Frequently ill children
Frequently ill children are a category of children exposed to a high incidence of acute respiratory diseases due to transient, correctable disorders in the body’s defense systems. The group of those who are often ill includes children who suffer more than 4-6 episodes of acute respiratory infections per year, which can occur in various clinical forms. Often sick children should be examined by a pediatrician, ENT doctor, allergist-immunologist; the diagnostic algorithm includes: UAC, sowing from the mucous membranes of the pharynx and nose, detection of infections by PCR, allergy tests, immunogram examination, radiography of the paranasal sinuses and chest. Often sick children need rehabilitation of foci of chronic infection, etiopathogenetic therapy of acute respiratory infections, vaccination and nonspecific prevention.
Frequently ill children (CBD) are children who suffer acute respiratory infections more often than conditionally healthy children (i.e. more than 4-6 times a year). The concept of “frequently ill children” is not a diagnosis and an independent nosological form: it may hide various diseases of the respiratory system (rhinitis, nasopharyngitis, sinusitis, laryngotracheitis, bronchitis, etc.).
In outpatient pediatrics, the term “frequently ill children” is used to refer to a group of dispensary observation and reflects mainly the multiplicity and severity of infectious morbidity. Sometimes, to emphasize the protracted nature of respiratory infections in this category of children, the concept of “frequently and long-term ill children” (BDBD) is used. In Western countries, the term “children with recurrent acute respiratory infections” is used in relation to such patients. According to epidemiological data, children who are often ill make up 15-40% of the total number of children.
Reasons
It is believed that the main cause of recurrent respiratory diseases in children are nonspecific violations of immunological reactivity, affecting all parts of the immune system. Although there are no gross primary defects in the immune system of often ill children, however, there is an extreme strain of the immune response and depletion of reserves of anti-infectious protective mechanisms. Apparently, a transient change in homeostatic equilibrium develops against the background of massive and prolonged antigenic effects on the child’s body.
The causative agents of repeated infections in frequently ill children in most cases are viruses (influenza and parainfluenza, respiratory syncytial, adenoviruses), atypical microorganisms (pathogens of chlamydia and mycoplasmosis), bacteria (Hemophilus bacillus, staphylococci, streptococci, Marcella, pneumococci, etc.).
Risk factors
In the anamnesis of often ill children, pathology of the perinatal and neonatal periods is often traced:
intrauterine infections,
asphyxia,
hypoxic-ischemic encephalopathy,
prematurity, etc.
Infants may have:
hypotrophy,
rickets,
anemia,
hypovitaminosis,
dysbiosis.
At an early age , they join:
helminthiasis
chronic infections of the nasopharynx: adenoids, rhinitis, sinusitis, otitis, pharyngitis, etc.
Early transfer of a child to artificial feeding, environmental problems, poor child care, passive smoking, irrational use of medicines (antipyretics, antibiotics, etc.), allergic burden can contribute to the disruption of already imperfect adaptation mechanisms.
Often sick children often have a lymphatic-hypoplastic anomaly of the constitution (diathesis). Sometimes, it would seem that a normally developing child passes into the category of frequently ill children after he begins to attend preschool educational institutions, which is explained by the high level of contacts with sources of infection.
Pathogenesis
Studies show that even during the period of complete clinical well-being in frequently ill children, the functional activity of T-lymphocytes is reduced; the ratio of helpers / suppressors is changed; hypo- and dysgammaglobulinemia, phagocytosis disorders, a decrease in the level of lysozyme and secretory ID, an increase in the content of pro-inflammatory interleukins and other changes are noted. These shifts cause an increased tendency of children to develop repeated respiratory infections and bacterial complications. At the same time, insufficient reserve capabilities of interferogenesis (antiviral protection) contribute to the maintenance of sluggish inflammation in the child’s body.
Characteristics of CBD
On average, most children suffer 3-5 episodes of acute respiratory infections per year; at the same time, the greatest incidence is observed among children of early, preschool and primary school age. In the first three years of life, children suffer from acute respiratory infections 2-2.5 more often than children older than 10 years.
The criteria for classifying children as frequently ill are: the frequency and severity of acute respiratory infections, the presence of complications, the duration of intervals between episodes of morbidity, the need to use antibiotics for treatment, etc. The main among these indicators is the number of repeated episodes of acute respiratory infections, taking into account the age of the child (A.A.Baranov, V.Y.Albitsky, 1986). Children can be classified as frequently ill:
the first year of life, who have suffered 4 or more cases of acute respiratory infections per year;
from 1 to 3 years old, who have suffered 6 or more cases of acute respiratory infections per year;
from 4 to 5 years old, who have suffered 5 or more cases of acute respiratory infections per year;
older than 5 years, who have suffered 4 or more cases of acute respiratory infections per year.
In addition, in children older than 3 years, when referring them to the group of those who are often ill, an infectious index can be used, calculated as the ratio of the number of all episodes of acute respiratory infections per year to the age of the child (in years). In rarely ill children, the infectious index usually does not exceed 0.2-0.3; in often ill children it is 0.8 and higher.
The structure of infectious morbidity in children who are often ill is dominated by acute respiratory viral infections. At the same time, respiratory infections in frequently ill children can occur in the form of lesions of the ENT organs (adenoiditis, tonsillitis, sinusitis), upper respiratory tract (rhinitis, nasopharyngitis, laryngotracheitis, etc.), lower respiratory tract (bronchitis, bronchiolitis, pneumonia).
Complications
Children who are often ill have a tendency to a prolonged and complicated course of infections. The structure of complications in them is dominated by sinusitis, purulent otitis, bronchial asthma, pneumonia, pyelonephritis, glomerulonephritis, rheumatism.
Frequent infectious morbidity leads to a violation of the neuropsychic and physical development of children, the formation of vegetative-vascular dystonia, restriction of social contacts with peers, poor academic performance. Often, children who are often ill have an unformed visual-effective and visual-imaginative thinking, a delay in speech development, a violation of fine motor skills.
Diagnostics
Examination and supervision of frequently ill children should be carried out by a group of specialists, including a pediatrician, a pediatric otolaryngologist, a pediatric allergist-immunologist, a pulmonologist.
ENT diagnostics. Since half of the frequently ill children have chronic diseases of the ENT organs, rhinoscopy, pharyngoscopy, otoscopy, ultrasound of the sinuses are necessary to assess the condition of the adenoids, tonsils, sinuses, eardrums.
Allergodiagnostics. In order to detect atopy, allergy tests are performed, the content of general and allergen-specific immunoglobulins E (IgE) is determined. It is advisable to study the indicators of the state of immunity, including the levels of IdA, IgG, IdM.
Laboratory examination. To assess the microbiocenosis of the nasopharyngeal mucosa in frequently ill children, bacteriological sowing from the pharynx and nose is mandatory. To detect viral and atypical pathogens (MS virus, mycoplasma, chlamydia, cytomegalovirus, HSV types 1 and 2), smears and flushes are examined by PCR. Often sick children undergo a clinical blood test, a general urine test, feces for dysbiosis, examination for helminthiasis and giardiasis.
Additional research. Instrumental diagnostics is supplemented by performing radiography of the nasopharynx and paranasal sinuses, chest radiography, FVD.
Treatment of frequently ill children
Since the concept of “frequently ill children” hides a wide range of individual problems, it is impossible to talk about a universal treatment algorithm. Nevertheless, the experience gained in pediatrics has allowed us to identify common approaches to the treatment and rehabilitation of frequently ill children, including increasing the body’s resistance, rehabilitation of foci of chronic infection, etiopathogenetic therapy during acute respiratory infections, and vaccination.
Drug therapy
During periods of respiratory infection incidence, etiopathogenetic treatment is often prescribed to sick children: anti-inflammatory (fenspiride), antiviral (alpha interferon, umifenovir, remantadine), local or systemic antibacterial therapy (amoxicillin, amoxicillin-clavulanate, cefixime, etc.).
To stimulate nonspecific protection factors, often ill children are shown to take bacterial lysates. It is necessary to correct the intestinal microflora with the help of probiotics and prebiotics. The possibility of monitoring often ill children by a homeopath is not excluded.
Therapeutic manipulations
In chronic ENT pathology, local treatment is carried out – washing the nasal cavity with saline solutions, rinsing the pharynx, washing the lacunae of the palatine tonsils, physiotherapy (UFO tonsils, inhalations, microwave, UHF, laser on regional lymph nodes); according to indications – cauterization of the nasopharyngeal mucosa, adenotomy, tonsillectomy, etc.
General strengthening measures
The rehabilitation and rehabilitation direction includes general hygienic measures: organization of a rational daily routine (adequate sleep, exclusion of physical and neuropsychiatric overloads, daily walks and physical activity), proper nutrition. During periods of clinical well-being, often ill children are recommended to take multivitamin complexes, conduct hardening procedures, hydrotherapy, general massage, respiratory gymnastics and physical therapy.
