When to Seek Medical Care for Your Child: Part 2

As parents, we are always concerned about the health of our children. One of the most common questions that I get is:

“When should I seek medical care for my child?”

My simple response is:

”Whenever you feel the need!”

This is part 2 in continuation of “When to Seek Medical Care for Your Child”. I will discuss infectious concerns in this current posting.

Infections can manifest in many different ways. It is difficult to summarize the topic of infections into a short post because volumes of textbooks have been written to address this subject. There are multitudes of different infectious agents in our world. My goal is to highlight a few major concerning infection categories in pediatrics that will require medical evaluation. The usual suspects in the pediatric population are viral infections and bacterial infections.

For viral infections, children will get “colds” quite often in their young lives. I actually wrote another article that addresses the frequency and course of common viral illnesses because families often express that their young child seems to be sick with a runny nose, congestion, and coughing for months. Nevertheless, while most viral illnesses are mild in children, some can be more concerning. The most common concerning viral illnesses fall into the category of respiratory infections where younger children and infants suffer from croup and bronchiolitis. Basically, croup is the result of a number of different viruses that cause swelling of a portion of the upper tracheal area to cause narrowing of the airway. The virus that is most often associated with croup is parainfluenza virus, but other viruses like adenovirus and human metapneumovirus can cause croup as well. Croup causes these children to have trouble taking a breath inward. When they inhale, there is a high-pitched squeak that is termed “stridor”. This is the result of the narrowed airway. Air passing through the narrowed airway at a high velocity causes turbulence in the flow and results in the sound, “stridor”. These children will also have a barky cough that sounds like a seal. The reason that this can be an urgent matter is that the restriction of airflow will result in more trouble breathing and, sometimes, respiratory failure (which I will discuss in a subsequent post). If your child is having these symptoms, they must be seen to be given specific medications to reduce the swelling within the airway to allow your child to breathe easier. The other common viral illness in young children is bronchiolitis. It is most commonly caused by respiratory syncytial virus (RSV), but other viruses can cause bronchiolitis as well. Bronchiolitis causes the small breathing tubes of the lungs (bronchioles) to swell and there is an excess production of mucous. This blocks airflow through the lungs, making it hard to breathe. This commonly affects young infants more than older children because they are more susceptible to having problems breathing with the small airway swelling and the excessive mucous that is produced during this illness as well. They have trouble clearing their secretions and will often require very frequent suctioning of the mucous from their nose and mouth. Not only will infants have trouble breathing, but they may become dehydrated because they cannot breath and feed at the same time because their nose is clogged with mucous. While some viruses can be treated with anti-viral medications, most cannot. Furthermore, viruses are not susceptible to antibiotics which are used to treat bacterial infections. While viruses usually have a benign course in children, there are some children that can be severely affected and require medical attention. Viruses can also affect the other organ systems in the body besides the lungs, from the brain to the heart and others as well. So, again, if you have any questions about a viral illness, be sure to reach out to your medical provider!

Now, bacterial infections can present in a myriad of ways and cause common medical illnesses in children, such as ear infections, strep throat, pneumonia, urinary tract infections, skin infections, and others. The primary treatment is antibiotic therapy. The trick with antibiotics is that different bacteria may have different resistant patterns to various antibiotics. So, there is not one type of antibiotic that treats all infections. The importance of this is that the type of infection will dictate the specific antibiotic that is used. Sometimes, cultures are obtained from various fluids and sites to confirm a bacterial infection (for example, pus drained from an abscess or urine). Cultures identify the specific organism that is causing the infection and are usually performed in a laboratory where the specimens are sent out to. These cultures usually have antibiotic sensitivity profiles performed, so that the clinician knows which antibiotics work and don’t work for a particular organism. This is particularly important because there are some bacteria that are resistant to multiple antibiotic agents. The more an antibiotic is used to treat infections, the more bacteria get used to seeing it and can develop protective strategies and evolve to become resistant to the antibiotic. If a bacterial agent is not treated with the correct antibiotic, an infection can go unchecked and cause severe problems for an individual. Skin infections, called cellulitis, ear infections, urinary tract infections, pneumonia, and other diseases caused by bacteria can have devastating consequences if not treated appropriately. One of the most serious bacterial infections is what is called sepsis. Sepsis is basically a bacterial infection that is spreading through the whole body, via the blood stream and into the surrounding tissues and organs. It can start with a localized infection, such as a urinary tract infection or cellulitis. Sepsis can eventually progress to septic shock with multisystem organ involvement, where the vascular system, the heart, kidneys, and other organs start to become impaired. When this happens, there is a higher likelihood of death and critical care is required. So, the proper treatment of a bacterial infection is crucial. Furthermore, the judicious use of antibiotics is important as well because we need antibiotics to work when we need them most. If antibiotics are used indiscriminately, the chances of bacteria evolving to become resistant to the usual antibiotic regiments is much greater.

If you have any questions about this or other topics, please feel free to comment in the comment section.

Stay tuned for the discussion about trouble breathing to follow…