Nasopharyngitis in children

Nasopharyngitis in children is a respiratory disease that ranks first among the pathologies of the upper respiratory tract in children of preschool and early school age.

Such prevalence of the disease is associated with the availability of transmission routes in organized children's groups.

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Causes nasopharyngitis in children

Nasopharyngitis is a disease that children suffer from several times a year. This is due to a variety of etiological factors.

The causes of nasopharyngitis in children are viruses. Possible pathogens include influenza virus, parainfluenza, adenovirus, respiratory syncytial virus, and rhinovirus.

All these viruses have a tropism for a certain part of the respiratory tract, for example, the respiratory syncytial virus most often affects the bronchioles, and the rhinovirus - the mucous membrane of the nasal cavity, but these same viruses can cause nasopharyngitis.

Infection occurs by airborne droplets. The source of infection is a patient with nasopharyngitis, rhinitis, bronchitis or a virus carrier. The disease develops in children against the background of weakened immunity, that is, when the child has not fully recovered from the previous infection. Often, nasopharyngitis develops against the background of an existing acute viral infection - acute rhinitis. Then breathing through the nose becomes difficult and the child breathes through the mouth. In this case, the air is not purified, is not warmed up and the protective function of the cilia of the nasal cavity epithelium is absent. Therefore, a secondary viral agent joins.

The incubation period depends on the type of pathogen. For influenza, it ranges from several hours to two days, and for respiratory syncytial virus, it ranges from two to five days.

Viruses have a tropism for the epithelium of the upper respiratory tract, so they easily get into and fix on the epithelium. The virus shell contains protein structures that are similar to the proteins of the cell membrane of a normal cell, so the virus particle is not perceived as foreign. This contributes to infection with the virus.

Thus, the main reason for the development of the disease is infection with a virus, especially against the background of weakened immunity.

Pathogenesis

The virus with droplets of saliva or with air aerosol gets on the mucous membrane of the nasopharynx. For the disease to develop, it is necessary that the number of viral particles be sufficient, that is, a certain viral number is needed.

The pathogenesis of nasopharyngitis in children has its own characteristics, which is associated with the anatomical and functional features of the structure of the upper respiratory tract. The lymphatic system of the posterior pharyngeal wall in children, unlike adults, is looser, the epithelium is well supplied with blood and is not mature enough. The epithelial cell has proteins in the membrane that are similar to the structures of the viral particle, which helps the virus very easily penetrate the cell. While in the cell, the viral particle easily penetrates the cell nucleus and damages DNA. The next stage is that the virus embeds its own DNA into the cell nucleus and new particles are synthesized. In this case, normal epithelial cells die and are rejected. The local immune system reacts to this process: lymphocytes of the retropharyngeal lymphatic system neutralize foreign elements by phagocytosis. This is how the immune response develops. In this case, pro-inflammatory substances are released - histamine, bradykinin, interleukins of different classes. They promote vasodilation and edema and hyperemia develop. Hyperplasia of the lymphatic system of the posterior pharyngeal wall occurs.

This is how clinical manifestations of the disease develop.

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Symptoms nasopharyngitis in children

Since this viral disease affects the general condition of the child, the signs of intoxication come to the fore, which are expressed moderately, given the viral etiology. The child becomes lethargic, appetite and sleep deteriorate. He complains of headache, muscle pain, sore throat when swallowing.

Symptoms of nasopharyngitis in children can be divided into general and local.

The first signs of the disease are a deterioration in the child's health, an increase in temperature to subfebrile numbers. Such a moderate increase in temperature confirms the viral nature of the disease.

Local symptoms develop later, when the degree of damage to the epithelial cells is significant and intense edema develops. Then complaints of a sore throat when swallowing appear, but unlike a bacterial infection, warm tea improves the child's condition with pharyngitis. Due to swelling of the nasopharynx, air flow deteriorates and a feeling of nasal congestion develops. Sometimes rhinitis may occur. As a local reaction, regional lymph nodes increase in size, but this is not common with viral infection.

Patients complain of a cough that is unproductive, difficult to cough up and bothers mainly in the morning. This cough is not a sign of damage to the bronchi or lungs, it is a reactive process. At night, in a horizontal position, mucus accumulates from the nasopharynx and in the morning, when the child gets up, this secretion is coughed up. There is not much of it, so the cough is insignificant. That is why you should not worry about a cough with nasopharyngitis, unless it is so insignificant.

The clinical picture of nasopharyngitis in children develops gradually and, if mild, may not affect the general condition of the child, with the exception of infants. Such children may experience weight loss, refusal to breastfeed, and diarrhea due to nasal congestion, so such children require special attention when treating any viral diseases.

Forms

Upper respiratory tract diseases in children often have an acute course. This is due to the high reactivity of the child's body and good functional activity of the immune system.

Acute nasopharyngitis in children lasts from 10 to 14 days: the first 2-3 days are the incubation period, when there are no signs of the disease yet, the next 3-5 days are the full clinical picture. In the absence of complications, the child recovers by the end of the second week. The disease can last longer if complications occur. In general, the criterion for an acute course is the development of the disease for no more than three weeks.

Chronic nasopharyngitis occurs in children with weakened immunity, in children from the risk group for respiratory pathology. The course of the disease for more than three weeks allows us to suspect a bacterial infection or a chronic process. This form, as a rule, is not catarrhal in nature, but hypertrophic or atrophic. In children, this pathology is not common, since a very long course is needed for chronicity and deep changes in the nasopharyngeal epithelium. Therefore, if nasopharyngitis in a child lasts more than 21 days, a comprehensive examination is necessary.

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Complications and consequences

Timely diagnosis and treatment of nasopharyngitis in children prevents complications. The main complications arise due to infection with bacterial flora against the background of a viral lesion. Then, on the 3rd-5th day of the disease, the condition of the sick child worsens, the temperature rises above 38 degrees, shortness of breath appears and the symptoms of intoxication increase. This indicates possible pneumonia. Sometimes the etiological factor in the development of pneumonia can be viral-bacterial associations. The course of such pneumonia is very severe, even a hemorrhagic component in the development of changes in the lungs is possible, which has an unfavorable prognosis.

In young children, the consequences of viral nasopharyngitis may include symptoms such as poor appetite, refusal to breastfeed, weight loss, and diarrhea. This is due to the deterioration of breathing through the nose, which disrupts the breastfeeding process. Also, in small children, due to the anatomical and functional features of the ear, otitis often develops. If the causative agent is adenovirus, then concomitant viral conjunctivitis develops, which, if the mucous membrane of the eye is not properly cared for, can be affected by bacteria and keratitis and uveitis can develop.

If the causative agent of nasopharyngitis is the respiratory syncytial virus, then the consequence of this may be the development of bronchiolitis in children in the first two years of life.

Parainfluenza virus, as one of the complications, can cause swelling of the larynx with the development of false croup syndrome.

Another complication of viral nasopharyngitis may be hyperthermic syndrome, which is characterized by the presence of febrile seizures, especially in children at risk.

The most serious complication is the development of toxic encephalopathy in a child, which is caused by the toxic effect of the virus's metabolic products on the central nervous system.

Complications of nasopharyngitis mainly occur due to improper treatment or lack of adequate treatment.

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Diagnostics nasopharyngitis in children

Symptoms of nasopharyngitis are not specific to a certain pathogen, so it is often impossible to establish an accurate etiological diagnosis. Diagnosis of nasopharyngitis in children is complex: complaints, anamnesis, objective examination data, instrumental and laboratory diagnostics.

When collecting anamnesis, the symptoms and time of onset of the disease are determined. During examination, the doctor detects bright hyperemia of the posterior pharyngeal wall. A characteristic diagnostic sign is hyperplasia of the follicles of the posterior pharyngeal wall - the "paving stone symptom". Regional lymph nodes may be enlarged.

Laboratory diagnostic methods are prescribed for the purpose of differential diagnostics. Changes in the general blood test are characteristic of a viral infection - this is relative lymphocytosis with an unchanged leukocyte formula.

Instrumental diagnostics, as a rule, are not used in uncomplicated cases. Only if pneumonia is suspected, chest X-ray is performed to confirm the diagnosis.

To identify a specific pathogen, a swab of the back of the throat must be sent for virological testing. The virus can be identified by polymerase chain reaction (PCR) when testing blood. But these diagnostic methods are rarely used, since the treatment of the disease is pathogenetic and does not depend on the type of pathogen.

Clinical examination of the child is the main method for diagnosing this disease.

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Differential diagnosis

Many viral diseases in children occur as nasopharyngitis or tonsillitis. Different etiological factors can cause similar clinical symptoms, but in some cases the pathogen should be identified by clinical manifestations for proper treatment.

Pharyngitis may be a symptom of infection not only with respiratory viruses, but also with herpes viruses. One example is infectious mononucleosis, which is caused by the Epstein-Barr virus from the herpesvirus family. The disease also manifests itself as bright hyperemia of the back wall of the pharynx, but unlike pharyngitis, it is also accompanied by an increase in all groups of lymph nodes, hepato- and splenomegaly. The main diagnostic sign of the disease is an increase in mononuclear cells in the general blood test.

Differential diagnostics of nasopharyngitis in children is also carried out with bacterial infections. In case of bacterial damage to the nasopharynx, in addition to hyperemia, white films appear on the tonsils, which is not the case with viral processes. A distinctive feature is the so-called "empty throat" symptom - with viral nasopharyngitis, warm tea reduces the intensity of pain in the throat, and with angina, any irritation only increases the pain.

It is necessary to differentiate between hyperemia of the nasopharynx in viral nasopharyngitis and in measles. The measles virus is characterized by bright hyperemia of the entire oral cavity with the subsequent appearance of a specific rash in the form of small grains and Filatov spots.

With scarlet fever, a red, "flaming" pharynx also appears, but these changes are accompanied by the appearance of a characteristic rash on the skin.

Treatment nasopharyngitis in children

It is necessary to start treatment of any disease as soon as possible, and this is no exception. Early and correct treatment helps prevent complications.

The regimen for nasopharyngitis in children should be bed rest during the peak period of the disease, when the temperature is elevated.

The diet should correspond to the child's age and be complete in terms of the main food ingredients. At the same time, it is necessary to increase the amount of protein and reduce the percentage of animal fats and simple carbohydrates. The food should be warm, not hot, with the consistency of porridge. This is intended to avoid irritating the affected throat. A very important element of treatment is the drinking regime. The child should drink a lot of fluids, as this removes viral toxins from the body through the sweat glands and with urine. It is advisable to drink warm weak tea with lemon without excess sugar. You can also drink fruit drinks, fruit compotes, but not multi-component ones. The correct drinking regime is one of the points of pathogenetic treatment.

Vitamins should be in the form of fruits and vegetables, which is a priority over medications.

Drug treatment involves the use of medications. These medications are used as local treatment or systemic.

1. Antiviral drugs are prescribed to act on the virus itself. One of them is "Amizon" for children.

"Amizon" acts on the virus shell, as a result of which it cannot infect epithelial cells and the virus is inhibited. The drug also has an immunomodulatory effect by increasing the synthesis of endogenous interferon. The drug also has an antipyretic effect due to the effect on the thermoregulation center. "Amizon" is available in tablets of 0.125 g. The dose for treating children from 6 years old is 1 tablet 2-3 times a day. The course of treatment is 5-7 days.

Precautions during use of the drug: should not be prescribed to children under 6 years of age, do not prescribe in case of allergy to iodine preparations or other components of the drug.

Side effects of the drug include swelling of the mucous membrane, a bitter taste in the mouth, allergic and dyspeptic reactions.

For local treatment, lozenges are used. They reduce swelling of the throat and have an analgesic effect.

2. "Faringosept" is a throat antiseptic that suppresses the growth of bacterial flora. This prevents the development of complications of bacterial etiology. The drug stimulates the secretion of saliva and reduces dryness and irritation in the throat. It is available in the form of tablets of 10 mg with lemon flavor. The dose for the treatment of pharyngitis is 1 tablet 3 times a day for children from three to seven years old, at least half an hour after meals; for children from 7 years old - 1 tablet 5 times a day. Dissolve the tablets until completely dissolved and do not drink or eat anything after 2-3 hours. The course of treatment is 5-7 days.

Precautions: Do not take if you are hypersensitive to any of the ingredients in the drug.

Side effects include allergic reactions, skin rash.

3. Symptomatic treatment for nasopharyngitis is prescribed when the temperature rises significantly.

Paracetamol is an antipyretic drug recommended for use in children. It has a central antipyretic effect by inhibiting the enzyme cyclooxygenase. It is necessary to bring down the temperature of children if it reaches above 39 degrees. If the child is under three months old, reduce the temperature above 38 degrees, and for children with diseases of the heart, lungs, nervous system - above 38.5

The drug is available in syrup - "Panadol baby" 100 ml. A single dose for a child is 10-15 mg per kg of body weight. The interval between doses, even if the drug is ineffective, should not be less than 4 hours.

Precautions: Do not give to children under 2 months of age, in the presence of allergic reactions and severe renal impairment.

Side effects: effects on bone marrow – agranulocytosis, thrombocytopenia, anemia.

Folk treatment of nasopharyngitis in children

Folk treatment of nasopharyngitis in children is widespread due to its simplicity and availability. Various methods are used that give good results, since they act on the virus or its toxins in one way or another. Aggressive means are not used in children, that is, garlic and any alcohol-based tinctures are not recommended.

The basic home remedy recipes are as follows:

• Spruce buds should be collected, washed thoroughly and boiled in a 1:1 ratio. Then drain the broth, put it in a dark place to brew for 3-4 hours. Before taking, add honey to taste so that the child can drink it, and take 1 teaspoon 3 times a day.
• Warm milk mixed with honey and butter helps well – drinking such a drink is not only pleasant for the child, but also reduces the sore throat.
• It is useful to steam your feet in water with chamomile and spruce flowers, then dry them with a towel, put on warm socks and sweat - your health will improve significantly.
• Mash the viburnum berries, add honey and rub, then pour hot water over them and strain, drink instead of tea.
• For an older child, you can grate a carrot on a fine grater and mix it with lemon juice and honey, hold it in the mouth for a few minutes, then spit it out and repeat the procedure several times.
• The benefits of tea with honey, lemon and ginger are undeniable.

Also, herbal infusions are very often used for treatment:

• blackberry inflorescences and fruits, you can also use blueberries, pour boiling water over them and let it brew, add honey for taste and drink a teaspoon three times a day.
• pour boiling water over mint, coltsfoot, linden and lemon balm leaves, let steep and take 50 ml throughout the day.
• Infuse sage herb in hot water and take 1 teaspoon at night, adding a little honey.

Homeopathic remedies are also used in the treatment of nasopharyngitis, especially in children. Homeopathic remedies include:

• "Lymphomyosot" is a drug that has anti-edematous, anti-inflammatory, lymphatic drainage effects, and improves the child's immune status. It is available in ampoules and is used in the form of drops. Dosage for children under 6 years old is 5 drops under the tongue 2 times a day, and for children over 6 years old - 10 drops 2 times a day. Precautions - do not use in hyperthyroidism, thyrotoxicosis. Side effects have not been identified.
• "Tonsilotren" is a drug that has an anti-edematous, immunomodulatory effect, and provides a trophic effect. It is used for children aged 1-12 years, 1 tablet every three hours on the first day (no more than 8 tablets per day) and then 1 tablet 3 times a day until recovery, and for children over 12 years old - 1 tablet every hour on the first day and then 1 tablet 3 times a day until symptoms disappear. Precautions - individual intolerance to the components of the drug. Side effects have not been identified.
• "Traumeel S" is an analgesic, decongestant, anti-inflammatory agent. It is available in ampoules for parenteral administration and in tablets. Dosage for children under 3 years old is half a tablet 3 times a day, and after three years, 1 tablet 3 times a day. Precautions - not recommended for hypersensitivity. Side effects are possible in the form of redness and itching at the injection site.
• "Faringomed" - lozenges for resorption, have an anti-edematous, anti-inflammatory effect. Available in tablet form. The dose for children over five years old is 1 tablet every 2 hours on the first day (no more than 5 tablets), then 1 tablet 3 times a day. Precautions: do not use for children under 5 years old. Side effects have not been identified.

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Prevention

This disease is easily transmitted, especially in children's groups, but it is impossible to limit the child in communication, so if the child gets sick once or twice a year, this is not a pathology. However, there are preventive measures that must be followed in order to protect against possible complications.

Prevention of nasopharyngitis consists of non-specific measures, since there is no specific immunization for this disease. It is necessary not to let the child go to kindergarten if he has not completely recovered, it is better to let him stay at home. It is necessary to prevent hypothermia, sudden changes in the child's body temperature. Nutrition should correspond to the age and needs of the child. It is necessary to walk in the fresh air, play games in nature. In severe frost, it is necessary to cover the child's mouth with a scarf so that he breathes through the nose. In case of acute rhinitis, it is better not to let the child outside for some time, so that pharyngitis does not develop.

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Forecast

The prognosis for recovery from nasopharyngitis is favorable, with proper and timely treatment, complications are rare. If bronchitis, bronchiolitis or pneumonia develops, the treatment will be longer and slightly different, but the prognosis is also favorable.

Nasopharyngitis in children is a common pathology, especially if the child goes to kindergarten or school. This is not a dangerous pathology, since the pathogens are viruses, but with improper treatment or its absence, bacterial complications in the form of pneumonia or otitis may appear. Therefore, you should monitor the health of your child, but take care of him in moderation.

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