Respiratory viral infections in children-Back to the basics

It is common for children to have up to 12 viral infections a year in the first few years of life, and it can seem like they are sick all the time. They account for many missed days of school and absences from work for parents caring for ill children. They gradually build up immunity and get fewer colds. Having said that children generally are having slightly more protracted course of viral illness off late which is likely a by-product of the long immune gap that they faced during the pandemic lockdown.

The current trending viruses are adenovirus, influenza A , RSV and rhino-enteroviruses. Most are self-limiting viral infection of the upper respiratory tract causing cold like symptoms, involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhoea), sore throat, cough, fever, headache, and malaise. Some may also be associated with gastrointestinal symptoms such as nausea, vomiting, diarrhoea and reduced appetite. Viruses like adenovirus can cause red, itchy eyes(conjunctivitis) and multisystem involvement. The other common viruses include corona virus (non-covid), respiratory syncytial virus, parainfluenza, metapneumovirus and SARS-CoV 2 viruses.

A small percentage of these viral illnesses continue with persistent fever and can have complications such as ear infection, tonsillitis, episodes of wheezing in children who have not wheezed before or worsening of asthma in children who have a history of this condition, sinusitis or pneumonias (associated with increased cough and rapid breathing), dehydration, and on some occasions lead to multi organ dysfunction. Protracted illness, complicated pneumonias, significant dehydration and organ dysfunction require hospitalisation and escalation of care. Chances of complications are also higher in children with asthma, who are immunocompromised and those with chronic medical conditions.

Treatment for viral illnesses majority of the time is symptomatic and managed on an outpatient basis. The best treatment is rest at home.  Antibiotics will not help treat viral illnesses or keep it from being contagious, and can sometimes cause unnecessary side effects and should only be used when required. Antibiotics are not usually indicated unless there are complication in the form of a bacterial infection of ears, tonsillitis, sinusitis or pneumonias. Children requiring hospitalisation may require additional treatment based on their clinical course.

Simple hygiene measures can help to prevent infection with the viruses that cause colds.

These measures include:

-Teaching children to cover their cough and sneezes. Coughing or sneezing into their elbow. Good respiratory etiquette helps reduce the spread of infection. Avoid touching face/ nose and eyes with hands.

-Hand washing is an essential and highly effective way to prevent the spread of infection. -Teach children to wash their hands before and after eating and after coughing or sneezing.

Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry and may be used several times. These rubs can be used repeatedly without skin irritation or loss of effectiveness.

-Replace hankies with tissues that can be discarded after use.

-It may be difficult or impossible to completely avoid people who are ill, although caregivers should try to limit direct contact.

-Keep your child’s immunizations up to date including annual flu vaccine

-If your child is unwell, keep them away from schools or play area or child care or kindergarten until they are well again.

-Avoid close contact with people who have cold or flu symptom

-Wearing a mask as much as possible

-Avoiding sharing items like cups or towels

-Using a household cleaner that kills viruses, such as phenol/alcohol may help to reduce viral transmission.

When to seek help:

-Fever persisting or high-grade fever for > 4 days

-Difficulty breathing, working hard to breathe, or breathing rapidly- this usually requires immediate medical attention

–Behaviour changes, including irritability or lethargy, decreased responsiveness- this usually requires immediate medical attention

-Refusing to drink anything for a prolonged period and /or reduced urine output

-Persisting symptoms that do not improve or new worrying symptoms

-If your child just does not look right to you

For most children, the worst of viral infection is over in about 7 days, although the cough may last for 3 weeks. However it is recommended to get your child checked if the symptoms persist.

It is just about impossible to prevent your child from catching viruses, but you can help keep your child’s immune system in good shape by ensuring they have a balanced diet and plenty of sleep. Most children do not need to take vitamins on a daily basis. It is important to be up to date with your child’s immunisations including annual flu vaccination.

Dr. ANUPAMA MENON

Consultant Pediatric Pulmonologist

Rainbow Children’s Hospital, Marathahalli, Bengaluru