- A very young child has an RTI that causes a severely ‘blocked nose’ as this can affect feeding. This may result in hospitalisation.
- There are associated febrile convulsions
- The RTI causes an exacerbation of asthma
- Tonsillitis can result in dehydration requiring IV rehydration if unable to tolerate oral fluids
It can sometimes be difficult to differentiate an URTI from an LRTI, especially in young children. It is best o be cautious if there is doubt over the diagnosis.
Bronchiolitis is also an important differential in any child under 12 months with respiratory symptoms. Other potentially more serious differential presentations include epiglottis and croup – these are covered under laryngeal and tracheal infections.
Common cold (coryza)
Viral. Most commonly rhinovirus, but may also be coronavirus and RSV.
The most common childhood infection. Good parental education can help to reduce and anxiety and unnecessary GP appointments.
Self limiting infection. Antibiotics are of no use due to viral nature of the infection.
Symptomatic relief including paracetomol and ibuprofen may be used.
Sore Throat (pharyngitis)
Usually viral. In older children, β-haemolytic streptococcus may be present.
Cannot differentiate between viral and bacterial causes clinically.
Viral cases are most common in younger children, and bacterial causes become more common in older children
See tolsilitis below
2/3 of cases are viral (e.g. EBV) and 1/3 are bacterial (e.g. β-haemolytic streptococcus).
This is a subtype of pharyngitis, where the tonsils are particularly badly affected.
Clinical signs are more common in bacterial cases.
Possible to partially differentiate between bacterial and viral causes uses the centor criteria
Depends on the centor criteria. Antibiotic recommended if a score of 4 (50% chance of bacterial infection in these cases).
Often antibiotics prescribed, despite only 1/3 of all infections being bacterial. 10 days treatment required to eradicate streptococcus and risk of rheumatic fever.
Amoxicillin should be avoided – can cause macuopapular rash if tonsillitis is due to infectious mononucleosis (EBV).
Many cases are viral, including RSV and rhinovirus. Bacterial causes are usually haemophilus influenzae and Moraxella catarrhais.
All children with a fever should have tympanic membrane examined with otoscope.
Rarely, the tympanic membrane may perforate. In these cases, pus may be visible in the external canal on otoscopy.
Complications (e.g. mastoiditis and meningitis) are rare.
Very common – most children will suffer from otitis media at some stage due to the short length of the Eustachian tube in this stage of development. 20% of children will suffer recurrent episodes.
80% of cases resolve spontaneously.
Antibioitcs reduce the duration of pain, but do not reduce the risk of perforation. Typically antibiotic treatment is given if symptoms are not improving after several days. Amoxicillin is the recommended antibiotic of choice if indicated.
Otitis media with effusion (OME) – aka Glue ear
Caused by recurrent otitis media. Very common at <1 years age. Persists up to around 10 years of age.
The condution hearing loss caused by OME can result in delayed development, particularly of speech and language. As a result, some children are considered for insertion of grommets. These are essentially tubes that ensure the Eustachian tube remains patents to allow fuller hearing.
Again, usually resolve spontaneously. Antibiotics have no long-term benefit, although they may improve the tympanic membrane appearance at first.
Grommets may be used in certain cases (see left)
In some cases, adenoidectomy may also be performed.*
Usually viral, occasionally bacterial
The sinuses do not formally develop until the end of the first decade of life, as a result, sinusitis is not usually present in those <10 years of age
Symptom relief with paracetomol and ibuprofen. Some cases may be treated with antibiotics.
- Recurrent tonsillitis – removal of the tonsils reduces the incidence of recurrent tonsillitis by around 30%
- Peritonsilar abscess (rare)
- Obstructive sleep apnoea – if the glands are so large that they affect normal breathing. Sometimes they may also be removed in cases of excessive snoring (aka sleep disordered breathing – see below)
- OME – certain cases may benefit from gland removal to allow better placing of grommets
- Obstructive sleep apnoea
- Adeno-tonsilar hypertrophy – Often there is a history of loud snoring, and periods of apnoea (Obstructive sleep apnoea). Quality of sleep is often affected. Some affected children are obese, other may have growth disorders (and in such cases, there may be daytime hyperactivity)although often there is no other underlying abnormality or disease. These cases can be treated by tonsillectomy +- adenoidectomy. The success rate is good.
- Craniofacial / neuromuscular /other congenital disorder (e.g. Down’s syndrome) – these patients are not suitable for surgery, but may be treated with ventilation.