Pneumonia and its symptoms in children. How to recognize pneumonia in a child

Pneumonia is an infectious-inflammatory disease that affects the lungs of a person. Often it occurs in childhood and accounts for about 80% of all pulmonary pathologies.

Even with the current level of medicine, pneumonia in a child is a fairly common cause of death.

Therefore, it is considered necessary to know how pneumonia manifests itself in children. Such information will allow you to recognize the disease in a timely manner and help prevent its further development.

Features of the disease and possible consequences for young children

Inflammation of the lungs in children in most cases develops around the fourth day with the defeat of SARS. This is due to the detrimental effect of a viral infection on human immunity and the protective barriers of the respiratory tract. Thus, foci of bacterial infection are formed, from which pneumonia begins.

As for the features of the development of the disease, in children the symptoms of the disease are somewhat different. This is determined by the following indicators:

All of these factors create a favorable environment for the emergence and spread of the inflammatory process.

It is also worth noting the child's immune system: it is obvious that in the first days of life, the baby's body is subjected to significant attacks by various pathogenic microorganisms. Therefore, it is important to pay sufficient attention to each manifestation, because any disease during this period can lead to irreversible consequences in the future.

As for pneumonia, it is an extremely dangerous disease for children. Microbes by their activity cause various complications. To fully understand how pneumonia manifests itself, it is necessary to consider the following points in the development of pneumonia:

Such consequences affect the functioning of the child's body too much, so it is important to study and remember the first signs of pneumonia in children.

Pneumonia: symptoms in children according to age

Every mother should know how to determine pneumonia in a child. Recognizing inflammation is quite simple - you just need to carefully monitor the baby. But it should be borne in mind that the age of the child determines the features of the manifestations.

To begin with, it is worth considering the signs of pneumonia in a child under 1 year old. First of all, it concerns the behavior of the newborn. If he wants to sleep all the time, the state is lethargic or apathetic, then you should start to worry. In addition, the reverse situation is also possible: the baby, on the contrary, begins to act up and cry more, refuse to eat. It is also worth considering the fact that the first signs of inflammation are changes in body temperature.

But for children under 1 year old, this symptom is not decisive. This is due to certain characteristics of the body - in such an age period, the temperature does not rise above 37.6 degrees. In addition, it is not decisive in the severity of the condition.

So, the first symptoms of pneumonia in children are as follows:

Without any adequate cause, restlessness, lethargy, decreased appetite, and refusal to breastfeed may occur.
The dream becomes disturbing, short.
The chair becomes liquid.
Constant feeling of nausea with vomiting.
Stuffy nose and cough, which can turn into an attack when crying or feeding.

The main manifestations of pneumonia are a change in breathing and accompanying processes:

An important point in the question "How to recognize pneumonia in children?" is a change in the relief of the skin surface in the process of breathing.

This can be observed if you look at the skin on the ribs of the baby: how it is drawn in when you inhale. If there is asymmetry between the two sides of the chest, then this may indicate the disease in question. In some situations, causeless failures in breathing and the frequency of the process, its stop for a short period of time, can be noted. Due to the defeat of one half of the lung, the child tends to lie on a certain side.

On visual examination, a disease affecting the pulmonary organ may manifest itself in cyanosis of the nasolabial triangle. It allows you to establish violations in the normal supply of oxygen to the body. Appears as blue between the lips and nose of the child. It is easy to notice it at the moment when the baby is breastfeeding. If the disease has had a significant impact on the body, then blueness can be observed not only on the front, but also on other parts of the body.

Separately, it is worth considering the signs of pneumonia in children older than 4 years. This is due to the fact that at the age of 4, the organ in question is formed sufficiently in the child. The presence of the following symptoms is sufficient reason to consult a doctor for a detailed diagnosis:

After an acute respiratory viral infection, there is no improvement in the state of the body for 5 days. Or, after a slight recovery of the body, the temperature suddenly rises, a strong cough occurs.
Poor appetite and sleep, or their complete absence.
It is also worth noting the pallor of the skin.
Body temperature can reach 38 degrees. However, most antipyretic drugs can not cope with their purpose.
There is shortness of breath. Again, you need to know the rate of breaths per minute to determine the presence of a violation in the respiratory process: from 4 to 6 years: 25 / m; in adolescents from 10 years old, the norm almost reaches an adult: 15-20 v / m.

Obviously, if the real figures exceed these figures, then this is a sign of pneumonia.

You need to understand that this is a fairly serious disease - pneumonia. Symptoms in children have some features - age determines the main nuances.

Symptoms in children, taking into account the form of the disease

Pneumonia can manifest itself in several forms. Each variety has its own specific symptoms, so it is important to get to know each of them.

So, initially it is necessary to consider the so-called focal pneumonia, which develops as a result of complications of SARS. According to the first signs, this form does not differ from the common cold: runny nose, cough, slight temperature.

But over time, the disease penetrates inside, affecting more and more layers of the lung tissue, as a result of which the state of the body worsens significantly after 7 days:

Although the focal form of the disease is not considered severe, nevertheless, possible complications can lead to death.

The next type of pneumonia is segmental, characterized by the rarity of occurrence and the danger of symptoms. The inflammatory process affects a fairly large area of the lung. This form occurs quickly and sharply. It is characterized by the following features:

In the initial stages, segmental pneumonia is quite difficult to diagnose due to the absence of wheezing and coughing.

Croupous pneumonia is considered the most dangerous form. At risk are children older than four years. It appears as a result of severe hypothermia, so the symptoms appear quite quickly:

chills, which is accompanied by a temperature of 40 degrees. It can sharply fall or rise;
increased sweating;
pain in the chest when breathing;
cough at the beginning dry. Further, it acquires a wet character with the release of sputum mixed with blood;
the skin is pale, but a feverish blush can often be observed;
depending on the localization of pneumonia, abdominal pain, headaches with vomiting, and convulsions may occur.

It is not always possible to isolate pneumonia as the cause of such manifestations, since they are not characteristic of a pulmonary infection.

Inflammation of the lungs is accompanied by symptoms of a detrimental nature, which in this case largely affects the general condition of the child. It is important to understand that with such a process it is necessary to respond in a timely manner to each symptom and in no case delay in contacting a doctor, since with pneumonia there is a high probability of death.

Absolutely any child can catch pneumonia. Every mom thinks with horror about how dangerous the complications of this disease can be. How parents should behave if the baby has caught pneumonia is described in this article.

What it is?

Pneumonia is an inflammation of the lung tissue. A variety of reasons can lead to the development of this condition in a child.

In childhood, as a rule, this disease is very difficult.

In the high risk group for possible complications of the disease are weakened babies and children suffering from concomitant chronic diseases.

The inflammatory process in the lungs triggers a cascade of various reactions that have a very adverse effect on the entire body. The complex of these violations leads to the appearance of numerous respiratory disorders in the baby.

The severity of the course of the disease largely depends on the initial state of health of the child. With local inflammation only in the lung tissue, doctors talk about the presence of pneumonia. If the bronchi are also involved in the inflammatory process, then this condition is already called bronchopneumonia.

The prevalence of this disease in the pediatric population is different. According to statistics, younger children get sick more often. Thus, the incidence of this disease in children under 5 years of age is 20-25 cases per 1000 children. At an older age, this figure decreases and amounts to 6-8 cases per 1,000 children.

Among newborn babies, the prevalence of pneumonia is relatively rare. This feature in infants is largely due to the presence of specific antibodies that they receive from their mother during breastfeeding.

Maternal immunoglobulins protect the child's fragile body from a variety of infectious agents, which in the vast majority of cases cause pneumonia.

Causes

Currently, there is a huge variety of different causal factors that contribute to the appearance of these symptoms in a child.

In the development of bronchopneumonia, infection of the baby with beta-hemolytic streptococcus plays a huge role. Also, these microbes quite often cause interstitial forms of this disease. Streptococcal pneumonia is highly contagious to others.

The presence of streptococcus in the throat of a child is an extremely unfavorable situation. In this case, an infected baby can easily infect a healthy one. A decrease in immunity in such a situation leads to a rapid infection of the child's body and the development of adverse symptoms.

Streptococcal infection, as a rule, spreads rapidly in crowded groups that are visited by a large number of children.

It is important to note that streptococcal pneumonia in a baby can also occur even in the period of intrauterine development.

In this case, the infected mother passes the infection to her baby. Infection occurs through the placental bloodstream. Streptococci are very small in size, which allows them to quite easily enter the common system of placental arteries and reach the lungs and bronchi of the fetus.

Every third pneumonia in babies, according to statistics, occurs due to infection with mycoplasma. Infection with these microorganisms can occur in a variety of ways.

Many scientists believe that additional aggravating conditions are required for the development of the mycoplasmal variant of pneumonia. These include a general decrease in immunity or an initially weakened state of the child.

Another similar microorganism that leads to the development of pneumonia in babies is chlamydia. It causes infection much less frequently. In most cases, cases of infection with chlamydial infection through the blood are recorded.

Children's doctors distinguish quite a lot of cases of intrauterine infection. Chlamydial pneumonia is usually sluggish and is manifested by the appearance of very blurred adverse symptoms of the disease.

Almost a quarter of all cases of pneumonia are caused by pneumococci. These microorganisms “prefer” to live and multiply in the lung tissue, since there are the most optimal conditions for their life activity there.

The course of pneumococcal infection is usually accompanied by the development of violent adverse symptoms of the disease. The disease proceeds quite brightly. This clinical variant of the disease can cause various complications in a sick child.

Staphylococcal flora can also cause disease in babies. The most aggressive pathogen is Staphylococcus aureus.

According to statistics, the peak incidence occurs in preschool age. Toddlers attending educational institutions have a higher risk of contracting staphylococcal flora. Quite often, mass outbreaks of staphylococcal pneumonia are recorded in children during the cold season.

Quite rarely, infection with a fungal flora leads to the development of pneumonia. This form of the disease is often found in children who suffer from diabetes.

Immunodeficiency pathologies are also important in the development of pneumonia in a child.

There are alternative microorganisms that can cause pneumonia in babies. It should be noted that they lead to the formation of pneumonia somewhat less frequently. These include: Escherichia coli, Mycobacterium tuberculosis, Haemophilus influenzae and Pseudomonas aeruginosa, Pneumocystis and Legionella.

In some cases, pneumonia occurs as a complication of previously transferred viral infections. Specific childhood diseases are quite often the causes of inflammation in the lungs. Such infections include: rubella, influenza and parainfluenza, cytomegalovirus and adenovirus infection, chicken pox, herpes infection of various origins.

The course of viral pneumonia is accompanied, as a rule, by the development of numerous symptoms of the disease, which manifest themselves quite rapidly in a sick baby.

Doctors distinguish several options for the development of the course of this disease:

Children who fall ill at home are most often infected with Haemophilus influenzae or pneumococci.
Toddlers attending preschool educational institutions quite often get sick with mycoplasma and streptococcal forms of the disease.
Schoolchildren and adolescents have a high risk of developing chlamydial variant of the disease.

A variety of factors also influence the course and development of the disease. Their impact greatly weakens the child's body and leads to the progression of the disease. These factors include:

Frequent colds. If the baby is sick with SARS or acute respiratory infections several times during the year, then he has a rather high risk of getting pneumonia.
Concomitant chronic diseases of internal organs. Diabetes mellitus and other endocrine diseases top the list of pathologies that affect the general condition of the child's body.

Cardiovascular diseases, which are quite severe, also lead to a weakening of the child's health.

Severe hypothermia. Some children only need to get their feet wet in order to catch pneumonia. Inefficient functioning of the immune system in babies and inadequate thermoregulation only exacerbate the process.
Insufficient supply of micronutrients. Reducing the intake of vitamins from food contributes to the disruption of metabolic processes in the body. This is especially dangerous during periods of intensive growth and development of the baby.
immunodeficiency states. They can be both congenital and acquired pathologies. Reduced work of the immune system contributes to the active reproduction in the child's body of various microorganisms, which are the root cause of the development of this disease.
Aspiration. The entry of acidic stomach contents into the respiratory tract causes damage to the lung tissue in babies. Most often this situation occurs in the smallest patients during regurgitation. Inhalation of a foreign body also contributes to the development of aspiration in babies and contributes to the appearance of adverse symptoms.

Classification

The variety of causes that cause pneumonia in babies contributes to the presence of a wide variety of clinical options. This classification is used by physicians to diagnose and prescribe appropriate treatment. Every year, new types of diseases are introduced into it.

Given the initial manifestation of symptoms pneumonia can be acute or chronic. It must be said that the first variant of the disease occurs in children more often. Acute pneumonia is characterized by the appearance of a huge number of a wide variety of symptoms that manifest themselves quite clearly in a sick child.

The inflammatory process can be both on the one hand, and move to the other. Most often, babies develop right-sided pneumonia.

This feature is due to the anatomical structure.

The right-sided bronchus, which is part of the bronchial tree, is usually somewhat shorter and thicker than the left. This leads to the fact that microorganisms usually penetrate into it and subsequently develop in the right lung.

Left-sided pneumonia occurs, as a rule, much less frequently. Unilateral pneumonia has a more favorable prognosis.

In some cases, a two-way process may also occur. Inflammation in both lungs is usually quite severe in a child and causes multiple adverse symptoms. To eliminate them, the appointment of a whole complex of treatment is required.

Taking into account the localization of the inflammatory focus, several clinical variants of the disease are distinguished:

Focal. It is characterized by the presence of a lesion, which can be localized in various parts of the lung.
Radical. Inflammation is localized mainly in the root of the lung.
Segmental. The inflammatory process extends to some anatomical zone of the lung.
Equity. Inflammation captures a whole lobe of the affected lung.

In some cases, pneumonia is asymptomatic or latent. To determine the disease in such a situation is possible only with the help of additional diagnostic methods.

To establish the correct diagnosis allows, as a rule, a complete blood count and x-ray of the chest. These studies detect inflammation in the lung tissue even at the earliest stages.

Given the causative agent of the disease, the following clinical forms of pneumonia are most common:

Viral. Various viruses lead to the development of the disease, which perfectly penetrate the lung tissue, causing an inflammatory process in it.
Bacterial. It is accompanied by a rather severe course and the appearance of a huge number of adverse symptoms that bring severe discomfort to the sick child. The most dangerous clinical variants turn into destructive forms, accompanied by massive loss of lung tissue.
Atypical. It is caused by microorganisms that have certain structural features. Such microbes are also called "atypical". These include: chlamydia, mycoplasma, legionella and others. Mycoplasma pneumonia occurs with the development of many adverse symptoms.

The course of the disease is usually quite long.

Doctors distinguish several specific types of the disease. Croupous pneumonia is accompanied by the appearance of liquid exudate in several parts of the lungs. The course of the disease is quite severe.

This pathology occurs in babies with the development of a pronounced intoxication syndrome. This clinical variant is more common in older children and adolescents.

Community-acquired pneumonia is an inflammation of the lungs that has developed in a child when he is outside the walls of hospitals. This form of the disease is quite common among kids of all ages. It is characterized by the development of severe symptoms and a specific picture on the radiograph.

Aspiration pneumonia occurs mainly in babies of the very first years of life. The reason for the development of this clinical variant is the aspiration of the lungs by some foreign body or the ingress of acidic stomach contents into the respiratory tract.

The disease develops rapidly. An ill baby requires mandatory emergency medical care.

Symptoms

The incubation period for pneumonia can be very different. This is due to the huge variety of reasons that contribute to the development of the disease.

Incubation period bacterial forms is usually 7-10 days.

The appearance of adverse symptoms for viral infections usually occurs within a couple of days.

The incubation period of some forms of fungal pneumonia can take 2-3 weeks.

Pneumonia in a baby is manifested by the development of a complex of respiratory disorders. The severity of these symptoms is a significant difference between this disease and bronchitis.

A more severe course of the disease is accompanied by the appearance of pronounced clinical signs of the disease, which significantly impair the child's well-being.

The most characteristic symptom of pneumonia is a pronounced intoxication syndrome. This pathological condition occurs in more than 75% of all cases. Intoxication is characterized by an increase in body temperature.

With pneumonia, febrile condition is quite often recorded. In this case, the body temperature of the sick baby rises to 38-39 degrees. Against the background of high febrile condition, the child feels fever or severe chills.

Some clinical forms of pneumonia occur without raising the temperature to high values.

In this case, the child appears only subfebrile condition. Usually this option is typical for fungal pneumonia.

A protracted course of the disease can also be accompanied by a rise in body temperature only up to 37-37.5 degrees.

A sick baby feels increased weakness and fatigue. Even the usual activities lead to the fact that the child quickly gets tired. The baby's appetite decreases.

Babies in the acute period, as a rule, are poorly applied to the mother's breast. Expressed intoxication syndrome may be accompanied by increased thirst. This symptom is well manifested in babies at 2-4 years old.

Viral pneumonia caused by adenoviruses occurs with impaired nasal breathing. Viruses that have settled on the mucous membranes of the nose contribute to the development of a severe runny nose. Allocations are mucous, plentiful. In some cases, the child also develops concomitant symptoms of conjunctivitis.

A sick baby usually has a cough. In most cases, it is productive with sputum discharge.

Protracted forms of pneumonia are often accompanied by a dry cough. Sputum in this situation, the child practically does not appear. The course of prolonged pneumonia can be quite long.

The color and consistency of sputum can be different:

Staphylococcal and streptococcal flora lead to the fact that the discharge from the lungs has a yellow or greenish color.
Mycobacterium tuberculosis contribute to the release of gray and foamy sputum, which in the active stage of the disease has bloody streaks.
Viral pneumonia usually accompanied by expectoration of white or milky sputum.

With a mild course of the disease, the amount of sputum per day may be insignificant. In this case, the amount of discharge does not exceed a tablespoon. With a more severe course of the disease, sputum leaves in a sufficiently large amount. In some situations, its amount may be ½ cup or more.

Soreness or congestion in the chest is also found in various types of pneumonia. Usually, the pain syndrome intensifies after coughing or when changing body position. The severity of pain is significantly reduced on the background of the treatment.

The presence of inflammatory fluid inside the lungs causes the child to develop characteristic wheezing.

They can occur both on inhalation and on exhalation.

In severe cases of the disease, parents hear how the child wheezes from the outside. The appearance of shortness of breath is a very unfavorable symptom, indicating that the crumbs show the first signs of respiratory failure.

If inflammation from the lung tissue passes to the pleura, then the baby develops pleurisy. This pathological condition often accompanies pneumonia.

Pleurisy can be suspected by increased pain in the chest. Usually this symptom can already be detected in a child at the age of 3 years.

A pronounced intoxication syndrome significantly disrupts the general well-being of the crumbs. The kid becomes more capricious, whiny.

A sick child tries to spend more time at home. The kid tries to avoid active games with peers. In a sick child, drowsiness increases significantly, especially in the daytime.

Intoxication leads to increased work of the cardiovascular system. This is manifested in the child by an increase in heart rate and pulse. Tachycardia is a fairly common symptom of a severe course of the disease. Toddlers suffering from cardiovascular pathologies may also experience jumps in blood pressure.

In some cases, the appearance of a child with pneumonia also changes. The baby's face becomes pale, and the cheeks become red. The severe course of the disease, accompanied by the development of respiratory failure, is accompanied by a blue area of the nasolabial triangle. Visible mucous membranes and lips become dry, with areas of increased peeling.

Some, especially atypically occurring forms of pneumonia, are accompanied by the appearance of symptoms that are not associated with respiratory manifestations. Such clinical signs include: the appearance of soreness in the abdomen, pain in the muscles and joints, impaired stool, and others.

The severity of these symptoms largely depends on the underlying cause that caused the disease.

For information on the types and symptoms of pneumonia, see the following video.

The first signs in a one-year-old child

According to statistics, the peak of the disease in babies up to a year falls on the age of 3.5 to 10 months. This is largely due to the characteristics of the child's body.

The bronchi of newborns and infants are much shorter than those of older children. All anatomical elements of the respiratory tree are very well supplied with blood.

This leads to the fact that any infection that has got there undergoes rapid development.

Recognizing pneumonia in infants is a rather difficult task. Parents will not be able to cope with this at home on their own. If any adverse symptoms associated with respiratory disorders appear, they should definitely seek the advice of their doctor. Often the diagnosis of pneumonia in young children is carried out quite late.

Pneumonia in a one-year-old child usually manifests itself non-specifically. Many fathers and mothers mistakenly "write off" the symptoms of the disease to the fact that the child "just erupts teeth."

Such a false diagnosis leads to the fact that the disease is detected in babies extremely late. Untimely prescribed treatment only aggravates the course of the disease and contributes to the development of complications.

Consequences

Pneumonia is dangerous by the development of various complications. Children with concomitant chronic diseases of internal organs and children suffering from immunodeficiency pathologies are in the highest risk group for the occurrence of adverse consequences of the disease.

A fairly common complication of the disease is the development of pleurisy. This is a condition in which the pleura is involved in the inflammatory process. The danger of this pathology is that it can lead to the transition of an acute process into a chronic one.

The combination of pleurisy and pneumonia usually has a more severe course and is accompanied by the appearance of a large number of adverse symptoms of respiratory disorders.

Lung abscess is one of the most dangerous complications of pneumonia. It occurs in children with a severe course of the disease. This pathology is accompanied by the appearance of an abscess, which is located in the lung tissue.

Lung abscess is treated only in stationary conditions. To eliminate such an abscess, a surgical operation is required to remove it.

The development of broncho-obstructive syndrome often accompanies bronchopneumonia. In this case, the child, as a rule, has the classic manifestations of respiratory failure.

The sick baby feels very bad: his shortness of breath increases and general weakness sharply increases. Respiratory failure is accompanied by the appearance of a cough that worries the baby both day and night.

Pulmonary edema, as a complication of pneumonia, is rare in children.

This emergency condition can occur in a sick child against the background of complete well-being. Symptoms of pulmonary edema appear in the baby suddenly. Treatment of this pathological condition is carried out only in the conditions of the intensive care unit and intensive care.

Bacterial infections can cause toxic shock in sick babies. This emergency is characterized by a sharp drop in blood pressure.

Babies who show signs of toxic shock may lose consciousness. Some children experience convulsions and severe dizziness. Treatment of infectious-toxic shock is carried out immediately only in a hospital.

Bacterial complications from the organs of the cardiovascular system and other vital organs are also quite common in babies who have had severe pneumonia.

Inflammation of the heart muscle is accompanied by the development of myocarditis or endocarditis. These conditions are manifested by the development of arrhythmias - violations of the heart rhythm. Quite often, these pathologies have a chronic course and significantly impair the health of babies.

The spread of microorganisms that caused pneumonia in babies throughout the body leads to the development of sepsis. This extremely unfavorable condition is characterized by a pronounced intoxication syndrome.

The baby's body temperature jumps to 39.5-40 degrees. The consciousness of the crumbs becomes confused, and in some cases the child may even fall into a coma. Treatment of bacterial sepsis is carried out in the intensive care unit of the hospital.

Diagnostics

Pneumonia can be recognized at the earliest stages. To do this, it is necessary that the attending physician has sufficient experience in identifying such diseases in babies.

The correct algorithm of medical clinical examination is very important in the diagnosis of pneumonia. During such a study, the doctor reveals the presence of pathological wheezing in the chest, and also determines the hidden signs of respiratory failure.

Pneumonia should be suspected by parents if they have found several symptoms of impaired breathing in their sick child.

A long-term ARVI in a baby should also alert, parents should think about conducting a complex of advanced diagnostics.

To clarify the diagnosis, a variety of laboratory tests are carried out. They help to identify various signs of infection in the child's body and establish the severity of functional respiratory disorders.

A complete blood count is a basic study that is performed for all babies with suspected pneumonia. An increase in the level of leukocytes and an accelerated ESR quite often indicate the presence of an inflammatory process in the child's body.

Bacterial infections lead to the fact that in the general blood test, normal indicators in the leukocyte formula change.

A change in the number of stab neutrophils occurs when a child's body is infected with various types of bacteria. Most clinical variants of pneumonia are characterized by an increase in the total number of lymphocytes. These immune cells normally prevent the body from various infections.

For a more accurate diagnosis of sick babies, various bacteriological studies are carried out. Biological material for such analyzes can be a variety of compartments from the nasal cavity, pharynx, oropharynx.

After 5-7 days, doctors get an accurate result that allows you to determine the causative agents of a particular disease. For the accuracy of the study, it is necessary to conduct a technically correct sampling of biomaterial.

To identify "atypical" pathogens, ELISA and PCR methods are used. These studies make it possible to identify microbes intracellularly. These tests are well and successfully used to diagnose chlamydial and mycoplasmal infections.

The "golden" diagnostic standard for determining pneumonia is radiography.

On the x-ray, doctors can see various pathological areas of the lung tissue, in which there are signs of severe inflammation. These areas look different than healthy lung tissue. A chest x-ray can also detect some complications, such as pleurisy and abscess.

In some complex diagnostic cases, more accurate diagnostic methods are required. These studies include computed tomography and magnetic resonance imaging.

These surveys allow you to identify the affected areas of the lung tissue quite effectively.

The resolution of modern devices used for tomography makes it possible to detect pneumonia already at the stage of growth of a pathological focus of several centimeters.

To make a correct diagnosis, a whole complex of diagnostics is required. Pneumonia, unfortunately, cannot be detected by just one blood test. The importance of diagnosing pneumonia is of great importance.

A timely diagnostic complex of diagnostic measures allows doctors to prescribe the necessary drug therapy regimen.

Treatment

Pneumonia is treated in children under three years of age in a hospital setting. Also, hospitalization is carried out in severe cases of the disease.

Toddlers who cannot be properly cared for at home are also hospitalized in a children's hospital for the necessary complex of treatment.

The treatment regimen for pneumonia includes not only the appointment of drugs. An important role in the treatment of pneumonia is the observance of the daily routine. The entire acute period of the disease the child should be in bed. Such forced bed rest is necessary to prevent multiple complications of the disease. Doctors recommend that the baby stay in bed throughout the entire period of high fever.

For a quick recovery, a sick child is prescribed special medical nutrition. Such a diet includes the use of products that have undergone gentle processing.

Dishes are best steamed or boiled. It is also allowed to bake in the oven or use a slow cooker. Frying in oil with the formation of a dense crispy crust is completely prohibited.

The basis of the nutrition of a sick child are various protein products and cereals. For younger babies, these products should be finely chopped. The use of sparing food is necessary. This allows you to optimize digestion. Pre-ground food is better absorbed, which is required during an acute illness.

To recover from pneumonia, the child must receive the necessary amount of vitamins and minerals. These chemical components are necessary for the child's body to actively fight the disease.

Various fruits and berries can be used as sources of vitamins and microelements in the summer. In winter, the appointment of multivitamin complexes is already necessary.

Drinking regime also plays an important role in the treatment of pneumonia. The incoming fluid washes away toxic decay products of substances from the child's body, which are formed in large quantities during the inflammatory process in the lungs.

Expressed thirst only provokes the use of a large amount of liquid.

To replenish water in the body of a sick child, at least 1-1.5 liters of fluid is required.

Various fruit drinks and compotes are well suited as drinks. They can be easily prepared at home as well. Cranberries or lingonberries, dried fruits and various fruits are excellent for making drinks. Ready juice can be further sweetened. Honey can be a substitute for regular sugar.

To improve breathing, it is necessary to observe certain indicators of the microclimate in the room. Normal humidity in the children's room should vary from 55 to 60%.

Too dry air only contributes to difficulty breathing and the development of dryness of the mucous membranes of the respiratory tract. To maintain optimal humidity in the children's room, special devices are used - room humidifiers.

Compliance with quarantine is a necessary measure that is necessary for all babies with signs of pneumonia. This will help prevent the development of mass outbreaks of the disease in organized children's groups.

Quarantine should be observed not only for kids, but also for schoolchildren. The baby should be at home until complete recovery. After the treatment, the doctor monitors the effectiveness of therapy and issues a certificate to the child about the possibility of visiting an educational institution when the baby has recovered.

Medical therapy

The appointment of medicines is a necessary condition for the recovery of the baby. With pneumonia, a whole range of different drugs is used.

The treatment regimen is built individually for each baby. At the same time, the attending physician must take into account the presence of concomitant diseases in a particular child, which may become contraindications to the use of some medicines.

Given that bacterial pneumonia is the most common, the appointment of antibacterial drugs is a necessary condition for the preparation of a treatment regimen.

Doctors prefer antibiotics that have a wide spectrum of action.

They allow you to quickly achieve a successful result. Modern drugs are well tolerated and cause fewer adverse side effects in babies.

During antibiotic therapy, it is mandatory to monitor the effectiveness of the prescribed treatment. It is usually carried out 2-3 days after the start of the use of drugs.

With a positive result, the child's general well-being improves, body temperature begins to decrease, and indicators in the general blood test normalize. At this stage, there are no significant changes on the radiograph.

If the result after the appointment of antibacterial drugs is not achieved, the basic therapy is subject to correction. In such a situation, one drug is replaced by an alternative.

In some cases, combined therapy is used, when several antibiotics are prescribed at the same time. The selection of antibacterial drugs is an individual situation, which is carried out only by the attending physician.

Parents should remember that they should not prescribe antibiotics for pneumonia to their child under any circumstances!

The choice of basic therapy is largely determined by the initial state of the baby, as well as his age.

In the treatment of pneumonia in children, several groups of drugs are currently used, which include:

clavulanic acid-protected penicillins;
cephalosporins of the latest generations;
macrolides.

These drugs are first line therapy. The remaining drugs are used only in exceptional cases, when there is no effect from the primary basic therapy.

Babies in the first months of life are usually prescribed semi-synthetic penicillins to eliminate adverse symptoms.

"Amicillin" or "Amoxiclav" in combination with cephalosporins are used in babies with developed pneumonia in the very first days after birth.

If the pathology was caused by Pseudomonas aeruginosa, then in this case Ceftazidime, Cefaperazone, Tienam, Ceftriaxone and others are used.

Macrolides are used to treat inflammation of the lungs caused by atypical microorganisms.

These agents have a detrimental effect on microbes that are located intracellularly. Such drugs will be effective for the treatment of pneumonia caused by mycoplasmas or chlamydia.

Inflammation of the lungs is a pathological process in the tissue of these organs, caused by the activity of the infection. The ability to cure the disease without consequences is increasing due to modern diagnostic methods, a wide selection of antibiotics. In order to timely identify the disease, it is necessary to familiarize yourself with the typical symptoms of pneumonia, and if they are detected, begin treatment.

Pneumonia is a dangerous pathology, for a complete cure from which it is necessary to apply a set of measures after the first symptoms appear. If the lung tissue suffers from the action, the work of the entire respiratory system is disrupted. The main symptom of a typical form of the disease is the implementation of the respiratory function is not in full. Cells receive an insufficient amount of oxygen, which negatively affects the general condition of the patient. Visually, you can notice the appearance of severe weakness, fatigue. The child is practically not interested in things that were of value to him before. Sleepiness appears.

Infectious pathogens

The following infectious agents can affect the occurrence of pneumonia:

bacteria. Inflammation of the lung tissue causes staphylococcus aureus, pneumococcus, Haemophilus influenzae or Escherichia coli.
Viruses.
Fungal.
Chlamydia, mycoplasmas.
Helminths. If a child fell ill with pneumonia at the age of 2 years, it is possible that the larvae influenced the onset of the pathological process. If roundworms are present in the body, the larvae can spread through the pulmonary circulation, reaching the lung tissue.

Impaired immune response

Immunity to the child improves slowly, bacterial infections have a special negative effect. If a child at the age of 2 begins to attend any circles, goes to kindergarten, the likelihood of a dangerous disease increases, including pneumonia. If your child suffers from frequent runny noses that turn into sinusitis, has a sore throat several times a year, it is possible that his body will not be able to cope even with a simple infection.

Deterioration of local immunity

The condition of the nasal mucosa affects the ability to purify the air from pathogenic bacteria. When air enters the nasal cavity, it is cleared of negative impurities, in particular, dangerous microorganisms. If for any reason the standard structure of the mucosa is broken, a runny nose occurs, from which a person cannot breathe through the nose, bacteria, viruses quickly penetrate below. An inflammatory process may occur in the tissues of the respiratory organs. Pharyngitis, bronchitis develops, the occurrence of pneumonia is not excluded.

On a note! It is necessary to pay attention to protracted pharyngitis in a timely manner, to conduct competent treatment in order to eliminate the likelihood of dangerous complications.

Physiological causes

In most cases, children as young as 2 years of age have anatomical features that may contribute to the onset of pneumonia.

Risk factors:

Insufficient airway patency, which affects the rapid increase in the number of infections, the emergence of difficulties in stopping the symptoms of the disease.
Slow ventilation of the lungs, which is caused by insufficient development of the bone tissue of the ribs.
An incompletely developed respiratory system, which increases the risk of atelectasis, which provokes the preparation of an optimal environment for the reproduction of dangerous microorganisms.
The constant presence of the child in a prone position, this is what there is a risk of formation of stagnant processes.

Signs of illness

Main symptoms:

Violation	Peculiarities
General restlessness, sleep disorders	Parents immediately notice a child’s poor appetite, unreasonable whims may appear even in calm children.
Increasing nasal congestion	Difficulty in breathing
Cough	At the first stage of the disease, this symptom may be absent.
Increase in body temperature	This phenomenon is not always observed. It is necessary to be attentive to the condition of the child in order to timely identify the disease, even if it is not accompanied by fever
Apnea	Often with pneumonia in children who have reached the age of two, there are respiratory arrests that last for several minutes. This deviation can affect the behavior of the baby, cause psychological disorders.
Change in skin tone in the nasolabial triangle	During this process, blanching of the wings of the nose and corners of the mouth is possible, sometimes these areas become cyanotic
Stool pathologies	Constipation is possible as a result of dehydration, as well as diarrhea if the infection has spread not only to the tissue of the lungs, but also to the organs of the gastrointestinal tract

Typical symptoms of pneumonia

When a child reaches the age of 2 years, there is a significant improvement in the protective functions of the body. At the same time, the likelihood of developing a bacterial infection, which leads to serious health problems, remains. Often, children suffer from pleurisy, accompanied by the release of exudate. In some cases, pneumonia does not go away as the only disease, but proceeds along with pharyngitis, severe tonsillitis. If a serious allergic reaction develops due to taking a large amount of antibiotics, a narrowing of the lumen in the bronchi is possible.

The first symptoms of pneumonia:

Deterioration of the general condition of the body.
Signs of severe intoxication without other symptoms of poisoning.
In the case of an increase in temperature, this indicator does not decrease. It is necessary to worry if such a deviation lasts for 3 days.
When breathing, the intercostal muscles are involved, which is why they are often drawn inward over the affected area.
Cyanosis that occurs in the region of the nasolabial triangle. This deviation can manifest itself in a calm state of the baby, but most often it intensifies during crying, emotional overstrain.

On a note! Usually inflammation of the lungs at the age of two develops due to the action of bacteria. The body at this age is less susceptible to viruses, but the immune system has not yet adapted enough to fight bacteria. When listening, hard breathing is diagnosed, the doctor notes moist rales.

With the aggravation of the disease, severe shortness of breath occurs. This deviation develops quite quickly, since the organs and cells receive an insufficient amount of oxygen. Signs of pneumonia are often associated with a respiratory viral infection. Parents first of all pay attention to the increasing runny nose, cough, fever. At this age, inflammation of one lung or its lobe most often appears.

Inflammation of the lungs can occur both unexpectedly and after a severe viral infection. Attention should be paid to a severe cough that cannot be stopped with standard medicines. If you find this symptom, you should contact a specialist as soon as possible. In some cases, with the development of pneumonia, the cough increases at night. The general condition of the child worsens, activity slows down. In this case, the baby can reveal severe anxiety, especially with the aggravation of negative symptoms.

It is worth paying attention to poor appetite. With pneumonia, one of the characteristic symptoms is pallor of the skin, an increase in the respiratory rate up to 40 times per minute. It should be taken into account the presence of a large number of cases of pneumonia without a strong increase in temperature, in conditions of an erased clinical picture.

On a note! It is necessary to assess the condition of the child, paying attention to specific indicators, in particular, temperature.

Dangerous forms of pneumonia

The latent form of pneumonia is characterized by blurred symptoms. It is the most dangerous type of the disease. It is necessary to carefully monitor the behavior of the child. With pneumonia, his condition worsens significantly, usually parents notice whims, crying, while coughing and runny nose do not occur.

A latent form of pneumonia can appear when immunity deteriorates. The risk of this disease increases if parents do not monitor the dosage and frequency of medication. These drugs adversely affect human immunity, especially dangerous at an early age. Often, antibiotics have a negative effect in conjunction with antitussive drugs, since as a result of blocking the process that regulates the release of sputum along with mucus, the risk of infection and the spread of infection increases. Children who are immunocompromised from birth have an increased risk of pneumonia.

On a note! Atypical pneumonia is caused by chlamydia, mycoplasmas. There may be strong structural changes in the lung tissue, while the general signs do not reflect the symptomatic picture.

The main signs of an atypical form of pneumonia:

Severe intoxication that does not go away for no apparent reason.
Headache.
Unpleasant sensations in the muscles.
Hyperhidrosis.
An increase in body temperature (this symptom may be absent).
The amount of food consumed per day is significantly reduced. The child may refuse food completely.
Enlargement of lymph nodes in size.

With atypical pneumonia, the disease can be detected due to the retraction of the skin in the area of the inflamed area during breathing. If inflammation of the lungs arose as a result of the activity of mycoplasma on the skin, the formation of a polymorphic rash is possible. An increase in the size of the spleen and liver is not excluded, which is most often noted only at a doctor's appointment. Often, pneumonia occurs with an erased symptomatic picture, which is why people confuse it with pharyngitis, protracted tonsillitis. It is necessary to identify the disease as early as possible in order to eliminate the risk of complications.

Video - How to suspect pneumonia?

How is the diagnosis made?

Signs that lead to the diagnosis of pneumonia:

Incessant shortness of breath, in some cases there is difficulty in breathing. In young children, shortness of breath is especially pronounced, and this phenomenon also increases in proportion to the area of \u200b\u200bthe site of inflammation.
Characteristic wheezing, retraction of the affected area inward during breathing.
Decreased duration of percussion sound in about half of patients. Even if this symptom is absent in the first stages of the disease, the absence of inflammation cannot be asserted.
Wheezing on breathing. If the disease proceeds in an acute form, this phenomenon may not be detected. If wheezing is heard evenly, this often indicates not pneumonia, but bronchitis.
Weakening of breathing. If there are no characteristic wheezing during pneumonia, this symptom is often diagnosed. To clarify the diagnosis, it is necessary to conduct an examination additionally.

Important, but not characteristic signs of pneumonia in children are disorders of the gastrointestinal tract, symptoms of severe intoxication in the body, fever, hyperhidrosis. Please note that if a cough occurs in the event of a deep breath, you should immediately consult a specialist, as this symptom may indicate a serious respiratory disease.

On a note! When taking a blood test for pneumonia, leukocytosis is often diagnosed, which is also an important diagnostic criterion. To determine the causative agent of the disease, conduct a bacteriological study. Also, during a diagnostic examination, sensitivity to antibiotics is detected, which allows you to choose the best medicines.

Video - How to diagnose pneumonia?

How to prevent pneumonia?

It is necessary to adhere to the basic rules to reduce the likelihood of developing the disease:

Pay close attention to the recommendations, advice of the attending physician when a viral, bacterial infection is detected.
Inflammation of the lungs may appear as a complication of SARS. To prevent the onset of the disease, it is necessary to treat the common cold, pharyngitis and other common diseases in a timely manner.
When recovering from SARS, the child should not be immediately sent to kindergarten, other places where there is an increased risk of contracting a bacterial or viral infection. It is advisable to wait about 2 weeks. During this time, the immune system will return to normal, which will reduce the likelihood of complications. Antibiotics can be used only with the appropriate appointment of a specialist.
If you find out about the spread of any epidemic, it is advisable to spend more time at home, do not go to places with a lot of people. During the epidemic, it is advisable to refuse to visit the kindergarten, if possible, leave the child at home.
Maintaining hygiene will help reduce the risk of infection in the body. It is necessary to accustom the child to basic hygiene standards from infancy.

On a note! If pneumonia is diagnosed, a specialized course of therapy is necessary. In some cases, the transfer of the child to the hospital is required. It is forbidden to choose a treatment regimen on your own. It is possible to treat a child at home only after visiting a doctor and receiving the appropriate permission.

Pneumonia can proceed both according to the classical scheme and atypically. In both cases, it is necessary to quickly identify the disease, as well as conduct competent treatment. Knowing the main signs of pathology, it is possible to diagnose pneumonia in a timely manner in order to prevent the development of complications.

Inflammation of the lungs in a child- this is a serious infectious disease, and for children the pathology is more characteristic, due to the peculiarities of the construction of the respiratory system and the underdevelopment of immune processes. Inflammation of the lungs in a child is usually of an acute infectious nature, with water-electrolyte and metabolic disorders, changes in all organ systems of a pathological nature. But, on the other hand, the concept of pneumonia in a child should be understood as a whole group of infectious and inflammatory lung diseases, with the obligatory presence of intra-alveolar exudative fluid. It is this exudate that prevents physiological gas exchange in the lung structures. The amount of oxygen is sharply reduced, adding disturbances in the work of the bloodstream. This condition poses an extreme danger to health, but not only, but also to life in general, increasing the possibility of a fatal outcome, so you should immediately seek medical help for the speedy appointment of treatment.

This disease occupies almost 80% of the pathology of the respiratory system, annually claiming the lives of 1.4 million lives of children under 5 years of age. Among those hospitalized under 1 year old, 25-30% of cases fall, pneumonia in a child 2 to 5 years old - more than 50%. In children of schoolchildren and adolescents, the incidence is significantly reduced and amounts to 8-12%.

Inflammation of the lungs in a 4-year-old child can differ significantly from those in an infant, this manifests itself both in a specific symptom complex and in x-rays. The highest mortality rates are just recorded before the age of four. Do not forget that children of any age group can get sick, even just born. And since this is an extremely dangerous disease for its course and complications, especially for the child's body and extremely dangerous for babies, it is important to suspect, recognize and start treating in time, differentiating other respiratory diseases. Procrastination leads to very severe, difficult-to-correct conditions in the future. An X-ray study will help with this, because it clearly defines obvious blackouts inherent in pneumonia.

Inflammation of the lungs in a child is classified into the following forms:

Focal - more often diagnosed in the age range of 1-3 years. Pathology is secondary and, mainly, as a result of having been ill with bronchitis. Symptom complex: hyperthermia, dry and deep cough. It is treated for 2-3 weeks with the use of antibiotic drugs.

Segmental - partially affects the lung, while the baby does not take food well, refusing it, does not want to play, does not sleep well, a temperature of 37-38 ° C occurs. Cough may practically not manifest itself, which is why this type is often difficult to detect from the first days.

Lobar - capturing only one or more lobes of the lung.

Drain - when the process from several lobes-segments merges into one large lesion.

Total - the defeat of the entire lung tissue.

Lobar - the lesion can equally be left-sided or right-sided. The baby has hyperthermia up to 39-40°C. Pain in the area of the projection of the lung and abdominal zone, a wet cough with rusty sputum, red rashes on the trunk and one-sided reddening of the face appear.

Staphylococcal - more typical for newborns and infants. The main symptom complex includes: shortness of breath, low-grade fever, vomiting, coughing shocks, wheezing audible by the ear. With timely and adequately prescribed treatment, the disease recedes in about 2 months, followed by a rehabilitation course of 10 days.

If the lesion is localized in only one lung, then such pneumonia in a child is called unilateral, both are bilateral. They also distinguish the primary state - the development of the disease independently, the secondary - as a result of an infectious disease already transferred earlier.

According to the causes of infection, the following forms are distinguished:

Hospital - the child falls ill after three days spent in the hospital walls or three days after discharge.

Community-acquired - an infection that has nothing to do with medical institutions. The most common type. It is subdivided with or without impaired immunity.

From medical interventions - pathogens are introduced into the human body during procedures, operations, often provoke frequent hospitalizations, hemodialysis, parenteral administration of drugs.

Aspiration - manifests itself when foreign particles, pieces of food or liquid, infectious sputum from the nasopharynx enter the respiratory tract.

Ventilation - early (up to 72 hours) and late (after 96 hours), when a person is on a ventilator.

Intrauterine - a congenital form, identified in the first 3 days from the birth of a child.

Cytostatic - when taking cytostatic drugs.

Atypical form - with etiopathogenetic rare types of pathogens (mycoplasma, chlamydia).

The frequency of inflammation of the lungs in children is explained by the following factors: lung tissue is not yet fully mature; the airways are narrow; mucous membranes are saturated with blood vessels, because of which they tend to swell instantly, which leads to a deterioration in ventilation functions; the ciliated epithelium is unable to adequately eliminate sputum and the infection easily penetrates, settles and multiplies; due to the underdevelopment of the additional sinuses, the lower nasal passage, the immaturity of local factors - the air does not warm up enough when inhaling and is not cleaned to the right degree; immaturity of the alveoli and surfactant; rich vascularization in the roots of the lungs; the length and width of individual bronchi differs from adults, which creates uneven drainage conditions. It differs from the adult form in the lightning speed of the flow, in young children it is rarely contagious, more often secondary - as a complication of tonsillitis, bronchitis, laryngitis.

Inflammation of the lungs in a 2-year-old child is risky for life because breathing is shallow, the lungs are less ventilated and this is a wonderful soil for the development of etiopathogenic agents.

Inflammation of the lungs in a child: causes

The causes of pneumonia in a child and in an adult are the same - the direct presence of the pathogen itself and reduced immunity.

Inflammation can be caused by:

— Bacteria. The most common etiopathogenetic agent is pneumococcus, as it is the most tropic to lung tissue. Staphylococcus, streptococcus, chlamydia, mycoplasma, legionella, escherichia can also act as provocateurs.

— Viruses. Occupy 50% of the etiological cohort. This is the Afanasiev-Pfeiffer wand, adenovirus, chickenpox virus, RS virus,.

- Fungi. Quite rarely, fungal contamination occurs (for example, candidal or). Basically, this subtype of lesion is characteristic of strong changes in immunity and a very severe course of the disease is observed.

There are a number of etiopathogenetic factors of pneumonia in a child:

- intrauterine hypoxia or lack of oxygen during childbirth;

- complicating factors in childbirth (trauma, asphyxia);

- prematurity with morphofunctional immaturity;

- infection that occurred from mother to child (chlamydia, herpes);

- unfavorable living conditions, unbalanced diet and digestive disorders;

- exudative diathesis;

- chronic inflammatory foci of the nasopharynx (tonsillitis, adenoiditis, pharyngitis, laryngitis);

- frequent recurrent bronchitis;

- lack of vitamin substrates and microelements;

- inhalation of toxic chemical fumes (household chemicals, nearby ongoing construction work);

- allergic processes, especially with accompanying cough;

- cooling and overheating, overwork. With significant hypothermia, the supporting-protective forces weaken and microbes easily penetrate into the lungs, this includes the cold season as a predisposing risk factor;

- smoking, alcoholism, drug addiction in adolescents;

- prolonged stay on bed rest in a horizontal position (after fractures, burns, surgical operations);

Auscultation reveals quiet hard breathing with fine bubbling crepitant rales, better heard when crying, when breathing is deeper.

“Preschool children have a more stable immunity, and they can present specific complaints, so pneumonia in a child has clear symptoms. Complaints of dizziness, muscle pain, the number of breaths exceeds 30 / min, low-grade fever, and with hyperthermia, seizures may occur, skin pallor is very pronounced and, in addition, a rash may appear, green-yellow sputum.

- In schoolchildren older than 6 years, the picture does not differ from that in adults. Only the incidence rate increases significantly during the autumn-winter period, due to the closely communicating team and the rapid spread of infection in it.

The symptom complex varies depending on the type of pathogen:

— Bacterial pneumonia in a child. With pneumococcal contamination, the debut is sudden, the state of health sharply becomes bad, the baby is constantly in a fever, breathing is frequent, the face is hyperemic, the child is lethargic, cough with "rusty" discharge, pain in the abdomen and when inhaling. Pfeiffer's stick causes a slow-flowing form, with prolonged hyperthermia, green sputum discharge and wheezing. Klebsiella causes a lightning-fast form with chills and an indicator of up to 40 ° C, a cough with a viscous mucous substrate. Staphylococcus aureus does not provoke a temperature increase, but there is a bluish-gray complexion, the pulse is filiform, the abdomen is swollen, often fatal. causes a nosocomial tropic infection to the lungs, acute development with morning feverish peaks, skin with blue, tachypnea with.

- Viral pneumonia in a child. This option was previously called atypical, because it was not possible to find the root cause and the disease did not respond to antibiotic therapy, the symptoms are disguised as colds. Differences appear when the temperature does not go astray with medication and does not subside on its own.

- Atypical pneumonia in children. With mycoplasma infection, rhinitis, sore throat, dry cough are the first to appear. Later, “muscle breakdown”, nosebleeds, inflammation of the lymph nodes. The first signs of chlamydia are rhinitis, a jump to 38-39 ° C, swollen lymph nodes, allergies and conjunctivitis in newborns. The legionella type is characterized by fever up to 40 ° C, with severe migraine headaches, diarrhea and vomiting.

- Aspiration pneumonia in a child. Pieces of food, liquid, foreign particles can get into the bronchi, and then an infection begins to develop, pathogenic microbes multiply. If the cause is bacteria, then the temperature gradually rises, a wet cough; in case of chemical damage - dyspnea, sputum frothy and pink; if the foreign body is a reflex painful cough shock, after a while they subside, but leaving behind an inflammatory process.

- Focal inflammation of the lungs in children. The most common form of childhood. The causative agents are bacteria, viruses, fungi, toxins of a chemical nature, an allergic reaction. One or multiple foci appear in the lungs of a child, which can turn into a focal-confluent form (segmental or entire lobe lesion). Symptoms at first are indistinguishable from colds: the child coughs, he is bothered by a runny nose, the condition worsens sharply after a week, and the symptoms become more pronounced: agitation or apathy, confusion, pallor of the skin, noisy breathing, tachycardia, fever 38-38.7 ° C, cough dry or with mucopurulent sputum, a focus of crepitant rales is objectively auscultated.

- Segmental pneumonia in a child. Within two days from the moment of penetration of the etiopathogenic agent, the following symptoms appear: temperature reaction, cough, malaise, loss of orientation in space, rapid and labored breathing, sweating.

— Croupous pneumonia in a child. Preschool children and schoolchildren get sick more often. It proceeds in several forms with their inherent symptoms: abdominal (pain as with appendicitis), meningeal (migraine, drowsiness, convulsions), abortive (it can be characterized as follows: it began acutely and violently and ended within 1-3 days) pain sensations. Also present: pleural reaction, cough with a rusty admixture, hemoptysis, forced position in bed, feverish blush on the face with cyanosis, herpetic rash on the lips, shortening of the percussion tone, bronchial breathing, fine bubbling crepitant rales, skin icterus.

- Interstitial pneumonia in a child. It begins acutely, painful cough, vomiting, tachypnea, inhalation-exhalation arrhythmia.

- Radical inflammation of the lungs in a child. Inspection, auscultation and X-ray give a completely different picture of the localization of the lesion, which makes diagnosis difficult. A disease of a protracted nature, with a pronounced symptom complex or without it at all.

Inflammation of the lungs in a child without fever

Inflammation of the lungs without fever tends to manifest itself in immunocompromised children. This option is also called quiet or secretive. It is especially dangerous for children, since the child is not able to adequately explain his complaints or is not yet able to speak at all. Inflammation of the lungs in a child of this type cannot be transmitted to others, that is, it is not contagious, but has the nature of the course of an infection.

The reasons for the decrease in the body's musculoskeletal forces are very diverse: in the presence of a source of infection - untreated teeth, tonsillitis, laryngitis, bronchitis; hypothermia of the body; may be the result of unformed or weak immunity; young age; uncontrolled intake of an antibiotic group of medicines (self-medication, antibiotics in inadequately high doses exceeding the weight and age norm, with prolonged use the body gets used to it, which will lead to a decrease in the desired therapeutic effect), against the background of prolonged use of antitussives (the mechanism of sputum elimination is suppressed, which leads to accumulation of etiopathogenic flora) drugs.

The symptom complex of pneumonia in children without fever includes:

- the duration of the cough exceeds two weeks, may be with scanty or abundant sputum;

- exhausting weakness, constant thirst against the background of a decrease in appetite, drowsiness, tearfulness, blue nasolabial triangle;

- whistling during breathing, which is heard if you focus on this, with retrosternal pain;

- asymmetry of fluctuations in the act of breathing of the chest;

- an unhealthy blush of the face on the side of the affected lung, spots of a red tint;

- strong sweating;

- when turning the body, palpable soreness in the chest;

- severe shortness of breath and increased heart rate;

— deep breath painful.

Inflammation of the lungs in a child: diagnosis

Diagnosis of pneumonia in a child includes the following steps:

- Making a diagnosis requires a lot of work, experience and accumulated knowledge, since changes are not recognized with auscultatory, percussion methods. General well-being is assessed, examination of the chest, analyzing asymmetry during breathing. You can listen to dry or wet rales, sometimes there is a dullness of sound over the lesion.

- General blood and urine tests, biochemical studies and sputum examination are prescribed.

- The most important point is x-ray examination in two projections. They try to find a zone of darkening of the lung tissue.

- Not always an x-ray is informative, then they resort to computed tomography. Indications for CT: in the presence of symptoms of inflammation on the radiograph, the area of inflammation is indeterminate; with relapses more than three times; if the results of the x-ray are not comparable with the symptom complex of the disease.

- Carrying out bronchoscopy - a study of an inserted flexible tube with a camera, through the nose and into the lumen of the bronchi, is applicable with concomitant complications to clarify the diagnosis.

With no temperature course, self-treatment is by no means unacceptable. For treatment, antibiotics are applicable that capture a wide range, more often even a combination of two - Cephalosporin and Macrolide, with a course of not a week. Pathogenetic therapy consists in taking expectorants with mucolytics; with shortness of breath - bronchodilators; inhalation therapy with a nebulizer. Symptomatic use of multivitamins, immunomodulators, physiotherapy, drainage massage.

At the end of treatment, the x-ray examination is repeated. Consultation with a phthisiatrician is necessary, since the possibility of decomposition of the lung parenchyma cannot be ruled out.

The outcome is mostly unfavorable, because due to untimely treatment, precious hours are lost and severe damaging processes develop in the body. Fatal cases account for half of all outcomes of the disease.

Inflammation of the lungs in a child: treatment

The sooner you diagnose and prescribe therapy, the more successful the chances of recovery without complications. Treatment of pneumonia in children includes the following steps:

- The first step is to determine whether the patient needs hospitalization. And starting from an outpatient or inpatient stay, the volume of a complex of procedures and medicines is prescribed. Treatment of babies under 3 years of age should be carried out strictly in a hospital, since daily dynamic monitoring is necessary and, if necessary, emergency assistance, this is not feasible on an outpatient basis. Also under the constant supervision of doctors should be children with severe respiratory failure, rickets, immunodeficiency states. Urgent hospitalization at any age in the absence of positive dynamics up to two since the start of treatment.

- Antibiotic therapy consists in the use of 2 - 3rd generations of antibiotics, since there is already resistance to the previous ones. These are Cephalosporins, Fluoroquinolones, Macrolides, Carbopenems, Sulfamethoxazole. Therapy is empirical, begins before the results of the bacteriological examination are obtained. If the condition does not change for 2 days, then the medicine changes. In the process of treatment caused by rhino-, adeno-, parainfluenza and influenza viruses, antibiotics often do not bring the expected effect, which means that antiviral drugs must be added to the course of treatment (Oseltamivir, interferon preparations). With fungal etiopathogenesis, the use of antifungal drugs (Fluconazole, Diflucan) is mandatory.

- General recommendations include: bed rest with a raised head end, frequent cleaning of the room and airing, diet food with easily digestible food, drinking plenty of warm liquids - tea, fruit drink, herbal infusions.

- Pathogenetic treatment: oxygen therapy - for dyspnea and changes in pulse oximetry, gas components, capnography. With severe hypoxia, they are transferred to ventilators under supervision in the intensive care unit. In case of dehydration, oral rehydration with saline solutions or, if necessary, the use of infusions - glucose-salt solutions. Life-saving extracorporeal membrane oxygenation of the bloodstream (oxygen is supplied to the blood through a special apparatus, thus excluding diseased lungs from gas exchange).

Expectorants, mucolytics (Mukaltin), bronchodilators (Ventolin, Eufillin), bronchoscopic sanitation, antipyretics and NSAIDs are applicable.

– Symptomatic therapy: physiotherapy, ultraviolet irradiation, drainage massage, breathing exercises, postural drainage, exercise therapy, nebulizer inhalations, vitamin prophylaxis, immunomodulators, probiotics to restore the intestinal microflora, sorbents to remove toxins (Polysorb, Enterosgel).

Early treatment will prevent complications, consequences in the future, and maintain psychological comfort, especially for young children.

Inflammation of the lungs in a child: complications

In the inflammatory process in the lungs in children, the following complications are often observed:

- In babies under the age of one year, more often observed: exudative pleurisy, allergic obstruction of the bronchi, the addition of inflammatory processes of the middle ear - otitis media, tonsillar lesions, pharyngitis, swelling of the already narrow airways or even the lungs themselves.

Inflammation of the lungs in a child: consequences

As a result of having been ill with such a pathological phenomenon as pneumonia, the child may develop aggravating conditions that require corrective measures in the future:

- broncho-obstructive syndrome, up to progression to frequent obstructions and asthmatic phenomena;

- toxic-infectious shock phenomenon;

- atelectasis of the lung;

- combined pulmonary-cardiac pathology;

- anemia;

- pneumosclerosis - proliferation of connective tissue elements in the lungs, which leads to severe processes of respiratory failure with difficult to correct dynamics.

Medical advances are palpable perhaps most of all in the treatment of pneumonia in children, one of the most common, serious, potentially life-threatening diseases that has moved from first place to the middle and even to the bottom of the list among causes of death. But this does not change the serious attitude to pneumonia, since its good prognosis depends on the timeliness of the diagnosis and the correct treatment tactics.

First of all, what is pneumonia. In Russia, since 1980, pneumonia has been defined as "an acute infectious disease of the lung parenchyma, diagnosed by a syndrome of respiratory disorders and / or physical data in the presence of focal or infiltrative changes on the radiograph." This does not mean that pneumonia cannot be diagnosed without an x-ray. However, these changes are the "gold standard", since they allow differentiating pneumonia - a predominantly bacterial disease - from purely viral lesions of the lower respiratory tract (bronchitis and bronchiolitis), which, in particular, is proved by their successful treatment without antibiotics.

Diagnostics

For pneumonia, the presence of a cough is typical, other signs of an acute respiratory disease (ARI) are not uncommon, as well as, in most cases, a temperature> 38 ° C (with the exception of atypical forms in the first months of life), without treatment it lasts 3 days or longer, then as with bronchitis, the temperature is usually<38°С или она в течение 1-3 дней снижается до этого уровня.

The first task in diagnosis is to identify a child with signs of acute respiratory infections of the lower respiratory tract, they are characterized by the presence of at least one of the following signs that are easily recognizable when examining a child:

Increased or difficulty (obstruction) of breathing, retraction of pliable places of the chest;

Shortening of percussion sound;

The presence of wheezing.

The second task is to distinguish pneumonia from bronchitis, a predominantly viral lesion of the lower respiratory tract. An important symptom of pneumonia is increased breathing, it is observed more often, the more extensive the lung damage and the smaller the child. However, this sign is significant only in the absence of symptoms of obstruction, which is characteristic of croup and bronchitis, incl. obstructive. The following respiratory rate parameters (in 1 min.), According to WHO, are characteristic of pneumonia: ≥60 in children 0-2 months old, ≥50-2-12 months old, ≥40-1-4 years old. Bronchial obstruction with a high probability excludes typical (caused by pneumococci, Haemophilus influenzae, streptococci) community-acquired pneumonia and occurs only in atypical forms and nosocomial infection.

Shortening of the percussion sound is characteristic of pneumonia, but it occurs only in half of the cases, so that its absence does not exclude pneumonia. The same applies to small bubbling or crepitating rales localized above the site of the lesion and weakened and / or bronchial breathing - their identification allows the diagnosis of pneumonia, but their absence does not exclude this diagnosis. In half of all patients with typical pneumonia in the acute period, wheezing is absent. On the other hand, rales evenly auscultated in both lungs, as well as obstruction, are characteristic of bronchitis, but not of pneumonia: dry rales are found only in 10%, and scattered moist rales are found in 25% of patients, most often they are asymmetric (mostly with atypical forms).

Since the diagnosis of pneumonia according to the above physical data can be made in less than half of the cases, an algorithm created on the basis of the signs proposed by WHO should be used (Fig.). It allows you to identify patients in whom an X-ray examination is likely to reveal pneumonic changes; in the absence of x-rays, their antibiotic therapy is fully justified.

The algorithm frees the pediatrician from the need to make a diagnosis with a lack of information. It reduces the overdiagnosis of pneumonia and reduces the number of unreasonable x-rays and antibiotic prescriptions; its sensitivity is 94% and its specificity is 95%.

To what extent do laboratory data help diagnose? Leukocytosis 10-15·10 9 /l is observed in the first days in half of patients with pneumonia, but also in a third of patients with acute respiratory infections, croup, acute bronchitis. So by itself, it does not indicate a bacterial infection and does not require antibiotics. But the number of leukocytes below 10 10 9 /l does not exclude pneumonia, it is typical for pneumonia caused by Haemophilus influenzae and mycoplasma, and is also often observed with coccal pneumonia in the first days of the disease. Leukocytosis numbers above 15 10 9 /l (and/or absolute neutrophil count ≥10 10 9 /l and/or stab ≥ 1.5 10 9 /l) make the diagnosis of pneumonia very likely. The same applies to an increase in ESR above 30 mm / h, lower numbers do not exclude pneumonia, but they are not uncommon in bronchitis.

Of the additional markers of bacterial infection, C-reactive protein (CRP) helps in the diagnosis, the levels of which are > 30 mg/l, as well as the levels of procalcitonin > 2 ng/ml, which make it possible to exclude a viral infection by 90%. But low levels of these markers can be observed in pneumonia, more often atypical, so their negative predictive value in relation to the diagnosis of pneumonia is insufficient.

Classification

The most important classification feature of pneumonia is the place of its occurrence—community-acquired and hospital-acquired pneumonia differ sharply in etiology and, therefore, require different therapeutic approaches. Community-acquired pneumonia occurs in a child under normal conditions of his life, nosocomial pneumonia occurs after 72 hours of hospital stay or within 72 hours after discharge from there. Pneumonia of newborns is classified separately; pneumonia that develops in the first 72 hours of a child's life is classified as intrauterine. There are also pneumonia associated with artificial lung ventilation (ALV) (early - the first 72 hours and late) and pneumonia in people with immunodeficiency states.

It is practically important to distinguish between typical pneumonias caused by coccal or bacterial flora; they look on the radiograph as pulmonary foci or infiltrates of a fairly homogeneous appearance with clear contours; clinically, these are patients with febrile fever, often toxic, often with local mild wheezing and dullness of percussion sound. Atypical pneumonias caused by mycoplasma, chlamydia, and, rarely, pneumocystis appear as inhomogeneous infiltrates without clear boundaries or disseminated foci; they are distinguished by an abundance of small bubbling wet rales, crepitations on both sides, usually asymmetrical with a predominance of pneumonic focus. The absence of toxicosis is characteristic, although the temperature reaction may be pronounced, as in mycoplasmosis, or absent (in children 1-6 months old with chlamydia).

The severity of pneumonia is determined by toxicosis, pulmonary heart failure, the presence of complications (pleurisy, infectious-toxic shock, focal confluent form is fraught with pulmonary destruction). With adequate treatment, most uncomplicated pneumonia resolves in 2-4 weeks, complicated ones - in 1-2 months; a protracted course is diagnosed in the absence of reverse dynamics in terms of 1.5 to 6 months.

Etiology of pneumonia

It is deciphered with great difficulty, since it requires the isolation of the pathogen from normally sterile environments; therefore, the treatment of pneumonia begins empirically based on data on the frequency of a particular etiology at a given age with an appropriate clinical picture (see below). Detection of pneumotropic (pneumococci, Haemophilus influenzae, strepto- and staphylococci) or intestinal flora, as well as viruses, mycoplasmas, chlamydia, fungi, pneumocysts in sputum does not indicate their role as a pathogen, tk. their carriage is the rule rather than the exception. An increase in antibody titers to pneumotropic pathogens is of relative importance, since it is often observed in any acute respiratory disease (polyclonal activation of the immune system). More reliable detection in the blood of antibodies of the IgM class to mycoplasma and Chlamydia trachomatis, to a lesser extent to C. pneumoniae. The following data on the bacterial etiology of pneumonia in children of different ages are based on studies to identify the pathogen or its antigen in punctures of the lung and pleural cavity, antibodies to chlamydia and mycoplasma, pneumococcal immune complexes.

newborns. The etiological spectrum of pneumonia largely depends on the nature of the infection (Table 1). Quite often pneumonia have a septic origin. Respiratory viruses can only cause upper respiratory tract infection or bronchitis, but this is often complicated by bacterial pneumonia or atelectasis and swelling in the lungs, which also meets the criteria for pneumonia.

Children 1-6 months. At this age, two types of pneumonia are often observed. Pneumonia caused by C. trachomatis is characterized by a gradual onset without fever, staccato cough, tachypnea, small bubbling rales, absence of obstruction, leukocytosis (often with miliary tuberculosis). In history - vaginal discharge from the mother and conjunctivitis in the first month of life. Staphylococcal pneumonia rarely occurs outside the hospital - in children of the first months of life and immunodeficient, more often there are nosocomial diseases caused by strains resistant to penicillin, and often to methicillin. With aerogenic infection, confluent foci with a tendency to necrosis appear in the lungs, with sepsis, a focus in the interstitium, followed by the formation of abscesses. Leukocytosis >25·10 9 /l is characteristic. Aspiration pneumonia can manifest itself as acute, with toxicosis, high fever, shortness of breath, or as asymptomatic with a picture of bronchitis. The bacterial process is caused by intestinal flora, often multiresistant (Proteus spp., K.pneumoniae, P.aeruginosa), as well as anaerobes. Its localization is the right, less often the left upper lobe; in the phase of reverse development, it looks like an inhomogeneous shadow, often with a concave lower boundary. The resolution of pneumonia is prolonged. The diagnosis confirms the detection of dysphagia (observation of feeding!), X-ray contrast examination of the esophagus reveals reflux and anomalies of the esophagus.

Community-acquired pneumonia in the first weeks of life usually occurs when infected from an older child in the family and is caused by coccal or bacterial flora. At this age, pneumonia due to immunodeficiency, cystic fibrosis, is common, so all children with pneumonia should be examined in this direction.

IN age 6 months - 5 years the majority of pneumonias are typical, they are caused by pneumococci, 5-10% by Haemophilus influenzae type b; only 10-15% - mycoplasma and C.pneumoniae. Pneumococcal pneumonia can proceed as uncomplicated with moderate toxicosis, but at this age it is often accompanied by the formation of large foci, followed by destruction and the formation of intrapulmonary cavities, often accompanied by pleurisy. Typical croupous pneumonia is characteristic of adolescents. Pneumonia caused by Haemophilus influenzae type b occurs practically only up to 5 years of age, it is accompanied by a homogeneous infiltrate with pleurisy and destruction. Low leukocytosis and ESR, hemorrhagic exudate helps to suspect it. Streptococcal pneumonia caused by group A hemolytic streptococcus develops lymphogenously from a focus in the pharynx - more often in children 2-7 years old. A pronounced interstitial component is characteristic with foci in both lungs (often with cavities), pleurisy. The clinical picture with a violent onset is indistinguishable from that of pneumococcal pneumonia.

Children and teenagers 5-17 years old. At this age, pneumococcus remains practically the only causative agent of typical pneumonias, which account for only 40-60% of all pneumonias, while the remaining pneumonias are atypical, caused by mycoplasma and chlamydia. M. pneumoniae causes up to 45% of all pneumonias in adolescents. Characteristic: cough, mass of small bubbling rales, often asymmetric, reddening of the conjunctiva with scanty catarrhal symptoms, inhomogeneous infiltrate, normal white blood cell count and slightly elevated ESR; temperature above 39°C is usually associated with a non-severe condition, which often leads to late (9-12 days) treatment. C. pneumoniae at this age causes 15-25% of pneumonia, sometimes it is combined with pharyngitis and cervical lymphadenitis; characterized by fever, the development of bronchospasm. Blood changes are not typical. Without treatment, it flows for a long time. Diagnostic criteria have not been developed, this etiology is supported by antibodies of the IgM class (micro-ELISA) in a titer of 1:8 and above, IgG - 1:512 and above, or a 4-fold increase in their titer.

Complications of pneumonia. Pneumococci of a number of serotypes, staphylococci, H.influenzae type b, GABHS, Klebsiella, Pseudomonas aeruginosa, serrations cause synpneumonic purulent pleurisy and early suppurating infiltrates with destruction cavities in the lungs. A decrease in the immune response (primary immunodeficiency, prematurity, severe malnutrition) or the effectiveness of bronchial clearance (cystic fibrosis, foreign body, food aspiration, etc.) aggravate the process. Before emptying the abscess, suppuration is accompanied by persistent fever and neutrophilic leukocytosis, it is often combined with serous-fibrinous metapneumonic pleurisy, which has an immunopathological nature; it is characterized by a 5-7-day fever, an increase in ESR at the 2nd week of illness.

Respiratory failure is typical for disseminated processes (pneumocystosis, chlamydia in children 0-6 months old). Toxic complications (disorders of the central nervous system, heart, microcirculation, acid-base state, disseminated intravascular coagulation (DIC)) depend on the severity of the process and the adequacy of therapy. They should be distinguished from compensatory changes (hypercoagulability, oliguria, decrease in circulating blood volume by less than 25%, hemoglobin and serum iron levels, compensated acidosis), the correction of which is impractical and can be dangerous.

Tactics of prescribing antibacterial drugs for pneumonia should take into account the likely etiology of the disease. Although the statements of a number of authors about the impossibility of accurately determining the ethology of pneumonia according to clinical and radiological data are true, nevertheless, at the bedside of the patient, the pediatrician in most cases can outline the range of likely pathogens (at least "typical" and "atypical") and prescribe the drug of the appropriate spectrum. The effectiveness of the drug is assessed by reducing the temperature below 38 ° C after 24-36 hours of treatment (with complicated forms - after 2-3 days with an improvement in the condition and local status).

V. K. Tatochenko, doctor of medical sciences, professor
NTsZD RAMS, Moscow