Prompt diagnosis and therapy is the only assured cure in case of Pneumonia. Furthermore, it is of vital importance that the child suffering from pneumonia receives proper and timely care.
Pneumonia is the leading cause of death in children under the age of 5 years. Pneumonia has claimed the lives of 1.3 million children in 2011!
Only 30 per cent of affected children receive appropriate antibiotics at the right time.
Pneumonia is an infection of the lungs caused by various microorganisms, including bacteria, viruses, fungi and parasites. In this era of medical advancements and greater global reach, it is unfortunate that the childhood mortality from pneumonia remains high.
The symptoms of pneumonia include cough, cold, fever, breathlessness and wheeze. Very ill children have other serious symptoms like convulsions and unconsciousness. Newborns with pneumonia may not have the symptom of cough but instead may grunt, with increased respiratory rate. The symptom of cough occurs after the first one month of life and is the most important symptom alert of a respiratory infection.
A healthy child’s body defence system can fight the infections most of the time, but a child who is undernourished or malnourished, or is suffering from infections like measles and HIV, can’t do so and develops pneumonia. Zinc deficiency has been identified as an individual risk factor to the development of pneumonia in known endemic areas, and needs prompt supplementation.
Bacterial pneumonias are treated with antibiotics, preferably dispersible tablets, at home. Only the really ill children with serious complications, and children less than two years, require to be hospitalised. Other indications for hospitalisation include low oxygen levels, respiratory distress, dehydration and need for intravenous therapy. Critically ill children, in addition to intravenous antibiotics, would require to be intubated, ventilated and observed in the critical care unit. Early detection of complications like pleural effusion (fluid in the pleural cavity) and empyema (pus in the pleural cavity) is essential with appropriate imaging modalities.
Viral pneumonias are most common in infants, toddlers and preschool children. Respiratory syncytial virus infections account for 90 per cent of pneumonias in this age group.
- Pneumococcal infections occur in children less than five years, those in day- care centres, or with history of frequent ear infections. Breast-feeding extends protection against invasive pneumococcal disease.
- School aged children and adolescent aged children are prone to infection by mycoplasma pneumonia. Children exposed to household contacts, in homeless shelters, and immune suppressed children, are at risk for this infection.
- Tuberculosis in children may manifest as pneumonia and the index of suspicion should be high in children from endemic areas and with contact history of tuberculosis. Children with tuberculosis show symptoms of the disease about one to six months after exposure to tuberculosis. The child has symptoms of fever, night sweats, chills, cough, haemoptysis and weight loss.
Consideration should be made that in certain special situations, the cause of pneumonia may be non-infective. This has to be thought of in children with neurological impairment who are prone to aspiration events.
With appropriate therapy, the prognosis of pneumonia is good. Viral infections are self-limiting and require no specific therapy. Rarely do post viral pneumonias progress rapidly and lead to respiratory failure. Prognosis of varicella pneumonia is guarded and staphylococcal pneumonias may leave residual sequale, despite appropriate therapy. Tuberculosis, if not treated appropriately, will lead to disease progression.
It appears that prevention is the key to preventing childhood pneumonia. Immunisation against measles, pertussis, pneumococcal infections, and haemophilus influenzae B infection are the pathways to combat childhood pneumonia. The Indian recommendations are made by the Indian Academy of Paediatrics Committee on Immunization (IAPCOI) and the international recommendations by the American Academy of Paediatrics.
Another important step is proper nutrition for a child. Exclusive breastfeeding for first six months is recommended. Other than reducing the child’s risk of acquiring pneumonia, it also helps in reducing the duration of the sickness, if the child does fall ill.
Other preventive measures include emphasis on environmental hygiene and avoidance of indoor air pollution. The estimated cost of antibiotics for treating childhood pneumonia in South Asia and Sub-Saharan Asia is $ 200 million. Parents need to be educated regarding the avoidance of tobacco smoke, caution regarding the hazards of infection exposure in day-care centres and the importance of hand washing.
The obvious need to mount an aggressive battle against pneumonia in children has prompted, in 2009, the creation of World Pneumonia Day, which is observed annually on 12th November. This is done to raise awareness about pneumonia, to promote interventions to protect against, prevent and treat pneumonia, and generate action to combat pneumonia. The Global Coalition against Childhood Pneumonia provides the leadership for the World Pneumonia Day.
From the medical standpoint, early prompt diagnosis, appropriate antibiotic therapy (the right dose at the right time), counselling and executing orders for vaccination is essential. As individuals, what can we do? Even when we make small contributions in the fight against childhood pneumonia, every ounce counts. It need not only be voluntary monetary contributions to the cause. It may range from protecting the environment against pollution – stop tobacco smoke pollution and encourage friends, family and acquaintances who are smokers to stop; cut down on excessive petroleum product use – go green, whenever the opportunity arises; spread the awareness regarding adequate nutrition in childhood, and stress on the importance of breast feeding, which sadly, with the bustle of today’s lifestyle, most women are finding difficult to do.
Ensure that there is safe and clean drinking water with adequate sanitation facilities. The last would be the emphasis on childhood vaccination – the right dose at the right month and year. Let us join hands in the fight against childhood pneumonia!