Acute Respiratory Infections

Paediatric Palliative Care For Home Based Carers

Funded by British High Commission, Pretoria Small Grant Scheme

Causes of Death in Children World-Wide

20 18 Percentage of Deaths 16 14 12 10 8 6 4 2 0
Respiratory Infections Diarrhoea Measles Malaria HIV

2.8 million HIV infected children worldwide 90 000 HIV Infected children born annually in S. Africa HIV infected children are at increased risk of respiratory disease
CFR=22%

30-40% admissions

CFR=34%

77% deaths in HIV infected infants

Children with HIV

Get more respiratory infections Get worse respiratory infections Get different respiratory infections Die more often from respiratory infections Die most often from respiratory infections

It is important that you can pick an infection up early so it can be treated in time

How to Diagnose Respiratory Infections

Do you need these?

NO. Most can be diagnosed without using the WHO Criteria.

SEVERITY CRITERIA MANAGEMENT ANTIBIOTICS

No pneumonia

Cough No tachypnoea Cough Tachypnoea No rib or sternal recession Cough Tachypnoea Chest wall retraction Cyanosis Inability to drink

Supportive measures Antipyretics No antibiotics Supportive Measures Antipyretics Antibiotics Supportive Measures Antibiotics Refer to hospital

Nil

Pneumonia

PO Amoxyl Or PO Bactrim IV Ceftrioxone and refer

Severe Pneumonia or very severe disease

IMCI 2002

What is tachypnea?
Breathing fast Under 2 months: 60/minute

2 months 1 year: 50/minute Over 1 year: 40/minute

IMCI 2002

What to ask
Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions? Does the child have a fever? Does the child have a cough? Has there been difficulty in breathing?

What To Do
Look at the child generally: Lethargy Unconscious Look, listen, feel Look for cyanosis Look for chest in drawing Look & listen for stridor and wheeze Count the respiratory rate Decide which sort of acute respiratory infection the child has

No Pneumonia
What you find: Cough Fever No fast breathing No chest in drawing What to do: Reassure the mother Give Paracetamol Encourage fluids If in doubt refer Ensure child is reviewed within 48 hrs.

IMCI 2002

Pneumonia
What you find: Cough Fever Fast breathing NO CHEST INDRAWING What to do: Reassure mother Give Paracetamol Refer to clinic Child will receive oral antibiotics. Ensure mum knows how to give them Follow-up in 48 hrs Ensure mum is giving medication If worse, refer hospital
IMCI 2002

Severe or Very Severe Pneumonia

What you find: Cough Fever Fast Breathing Chest In drawing Cyanosis (very severe) If able: Give oxygen and IV ceftriaxone and refer to hospital. Under 6 months, add in oral bactrim. Test blood sugar and treat if low If not able: refer to nearest available health centre for stabilisation and transfer.
IMCI 2002

Tuberculosis
TB is common in both adults and children Children present with: Chronic cough (more than 2 weeks) Weight loss or Failure to thrive Night sweats TB is difficult to diagnose so if you suspect refer to clinic