosis

Clinical Presentation

History

  • Symptoms develop gradually, reach a peak 2 to 3 days after infection, and then gradually subside 7
    • Mean symptom duration is approximately 7 to 10 days; 1 by 10 days of illness most symptoms are improving 8
    • Infants and young children typically experience prolonged symptoms; 73% continue to be symptomatic 10 days after onset 6
    • Some symptoms (eg, cough) may persist for over 3 weeks 1
  • Common symptoms include the following: 6
    • Nasal congestion
      • Present in 59% of patients on first day of illness and peaks by day 3 in 88%; persists through day 7 in over 75% of patients 6
      • Occasionally manifests in an asymmetrical pattern, alternating between nasal passages (ie, 1 nasal passage is patent while the other is obstructed) 1
    • Rhinorrhea
      • Peaks on day 3 in 72% of patients and persists through day 6 in over 50% 6
      • Occasionally associated with epiphora (eg, itchy, watery eyes) 1
    • Cough
      • Present in 46% of patients on the first day of illness and peaks on day 1 in 69%; persists through day 8 in over 50% of patients 6
      • Occasionally moist and productive, 2 particularly later in the course of the infection 1
    • Sneezing
      • Present in 36% of patients on the first day of illness and peaks on day 1 in 55%; persists through day 5 in over 35% of patients 6
    • Otalgia
      • Common and usually manifests 3 or 4 days after the onset of other symptoms 7
      • Often intermittent or alternating between ears 9
      • Can be associated with mild hearing difficulty 10
  • Other symptoms include:
    • Fever
      • Found in 15% of patients at onset of illness 6
      • More common in infants and small children 2
      • Usually intermittent
    • Headache
      • Found in 15% of patients at onset of illness 6
    • Sore throat 1
      • Initially characterized by throat irritation and scratchy sensation, later developing into mild pain
    • Mild myalgia 2
    • Mild fatigue 2
  • Additional signs in infants who are obligate nasal breathers include the following:
    • Difficulty sleeping 11
    • Difficulty feeding
    • Fussiness 11

Physical examination

  • Vital signs are expected to be normal for age (eg, child is active, well appearing, and hydrated, with normal respiratory rate)
  • Nares
    • Mucosal erythema and edema
    • Initially clear mucus; typically becomes cloudy white or yellow before resolution of illness
  • Tympanic membrane
    • Transient middle ear abnormalities (observed by direct visualization) occur in 42% of patients in the first several days after infection 9
      • Serous or mucoid (nonpurulent) middle ear effusion 10
      • Visible air-fluid levels or bubbles behind the membrane 12
      • Retracted tympanic membrane without bulging 12
      • Decreased tympanic membrane mobility 12
      • Abnormal tympanic membrane color (eg, white, yellow, opaque) 12
    • Abnormal middle ear pressure detected by tympanometry occurs in up to 66% of children during the 2 weeks after onset of symptoms 9
      • Abnormal middle ear pressures are intermittent and alternate between ears
  • Oropharynx
    • Nonspecific erythematous inflammation in the pharynx without exudate
    • Posterior nasal drainage

Causes and Risk Factors

Causes

  • Infection by 1 of the numerous respiratory viruses; over 200 pathogenic viral serotypes infect humans 1
    • Rhinoviruses are the most common; responsible for 30% to 50% of all cases 1
    • Coronaviruses are the second most common causative agent; responsible for 10% to 15% of cases 1
    • Influenza viruses are responsible for 5% to 15% of cases 1
    • Other less common viruses include respiratory syncytial virus in up to 5% of cases, parainfluenza viruses in up to 5% of cases, adenoviruses in less than 5% of cases, and enteroviruses in less than 5% of cases 7
    • Unknown cause in 20% to 30% of cases 7
  • Viral transmission occurs according to the following mechanisms:
    • Direct contact with nasal or oral secretions of an infected individual
    • Direct contact with contaminated objects (eg, doorknobs, toys)
    • Airborne droplets 2

Risk factors and/or associations

Age
  • Upper respiratory tract infections are more frequent in younger children
    • 6 to 10 episodes per year in preschool-aged children 2
    • 7 to 12 episodes per year in school-aged children 2
    • 2 to 4 episodes per year in older children/adolescents 2
Other risk factors/associations
  • More frequent during cold seasons (eg, autumn through winter) in temperate regions and during rainy season in tropical areas 7
  • Close contact with other affected individuals (eg, school or day care attendance) increases risk
    • Frequency of colds increases with increasing number of children in the group 7
  • Environmental exposure to tobacco smoke increases risk 13
  • Weakened immune system increases risk (eg, immunocompromise, prematurity)
  • Allergic disorders that affect integrity of natural barriers to infection (eg, sinuses, throat) increase risk
  • Psychological stress increases risk for an upper respiratory tract infection 7
  • Heavy physical training may increase risk for upper respiratory tract infection; moderate physical activity is associated with decreased risk

Diagnostic Procedures

Primary diagnostic tools

  • History and physical examination are the only diagnostic tools necessary to confirm an upper respiratory tract infection 11
  • Laboratory or other testing offers no diagnostic utility for upper respiratory tract infection in an otherwise healthy child with normal vital signs 11

Differential Diagnosis

Most common

  • 14Allergic rhinitis
    • Classic allergic rhinitis presents similarly to upper respiratory tract infection with congestion, rhinorrhea, nasal itching, and sneezing; 2 or more symptoms for over an hour a day for 2 weeks is concerning for the diagnosis of allergic rhinitis 14
    • As opposed to upper respiratory tract infection, allergic rhinitis is often accompanied by ocular symptoms and findings (eg, itchy and watery eyes, conjunctival injection and swelling), and many patients have a positive family history for allergic rhinitis or personal history of atopy (eg, asthma, eczema); often, allergic rhinitis triggered by environmental allergies is familial and occurs during warmer seasons
    • Differentiate by clinical presentation (eg, itching and ocular symptoms, timing of presentation, identification of triggers, family history), response to trigger avoidance, response to medications for treating allergic rhinitis (eg, intranasal steroids, antihistamines), and lack of viral exposure
    • Trigger identification can be confirmed by skin prick testing or serum specific IgE testing if the diagnosis remains in question 15
  • 16Croup
    • Early viral croup is indistinguishable from an upper respiratory tract infection; nonspecific rhinorrhea and sore throat for 12 to 48 hours precedes the development of a classic barky cough, hoarse voice, stridor, and difficulty breathing in most children with croup
    • Croup is most common in patients aged 6 months to 3 years and presents most often in the late autumn season in North America; symptoms are worse at night
    • Croup symptoms can last up to 1 week, but most children experience a shorter course of symptoms; croupy cough resolves in 60% of children within 48 hours
    • Croup is a clinical diagnosis and additional testing is not routinely indicated (eg, airway radiographs); differentiate croup from upper respiratory tract infection by clinical presentation and clinical course
  • Bacterial sinusitis (Related: ) 8Sinusitis
    • Acute bacterial sinusitis presents similarly to upper respiratory tract infection with rhinorrhea, congestion, cough, and sometimes fever and headache; edema and erythema of nasal mucosa are common
    • An antecedent upper respiratory tract infection is commonly reported owing to the fact that sinusitis may develop as a complication of upper respiratory tract infection
    • As opposed to an upper respiratory tract infection, patients with acute sinusitis experience worsening signs and symptoms well beyond 10 days; 17 purulent nasal drainage and halitosis are common 11
    • Persistent facial pain and facial swelling are distinct to individuals with sinusitis
    • Differentiate by clinical presentation and course of illness (ie, most patients with an upper respiratory tract infection are improving by day 10 of illness)
    • Sinusitis is most often a clinical diagnosis; imaging is used to confirm sinusitis and evaluate for complications of sinusitis when indicated; CT scan sinus findings consistent with sinusitis include clouding, opacity, and thickening of the mucosal interface (4 mm or more) of the affected sinus with or without air-fluid levels 8
  • Nasal foreign body 18
    • Nasal foreign body presents similarly to an upper respiratory tract infection with significant rhinorrhea
    • Associated discharge on examination is often unilateral, purulent, foul smelling, and blood stained in patients with a nasal foreign body; occasionally a foreign body is visible on physical examination
    • Clinical presentation will usually differentiate a nasal foreign body from upper respiratory tract infection with nasal discharge
    • A small suction catheter is passed through the nasal passage to assess gross patency if the diagnosis is of concern
    • Nasal endoscopy is performed for definitive diagnosis and treatment if history and physical examination are suggestive of nasal foreign body
  • 19Influenza
    • Presents similarly to an upper respiratory tract infection in colder months with the acute onset of cough, fever, and systemic symptoms (eg, myalgia, fatigue)
    • Patients with influenza typically experience a significantly more severe symptom complex than patients with upper respiratory symptoms (eg, higher fevers, severe myalgias, patients more ill appearing and limited in activities of daily living)
    • Patients with influenza typically experience less pronounced rhinorrhea than patients with upper respiratory tract infection; sore throat is less common 2
    • Differentiate upper respiratory tract infection from influenza primarily by clinical presentation; specific testing for influenza is available if the diagnosis remains in question
    • Confirmatory rapid diagnosis of influenza can be determined by commercially available rapid influenza diagnostic tests but is limited by their relatively low sensitivity; higher-sensitivity confirmation tests include direct and indirect immunofluorescence antibody staining and reverse transcriptase polymerase chain reaction to detect viral RNA
  • Streptococcal pharyngitis
    • Presenting predominant symptoms are sudden onset of sore throat, fever, and headache with a lack of rhinorrhea and cough; history of contact with a person with streptococcal pharyngitis is often elicited 11
    • Typical age for children to experience streptococcal pharyngitis is between 5 and 15 years; prevalence of streptococcal pharyngitis is lower in children younger than 5 years 20
    • Patients have pharyngeal erythema and swelling, with or without tonsillar exudate; a lack of rhinorrhea on examination is typical
    • Differentiate illnesses by clinical presentation and laboratory testing if the diagnosis remains in question
    • To confirm diagnosis if the rapid strep test result is negative, perform rapid strep testing and backup throat culture for group A β-hemolytic streptococcus
  • Pertussis
    • Initial catarrhal stage of Bordetella pertussis in an unimmunized or underimmunized individual is indistinguishable from an upper respiratory tract infection with significant rhinorrhea and minimal to absent fever lasting up to 2 weeks 21
    • A paroxysmal stage follows the initial catarrhal stage, lasting 1 to 6 weeks, and is characterized by a specific cough; intermittent sudden bursts of staccato coughing fits occur and classically end with a whoop on inspiration followed by posttussive emesis; infants younger than 6 months are at risk for cyanosis, apnea, and severe disease requiring hospitalization 22
    • A long convalescent stage with persistent cough lasting 8 to 12 weeks typically follows the paroxysmal stage 21
    • Differentiate by clinical presentation, course of illness, and testing for Bordetella pertussis
    • Confirm infection with a positive polymerase chain reaction result for Bordetella pertussis, serologic tests using enzyme immunoassay to detect antibody against Bordetella pertussis protein, or culture 22
  • 23Bronchiolitis
    • Bronchiolitis is a common, self-limited, lower viral respiratory tract infection that affects infants and toddlers; often presents in colder months
    • Bronchiolitis is indistinguishable early in the course of illness from an upper respiratory tract infection with symptoms, including 1 to 3 days of rhinorrhea, cough, and low-grade fever; wheezing, dyspnea, retractions, and symptoms of respiratory distress follow as lower airways become involved 23
    • Examination findings consistent with lower airway disease distinguish bronchiolitis from upper respiratory tract infection (eg, diffuse, crackles, expiratory wheezing, prolonged expiratory phase); hypoxemia (ie, oxygen saturation less than 93%) can result 23
    • Lower airway disease can be prolonged in patients with bronchiolitis; 18% of patients remain symptomatic at 21 days and 9% remain symptomatic after 28 days 23
    • Bronchiolitis is a clinical diagnosis and additional testing is not routinely indicated (eg, viral testing, chest radiographs); differentiate bronchiolitis from upper respiratory tract infection by lower airway findings and clinical course
  • Asthma 24
    • Asthma presents similarly to an upper respiratory tract infection with a cough; episodic asthma is often triggered by an upper respiratory tract infection
    • Children with asthma may have a family history significant for asthma or personal history of atopy (eg, eczema, allergic rhinitis)
    • Patients will have variable findings of lower airway obstruction on examination, including prolonged expiratory phase, tachypnea, diminished aeration, and wheezing; hypoxia may result
    • Clinical presentation, course of illness, and response to a trial of bronchodilators separate asthma from an uncomplicated upper respiratory tract infection
    • Confirm asthma based on demonstration of reversible airflow obstruction (ie, improved FEV₁ following bronchodilator administration) 24
  • Pneumonia (Related: ) 25Community-acquired pneumonia in children (aged older than 3 months)
    • Pneumonia and upper respiratory tract infection present similarly with fever, cough, and possibly rhinorrhea; patients presenting with pneumonia usually have acute symptoms of 1 to 2 days duration 25
    • Chest pain, dyspnea, tachypnea, retractions, and focal lower airway findings distinguish pneumonia from an uncomplicated upper respiratory tract infection clinically; hypoxia can occur in children with pneumonia
    • Distinguish pneumonia with clinical presentation and course of illness
    • Obtain a chest radiograph to assess for focal consolidation consistent with pneumonia if the diagnosis is in question or complications of pneumonia are suspected
  • Foreign body aspiration
    • Foreign body aspiration can present similarly to upper respiratory tract infection with a prominent cough, depending upon location at which foreign body lodges
    • History may reveal a choking event or child with small object in the mouth preceding the acute onset of cough; sudden onset of cough is usually not associated with any other symptoms (eg, fever, significant nasal discharge)
    • Examination may reveal tachypnea or focal lung findings with unilateral wheezing when foreign body lodges in a large bronchus; right main stem bronchus is more often involved than the left
    • History and physical examination will often differentiate foreign body aspiration from upper respiratory tract infection
    • If the diagnosis is in question, a bronchoscopy will definitively differentiate foreign body aspiration from upper respiratory tract infection with cough

Treatment

Goals

  • Provide anticipatory guidance to caregivers
  • Provide symptom relief 1
  • Avoid harmful treatments

Disposition

Admission criteria

Hospitalization for further monitoring and management is necessary for patients presenting with acute severe respiratory infection causing respiratory distress, hypoxia, apnea, 26 or dehydration unresponsive to parenteral fluid replacements

Neonates with a febrile upper respiratory tract infection require hospitalization for further management (eg, antibiotics pending sepsis culture results) and monitoring for clinical deterioration

Criteria for ICU admission
  • Admit patients requiring intubation and mechanical ventilation to the ICU for further care; usually associated with underlying comorbidities (eg, asthma, cystic fibrosis, bronchopulmonary dysplasia) exacerbated by an upper respiratory tract infection

Treatment Options

Anticipatory guidance and caregiver education is a mainstay of treatment 4

  • Includes education about expected course of illness, possible complications, reasons to return for reevaluation, supportive measures, potentially harmful measures (eg, OTC preparations, antitussives, antibiotics), and prevention of spread
  • Provide written anticipatory guidance information to parents; written information may reduce the number of unnecessary antibiotics used by patients 27
  • Lack of appropriate anticipatory guidance and education of parents can lead to increased parental anxiety associated with upper respiratory tract infections in young children and unnecessary physician office visits

Symptomatic care includes the following: 2

  • Rest 2
  • Fluids to maintain adequate hydration and replenish fluid loss 28
  • Analgesics (eg, acetaminophen, ibuprofen 29) to reduce discomfort associated with upper respiratory tract infection (eg, fever, headache, otalgia, myalgia)
    • Urgently evaluate in office all neonates with a reported fever before administering acetaminophen; a documented fever in a neonate is a medical emergency requiring evaluation for sepsis despite symptoms and signs of an upper respiratory tract infection
  • Saline or warm water nasal irrigation with bulb suction or blowing nose to relieve nasal congestion and rhinorrhea 28 30
  • Topical anticholinergic to reduce rhinorrhea (eg, ipratropium bromide nasal spray) in patients older than 5 years 2 31
  • Throat lozenges to provide temporary relief from scratchy or sore throat; use only for children older than 6 years who are not at risk for aspiration 2
  • Honey and warm fluids to help relieve cough 32
  • Indoor air sufficiently humidified to facilitate comfort; 28 do not recommend steam inhalation or heated humidified air 33
  • Sleep position modification with the head raised by an extra pillow or by positioning the mattress at 45° for infants to allow for effective nasal passages drainage 2
  • Consider a single dose of oral (eg, phenylephrine, pseudoephedrine) or topical decongestant (eg, oxymetazoline, phenylephrine) to reduce edema and swelling of the nasal mucosa and promote drainage when symptoms are severe and other supportive measures fail in children older than 12 years 2 34 35

Avoid the following:

  • OTC cough medication preparations in young children 36
    • Efficacy of OTC cold medications is debated and safety concerns exist 4 37 38 39
    • The Institute for Clinical Systems Improvement does not recommend the use of OTC medicines in children 4 years and younger 11
    • American Academy of Pediatrics recommends against the use of OTC cough and cold medications in children younger than 6 years owing to lack of proven efficacy and risk of adverse effects
    • OTC antihistamine-analgesic-decongestant combinations may have a general benefit in older children and adults; potential for adverse effects exists and clinician must weigh risk of adverse effects (eg, drowsiness, excessive sleepiness, dry mouth, insomnia, dizziness, palpitations, nervousness, headache, gastrointestinal upset) with possible benefits in any given individual older patient 34
  • Antihistamines to treat symptoms of upper respiratory tract infection in children
    • Demonstration of effectiveness is lacking and risk of adverse effects is high 40 41
  • Antitussives (eg, dextromethorphan, 40 codeine) to treat cough in children 3
    • Demonstration of effectiveness is lacking and risk of adverse effects is high
  • Unnecessary and inappropriate use of antibiotics in children with upper respiratory tract infection 5
    • Infants and young children commonly experience prolonged symptoms (ie, 73% of patients are symptomatic 10 days after symptom onset) with upper respiratory tract infections

Drug therapy

  • Anticholinergic
    • Ipratropium bromide nasal spray 31
      • Ipratropium Bromide Nasal spray, solution; Children 5 to 11 years: 2 sprays (84 mcg) per nostril is recommended dose. Frequency and duration dependent on indication. For rhinorrhea associated with allergic rhinitis, administer 4 times daily; use beyond 3 weeks not established. For rhinorrhea associated with the common cold, administer 3 times daily; use beyond 4 days not established.
      • Ipratropium Bromide Nasal spray, solution; Adults, Adolescents, and Children 12 years and older: 2 sprays (84 mcg) per nostril is recommended dose. Frequency and duration dependent on indication. For rhinorrhea associated with allergic rhinitis, administer 4 times daily; use beyond 3 weeks not established. For rhinorrhea associated with the common cold, administer 3 or 4 times daily; use beyond 4 days not established.

Nondrug and supportive care

  • General symptomatic care
    • Maintain adequate hydration and encourage fluids 2
      • Use commercial rehydration fluid with electrolytes for infants refusing formula
    • Maintain adequate humidity
      • A cool mist humidifier or running a warm shower will increase indoor air humidity to lubricate the airways and prevent nasal secretions from drying 28
  • Symptomatic relief for congestion and rhinorrhea
    • Nasal saline solution or warm water 28
      • Apply 2 to 3 drops for each nostril as needed
      • A mixture of salt and water can be prepared at home by mixing 2 mL of table salt with 240 mL of warm water 28
      • Apply nose drops before feedings for nursing or bottle-feeding infants 28
    • Bulb nasal suction or blow nose after nasal wash 28
  • Symptomatic relief for cough 32
    • Honey (ie, buckwheat honey, eucalyptus honey, citrus honey, labiatae honey 4228 37
      • One-half to 2 teaspoons by mouth; raw honey is contraindicated in children younger than 1 year 43
      • A single dose before bedtime or diluted in a noncaffeinated beverage 39
    • Warm clear fluids
      • 5 to 15 mL of warm apple juice or water when coughing; use up to 4 times a day for children aged 3 months to 1 year 28
      • Warm soup, broth, or tea for older children
    • Warm mist from shower can diminish coughing associated with acute coughing paroxysms 28

Comorbidities

  • Patients with underlying pulmonary disease (eg, asthma, cystic fibrosis, bronchopulmonary dysplasia) or immunocompromise are at increased risk of decompensation and complications from upper respiratory tract infection; patients with underlying pulmonary disease or immunocompromise require closer monitoring and individualized management 44
  • Implement individualized asthma action plan in patients with asthma (ie, written plan for increased monitoring of symptoms and peak flow measurements with instructions for appropriate actions to manage worsening symptoms) 45
  • Implement close monitoring of glucose in patients with underlying diabetes; upper respiratory tract infection can compromise glycemic control and require insulin dosing modification during acute illness

Complications and Prognosis

Complications

  • Asthma exacerbation 46
    • Exacerbation of asthma-related symptoms may be precipitated by an upper respiratory tract infection
    • Recurrent episodes of bronchodilator responsive wheezing with upper respiratory tract infection are common in children younger than 3 years; resolves in up to 50% of children by school age 47
  • Acute otitis media
    • Complicates upper respiratory tract infection in up to 37% of children aged 6 months to 3 years; incidence diminishes with increasing age 48
    • Often the acute otitis media complicating an acute upper respiratory tract infection in children is caused by a viral pathogen; it is difficult to clinically distinguish between bacterial and viral causes of acute otitis media 49
    • Less than one-quarter of young children who develop acute otitis media associated with an upper respiratory tract infection require antibiotics for presumed bacterial infection of the middle ear space (eg, purulent otorrhea from a perforated tympanic membrane, bulging tympanic membrane with purulent fluid presence in the middle ear space) 50
    • Antibiotic use does not prevent otitis media from complicating an upper respiratory tract infection and is harmful (ie, results in increased antimicrobial resistance) 51
  • Acute sinusitis 52
    • 0.5% to 10% of upper respiratory tract infections evolve into bacterial sinusitis requiring antibiotic treatment 52
  • Pneumonia
    • Uncommonly develops as a sequela of a upper respiratory tract infection
      • Infection of the upper respiratory tract with certain viruses (eg, respiratory syncytial virus, influenza virus) can lead to increased binding of pathogenic bacteria (eg, Haemophilus influenzae, Streptococcus pneumoniae) to nasopharyngeal epithelium 53
    • Lower airway disease extension from an upper respiratory tract colonization with certain viruses (eg, respiratory syncytial virus pneumonia, influenza virus pneumonia) can follow an upper respiratory tract infection
      • Viruses cause up to 50% of pneumonia in hospitalized infants and children in developing countries (eg, measles virus, respiratory syncytial virus, parainfluenza viruses, influenza type A virus, adenoviruses) 53
    • Antibiotic use does not prevent bacterial pneumonia from complicating an upper respiratory tract infection and is harmful (ie, results in increased antimicrobial resistance); immunization against respiratory pathogens (eg, Streptococcus pneumoniaeHaemophilus influenzae type B, influenza virus) does prevent secondary pneumonia 51 53
  • Mastoiditis
    • Uncommonly develops as a complication of an upper respiratory tract infection

Prognosis

  • Upper respiratory tract infection is a self-limiting illness causing no mortality or morbidity in an otherwise healthy child

Screening and Prevention

Prevention

  • Hand hygiene is the most critical and effective way to reduce occurrence and prevent transmission 2
  • Disinfect common areas (eg, tables, doorknobs, sink handles, toys, sleeping mats)
  • Teach methods to prevent viral spreading, such as coughing or sneezing in a tissue or in the bend of the elbow instead of the hands or diffusely into the environment
  • Restrict activities of patients with illness to prevent spread among other individuals
  • Avoid secondhand smoke; secondhand smoke is particularly dangerous for children with comorbid asthma 46
  • Encourage breastfeeding to diminish the risk of upper respiratory tract infection in infants 54
  • Low-quality evidence suggests that probiotics are more beneficial than placebo at preventing acute upper respiratory tract infections by diminishing the yearly number of respiratory infections; studies are ongoing 55
  • Encourage regular recommended immunizations to prevent certain causes of upper respiratory tract infection (eg, influenza virus) and prevent complications caused by certain bacterial pathogens (eg, Haemophilus influenzaeStreptococcus pneumoniae)

Sources

1: Eccles R: Understanding the symptoms of the common cold and influenza. Lancet Infect Dis. 5(11):718-25, 2005

Cross Reference

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