Table of ContentsView AllTable of ContentsDefinitionSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Definition
Symptoms
Causes
Diagnosis
Treatment
Recurrent respiratory infections are very common in children, but can sometimes be a sign of an underlying medical condition ranging from congenital abnormalities of the lungs to primary immunodeficiency syndromes. Yet, since the average young child has six to ten “colds” a year, it can be hard to know when you should be concerned.
We will take a look at the “normal” frequency of upper and lower respiratory tract infections in children, what is abnormal (such as two or more episodes of pneumonia in 12 months), and some of the potential causes. While most evaluations for frequent infections are normal, diagnosing some of these causes allows for treatment that may reduce long term complications.
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For infections to be considered “recurrent,” they should occur at least two weeks apart with a period of no symptoms in between. That said, there is not a universally held definition of recurrent respiratory infections in children.
Infections involving the upper respiratory tract include:
Infections involving the lower respiratory tract in children include:
Examples of what may be referred to as “recurrent infections” include:
Incidence and Impact
Recurrent respiratory infections are far too common, with 10% to 15% of children experiencing these infections. Recurrent respiratory tract infections are uncommon in the first six months of life, as antibodies from the mother are still present. After 6 months of age children still have a relative immune deficiency until their immune systems mature at the age of 5 or 6 years old.
In developed countries, recurrent respiratory infections are a major cause of hospitalization, responsible for 8% to 18% of hospitalizations in the UK. In developing countries, the story is grim. Recurrent respiratory tract infections are thought to result in 2 million deaths yearly.
The signs and symptoms of upper respiratory infections are familiar to many people and can include:
With lower respiratory tract infections symptoms may include:
General Symptoms
It can be difficult to know the source of discomfort upfront in a young child. Symptoms of respiratory tract infections may include fussiness, refusing to eat, lethargy, and more. Your intuition as a parent is very important, as you are familiar with how your child normally behaves. Most pediatricians have learned to listen to a parent’s concern above anything else.
Impact and Complications
Recurrent infections can lead to complications, but on their own can have a tremendous impact on both the child and his family.
Children who experience recurrent respiratory infections also require antibiotics frequently, and antibiotic use has recently been shown to adversely affect thegut microbiomeor flora (gut bacteria) and even increase the risk of colon cancer. Antibiotic use can also lead to resistance.
These children also at risk for asthma due to the infections, and in those who have asthma, the infections can trigger an attack.
Emotionally, recurrent infections can affect the whole family. Missing school can result in a child falling behind, and the emotions that follow. They can change family dynamics.
For parents, lost time from work, the economic burden of health care, the stress of having an ill child, and sleep deprivation can add together to further impact the family.
Respiratory infections in children usually occur due to an imbalance between exposure to infectious diseases (microbial load) and the ability of the immune system to ward off the infection. That said, there are several conditions that may predispose a child to develop an infection, and knowing when to search for an underlying cause is challenging.
Risk Factors
There are several risk factors (not underlying causes). These include:
Microorganisms
There are a number of bacteria and viruses that are most commonly found in children with recurrent respiratory infections. Episodes usually begin with a viral infection with a secondary bacterial superinfection (the viral infection creates a setting in which bacteria can flourish more easily). It is this combination of a viral infection and secondary bacterial infection that is responsible for the danger associated with the flu virus.
That immunizations are available for several of these infections emphasizes the importance of vaccinations in children.
Underlying Causes
As noted, recurrent respiratory infections are common in children and most often are related to the lack of a fully mature immune system sometimes combined with the risk factors above. In some cases, however, an underlying medical condition (either present from birth (congenital) or acquired later on) is present. Underlying causes can be divided into categories:
Anatomic Factors
There is a wide range of conditions that may predispose a child to repeated respiratory infections. Some of these include:
Functional Factors
Possible function related causes include:
Secondary Immunodeficiency
There are several conditions and treatments that can reduce the ability of a child’s immune system to fight off the infections associated with recurrent respiratory infections. Some of these include:
Primary Immunodeficiency Disorders
Primary immunodeficiency disorders are an uncommon cause of recurrent respiratory infections in children, but are thought to be underdiagnosed. While uncommon, diagnosing and treating some of these conditions may not only reduce the number of infections, but minimize long term lung damage as well.
There are over 250 types of primary immunodeficiency disorders, and these can include problems with antibody production, T cell disorders, complement disorders, phagocyte disorders, and more, though antibody disorders are a frequent culprit when recurrent respiratory infections occur.
Some of these disorders may not be diagnosed until adulthood, whereas the more severe disorders are usually evident early in life. They most commonly present between the ages of 6 months and 2 years—after maternal antibodies are no longer present.
A few examples of primary immunodeficiency disorders that may be associated with recurrent respiratory infections include:
If you and your pediatrician believe that your child might possibly have an underlying reason for recurrent respiratory infections, a thorough history and physical exam as well as additional testing is often done. It’s important to note, however, that very often a clear cause is not found. But when might a further evaluation be needed?
When to Be Concerned
There are a number of situations that might suggest an underlying anatomic or immunodeficiency problem. When figuring out the number of infections, it’s important to note that infections commonly last longer than people realize. In other words, what may appear to be two infections may actually be the same infection that is just lasting longer. The average duration of the common cold is up to 15 days, coughs can last 25 days, and non-specific respiratory symptoms, 16.
Some of these situations include:
A very important question when considering whether a workup is needed is how a child is doing between infections. In other words, is the child healthy, growing well, and free from symptoms when he does not have an infection?
History
A careful history is often the most important part of a workup for repeated infections. This should include a detailed account of infections in the past, including the severity and treatments used. A family history is also very important.
Physical Exam
There are several things doctors look for when examining a child with recurrent infections.
Blood Tests
Imaging Tests
X-ray studies, computed tomography (CT), and/or magnetic resonance imaging (MRI) may be needed if a congenital defect is suspected or to determine the severity of an infection or complications such as bronchiectasis.
Procedures
Procedures that may be considered include:
The treatment of recurrent respiratory infections will depend on the underlying cause. Certainly addressing modifiable risk factors is important for all children, such as making sure your child does not have exposure to secondhand smoke.
Immunizations to prevent primary and secondary infections should also be up to date, and are safe and effective even for most children who have immunodeficiency disorders.Vaccines exist for several of the infections that are common in children with recurrent infections. Available vaccines include those for measles, influenza, pertussis (whooping cough), Haemophilus influenzae type b (H. Flu), and Streptococcus pneumonia (the pneumonia vaccine).
Judicious antibiotic treatment is needed when secondary infections occur.
For children with immunodeficiency syndromes, treatment may include immunoglobulin (such as IM or IV gammaglobulin).
Synagis (palivizumab) and Beyfortus (nirsevimab) are monoclonal antibodies that can help protect certain infants and children 24 months and younger who are at high risk of serious complications from RSV during their RSV season. Synagis and Beyfortus are not vaccines, and cannot cure or treat a child already diagnosed with RSV. If your child is at very high risk for RSV infection, your pediatrician may discuss this option with you.
A Word From Verywell
Having your child experience recurrent respiratory infections is extremely frustrating as a parent, and you may wish that it was you who had the infections instead. Fortunately, most of the time there is not an underlying reason for the infections, and children outgrow them in time. That said, the recurrent infections themselves need to be addressed to reduce the risk of long term lung damage, and potential underlying causes should be evaluated when indicated for the same reason. Importantly, trust your gut as a parent. If you believe something is wrong, speak up. There is no blood test or X-ray study that can equal a parent’s intuition in medicine.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hughes D.Recurrent pneumonia . . . Not!.Paediatr Child Health. 2013;18(9):459–460. doi:10.1093/pch/18.9.459Troullos E, Baird L, Jayawardena S.Common cold symptoms in children: results of an Internet-based surveillance program. J Med Internet Res. 2014 Jun 19;16(6):e144. doi: 10.2196/jmir.2868.Schaad UB, Esposito S, Razi CH.Diagnosis and management of recurrent respiratory tract infections in children: A practical guide.Archives of Pediatric Infectious Disease. 2016. 4(1):e31039. doi:10.5812/pedinfect.31039de Benedictis FM, Bush A.Recurrent lower respiratory tract infections in children.BMJ. 2018. 362:k2698. doi:10.1136/bmj.k2698Thomas M, Bomar PA.Upper respiratory tract infection. StatPearls.Chalmers JD, Chang AB, Chotirmall SH, et al.Bronchiectasis.Nature Reviews. Disease Primers.2018. 4(1):45. doi:10.1038/s41572-018-0042-3Toivonen L, Karppinene S, Schuez-Havupalo L, et al.Burden of recurrent respiratory infections in children. A prospective cohort study.The Pediatric Infectious Disease Journal. 2016. 35(12):e362-e369. doi:10.1097/INF.0000000000001304Loenen MHM, van Montfrans JMJ, Sanders EAM, et al.Immunoglobulin A deficiency in children, an undervalued clinical issue.Clinical Immunology.2019. 209:108293. doi:10.1016/j.clim.2019.108293Genetics Home Reference. U.S. National Library of Medicine.22q11.2 deletion syndrome.Ventola CL.Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood vaccinations.P T. 2016;41(7):426–436.Additional ReadingFortes HR, von Ranke FM, Escuissato DL, et al.Recurrent respiratory papillomatosis: A state-of-the-art review.Respiratory Medicine. 2017. 126:116-121. doi:10.1016/j.rmed.2017.03.030Immune Deficiency Foundation Patient & Family Handbook. For Primary Immunodeficiency Diseases, 5th EditionMontella S, Corcione A, Santamaria F, et al.Recurrent pneumonia in children: A reasoned diagnostic approach and a aingle centre experience.International Journal of Molecular Sciences. 2017. 18(2). pii: E296. doi:10.3390/ijms18020296Nelson’s Textbook of Pediatrics, 21st Edition. Elsevier.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hughes D.Recurrent pneumonia . . . Not!.Paediatr Child Health. 2013;18(9):459–460. doi:10.1093/pch/18.9.459Troullos E, Baird L, Jayawardena S.Common cold symptoms in children: results of an Internet-based surveillance program. J Med Internet Res. 2014 Jun 19;16(6):e144. doi: 10.2196/jmir.2868.Schaad UB, Esposito S, Razi CH.Diagnosis and management of recurrent respiratory tract infections in children: A practical guide.Archives of Pediatric Infectious Disease. 2016. 4(1):e31039. doi:10.5812/pedinfect.31039de Benedictis FM, Bush A.Recurrent lower respiratory tract infections in children.BMJ. 2018. 362:k2698. doi:10.1136/bmj.k2698Thomas M, Bomar PA.Upper respiratory tract infection. StatPearls.Chalmers JD, Chang AB, Chotirmall SH, et al.Bronchiectasis.Nature Reviews. Disease Primers.2018. 4(1):45. doi:10.1038/s41572-018-0042-3Toivonen L, Karppinene S, Schuez-Havupalo L, et al.Burden of recurrent respiratory infections in children. A prospective cohort study.The Pediatric Infectious Disease Journal. 2016. 35(12):e362-e369. doi:10.1097/INF.0000000000001304Loenen MHM, van Montfrans JMJ, Sanders EAM, et al.Immunoglobulin A deficiency in children, an undervalued clinical issue.Clinical Immunology.2019. 209:108293. doi:10.1016/j.clim.2019.108293Genetics Home Reference. U.S. National Library of Medicine.22q11.2 deletion syndrome.Ventola CL.Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood vaccinations.P T. 2016;41(7):426–436.Additional ReadingFortes HR, von Ranke FM, Escuissato DL, et al.Recurrent respiratory papillomatosis: A state-of-the-art review.Respiratory Medicine. 2017. 126:116-121. doi:10.1016/j.rmed.2017.03.030Immune Deficiency Foundation Patient & Family Handbook. For Primary Immunodeficiency Diseases, 5th EditionMontella S, Corcione A, Santamaria F, et al.Recurrent pneumonia in children: A reasoned diagnostic approach and a aingle centre experience.International Journal of Molecular Sciences. 2017. 18(2). pii: E296. doi:10.3390/ijms18020296Nelson’s Textbook of Pediatrics, 21st Edition. Elsevier.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hughes D.Recurrent pneumonia . . . Not!.Paediatr Child Health. 2013;18(9):459–460. doi:10.1093/pch/18.9.459Troullos E, Baird L, Jayawardena S.Common cold symptoms in children: results of an Internet-based surveillance program. J Med Internet Res. 2014 Jun 19;16(6):e144. doi: 10.2196/jmir.2868.Schaad UB, Esposito S, Razi CH.Diagnosis and management of recurrent respiratory tract infections in children: A practical guide.Archives of Pediatric Infectious Disease. 2016. 4(1):e31039. doi:10.5812/pedinfect.31039de Benedictis FM, Bush A.Recurrent lower respiratory tract infections in children.BMJ. 2018. 362:k2698. doi:10.1136/bmj.k2698Thomas M, Bomar PA.Upper respiratory tract infection. StatPearls.Chalmers JD, Chang AB, Chotirmall SH, et al.Bronchiectasis.Nature Reviews. Disease Primers.2018. 4(1):45. doi:10.1038/s41572-018-0042-3Toivonen L, Karppinene S, Schuez-Havupalo L, et al.Burden of recurrent respiratory infections in children. A prospective cohort study.The Pediatric Infectious Disease Journal. 2016. 35(12):e362-e369. doi:10.1097/INF.0000000000001304Loenen MHM, van Montfrans JMJ, Sanders EAM, et al.Immunoglobulin A deficiency in children, an undervalued clinical issue.Clinical Immunology.2019. 209:108293. doi:10.1016/j.clim.2019.108293Genetics Home Reference. U.S. National Library of Medicine.22q11.2 deletion syndrome.Ventola CL.Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood vaccinations.P T. 2016;41(7):426–436.
Hughes D.Recurrent pneumonia . . . Not!.Paediatr Child Health. 2013;18(9):459–460. doi:10.1093/pch/18.9.459
Troullos E, Baird L, Jayawardena S.Common cold symptoms in children: results of an Internet-based surveillance program. J Med Internet Res. 2014 Jun 19;16(6):e144. doi: 10.2196/jmir.2868.
Schaad UB, Esposito S, Razi CH.Diagnosis and management of recurrent respiratory tract infections in children: A practical guide.Archives of Pediatric Infectious Disease. 2016. 4(1):e31039. doi:10.5812/pedinfect.31039
de Benedictis FM, Bush A.Recurrent lower respiratory tract infections in children.BMJ. 2018. 362:k2698. doi:10.1136/bmj.k2698
Thomas M, Bomar PA.Upper respiratory tract infection. StatPearls.
Chalmers JD, Chang AB, Chotirmall SH, et al.Bronchiectasis.Nature Reviews. Disease Primers.2018. 4(1):45. doi:10.1038/s41572-018-0042-3
Toivonen L, Karppinene S, Schuez-Havupalo L, et al.Burden of recurrent respiratory infections in children. A prospective cohort study.The Pediatric Infectious Disease Journal. 2016. 35(12):e362-e369. doi:10.1097/INF.0000000000001304
Loenen MHM, van Montfrans JMJ, Sanders EAM, et al.Immunoglobulin A deficiency in children, an undervalued clinical issue.Clinical Immunology.2019. 209:108293. doi:10.1016/j.clim.2019.108293
Genetics Home Reference. U.S. National Library of Medicine.22q11.2 deletion syndrome.
Ventola CL.Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood vaccinations.P T. 2016;41(7):426–436.
Fortes HR, von Ranke FM, Escuissato DL, et al.Recurrent respiratory papillomatosis: A state-of-the-art review.Respiratory Medicine. 2017. 126:116-121. doi:10.1016/j.rmed.2017.03.030Immune Deficiency Foundation Patient & Family Handbook. For Primary Immunodeficiency Diseases, 5th EditionMontella S, Corcione A, Santamaria F, et al.Recurrent pneumonia in children: A reasoned diagnostic approach and a aingle centre experience.International Journal of Molecular Sciences. 2017. 18(2). pii: E296. doi:10.3390/ijms18020296Nelson’s Textbook of Pediatrics, 21st Edition. Elsevier.
Fortes HR, von Ranke FM, Escuissato DL, et al.Recurrent respiratory papillomatosis: A state-of-the-art review.Respiratory Medicine. 2017. 126:116-121. doi:10.1016/j.rmed.2017.03.030
Immune Deficiency Foundation Patient & Family Handbook. For Primary Immunodeficiency Diseases, 5th Edition
Montella S, Corcione A, Santamaria F, et al.Recurrent pneumonia in children: A reasoned diagnostic approach and a aingle centre experience.International Journal of Molecular Sciences. 2017. 18(2). pii: E296. doi:10.3390/ijms18020296
Nelson’s Textbook of Pediatrics, 21st Edition. Elsevier.
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