Dear Doctor: Respiratory infections act differentlyJune 1, 2016

By Michael Palumbo M.D., Allergy and Clinical Immunologymichael palumbo article

Q. My 3-year-old child is sick with respiratory infections all of the time. What should I do?

A. In addressing this issue it is important to discuss the particular types of infections that children are having. Viral respiratory infections, or colds, are common and typically last five to 10 days. Children can get up to 12 colds a year and still not be a concern as long as these infections improve without needing treatment. Young children have immature immune systems and close contact through daycare and schools leads to a rapid spread of infections.

Evaluation by a doctor should be sought for infections that routinely linger for longer than 10 days without improvement. Viral respiratory infections should clear on their own with only palliative measures to control fever, cough and nasal drainage. Patients who always require antibiotic courses to clear infections should be considered for further evaluation, as this is a sign of a bacterial infection.

Underlying factors contributing to frequent infections need to be considered. They include an anatomical obstruction in the sinuses, immune deficiency, allergic disease or certain other upper respiratory conditions (such as ciliary dyskinesia or cystic fibrosis) that can impair the body’s ability to fight or clear these infections. Of course, if we are talking about other types of infections — such as pneumonia or more severe infections — the indications for further testing vary.

Immune deficiency may also explain recurring infections. According to the Jeffrey Modell Foundation, warning signs of a deficiency include: two or more pneumonias a year, two or more months on antibiotics with little effect, two or more serious sinus infections within one year, the need for intravenous antibiotics to clear infections, or recurrent deep skin or organ abscess. If any of these are present, further testing for underlying immune problems should be discussed. As always, it is a good idea to keep documented history of these infections including any laboratory testing or radiologic imaging and discuss these concerns with your pediatrician before considering further

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