Why do children suffer from repeated airway infections?

Airway infections are common – especially in young children. Every child will suffer from an ear, nose, throat, airway, or lung infection at some stage. These infections may also recur (sometimes quite frequently) and it is especially young children who attend day-care centres that are more frequently sick with airway infections.

Parents are often frustrated by the number of doctor visits, and repeated antibiotic courses, that their child must endure. Airway infections are most frequently caused by viruses. A typical viral airway infection will result in a runny or blocked nose, poor sleep and cough that may last for two weeks or even longer. Some patients may be more severely affected than others. Very little can be done for a typical viral airway infection. Antibiotic treatment does not work and will only be valuable in those few patients who suffer from a bacterial infection. Other commonly prescribed treatments like cortisone syrup, cough mixtures and nebulising may be of no benefit, or even harmful rather than helpful. It is often the simple measures, like saline nose washes, a decongestant nose spray and paracetamol that offer the most value.

The patient will almost inevitably cough. It is often the cough that brings parents to the doctor. The cough alone may not necessarily warrant a doctor visit or an antibiotic prescription. Children who cough and suffer from recurring fever, airway narrowing (difficult breathing), laboured breathing, or a wet cough that lasted more than 4 weeks, should consult a doctor. There are specific diagnostic and treatment guidelines to follow.

It is important to know that a higher frequency of airway infections may be associated with an underlying problem like an immune deficiency or chronic airway abnormality. Doctors are often prompted to investigate children with recurrent airway infections further because of infections that are too frequent in number, too severe, last too long, fail to improve with standard treatment or result in complications.

Many of the children who present with recurrent airway infections may be immunologically “normal” but it is important to recognise the features of possible underlying disorders. The decision to investigate relies on the doctor’s good knowledge of the possible underlying disorders and sound clinical judgement. Pointers, like a family history of repeated infections, cystic fibrosis, allergy, failure to grow well and specific clinical findings will guide the doctor on appropriate further evaluation. There are several underlying disorders to consider. These include airway allergy, immune deficiency and many non-immune diseases like cystic fibrosis and ciliary dyskinesia. Those children who present with severe, persistent, unusual and recurrent airway infections must be evaluated for a possible underlying disorder that could explain their recurrent airway infections.