Coughs and splutters are common in young children but they can easily develop into chest infections. Paediatrician, Kerry Robinson looks at symptoms and treatments

Children get about six upper airway infections a year causing coughs and colds though not all of these will affect their lungs. The term ‘chest infection’ covers a range of conditions from bronchitis to pneumonia, which affect different parts of the breathing apparatus but produce similar symptoms. Broadly speaking, Bronchitis means infection of the big airway passages, while Pneumonia, or ‘chest infection’, refers to infection of the tissue of the lungs.

How do chest infections develop?

Bugs breathed in from the air and passed from person to person by coughing, sneezing or close contact are the main cause. The bugs usually gather in the upper airways of the nose and throat causing a mild cough/cold type illness before travelling down to the lungs.

What are the common symptoms?

• Initially a mild cough/cold which then develops into something bigger. Children can run a high temperature (often higher than 39C) that swings up and then down again. They may also experience rigors – these are sudden attacks of shivering and a sensation of coldness accompanied by a rapid rise in body temperature.
• Your child may have a dry cough that does not produce any phlegm but in a chest infection this will develop into a more obvious cough and the child will bring up phlegm that may be green or yellow in colour. It can become bloodstained.
• Younger children may be off their food and may suffer from diarrhoea.
• Older children will complain of chest pain when they breathe. The pain is usually sharp and worse on taking a big breath in.
• The breathing may be shallow and rapid.

It is difficult to give a precise time but you should see your doctor if:

• your child is panting and having difficulty getting their breath
• their breathing is very fast
• their breathing is painful
• your child’s lips are a bluish colour
• your child coughs up blood
• your child isn’t eating or drinking or passing urine

You have to use your own judgement a bit but the answer is yes. If you are worried and your child is short of breath then don’t worry about the time of day.

What treatment is available?

Chest infections can be caused by viruses or bacteria. Antibiotics will only be effective in those cases caused by bacteria. Green or yellow phlegm on coughing indicates a bacterial infection and in these cases antibiotics will be prescribed.
If your child is very unwell they may be admitted to hospital and given antibiotics straight in to the vein. They may also need intravenous fluids if they aren’t drinking enough. Some children need extra oxygen to help them breathe and later, physiotherapy to help them clear the lungs as they start to get better.

Why are antibiotics not given to everyone with a chest infection?

Doctors try to limit the use of antibiotics. This is because bacteria are evolving all the time and new types are developing which are resistant to antibiotics. If children have been prescribed antibiotics unnecessarily and they then become seriously ill with a bacterial infection, there may not be an effective antibiotic to treat them with. Likewise, if your doctor feels that your child’s illness is caused by a virus he/she will not prescribe antibiotics.

In a way, it is good for your child’s immune system to clear bugs from the body of its own accord. In this way, when it next meets that same bug it remembers and can clear it from the body more quickly, thus preventing your child getting ill a second or third time. This is how children build up their own immune systems.

What if my child carries on coughing for a long time?

Some chest infections – particularly those caused by viruses in little babies – can make people cough for weeks after the acute illness is over. If this is the case and your child is troubled by the symptoms you should take them back to see the doctor.

Some infections leave children with a wheeze for some time after the initial illness. Again, take your child to see the doctor if they’re troubled and he/she may prescribe some inhaler medication. This does not necessarily mean your child has asthma – a wheeze can sometimes be caused by the infection itself and may settle over time.

For more information: see childhood asthma