Viral respiratory tract infections affect the nose, throat, and airways and may be caused by any of several different viruses. Common respiratory tract infections include the common cold and influenza.
Typical symptoms include nasal congestion, a runny nose, scratchy throat, cough, and irritability.
The diagnosis is based on symptoms.
Good hygiene is the best way to prevent these infections, and routine vaccination can help prevent influenza.
Treatment aims to relieve symptoms.
Children develop on average six viral respiratory tract infections each year.
Viral respiratory tract infections are typically divided into
Upper respiratory tract infections: Symptoms occur mainly in the nose and throat. Viral upper respiratory tract infections may occur at any age and include the common cold and influenza.
Lower respiratory tract infections: Symptoms occur in the windpipe, airways, and lungs. Viral lower respiratory tract infections are more common among children and include croup, bronchiolitis, and pneumonia.
Children sometimes have infections involving both the upper and lower respiratory tracts.
In children, rhinoviruses, influenza viruses (during annual winter epidemics), parainfluenza viruses, respiratory syncytial virus (RSV), enteroviruses, coronaviruses, and certain strains of adenovirus are the main causes of viral respiratory infections.
Most often, viral respiratory tract infections spread when children’s hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the children touch their nose or eyes, the viruses gain entry and produce a new infection. Less often, infections spread when children breathe air containing droplets that were coughed or sneezed out by an infected person.
When viruses invade cells of the respiratory tract, they trigger inflammation and production of mucus. This situation leads to nasal congestion, a runny nose, scratchy throat, and cough, which may last up to 14 days. Some children may continue to cough for weeks after the upper respiratory infection has resolved. Fever, with a temperature as high as 38.3 to 38.9° C (101 to 102° F), is common in young children or those with influenza. The child’s temperature may even rise to 40° C (104° F).
Other typical symptoms in children include decreased appetite, lethargy, and a general feeling of illness (malaise). Headaches and body aches develop, particularly with influenza. Infants and young children are usually not able to communicate their specific symptoms and just appear cranky and uncomfortable.
Complications of viral respiratory tract infections
Because newborns and young infants prefer to breathe through their nose, even moderate nasal congestion can create difficulty breathing. Nasal congestion leads to feeding problems as well, because infants cannot breathe while suckling from the breast or bottle. Because infants are unable to spit out mucus that they cough up, they often gag and choke.
The small airways of young children can be significantly narrowed by inflammation and mucus, making breathing difficult. Children breathe rapidly and may develop a high-pitched noise heard on breathing out (wheezing) or a similar noise heard on breathing in (stridor). Severe airway narrowing may cause children to gasp for breath and turn blue (cyanosis). Such airway problems are most common with infection caused by parainfluenza viruses, RSV, and human metapneumovirus infection. Affected children need to be seen urgently by a doctor.
Some children with a viral respiratory tract infection also develop an infection of the middle ear (otitis media) or the lung tissue (pneumonia). Otitis media and pneumonia may be caused by the virus itself or by a bacterial infection that develops because the inflammation caused by the virus makes tissue more susceptible to invasion by other germs. In children with asthma, respiratory tract infections often lead to an asthma attack.
A doctor’s evaluation
Doctors and parents recognize respiratory tract infections by their typical symptoms. Generally, otherwise healthy children with mild upper respiratory tract symptoms do not need to see a doctor unless they have trouble breathing, are not drinking, or have a fever for more than a day or two.
X-rays of the neck and chest may be taken in children who have difficulty breathing, stridor, or wheezing or if the doctor can hear congestion in the lungs. Blood tests and tests of respiratory secretions are rarely helpful.
Vaccination for influenza
The best preventive measure is practicing good hygiene. An ill child and the people in the household should wash their hands frequently. In general, the more intimate physical contact (such as hugging, snuggling, or bed sharing) that takes place with an ill child, the greater the risk of spreading the infection to other family members. Parents must balance this risk with the need to comfort an ill child. Children should stay home from school or child care facilities until the fever is gone and they feel well enough to attend.
Rest and fluids
Drugs for fever and pain
Antibiotics are not necessary and do not help treat viral respiratory tract infections. Children with respiratory tract infections need additional rest and should maintain normal fluid intake. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be given for fever and aches. School-aged children may take a nonprescription (over-the-counter) decongestant for bothersome nasal congestion, although the drug often does not help. Infants and younger children are particularly sensitive to the side effects of decongestants and may experience agitation, confusion, hallucinations, lethargy, and rapid heart rate and should not take these drugs.
In infants and young children, congestion may be relieved somewhat by using a cool-mist vaporizer to humidify the air and by suctioning the mucus from the nose with a rubber suction bulb.
More than 200 viruses can cause the common cold, and infections can spread from person to person through the air and close personal contact. Antibiotics do not work against these viruses. Rhinovirus is the most common type of virus that causes colds.
• Exposure to someone with the common cold
• Age (infants and young children are at higher risk for colds)
• A weakened immune system or taking drugs that weaken the immune system
• Season (colds are more common during the fall and winter)
Signs and Symptoms
When germs that cause colds first infect the nose and sinuses (air-filled pockets in the face), the nose makes clear mucus. This helps wash the germs from the nose and sinuses. After two or three days, mucus may change to a white, yellow, or green color. This is normal and does not mean the child needs antibiotics.
Other signs and symptoms of the common cold can include:
• Stuffy nose
• Sore throat
• Post-nasal drip (mucus dripping down your throat)
• Watery eyes
• Mild headache
• Mild body aches
These symptoms usually peak within 2-3 days but can last for up to 10-14 days.
See a healthcare professional if the child has any of the following symptoms:
• Symptoms that last more than 10 days without improvement
• Symptoms that are severe or unusual
• If the child is younger than three months of age and has a fever, it’s important to call the healthcare professional right away.
Rest, over-the-counter medicines and other self-care methods may help the child feel better. Many over-the-counter products are not recommended for children of certain ages.
Flu symptoms include: fever, cough, sore throat, body aches, headache, chills and fatigue. Some people also have diarrhea and vomiting. One difference between a cold and the flu is that a cold is centered on the nose.
Children under 5 are at higher risk for complications from the flu. Influenza is the only viral respiratory infection preventable by vaccination. All people 6 months and older should get the flu vaccine each year. A flu vaccine is the best way to prevent the flu, and getting it early is best.
Vaccination is particularly important for children and adults who have certain disorders, such as heart or lung disease (including cystic fibrosis and asthma), diabetes, kidney failure, and sickle cell disease. Additionally, children who have a weakened immune system, including children with human immunodeficiency virus (HIV) infection and those undergoing chemotherapy, should receive the vaccine.
Pneumonia continues to be the biggest killer worldwide of children under five years of age. Although the implementation of safe, effective and affordable interventions has reduced pneumonia mortality from 4 million in 1981 to just over one million in 2013, pneumonia still accounts for nearly one-fifth of childhood deaths worldwide.
Pneumonia can occur at any age, although it is more common in younger children. Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years.
Newborns with pneumonia commonly present with poor feeding and irritability, as well as tachypnea, retractions, grunting, and hypoxemia. Infections with group B Streptococcus, Listeria monocytogenes, or gram-negative rods (eg, Escherichia coli, Klebsiella pneumoniae) are common causes of bacterial pneumonia. Group B streptococci infections are most often transmitted to the fetus in utero. The most commonly isolated virus is respiratory syncytial virus (RSV).
Cough is the most common symptom of pneumonia in infants, along with tachypnea, retractions, and hypoxemia. These may be accompanied by congestion, fever, irritability, and decreased feeding. Streptococcus pneumoniae is by far the most common bacterial pathogen in infants aged 1-3 months.
Adolescents experience similar symptoms to younger children. They may have other constitutional symptoms, such as headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are also common in this age group. Mycoplasma pneumoniae is the most frequent cause of pneumonia among older children and adolescents.
Case management is a cornerstone of pneumonia control strategies. It consists of classifying the severity of illness using simple clinical signs such as fast breathing, chest indrawing and general danger signs, and then applying the appropriate treatment. Treatment includes home care advice, antibiotics for home therapy, or referral to a higher-level health facility.
Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation.
Chest radiography is often performed for suspected pneumonia, which is the most common indication for imaging of the chest. This is despite several guidelines advising against the routine use of chest radiography and the lack of evidence for its impact on clinical outcomes. Several international or national guidelines do not recommend chest radiography in children who are well enough to be treated as outpatients. Rather, chest radiography is recommended only in children who are admitted to hospital with severe symptoms, hypoxia, or suspected complications such as empyema.
• Children with fast breathing pneumonia with no chest indrawing or general danger sign should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily (80mg/kg/day) for five days. In areas with low HIV prevalence, give amoxicillin for three days.
• Children with fast-breathing pneumonia who fail on first-line treatment with amoxicillin should have the option of referral to a facility where there is appropriate second-line treatment.
• Children age 2–59 months with chest indrawing pneumonia should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily for five days.
• Children aged 2–59 months with severe pneumonia should be treated with parenteral ampicillin (or penicillin) and gentamicin as a first-line treatment.
• Ampicillin: 50 mg/kg, or benzyl penicillin: 50 000 units per kg IM/IV every 6 hours for at least five days
• Gentamicin: 7.5 mg/kg IM/IV once a day for at least five days
• Ceftriaxone should be used as a second-line treatment in children with severe pneumonia having failed on the first-line treatment.
• Ampicillin (or penicillin when ampicillin is not available) plus gentamicin or ceftriaxone are recommended as a first-line antibiotic regimen for HIV-infected and -exposed infants and for children under 5 years of age with chest indrawing pneumonia or severe pneumonia.
• For HIV-infected and -exposed infants and for children with chest indrawing pneumonia or severe pneumonia, who do not respond to treatment with ampicillin or penicillin plus gentamicin, ceftriaxone alone is recommended for use as second-line treatment.
• Empiric cotrimoxazole treatment for suspected Pneumocystis jirovecii (previously Pneumocystis carinii) pneumonia (PCP) is recommended as an additional treatment for HIV-infected and -exposed infants aged from 2 months up to 1 year with chest indrawing or severe pneumonia.
• Empirical cotrimoxazole treatment for Pneumocystis jirovecii pneumonia (PCP) is not recommended for HIV-infected and -exposed children over 1 year of age with chest indrawing or severe pneumonia.
Aside from avoiding infectious contacts (difficult for many families who use daycare facilities), vaccination is the primary mode of prevention. Influenza vaccine is recommended for children aged 6 months and older. The pneumococcal conjugate vaccine (PCV13) is recommended for all children younger than 59 months old. The 23-valent polysaccharide vaccine (PPV23) is recommended for children 24 months or older who are at high risk of pneumococcal disease.
In children, several types of cough may be defined. Acute cough, typically lasting less than 2 weeks, is considered a mere symptom most frequently related to a respiratory tract infection. Cough lasting 4–8 weeks is increasingly recognized as “prolonged acute cough” mostly in relation to protracted bacterial bronchitis. Chronic cough lasts more than 4 weeks in children vs. 8 weeks in adults, and the quality—dry or productive, the latter suggesting more serious condition—must be specified. This cough may be associated to other signs or symptoms, called “cough pointers,” thus cough may be specific or non-specific, depending on the presence or absence of pointers.
In contrast to adults, assessing cough in children is rather difficult due to the lack of objective methods to measure cough frequency and intensity; subjective scoring methods are biased by parental perception of the child’s symptoms. Twenty-two percent of preschool children report chronic cough without cold and the prevalence is up to 50% in children with 2 smoking parents.
Chronic cough is associated with high morbidity in children and their families. In contrast to adults, the child with chronic cough does not report anxiety or depression, but parents are often stressed, frustrated and unable to cope with their children’s symptoms and their own sleepless nights.
The most common cause for prolonged acute cough in children is post-viral or post-infectious cough. Post-infectious cough can be defined as a cough that began with symptoms related to the common cold and persists. It has a high rate of spontaneous resolution without any therapeutic intervention.
Some specific causes of prolonged acute coughing are as follows:
Infants with acute bronchiolitis
Acute bronchiolitis is a common acute respiratory infection especially in children less than 1 year. The children clinically present with tachypnoea, crackles, dry cough and audible wheeze. The symptoms typically worsen in the acute phase of bronchiolitis before resolving by 14 days. Although bronchiolitis is usually a self-limiting condition, a significant number of children have persistent respiratory symptoms such as cough in the post-acute phase.
While infants too young to have been vaccinated are at particular risk for severe whooping cough disease there has been a recent epidemic of pertussis as a cause of prolonged acute coughing in older children and adolescents in many countries.
Children recovering from a complicated acute pneumonia (e.g. empyema)
At least a third of children who initially have a treated empyema are still coughing by 4 weeks with one quarter at 6 months reducing to around 3% at 12 months. Some of these patients have prolonged cough due to residual of disease and as a result will benefit from a prolonged course of antibiotics 1–4 weeks from discharge or longer.
The criteria used to diagnose rhinosinusitis in children are nasal secretions with or without a wet or dry cough occurring longer than 10 days. Chronic rhinosinusitis is more common in those with atopy and is considered present if symptoms persist longer than 4–8 weeks. Facial pain and discomfort is not so common in children when compared with adults.
Persistent bacteria bronchitis
Persistent bacterial bronchitis (PBB) has been defined as the presence of a chronic wet cough with resolution of cough with appropriate antibiotics and absence of pointers suggestive of alternative specific cough.
There is no objective method to measure cough in children and instruments designed for the adult require modification for use in children. Cough-specific quality of life (QOL) questionnaires exist for adults but not children and adult QOL scores cannot be applied to children.
A chest X-ray and spirometry, at a minimum, are typically ordered to find the cause of a chronic cough in a child.
Treatment of cough is not a “one size fits all” proposition. Rather, the clinician must evaluate each case of cough individually and determine treatment according to the cause of the cough. It is important to consider the age of the child, the nature and timing of the cough.
Previous guidelines have been published by American, British and European respiratory groups regarding the management of cough. However, some of these guidelines do not specifically address the role of antibiotic therapy in the management of prolonged cough for children. No specific treatments, including the use of antibiotics, can be recommended for a prolonged dry or nonspecific cough in children. It should be remembered that a prolonged cough can be indicative of a more serious underlying condition, and always warrants thorough investigation.
Routine upper respiratory infections (“common cold”) respond best to rest, fluids, and tender loving care. Multiple studies have demonstrated no benefit for the various over-the-counter (OTC) medications. Moreover, a number of studies have demonstrated potential side effects to children below six years of age due to the nature of the medications included in these formulations.
Bacterial infections (for example, pneumonia, sinus infections) respond well to selected antibiotics.
Wheezing is treated with various inhaled medications, and if there is a concern regarding aspiration of a foreign object it may require removal by bronchoscopy.
Acute otitis media (AOM) is a common problem in early childhood
• 75% of children have at least one episode by school age
• Peak age prevalence is 6-18 months
Causes of acute otitis media are often multifactorial. Exposure to cigarette smoke from household contacts is a known modifiable risk factor.
Features: recent onset ear pain (irritability in pre-verbal children), fever, anorexia, vomiting, lethargy.
Examination: signs of acute inflammation of the tympanic membrane (TM) Including a haemorrhagic, injected or cloudy appearance. Many febrile or crying children have red TMs. A red TM alone is not considered as AOM.
Diagnostic Criteria for AOM (all 3 required)
Acute onset of signs and symptoms
Best predictor of bacterial infection
Middle Ear Effusion
Reduced TM mobility with pneumatic otoscopy
AOM should be diagnosed in children with new onset otorrhea without otitis externa
Symptomatic treatment with adequate and regular analgesia is very important. As an adjunct, short-term use of topical 2% lignocaine, 1-2 drops applied to an INTACT tympanic membrane may be effective for severe acute ear pain.
Decongestants, antihistamines and corticosteroids are not effective in AOM.
Most cases of AOM in children resolve spontaneously. The routine use of antibiotic treatment should be avoided.
Antibiotic Therapy for Acute Otitis Media in Children 2 Months to 12 Years Old
First line for majority
80-90 mg/kg/day in 2 doses
First line if:
90 mg/kg/day of Amoxicillin in 2 doses
Use ES formulation
90 mg/kg/day of Amoxicillin in 2 doses
50 mg/kg IM or IV x 3 days
Clindamycin + Cefdinir or cefpodoxime
Cross-reactivity among penicillin and ccephalosporin allergy is very low, especially when using specific cephalosporin above
4 mg/kg/day in 1 or 2 doses
30 mg/kg/day in 2 doses
10 mg/kg/day in 2 doses
50 mg/kg/dose IM or IV x3 days
Oral antibiotic and Floxin-ocuflox Drops (Ofloxacin)
5 drops affected ear BID 10 days
Measles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 40° C / 105°F) and malaise, cough, coryza, and conjunctivitis, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Of note, sometimes immunocompromised patients do not develop the rash.
Measles is caused by a single-stranded, enveloped RNA virus with 1 serotype. It is classified as a member of the genus Morbillivirus in the Paramyxoviridae family. Humans are the only natural hosts of measles virus.
Since 2000, when measles was declared eliminated from the U.S., the annual number of cases has ranged from a low of 37 in 2004 to a high of 667 in 2014. The majority of cases have been among people who are not vaccinated against measles. Measles cases in the United States occur as a result of importations by people who were infected while in other countries and from transmission that may occur from those importations. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated. In recent years, measles importations have come from frequently visited countries, including, but not limited to, England, France, Germany, India, and the Philippines, where large outbreaks were reported.
Common complications from measles include otitis media, bronchopneumonia, laryngotracheobronchitis, and diarrhea.
Even in previously healthy children, measles can cause serious illness requiring hospitalization. One out of every 1,000 measles cases will develop acute encephalitis, which often results in permanent brain damage. One or two out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection.
Healthcare providers should consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if the person recently traveled internationally or was exposed to a person with febrile rash illness. Healthcare providers should report suspected measles cases to their local health department within 24 hours.
Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction (RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus.
Molecular analysis can also be conducted to determine the genotype of the measles virus. Genotyping is used to map the transmission pathways of measles viruses. The genetic data can help to link or unlink cases and can suggest a source for imported cases. Genotyping is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.
Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available.
One dose of MMR vaccine is approximately 93% effective at preventing measles; two doses are approximately 97% effective. Almost everyone who does not respond to the measles component of the first dose of MMR vaccine at age 12 months or older will respond to the second dose. Therefore, the second dose of MMR is administered to address primary vaccine failure.
CDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age or at least 28 days following the first dose.
MMR vaccine as post-exposure prophylaxis
If MMR vaccine is not administered within 72 hours of exposure as PEP, MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures.
If many measles cases are occurring among infants younger than 12 months of age, measles vaccination of infants as young as 6 months of age may be used as an outbreak control measure. Note that children vaccinated before their first birthday should be revaccinated when they are 12 through 15 months old and again when they are 4 through 6 years of age.
Polio, or poliomyelitis, is a crippling and potentially deadly infectious disease. It is caused by the poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis.
Most people who get infected with poliovirus (about 72 out of 100) will not have any visible symptoms. About 1 out of 4 people with poliovirus infection will have flu-like symptoms that may include:
• Sore throat
• Stomach pain
These symptoms usually last 2 to 5 days then go away on their own.
A smaller proportion of people with poliovirus infection will develop other more serious symptoms that affect the brain and spinal cord:
• Meningitis (infection of the covering of the spinal cord and/or brain) occurs in about 1 out of 25 people with poliovirus infection
• Paralysis or weakness in the arms, legs, or both, occurs in about 1 out of 200 people with poliovirus infection
Paralysis is the most severe symptom associated with polio because it can lead to permanent disability and death. Between 2 and 10 out of 100 people who have paralysis from poliovirus infection die because the virus affects the muscles that help them breathe.
Even children who seem to fully recover can develop new muscle pain, weakness, or paralysis as adults, 15 to 40 years later. This is called post-polio syndrome.
Note that “poliomyelitis” (or “polio”) is defined as the paralytic disease. So only people with the paralytic infection are considered to have the disease.
Poliovirus only infects humans. It is very contagious and spreads through person-to-person contact. The virus lives in an infected person’s throat and intestines. It enters the body through the mouth and spreads through contact with the feces (poop) of an infected person and, though less common, through droplets from a sneeze or cough.
An infected person may spread the virus to others immediately before and about 1 to 2 weeks after symptoms appear. The virus can live in an infected person’s feces for many weeks. It can contaminate food and water in unsanitary conditions. People who don’t have symptoms can still pass the virus to others and make them sick.
Polio mainly affects children under the age of five years, although adults can be also susceptible to the virus at a later stage of their life if the sero protection level is not high enough.
Polio vaccine protects children by preparing their bodies to fight the polio virus. Almost all children (99 children out of 100) who get all the recommended doses of vaccine will be protected from polio.
There are two types of vaccine that can prevent polio: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). Only IPV has been used in the United States since 2000; OPV is still used throughout much of the world.
The Center for Disease Control (CDC) recommends that children get four doses of polio vaccine. They should get one dose at each of the following ages:
• 2 months old
• 4 months old
• 6 through 18 months old
• 4 through 6 years old
Gastroesophageal reflux (GER) happens when stomach contents come back up into the esophagus. Stomach acid that touches the lining of the esophagus can cause heartburn, also called acid indigestion.
Occasional GER is common in children and teens—ages 2 to 19—and doesn’t always mean that they have gastroesophageal reflux disease (GERD). GERD is a more serious and long-lasting form of GER in which acid reflux irritates the esophagus.
Up to 25 percent of children and teens have symptoms of GERD, although GERD is more common in adults.
Without treatment, GERD can sometimes cause serious complications over time, such as:
Esophagitis may lead to ulcerations, a sore in the lining of the esophagus.
An esophageal stricture happens when a person’s esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.
A child or teen with GERD might breathe stomach acid into his or her lungs. The stomach acid can then irritate his or her throat and lungs, causing respiratory problems or symptoms, such as
• asthma —a long-lasting lung disease that makes a child or teen extra sensitive to things that he or she is allergic to
• chest congestion, or extra fluid in the lungs
• a dry, long-lasting cough or a sore throat
• hoarseness—the partial loss of a child or teen’s voice
• laryngitis—the swelling of a child or teen’s voice box that can lead to a short-term loss of his or her voice
• pneumonia—an infection in one or both lungs—that keeps coming back
• wheezing—a high-pitched whistling sound that happens while breathing
Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.
Upper GI Series
An upper GI series looks at the shape of the child or teen’s upper GI tract. During the procedure, the child or teen will drink liquid contrast (barium or gastrograffin) to coat the lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the child or teen to get the best view of the GI tract.
Esophageal pH and impedance monitoring
The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in a child or teen’s esophagus while he or she does normal things, such as eating and sleeping.
This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the child or teen’s nose into the stomach. The tube is then pulled back into the esophagus and taped to the child or teen’s cheek. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while a child is fully awake.
Upper Gastro Intestinal (GI) endoscopy and biopsy
In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside a child or teen’s upper GI tract. This procedure takes place at a hospital or an outpatient center.
An intravenous (IV) needle will be placed in the child or teen’s arm to give him or her medicines that keep him or her relaxed and comfortable during the procedure. They may be given a liquid anesthetic to gargle or spray anesthetic on the back of his or her throat. The doctor carefully feeds the endoscope down the child or teen’s esophagus then into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the child or teen’s stomach and duodenum, making them easier to see.
In most cases, the procedure only diagnoses GERD if the child or teen has moderate to severe symptoms.
A child or teen’s gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD)can be controlled by having him or her:
• not eat or drink items that may cause GER, such as greasy or spicy foods
• not overeat
• avoid smoking and secondhand smoke
• lose weight if he or she is overweight or obese
• avoid eating 2 to 3 hours before bedtime
• take over-the-counter medicines
Depending on the severity of the child’s symptoms, a doctor may recommend lifestyle changes, medicines, or surgery.
Helping a child or teen make lifestyle changes can reduce his or her GERD symptoms. A child or teen should lose weight, if needed, eat smaller meals, avoid high-fat foods, wear loose-fitting clothing around the abdomen.
Over-the-counter and prescription medicines
All GERD medicines work in different ways. A child or teen may need a combination of GERD medicines to control symptoms.
Doctors often first recommend antacids to relieve GER and other mild GERD symptoms. A doctor will tell you which over-the-counter antacids to give a child or teen.
Antacids can have side effects, including diarrhea and constipation.
H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. If a doctor recommends an H2 blocker for the child or teen, you can buy them over the counter or a doctor can prescribe one.
Proton pump inhibitors (PPIs)
PPIs lower the amount of acid the stomach makes. PPIs are better at treating GERD symptoms than H2 blockers. They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.
However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. A child or teen should take these medicines on an empty stomach so that his or her stomach acid can make them work correctly.
Antibiotics, including erythromycin, can help the stomach empty faster.
A pediatric gastroenterologist may recommend surgery if a child or teen’s GERD symptoms don’t improve with lifestyle changes or medicines. A child or teen is more likely to develop complications from surgery than from medicines.
Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.
Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. The results for endoscopic techniques may not be as good as those for fundoplication.
- Merck Manual. Overview of Viral Respiratory Tract Infections in Children. Available at: https://www.merckmanuals.com/home/children-s-health-issues/viral-infections-in-infants-and-children/overview-of-viral-respiratory-tract-infections-in-children
- Center for Disease Control (CDC). Common Cold and Runny Nose, 2017. Available at: https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/colds.html
- Seattle Children’s Hospital, Seattle, Washington, 2017. Flu Season
- World Health Organization (WHO), 2014. Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries.
- Mark L. Everard. Paediatric respiratory infections. Eur Respir Rev 2016; 25: 36–40 | DOI: 10.1183/16000617.0084-2015
- Heather J Zar, Savvas Andronikou, Mark P Nicol. Advances in the diagnosis of pneumonia in children. BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j2739
- Julia Ioan et al. What is chronic cough in children? Frontiers in Physiology 2014, doi: 10.3389/fphys.2014.00322
- Mayo Clinic. Chronic cough, 2017. Available at: https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580
- Michael D Shields and Surendran Thavagnanam. The difficult coughing child: prolonged acute cough in children. Cough 2013; 9:11 https://doi.org/10.1186/1745-9974-9-11
- Emily J Bailey, BN and AB Chang. In children with prolonged cough, does treatment with antibiotics have a better effect on cough resolution than no treatment? Paediatrics & Child Health. 2008;13(6):514
- The Royal Children’s Hospital Melbourne. Acute otitis media, 2018. Available at: https://www.rch.org.au/clinicalguide/guideline_index/Acute_otitis_media/
- Children’s Hospital of Philadelphia. Clinical Pathway for Evaluation/Treatment of
Acute Otitis Media in Children 2 Months to 12 Years Old, 2018. Available at: https://www.chop.edu/clinical-pathway/otitis-media-acute-clinical-pathway
- Center for Disease Control (CDC). Measles (Rubeola), 2018. Available at: https://www.cdc.gov/measles/hcp/index.html
- Center for Disease Control (CDC). Polio, 2017. Available at: https://www.cdc.gov/polio/about/index.htm
- National Institute of Diabetes and Digestive and Kidney Diseases. Acid Reflux (GER and GERD in Children and Teens, 2015. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children-teens/definition-facts