Enf. Diogo Vitorino

Pediatric Ward

Winter alert
Prevention of child respiratory health

HPA Magazine 21 // 2024

Acute respiratory infections are one of the leading causes of morbidity and mortality in children, accounting for 11.3% of deaths worldwide. In Portugal in 2023, there is a continuing upward trend in the number of hospitalizations due to respiratory infections, especially Respiratory Syncytial Virus (RSV), which accounts for 90% of infections in children under two years of age, with a global total of 33 million acute respiratory infections, of which 3.6 million require hospitalization and about 26,000 results in death due to complications.

In a context of global regression in vaccination rates, this is an opportunity to reflect on the vaccines available to us and how they can benefit our well-being. 
Effective compliance with the childhood vaccination schedule is essential, being the main element responsible for reducing the infant mortality rate and the incidence of numerous contagious diseases.
With the arrival of winter in Portugal, we observe a significant increase in the number of hospitalized children due to respiratory conditions, such as pneumonia, Haemophilus Influenzae type b (Hib), Staphylococcus Aureus, and other bacterial species, in addition to Respiratory Syncytial Virus (RSV), Human Parainfluenza Virus types 1, 2, and 3 (PIV-1, PIV-2, and PIV-3), Influenza Virus, and Varicella Virus. 
It is estimated that the majority of acute respiratory infections are caused by viral agents.
The need to discuss and implement effective preventive and intervention measures becomes even more urgent, considering the additional challenges that this season imposes on children's respiratory health.
In this context, it is essential to promote awareness of practices that can help mitigate the impact of respiratory conditions, not only to reduce the incidence of hospitalizations but also to maximize children's health during the winter months.
Firstly, creating a healthy environment, avoiding children's exposure to smoke, and ensuring good ventilation in the places where they spend most of their time. 
Regular nasal washing with saline solution contributes to relieving congestion and keeping the airways unobstructed. 
Another effective strategy is to elevate the head of the bed during sleep, especially if the child has respiratory difficulties. 
This simple postural modification facilitates breathing during the night, reducing symptoms, and improving the quality of sleep for the little ones. 
It is crucial to integrate these practices into daily life, as caregivers play an active role in promoting children's respiratory health. 
Optimizing the home environment not only reduces the risk of respiratory complications but also creates a conducive space for recovery and ongoing well-being for children.
Furthermore, the importance of regular cleaning and disinfection of all compartments of the house, including toys, should not be overlooked. 
Avoiding the accumulation of dust and microorganisms is essential for preventing respiratory infections. 
Promoting handwashing, especially after coughing and using the bathroom, before meals, and before touching the mouth, eyes, and nose, are additional practices that significantly contribute to creating a healthy environment.
In the case of respiratory illness, it is necessary to recognize the early signs of respiratory distress in children for an effective response and to preserve lung health. 
 

The attentive observation of some indicators that we will address next serves as a guide for parents and caregivers, empowering them to make quick decisions and seek medical help promptly.
Intercostal, subcostal, and suprasternal retractions, characterized by "dimpling" between the ribs, are clear indicators that the child is making an additional effort to breathe. 
Retractions indicate an increased workload of the respiratory muscles and should be promptly recognized to avoid worsening the child's clinical condition. 
Nasal flaring, or widening of the nostrils during breathing, is a sign that the child is experiencing significant resistance in the airways. 
This reflex is an instinctive response to optimize air entry and should be considered an alert for the possibility of airway obstruction or respiratory discomfort. 
Head bobbing movements during breathing, where the head rocks forward and backward, are a natural attempt to optimize the airways. This behavior suggests discomfort and may indicate the need for further assessment, especially if it occurs persistently. 
The presence of cyanotic lips, with a bluish/purple coloration, is a clear sign that blood oxygenation may be compromised. 
It is a critical indicator of acute respiratory distress and should be treated as a medical emergency. Observing an accelerated respiratory rate, known as tachypnea, is another indicative sign that the child may be struggling to breathe. 
Rapid and shallow breathing can be an early indicator of respiratory discomfort and requires immediate attention.
By understanding these signs, parents and caregivers acquire a significant tool in promoting child respiratory health. 
The prompt identification and response to these signs can make all the difference in intervention and prevention of more severe complications. 
It is important to emphasize that upon observing any of these signs, it is imperative to seek immediate medical assistance. 
Healthcare professionals are prepared to assess the severity of the situation and initiate appropriate interventions.
Continuous education about these signs is essential, empowering caregivers to act as proactive advocates for children's respiratory health, contributing to a safer and more peaceful winter.