Management of respiratory tract infections in children

Figures & data

Table 1 Respiratory and heart rates in children at rest

Age (years)	Respiratory rate (per minute)	Heart rate (per minute)
<1	30–40	110–160
1–2	25–35	100–150
2–5	25–30	95–140
5–12	20–25	80–120
>12	15–20	60–100

Note: Adapted from the Advanced Paediatric Life Support: The Practical Approach, 5th Edition, Advanced Life Support Group; edited by Martin Samuels, Susan Wieteska.⁶⁰ Copyright © 2011, John Wiley and Sons.

Figure 1 Reasons for increased vulnerability in children with respiratory tract infections.

Note: Adapted from Schaad,¹ Paul et al,² NHS Choices 2011,⁴ SIGN 2006,⁶ and Snellman et al.⁷
Abbreviations: NHS, National Health Service; SIGN, Scottish Intercollegiate Guidelines Network.

Figure 2 Risk factors for respiratory tract infection.

Note: Adapted from Paul et al,² Harris et al,⁵ the Scottish Intercollegiate Guidelines Network,⁶ and Paranjothy et al.⁸
Abbreviation: CLD, chronic lung disease.

Figure 3 Red flag signs in children with respiratory tract infections.

Figure 4 Consider referral for tonsillectomy.

Note: Adapted from the Scottish Intercollegiate Guidelines Network.³⁴

Table 2 Auscultatory findings in respiratory illnesses

Condition	Auscultatory findings
CAP	Differential air entry, crepitations, localized wheeze due to bronchospasm, decreased or no air entry in CAP with consolidation
Bronchiolitis	Fine inspiratory crackles and/or high pitched expiratory wheeze
Preschool viral wheeze Chronic lung disease of prematurity Croup	Wheeze (during expiration) on auscultation during episodes of exacerbation in episodic viral wheeze Will depend on nature of presenting respiratory tract infection, eg, fine inspiratory crackles and/or high-pitched expiratory wheeze Normal or upper airway conducted noises may be auscultated (during inspiration)
Tonsillitis	Normal or upper airway conducted noises may be auscultated
Otitis media	Will be normal unless concurrent respiratory tract infection pre-exists
Protracted bacterial bronchitis	Normal

Abbreviation: CAP, community-acquired pneumonia.

Table 3 Types of respiratory tract infections and common causative organisms

Condition	Viral organism	Bacterial organism
Community-acquired pneumonia	RSV, rhinovirus	Streptococcus pneumoniae, Mycoplasma pneumoniae
Bronchiolitis	RSV, rhinovirus	Not applicable
Preschool (viral) wheeze	Rhinovirus	Not applicable
Laryngotracheobronchitis	Parainfluenza virus (croup)	Haemophilus influenzae type B (epiglottitis)
Tonsillitis	Rhinovirus	Group A Streptococcus
Otitis media	RSV, influenza virus	S. pneumoniae, H. influenzae
Protracted bacterial bronchitis	Not applicable	Non-typable H. influenzae, S. pneumoniae

Abbreviation: RSV, respiratory syncytial virus.

Figure 5 Pathway for deciding antibiotics in respiratory tract infections.

Notes: Copyright © 2008. National Institute for Health and Clinical Excellence. This figure is an adaptation of content from CG69 Respiratory tract infections – antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care, published by the National Institute for Health and Clinical Excellence (2008). The original publication is available from www.nice.org.uk/CG69. This adaptation has been reproduced with permission of NICE. NICE, however, has not checked the adaptation to confirm that it accurately reflects the original NICE publication and no guarantees are given by NICE in regard to the accuracy of the adaptation. The NICE guidance that this adaptation is based upon was prepared for the National Health Service in England and Wales. NICE guidance does not apply to New Zealand.³⁵

Figure 6 Antipyretic use in children.

Abbreviation: NSAIDs, non-steroidal anti-inflammatory drugs.

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