The child with repeated infections

One of the most frequent reasons for pediatric consultation is that of a child, generally less than 3 or 4 years old, with recurrent respiratory disease. Since when? Since he began his schooling, either in Nursery or Nursery School. Justifying everything by the well-known immune incompetence of the child may be the most comfortable, but not the most real. You have to think of something else.

It is considered "normal" in children under 3 years of age suffering from up to 6 respiratory infections each year, some of them even with bronchial involvement. If this number of infectious episodes is exceeded, not only in the respiratory tract, but in any organ or system, such as the urinary tract or skin, for example, an effort will have to be made to investigate the possible causal factors.

In a schematic but didactic way, we can consider four large groups of diagnostic possibilities:

Recurrent infection due to anatomical causes

A cleft palate, a congenital choanal atresia (nasal obstruction), even a nasal foreign body, can be, among many other anatomical abnormalities to take into account, triggers of repeated infectious pictures. In any case, adenoid hypertrophy (vegetations) and tonsillar will be the factor most frequently responsible for repeated infections of the upper respiratory tract. For this reason, the pediatrician will not stop exploring the otorhinolaryngological area, requesting X-rays of the cavum (to assess the size of the vegetations) and of the paranasal sinuses (to rule out possible sinusitis). A systematic blood test and a chest X-ray may be necessary to complete the study to rule out bronchial involvement. The appearance of recurrent pneumonias will make it necessary to emphasize the complementary tests: tuberculin test, blood culture, sputum study, sweat test (to rule out cystic fibrosis of the pancreas) and immunoglobulin study, guiding a possible allergy.

Recurrent infection by infectious agent

the fundamental role –more than 85% of febrile episodes- is represented by viral infections. There are more than 200 types of virus –especially in school communities- that can affect the respiratory tract (pharyngoconjunctivitis, common cold, laryngitis, bronchitis, bronchiolitis, pneumonia) and the digestive system (gastroenteritis).

Less frequent, but of great interest, will be bacterial infections, usually well resolved with timely and adequate antibiotic therapy, but sometimes with torpid and recurrent evolution due to bacterial resistance (pneumococcus), poor treatment or even the dreaded non-compliance family therapy.

Recurrent infection by environmental agent

Having ruled out the anatomical anomaly and the infectious cause, it will be necessary to know how to assess the child's environment. Early schooling, before the age of 3, with the nursery as a great reservoir for all types of viruses, is the first and greatest cause to consider. Children with emotional deprivation, or poor general hygiene, with siblings in school - virus carriers -, or with overcrowded conditions, with inadequate heating systems for the child's respiratory tract (firewood, charcoal, gas or air conditioning), excess Environmental CO2 from automobiles with leaded gasoline or polluting industries, without forgetting the problem of the child as a passive smoker with smoking parents, become factors to consider when faced with a child with a recurrent respiratory infection.

Recurrent infection due to immune disorder

Both the immune deficit and the excess of immunity can lead to repeated infectious processes. An immunological deficit either local (mainly secretory Immunoglobulin A deficiency) or general, which will require a complete study of immunity and on other occasions due to excess immunity giving rise to allergic reactions are favorable situations of upper respiratory infections, bronchitis, bronchial asthma and recurrent pneumonia.

Finally, it should be noted that the viral infection in infants can sometimes act as a trigger for respiratory allergy.