Viral Infection and Respiratory Diseases In Children Under 5 Years

Viral Infection and Respiratory Diseases In Children Under 5 Years

Respiratory illnesses are common in children under 5 years of age. Most children will develop three to eight colds or respiratory illnesses a year. The higher in children who attend day care or are exposed to tobacco smoke. Most cases are mild, but about one-third of all hospitalizations in this age group are due to respiratory problems, including asthma and pneumonia. Acute respiratory infection is one of the leading causes of child morbidity, especially in developing countries. Viruses are recognized as the predominant causative agents of acute respiratory infections in children less than 5 years old.

Follow this guide to recognize which respiratory symptoms are caused by illness or infection and which are caused by non-respiratory conditions —and when your child needs medical attention.

The respiratory system has two parts: upper and lower. The upper respiratory system includes the nose, mouth, sinuses and throat. If your child has an upper respiratory infection he or she may feel uncomfortable and sound congested, with runny nose, cough and poor appetite.

Viral Acute respiratory infection

Acute respiratory infection is one of the leading causes of child morbidity, especially in developing countries. Viruses are recognized as the predominant causative agents of acute respiratory infections. Clinical and virological surveillance of acute respiratory infections was carried out in a rural community in children less than 5 years old. A standardized questionnaire was used and a nasopharyngeal swab sample was collected from each patient. These samples were tested for the detection of 20 respiratory viruses by multiplex RT-PCR or by viral culture. A total of 82 acute respiratory episodes were included, and 48 (58.5%) were found to be positive, with a total of 55 viral detections; several samples were positive for two or 3 viruses. Ten different viruses were identified: influenza viruses A, B, and C, human respiratory syncytial virus type A, rhinoviruses , human coronaviruses type 229E and NL63, parainfluenza viruses 3 and 4, and bocavirus. These results provide evidence on the importance and the diversity of viruses as causative agents of acute respiratory infections in children living in a rural community. The establishment of sentinel surveillance sites could help estimate the burden of acute respiratory infection in the pediatric population and should help prepare the health care systems to identify and respond to new viral respiratory emergencies.

Respiratory syncytial virus (RSV), which causes infection of the lungs and breathing passages, is a major cause of respiratory illness in young children. RSV is highly contagious and can be spread through droplets containing the virus when someone coughs or sneezes. It also can live on surfaces (such as countertops or doorknobs) and on hands and clothing, so can be easily spread when a person touches something contaminated.

RSV can spread rapidly through schools and childcare centers. Babies often get it when older kids carry the virus home from school and pass it to them. Almost all kids are infected with RSV at least once by the time they’re 2 years old. RSV infections often occur in epidemics that last from late fall through early spring. Respiratory illness caused by RSV — such as bronchiolitis or pneumonia — usually lasts about a week, but some cases may last several weeks. The typically diagnose RSV by taking a medical history and doing a physical exam. Generally, in healthy kids it’s not necessary to distinguish RSV from a common cold. But if a child has other health conditions, a doctor might want to make a specific diagnosis; in that case, RSV is identified in nasal secretions collected either with a cotton swab or by suction through a bulb syringe.

Upper Respiratory Infections (URIs):

The lower respiratory system refers to the bronchial tubes and lungs. Among children under five, symptoms of a lower respiratory infection are usually more severe than those of upper respiratory illnesses and may include shortness of breath, wheezing and rapid breathing. As a result, the child is more likely to require a visit to a healthcare provider.

Lower Respiratory Diseases:

  • Bronchiolitis
  • Pneumonia
  • Asthma

Upper respiratory infections

  • Common cold
    What is referred to as “a cold” can be caused by 200 different viruses. These viruses spread easily from person to person both through the air and by touching germ-laden surfaces then touching your nose, mouth or eyes. That’s why hand-washing—for you and your child—is so important. Most people are familiar with the main symptoms of colds: Nasal congestion, Runny nose, Sneezing, Sore throat, Mild to moderate hacking cough and Possible low-grade fever for the first day or two
  • Influenza (flu)
    Like a cold, influenza affects the upper respiratory system. Unlike a cold, though, it often causes more severe illness and complications. Symptoms: Fever with chills, Body aches, Headache, Cough, Sore throat, Nasal congestion/runny nose, Extreme exhaustion and weakness and Possible stomachache or vomiting in children
  • Croup
    The common early childhood ailment known as croup (tracheolaryngobronchitis) involves inflammation of the trachea (windpipe), the larynx (voice box) and the bronchioles (tiny airways leading to the lungs). It is recognized by a distinctive “barking cough” that usually starts suddenly and at night. Children ages 3 months to 3 years are most susceptible to croup. Signs and symptoms: Dry, barking (brassy) cough
    Stridor – noisy, labored breathing; high-pitched noise when inhaling, Hoarseness and A tight throat
  • Sinusitis
    Viral infections and allergies affect sinuses the same way they affect the nasal passages, causing swelling and producing extra mucus. This makes it difficult for the sinuses to drain properly and as mucus accumulates, the sinuses become a safe haven for germs to grow. The resulting infection can cause sinus pressure and pain. Signs and symptoms: Upper respiratory tract infection symptoms lasting more than 10 days without improvement, Nasal congestion or discharge, any color
    Cough, day and night, Facial pain or headache Fatigue and irritability, Low-grade fever
    More severe symptoms: Fever (temperature above 102°F ) and Yellow or green nasal mucus

Lower respiratory diseases

  • Respiratory Syncytial Virus – RSV
    While it begins in the upper respiratory system, RSV is one of the most common causes of lower respiratory tract illness in infants and young children, affecting more than 90 percent of all children before the age of 2. For some children, RSV is a mild illness with symptoms of the common cold. However, in 20-30 percent , the infection spreads into the lower respiratory tract’s tiny airways—or bronchioles—causing them to swell, at which point the infection is known as “RSV bronchiolitis.” When there’s less room for air to pass through the airways, the child begins to wheeze and have difficulty breathing. Some research indicates that children who experience severe cases of RSV are at increased risk of developing asthma. Signs and symptoms: Upper respiratory symptoms of common cold, Cough, Fast breathing, Fever, Retractions–drawing in of muscles and skin in neck and chest with each breath, Irritability, Difficulty sleeping and signs of fatigue or lethargy
  • Bronchiolitis
    Bronchiolitis is caused by an infection that affects the tiny airways—called the bronchioles— that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult. This disease affects mostly infants and young children—typically during the first 2 years of life, with peak occurrence at 3 to 6 months. Bronchiolitis is usually caused by RSV (Respiratory Syncytial Virus). It can be also caused by colds, influenza (flu) and human metapneumovirus (hMPV, which may also cause pneumonia). Signs and symptoms: Cough, Fever, Rapid heartbeat
    Rapid, shallow breathing, Retractions—drawing in of muscles and skin around neck and chest with each breath and Flaring of the nostrils
  • Pneumonia  Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs (alveoli)—associated with fever, chest symptoms, and a lack of air space (consolidation) on a chest X-ray.Pneumonia is a bacterial or viral infection of the lung that causes the lungs’ airpockets (alveoli) to become inflamed. Lungs may produce extra fluid, which can accumulate in the airways. Healthcare providers often use x-rays to diagnose pneumonia. Pneumonia is typically caused by an infection but there are a number of other causes.Infectious agents include: bacteria, viruses, fungi, and parasites.    Typical symptoms include cough, chest pain, fever, rapid breathing, decreased activity and poor eating, a grunting sound when child exhales, retractions drawing in of muscles and skin around neck and chest with each breath and difficulty breathing.Diagnostic tools include x-rays and examination of the sputum. Vaccines to prevent certain types of pneumonia are available. Treatment depends on the underlying cause. Presumed bacterial pneumonia is treated with antibiotics. Although pneumonia was regarded by William Osler in the 19th century as “the captain of the men of death”, the advent of antibiotic therapy and vaccines in the 20th century have seen radical improvements in survival outcomes. Nevertheless, in the third world, and among the very old, the very young and the chronically ill, pneumonia remains a leading cause of death. Pneumonia is a bacterial or viral infection of the lung that causes the lungs’ airpockets (alveoli) to become inflamed. Lungs may produce extra fluid, which can accumulate in the airways. Healthcare providers often use x-rays to diagnose pneumonia.
  • Asthma
    In the United States nearly 6 percent of children under 5 have asthma – that’s one out of every 18. Asthma is one of the most common causes of hospital admission and visits to healthcare providers in this age group. Children with asthma have sensitive, easily irritated airways in their lungs. When exposed to certain triggers – like viruses, allergens, secondhand smoke, chemical irritants, cold air or pollution – the airways become more inflamed, producing increased mucus, mucosal swelling and muscle contraction. This results in airway obstruction, chest tightness, coughing, shortness of breath and wheezing. Asthma in children varies by age group, and infants, toddlers and 4-year-olds are diagnosed and treated differently than teens and adults. The way asthma affects a child also varies from person to person, and symptoms may get better or worse at certain times. In some children, asthma symptoms get better as the child grows. While asthma can’t be cured, symptoms can be managed by following the treatment plan you develop with your child’s healthcare provider. Symptoms: Coughing on expiration (breathing out), especially at night, Wheezing on expiration, Difficulty breathing, Shortness of breath when exercising or playing and Rapid heartrate


  • GERD (Gastroesophageal Reflux Disease)  It is common for healthy infants and children Under 5 Years to bring up partially digested food from the stomach, but in most children this resolves spontaneously by the age of 1 year. However, a significant proportion develop gastroesophageal reflux disease (GERD), in which persistent reflux causes symptoms or complications. The pathophysiology of GERD in children Under 5 Years is similar to that in adults. Typical reflux symptoms in younger children include repeated vomiting, acid regurgitation, swallowing difficulties that lead to weight loss or failure to thrive, respiratory problems, abdominal pain, irritability, sleeping problems, and abdominal pain. Older children are more likely to experience symptoms that are similar to those in adults, such as chronic heartburn, regurgitation with re-swallowing, and dysphagia. Troublesome reflux symptoms are the key to the diagnosis of GERD, but younger children and infants cannot reliably report their symptoms. In a practice-based study, heartburn and acid regurgitation were reported to occur weekly in approximately 2% of children aged 3–9 years and 5–8% of those aged 10–17 years. GERD can significantly impair children’s quality of life and that of their families. The primary aims of treatment in childhood GERD are to relieve symptoms and heal reflux esophagitis, if present.The opening between the esophagus (food pipe) and the stomach is guarded by a small muscle. When this muscle relaxes and opens up at the wrong time, small amounts of food or gastric acid can splash up from the stomach into the esophagus, causing a burning sensation and irritation of the lining of the esophagus. Common symptoms in infants and young children: Frequent spitting up or vomiting, Frequent or persistent cough, Refusing to eat or difficulty eating (choking or gagging with feeding), Chest pain, Hoarseness and Sleep apnea
  • Teething
    Parents often report that teething causes respiratory symptoms such as runny nose or coughing in their young child. In fact, the symptoms may be a matter of timing rather than a direct effect of cutting a tooth. Infants have a natural, passive immunity to germs and allergens in the environment. However, most of this natural immunity is gone by the age of 6 months – just the time when most children begin to get their teeth. As a result, the child suddenly becomes more susceptible to common germs in the environment and minor illnesses that bring nasal congestion, cough and fever. Even though symptoms may appear at the same time as new teeth, studies have shown they are more likely due to an illness or infection than to the teething process. Signs and symptoms: Sore gums, Fussiness; irritability, Excessive drooling (caused by the body making more saliva than they can swallow) and Possible runny nose
  • Respiratory allergies
    Allergies are frequently to blame for breathing problems, especially during a pollen-heavy springtime or fall. Common year-round allergens include mold, dust mites, cockroaches and furry pets. Signs and symptoms: Nasal congestion, Runny nose, Sneezing, Red, itchy eyes
  • Food allergies
    If your child has food allergies, coming into contact with the allergen can lead to a wide range of signs and symptoms that typically involve the three major organ systems in the body: Skin, such as hives or eczema, Gastrointestinal tract, including nausea, stomach upset and diarrhea and Respiratory tract, including sneezing, runny nose (rhinitis) and difficulty breathing (asthma)
  • Anaphylaxis
    Some allergies – including insect sting, latex, medication and some foods – can cause a life-threatening reaction called anaphylaxis, which can lead to death in a matter of minutes if not treated. If your child is diagnosed with a life-threatening allergy, you should always carry auto-injectable epinephrine to use in case of emergency. Symptoms: Mouth: itching, swelling of lips and/or tongue, Throat: itching, tightness/closure, hoarseness, difficulty swallowing, Skin: itching, hives, flushing (redness) and swelling of face, Gut: vomiting, diarrhea, cramps, Lung: shortness of breath, cough, wheeze and Heart: weak pulse, dizziness, passing out, loss of consciousness


  • Niang MN, Diop OM, Sarr FD, Goudiaby D, Malou-Sompy H, Ndiaye K, Vabret A, Baril L. Viral etiology of respiratory infections in children under 5 years old living in tropical rural areas of Senegal: The EVIRA project. J Med Virol. 2010 May;82(5):866-72.
  • Respiratory Diseases In Children Under 5


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