Upper respiratory tract infection in children

Abstract

In terms of potential danger acute stridor must be taken seriously. Most cases are self-limiting. Indeed, recurrent spasmodic croup may last a few hours only. But an occasional case of laryngotracheitis may progress to severe obstruction, and epiglottitis, though rare, may be fatal. In terms of morbidity otitis media is perhaps the most important of these conditions. There are children in every practice who need to have their serous otitis treated by the insertion of tympanostomy tubes or by adenoidectomy. Some of them are undiagnosed and suffer from learning disorders, speech problems, and undesirable behaviour. In general practice it should be possible to test children's hearing at any age. Recurrent sore throat certainly causes acute distress but is only rarely a genuine cause of longterm ill health. Colds and most coughs are self-limiting, and teaching parents about their incidence and natural history is perhaps the most valuable therapeutic tool available. Bacteria can rarely be convincingly shown as a cause of colds and coughs, though mycoplasma may play a part. In any case, not every runny nose and cough is caused by infection. There is no doubt that atopy is underdiagnosed, and the trainee should be very cautious in labelling as bronchitic the child with recurrent episodes of fever and cough, particularly if he wheezes. He may have asthma, for which specific and effective treatment is available. Likewise, the child with a runny nose may have perennial rhinitis rather than a persistent cold. Parents should be helped to understand when to phone, when to attend, and when to give medicines to their children. Some practices have prepared booklets, which in simple language help parents to understand how much importance to attach to these illnesses. In the end self-interest and the patient's interest will neatly coincide. As families learn self-help, the general practitioner's work load may be reduced.