Acute respiratory infections in children

November 19, 2018 - 10:00

Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs), from the nostrils to the vocal cords in the larynx, including the sinuses and the middle ear, or lower respiratory tract infections (LRIs), from the trachea and bronchi to the lungs.

Dr. Mattias Larsson — Photo courtesy of Family Medical Practice Hanoi
Viet Nam News

By Dr. Mattias Larsson*

Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs), from the nostrils to the vocal cords in the larynx, including the sinuses and the middle ear, or lower respiratory tract infections (LRIs), from the trachea and bronchi to the lungs.

ARIs are the most common causes of both illness and mortality in children under five with an average of three to six episodes of ARIs annually. The proportion of mild to severe ARI varies between high- and low-income countries, due to different pathogens (bacteria and virus), risk factors such as poor nutrition and access to healthcare and treatment. About 5.6 million children under the age five died in 2016, 15,000 every day, about 20 per cent due to ARI (WHO, 2017).

Upper respiratory tract infections

URIs are the most common infectious diseases, especially in children, and are commonly transmitted in crowded settings such as kindergarten. They include rhinitis (common cold), sinusitis, ear infections, acute tonsillitis, epiglottitis and laryngitis. The vast majority of URIs have a viral etiology and antibiotic treatment is not needed. Because most URIs are self-limiting, their complications are more important than the infections. Acute viral infections may predispose children to bacterial infections of the sinuses and middle ear. Coughing helps to remove mucus, preventing aspiration and LRIs as pneumonia.

Acute pharyngitis and tonsillitis

Acute pharyngitis with pharyngeal redness, swelling and tonsil enlargement is in more than 70 per cent of cases caused by viruses in young children and antibiotics are not needed. Streptococcal tonsillitis is rare in children under two years of age and more common in older children. If not treated, poststreptococcal rheumatic fever may cause inflammatory lesions in tissues such as joints and heart.

Lower respiratory tract infections

The most common LRIs in children are pneumonia and bronchiolitis. The respiratory rate is a valuable clinical sign for diagnosing acute LRI in children who are coughing and breathing rapidly. The presence of lower chest wall retraction can identify more severe cases. 

The most common causes of viral LRIs tend to be seasonal. If the examination and test indicate viral causes no antibiotic treatment is needed. Inhalation of salbutamol can help to decrease inflammation in the respiratory tract, open up the airways and remove mucus.


Pneumonia often presents itself with fever, difficulty of breathing and fatigue, and possibly painful breathing. Viruses are responsible for about half of all pneumonias in children. Measles, RSVs, parainfluenza, influenza type A and adenoviruses are the most common causes of viral pneumonia. Bacterial pneumonia is often caused by Streptococcus pneumoniae (pneumococcus) or Haemophilus influenzae. Radiology and tests as full blood count and CRP may be helpful to differentiate between viral and bacterial etiology.  

Atypical pneumonias with symptoms such as a dry cough, low grade fever and headaches are caused by pathogens such as Mycoplasma pneumoniae and Chlamydia pneumoniae, which can be treated with antibiotics.

Tuberculosis often presents with persistent cough for several weeks, sometimes blood in sputum, low grade fever, nightly sweating and weight loss. Tuberculosis can be treated with a combination of antibiotics. 

Pneumonia is often spread in hospitals and may be difficult to treat due to high antibiotic resistance.


Bronchiolitis occurs predominantly in the first years of life. The clinical features are rapid breathing and wheezing and in some cases lower chest wall indrawing and fever. The main cause of bronchiolitis are viruses such as RSVs, metapneumovirus,  parainfluenza virus and influenza viruses.

Many respiratory infections can be prevented with vaccines! 

Vaccines cause antibodies to develop in the body and protect from disease, it is as you would have a disease without being sick. Vaccination is important not only to prevent disease for the individual but also to prevent transmission in the society. If more then 80 per cent of people are vaccinated it is low risk that a disease can spread. This is called herd immunity.

Influenza A vaccine

Influenza is a serious disease that can lead to hospitalisation and sometimes even death. Every flu season is different. Millions of people get the flu every year, hundreds of thousands of people are hospitalized and thousands die. An annual seasonal flu vaccine is the best way to reduce your risk of getting sick and spreading it to others. Everyone six months of age and older is recommended to get a flu vaccine every season.

Hib Vaccine

Haemophilus influenzae type b (Hib) is a bacteria that causes serious diseases such as meningitis (an infection of the lining of the brain and spinal cord), pneumonia, epiglottis (severe swelling in the throat, making it hard to breathe), infections of the blood, joints, bones, and pericarditis (covering of the heart). It usually affects children under 5 years old. Before Hib vaccine the mortality in Hib B infections was about 5 per cent. Since use of the Hib vaccine began, the number of cases of invasive Hib disease has decreased by more than 99 per cent.

Pneumococcal vaccines

Streptococcus pneumoniae is a bacteria that is the most common cause of pneumonia and meningitis. CDC recommends pneumococcal vaccines for all children younger than 2 years old, all adults 65 years or older, and people 2 through 64 years old with certain medical conditions. — Family Medical Practice

*Dr. Mattias Larsson first came to Viet Nam in 1997 to conduct research on child infections and antibiotic use and resistance. In 2003 he defended his PhD and graduated from his medical training. Since then he has spent about half of his time in Sweden working as a physician in pediatrics and infectious diseases. The other half has been spent in Viet Nam and other developing countries working with medical training and research. Dr. Larsson speaks English, Swedish, German and Vietnamese as well as some Spanish. He will complement the team at Family Medical Practice, and intends to participate in the development of diagnostics care and treatment towards the best international evidence based standards.

For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã Street, Ba Đình District. Tel: (024) 3843 0748.  E:

FMP’s downtown Hồ Chí Minh location is: Diamond Plaza, 34 Lê Duẩn Street, District 1; 95 Thảo Điền Street, District 2. Tel: (028) 38227848. E:

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh Street, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699.