Obstructive Bronchitis In Children Under One Year Old, 2-3 Years Old - Causes, Signs, Symptoms And Treatment Of Bronchitis In Children

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Bronchitis in children

Common diseases that many parents face are acute and chronic bronchitis in its various forms and course variants. Of particular interest is the occurrence of the disease in early childhood. This is due to individual mechanisms of development, course, diagnosis and treatment of the disease in children of this age group.

Description of the disease

Content:

• Signs and symptoms
• Causes of bronchitis in children
• Obstructive bronchitis
• Acute bronchitis in children
• How is bronchitis treated?
• General recommendations

Bronchitis is an inflammatory process that occurs in the area of the bronchial mucosa, often affecting the mucous membrane of the nose and throat, trachea and larynx. First, inflammation appears in the nasopharynx, then passes into the respiratory tract. This means that under the influence of certain causal factors and background conditions, the structures located in the lumen of the bronchus of any caliber are damaged. At the same time, in the classical version, the inflammation does not spread to the adjacent tissues of the lungs or other parts of the upper respiratory tract.

The reasons for the development of the disease can be several factors: a viral infection that promotes the invasion of harmful microbes into the respiratory organs, hypothermia, dustiness, gas pollution, contacts with patients in the family.

An increase in primary morbidity is noted in the cold season, especially during the transitional autumn-winter and winter-spring periods, when microorganisms are especially active, due to an improvement in the temperature regime of the environment, and the body's defenses are reduced. The incidence for children under the age of one year is 75-80 cases per 1000 children per year, from one to 3 years - 180-200. Primary and independent bronchial involvement is extremely rare. More often bronchitis in children develops as a result of the spread of inflammation from other parts of the upper respiratory tract (pharyngitis, laryngitis, tracheitis), which occur with respiratory and colds. In this case, there is a descending path of penetration of the infection into the bronchi. There is no reverse spread - from the bronchi to the trachea.

Girls and boys get sick equally often. With regard to the type of physique of the child, children with increased weight and signs of paratrophy are more susceptible to bronchitis, especially to its obstructive forms. Hereditary predisposition and cases of familial bronchitis have also been noticed.

For a complete understanding of the essence of bronchitis in children under one year old and its frequent course up to 2-3 years, it is necessary to consider some anatomical and physiological features of the bronchial structures characteristic of a given age period. These factors act as a favorable background, predisposing to the onset and development of bronchitis, which can proceed in the form of an acute, chronic or obstructive process.

1. The relatively long length of the bronchial structures with their small lumen.

2. Insufficient development of the mucociliary apparatus. This means that too thick mucus is produced, which normally should protect the bronchial tree from irritating agents. Moreover, special villi for its removal are poorly developed.

3. Increased reactivity of the smooth muscles of the bronchus, which can lead to its spasm at the slightest irritation.

4. Imperfection of local immune mechanisms.

5. General immune dysfunction associated with the differentiation of immunocompetent cells in the specified age interval.

6. Relative weakness of the muscles of the chest and cough center. This prevents good ventilation of the lungs and the natural excretion of mucus from the lumen of the bronchi.

7. Presence of allergic conditions in a child (diathesis, food allergy, atopic dermatitis, seborrhea.)

The severity and number of these prerequisites are the main trigger point in the start of the inflammatory process in the bronchus. In this case, edema of the mucous membrane occurs, a decrease in the lumen of the bronchus with a decrease in the volume of passing air, and as a result, the development of respiratory failure.

Signs and symptoms of bronchitis in children

Early detection of signs of the disease will prevent complications and help to start treatment in a timely manner, which will increase its effectiveness. For bronchitis in children under one year old, as well as in young children (up to 2-3 years), the criteria for making a diagnosis are:

1. The temperature for bronchitis in children precedes the detailed clinical picture. Its numbers can be of the most varied nature (from 37.1 ° C to 39.9 ° C), maintenance throughout the day and conditions of decline. These characteristics depend on the pathogen and the child's immune system;
2. Preceding acute respiratory illness. Very often children can get bronchitis due to viral infections. This usually happens on the 3-4th day of ARVI;
3. Cough is an underlying symptom of bronchitis. By its nature, we can say with clear certainty that the inflammation is localized precisely in the bronchi and at what stage it is. Usually, its appearance corresponds to the onset of the disease. At this time, it has a dry, sometimes harsh character. The child is constantly coughing, almost with every breath. This occurs as a result of irritation of the inflamed mucous membrane with air. After a few days, the bronchial epithelium is restored and mucus is actively produced to remove bacteria that colonize in places of inflammation. Clinically, this manifests itself as a moist cough that becomes less frequent and milder. During this time, the child may cough up clear or yellow phlegm, which he usually swallows.
4. Chest pain. Children under one year old cannot say about this, but older children sometimes indicate this. Retrosternal localization is more typical for tracheobronchitis, which very often develops as a sequential descending process.
5. General weakness, lethargy and poor appetite in a child are far from specific signs of bronchitis. But their development should always alert parents. The fact is that the child's body is so changeable that the course of the disease can change its direction every hour. Indicators that signal deterioration are these signs.
6. Wheezing is also one of the specific symptoms. Their characteristics can help determine the solution to the question - simple or obstructive bronchitis. They can be dry or wet. Among the latter, there are large and small-bellied ones. The more they resemble crepitant, the smaller the bronchi are affected, which requires differential diagnosis with pneumonia. At the same time, they can be heard either with auscultation of the chest, or even remotely, at a distance. Do not forget that they can also appear due to the accumulation of mucus in the pharynx, which can simulate the clinic of bronchitis.
7. Shortness of breath is a severe symptom of bronchitis. Characterizes the appearance of respiratory failure and the degree of its severity. The child begins to breathe often and heavily, especially with any exertion. In young children, this is also manifested by the appearance of cyanosis of the skin during breastfeeding, which he refuses.
8. Palpitations and tachycardia occur simultaneously with shortness of breath and are also a sign of respiratory failure. The very appearance already speaks of a serious condition.

Usually, these signs are sufficient to make a diagnosis of bronchitis. In doubtful cases, to exclude concomitant lung damage in the form of bronchopneumonia or developmental anomalies, an X-ray examination of the chest organs is indicated. It is highly desirable to inoculate sputum for the composition of microflora and its sensitivity to antibiotics, which will prevent the prescription of drugs that are not suitable for a particular child in this case.

Causes of bronchitis in children

Among the etiological factors and mechanisms of the development of bronchitis in children under one year old with its frequent chronicity and recurrent course up to 2-3 years of age, we can distinguish the characteristics of the child's body, factors that provoke the development of the disease and microorganisms that directly caused it. It is not worth dwelling additionally on the features of the child's body in infancy, as they are described in the section "description of the disease". One has only to point out that they all contribute to the progression of the inflammatory process.

As for the provoking factors in the development of bronchitis, here it is necessary to designate important elements.

• Hypothermia of the child. This is due to imperfect thermoregulation of babies, especially in the first three months of life. If parents dress the child too easily and at the same time walk outside or he is in a room with an air temperature below 18-19 ° C, this can lead to hypothermia. Conversely, if you wrap the child tightly, he will sweat. The smallest draft is enough for wet skin to cause hypothermia and subsequently bronchitis.
• Teething. In this case, a huge amount of disagreement arises. When a child starts coughing and teeth are being cut in parallel, many parents perceive all the symptoms as signs of a natural process. Doctors stubbornly deny this as a variant of the norm, and insist on treating bronchitis. In fact, these two processes are interconnected. Naturally, teething requires a huge expenditure of energy and the immune mechanisms suffer at the same time, mucus begins to be produced in the bronchi. If the process becomes inflammatory with all the signs, then it is stated as bronchitis (for more details: How to help a child with teething?).
• Acute respiratory diseases. In 75-80% of cases, they become the cause and background for the development of bronchitis. Among the direct causative agents of bronchitis in children under one year old, which primarily affect the bronchi and provoke the reproduction of the bacterial flora, are influenza viruses, parainfluenza, rhinosyncytial virus, cytomegalovirus, less often pathogens from the adenovirus family. They cause the destruction of the bronchial epithelium. In this case, the mucous membrane becomes unprotected. Against this background, a secondary bacterial infection joins, which under normal conditions lives in the lumen of the bronchi, without causing any disturbances. These are most often streptococci, staphylococci, Haemophilus influenzae, pneumococci.

For reasons of occurrence, they share viral, allergic, obstructive, asthmatic bronchitis. There are three types of bronchitis in children according to the international classification:

• Acute bronchitis, manifested by acute inflammation of the bronchial mucosa.
• Acute obstructive - leads to changes in the structure of the mucous membrane.
• Acute bronchiolitis - the inflammatory process affects the small bronchi.

These types of bronchitis in children differ in the developmental factor, the severity of the disease and methods of treatment. Bronchitis in children is only viral. Infection occurs through airborne droplets, coughing and sneezing. It should be noted that breastfed babies rarely get bronchitis, with the exception of cases when the baby is born prematurely, has congenital malformations of the respiratory organs and or is in contact with sick children. Bronchiolitis in children under one year old carries a danger, which consists in the development of acute respiratory failure against its background.

Small children always take parts from toys and constructors into their mouths. Foreign bodies, getting into the child's mouth, touching the mucous membrane, provoke the development of bronchitis, due to the fact that microbes live on their surface. Bronchitis is the result of irritation of the bronchi, such as inhalation of chemicals. An allergy occurs, which leads to inflammation of the bronchial mucosa.

Acute bronchitis in children always follows a severe cold or flu, infection, or external irritants. Bronchitis begins as a common cold disease, it can be very long and difficult.

Obstructive bronchitis in children

The first symptoms are a runny nose and dry cough, worse at night. A sick child feels weakness, pain behind the sternum, they are usually very restless, capricious, there is increased nervous excitability. In a blood test, slight leukocytosis and an increase in ESR can be detected. There is an increase in body temperature, wheezing, shortness of breath appear.

After a few days, the cough becomes moist, sputum is released, which can be used to determine the type of bronchitis. The acute stage of the disease lasts less than a week and usually heals within 5-6 days. Isolation of a transparent substance confirms a sign of an acute form of bronchitis, and a purulent form of a chronic form. Untimely or incorrect treatment of the manifestations of acute bronchitis is dangerous with the occurrence of prolonged bronchitis, which threatens with complications.

Among all types of childhood bronchitis, two forms can be globally relevant - simple and obstructive. If the first does not cause special dangers and difficulties in treatment, then the second is quite the opposite. Obstructive bronchitis is a type of inflammatory lesion of the bronchi, in the mechanisms of development and clinical manifestations of which, the main role belongs to the violation of bronchial patency with respiratory failure.

The obstructive form of bronchitis, in contrast to ordinary bronchitis, is manifested by edema and deterioration of bronchial patency. The development of such pathologies is facilitated by various intrauterine disorders of the development of the respiratory organs, hypoxia, trauma, and early childbirth. Symptoms of this type of bronchitis are paroxysmal cough and blue skin on the baby's fingers and lips.

Obstructive bronchitis symptoms in children

Symptoms in children are quite specific, which helps in its rapid diagnosis and timely treatment. They are characterized by the sudden appearance and lightning speed of progression. The child's condition may worsen by the minute. A whole group of symptoms can be attributed to the threatening signs of obstructive bronchitis.

• A sudden onset at night, especially if the child was actively walking outside with other children during the day.
• Child's anxiety. Little children under one year old constantly cry, the older ones cannot sleep, they constantly rush.
• Bubbling breath. Many parents describe it like this: "the baby has an accordion in his chest."
• Whistling wheezing sounds heard from a distance. If auscultation is performed, you can hear moist fine bubbling rales over the entire surface of the lungs on both sides.
• Shortness of breath, accompanied by the participation of the auxiliary muscles in the act of breathing. Clinically, this is manifested by retraction of the intercostal spaces and abdominal movements during breathing. The chest, as it were, is in a state of constant inhalation and it is difficult for the child to exhale, for which he must additionally strain.
• Cough that appears with the onset of obstruction. With highly developed obstruction, it decreases slightly, with a reverse increase after its elimination. At the same time, sputum begins to flow.
• Signs of progressive respiratory failure in the form of increased respiration and tachycardia, accompanied by cyanosis of the skin.

Causes of obstructive bronchitis in children

The reasons are associated with the characteristics of the pathogen and the reactivity of the child's bronchial system. In the mechanism of development of bronchial obstruction in infancy, there is a spasm of the smooth muscles of the bronchi, edema of the mucous membrane and thick abundant bronchial mucus.

Some bacteria and viruses penetrate the nerve nodes around the bronchi, which causes a loss of regulation of their tone. As a result - bronchospasm. Other types of microbes cause excess mucus secretion. There are those that mainly cause swelling of the bronchial mucosa, narrowing its lumen. More often, there is a combination of these mechanisms, leading to progressive obstruction. The presence of allergic diseases and overweight in a child is a risk factor for the development of obstructive bronchitis, which is associated with a tendency to bronchospasm and reactive edema, especially under the influence of a microbial factor.

Treatment of obstructive bronchitis in children

Treatment is an emergency. The smaller the child is, the less time there is to think. Priority measures should be aimed at eliminating bronchial obstruction and restoring bronchial patency.

• Try to calm the child down. Excitement provokes an increase in respiratory failure. The introduction of sedatives in age-related doses is allowed.
• Inhalation therapy. The most effective method for relieving obstruction. For this purpose, nebulizers, ultrasonic inhalers operating from the mains are used. If there is no such equipment, you can use special children's devices (bebihaler) in combination with pocket inhalers. Inhaled mixtures include salbutamol and glucocorticoid hormones. The most common representatives are Ventolin and Flexotide. The advantage of the method is that the drugs are injected directly into the bronchi. The effect occurs within a few minutes after inhalation.
• Instillation of humidified oxygen. Should be carried out in parallel with other activities.
• If inhalation therapy does not work or the child has signs of severe intoxication with dehydration, infusion therapy with intravenous administration of bronchodilators is indicated.
• Basic treatment for bronchitis, including antibiotic therapy, expectorants, immune medications, physiotherapy, and vibration massage.

Acute bronchitis in children

The most common type of bronchitis in children is acute. Its other name is simple bronchitis. It develops in any period of the life of babies, regardless of the individual characteristics of the organism. It is characterized by a gradual, consistent and favorable course. Rarely complicated by respiratory failure. The average duration of the disease until complete recovery is 2.5-4 weeks.

Symptoms of acute bronchitis in children

Symptoms of acute bronchitis differ from other diseases of the respiratory tract in some features that are important in the differential diagnosis. They consist of a triad of signs.

• Cough is the central symptom around which the diagnostic search is built. Its appearance indicates the beginning of the inflammatory process in the bronchi. It differs from other species that develop with laryngitis and tracheitis in its softness and character. Its two-phase is observed - at first dry, then wet. Appears at approximately the same intervals, rarely associated with inhalation of air, which is observed with laryngotracheitis.
• A general hyperthermic reaction that appears even before the onset of coughing.
• Rough dry or wet rales of different sizes. Small creping noises are not typical. They develop in obstructive bronchitis, bronchiolitis and bronchopneumonia.

Other symptoms in the form of a disturbance in general condition, poor sleep and refusal to eat, shortness of breath, tachycardia and an increase in the frequency of respiratory movements are not typical for the usual course of acute bronchitis. Their appearance indicates the addition of complications or the transition of the process to an obstructive form.

Treatment of acute bronchitis in children

Treatment begins immediately after confirmation of the diagnosis:

1. Antibiotics with a broad spectrum of action. They have the same blocking effect on many groups of microorganisms that can cause bronchitis. Recommended in pediatrics: Augmentin, Amoxiclav, Ceftriaxone, Cefotaxime. The dosage form of drug administration is selected depending on the severity of the disease.

2. Mucolytics and expectorants (drugs stimulating the excretion of mucus and its rarefaction.) In children under one year old, as well as up to 2-3 years, the use of herbal and synthetic preparations based on ambroxol, ivy, thermopsis, plantain, etc. is shown., fluditec, lazolvan, ACC in age dosages.

3. Antitussive drugs. They are prescribed in the first phase of bronchitis, when there is still no expectoration, but the cough is of a hacking character (sinekod, stopussin.)

4. Anti-inflammatory and antipyretic drugs, depending on body temperature.

5. Immunomodulators - preparations based on echinacea, vitamin C, bronchomunal.

Read more: Acute bronchitis in children and adults - causes, symptoms and treatment

How to treat bronchitis in a child?

With bronchitis, practical advice regarding treatment should be based on a single rule - no initiative. The treatment process can take place on an outpatient and inpatient basis, depending on the condition of the child. All infants must be hospitalized without fail. Children under one year old and up to 2-3 years old with a mild course of bronchitis can be treated at home, subject to the therapeutic regimen.

In children, bronchitis often becomes chronic, with constant relapses up to a period of three years. Therefore, it is imperative to adhere to the established terms of the treatment process. It includes:

1. Diet. Allergenic foods (chocolate, honey, raspberries, citrus fruits) are excluded. Food should be fractional, high-calorie and nutritious food. Be sure to drink plenty of water (alkaline mineral water without gas, light tea, cranberry juice.) The mother's nutrition during breastfeeding is the same.

2. Mode. Exclude active loads and walks on the street, especially in bad weather and in the acute period of the disease. After reducing the temperature, you can go out into the fresh air. Dress your child appropriately for the weather.

3. Expectorant and antitussive drugs. This requires a differentiated approach to the appointment. If a child has a dry cough, constantly disturbing and disturbing sleep, it is recommended to take antitussive drugs (sinekod, stopussin.), slept, herbion). (more: list of expectorants)

4. Inhalation therapy. The most effective treatment for any type of bronchitis. When used correctly, any need for prescribing antibacterial drugs may disappear.

5. Antiviral and immunomodulatory drugs. Given that most cases of bronchitis occur against the background of respiratory and colds infections, homeopathic drops or tablets (aflubin, anaferon for children, umkalor.)

Antibiotics for bronchitis in children are an indispensable attribute of treatment. It is advisable to include them from 2-3 days of any bacterial infection at the slightest signs of bronchitis. The duration of their application for at least five days must be strictly observed. If necessary, it is better to extend the duration of treatment in order to prevent the development of bacterial resistance to antibiotics and the chronization of the process (for more details: list of antibiotics for bronchitis). In case of an allergic reaction to the drug, it is replaced by another (preferably from a different group) and antihistamines are prescribed to cover up.

Massage for bronchitis in children is a natural method of auxiliary therapy that does not require financial costs. It has proven itself very well in the recovery period. Contraindicated in the acute stage. The criterion for the appointment may be the appearance of a wet cough after a decrease in temperature. It should be vibrational and promote the excretion of phlegm. For this, the child lies on his stomach. Sequential stroking of the skin is performed with further tapping movements towards the spine from the bottom up. The duration of one procedure is 7-9 minutes. The procedures are performed daily for about two weeks (in more detail: why do you need a massage for bronchitis?).

General recommendations

A doctor examining a baby may detect a swollen chest. The retraction of the chest sections is visually visible, which is a consequence of the fact that the auxiliary muscles are involved in the breathing process. The main requirements in the treatment of bronchitis in children are the exclusion of self-medication, timely referral to a specialist who will determine the direction of treatment.

If there is a danger of bronchitis becoming a protracted form, in the presence of an elevated body temperature, the child must be hospitalized. This is especially true for children under 1 year old and younger, since they are characterized by incomplete functioning of the respiratory system. Acute bronchitis is treated with warm drinks, antipyretic drugs, and bed rest. After the body temperature drops and becomes stable, inhalations are carried out, rubbing the chest area.

If the disease persists within a week, an additional examination is required. It is not advisable for children to take antibiotics. Physiotherapeutic methods are introduced into the complex of medical procedures, a special diet is prescribed.

As antibiotic therapy, the child should be given only those indicated in the medical prescription. Parents need to be responsible for this problem, not to buy random advertised drugs.

Children under one year old are prohibited from giving drugs containing codeine. Traditional methods of treating bronchitis can be used as ancillary in the presence of basic medical therapy.

In order to avoid further the diagnosis of "bronchial asthma", children who have bronchitis are put on dispensary records. In winter, it is advisable not to wrap children too much, avoid sweating, clothes should not be blown by the wind.

Hypothermia is one of the first causes of bronchitis. Industrial dust also often causes illness, the best place for children to play is the area where trees grow, it is recommended to walk with them away from industries. Attention should be paid to cleanliness in the children's room, dusty air is a breeding ground for microorganisms that can provoke inflammation of the bronchi. It is useful to carry out hardening measures, to introduce physical exercises, breathing exercises into the regime.

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Author of the article: Sokolova Praskovya Fedorovna, pediatrician