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2. Respiratory diseases
Acute laryngitis
L aryng itis is an acute infection of th e laryng eal m ucosa of v iral or som etim es bacterial 2
orig in.
Clinical features common to all laryngitis
– Inspiratory d yspnoea w ith coug h and h oarse v oice. C h est ind raw ing and strid or m ay
be present.
– Sig ns of serious illness: sw eating , tach ycard ia, cyanosis, altered lev el of
consciousness.
E xam ine ch ild ren in a sitting position. D o not lay ch ild ren d ow n: th ere is a risk of
respiratory airw ay obstruction.
Aetiology and treatment
Children over 6 months
1st case: rapid onset dyspnoea (over a few hours)
– Acute epiglottitis d ue to Haemophilus influenzae: sud d en onset, sev ere d yspnoea,
ch est ind raw ing , h ig h fev er, cerv ical lym ph ad enopath y. T h e ch ild is sitting ,
breath ing
th roug h th e m outh , d rooling clear saliv a w h ich h e cannot sw allow d ue to
d ysph ag ia.
T h e ov erall cond ition m ay d eteriorate v ery quickly.
• A v oid exam ining th e larynx (risk of respiratory arrest), d o not lay th e ch ild d ow n ,
keep h im in a sitting position.
• H av e th e ch ild breath e in a h um id env ironm ent (next to a bow l of w ater or a w et
ctoewftriaexlo).ne IM : 1 0 0 m g / kg / d ay in 2 injections for 5 d ays
• A ntibiotic treatm ent:
ampicillin I V : 2 0 0 m g / kg / d ay in 3 or 4 injections, ch ang e as soon as possible to oral
or, failing th at,
treatm ent w ith amoxicillin P O : 1 0 0 m g / kg / d ay in 2 or 3 d iv id ed d oses to
cholmoramplpehtenicol I V : 1 0 0 m g / kg / d ay in 3 injections, ch ang e as soon as possible to
5 d ays of treatm ent
or
oral treatm ent, at th e sam e d osag es to com plete 5 d ays of treatm ent
• If a patient h as sev ere respiratory d istress: intubation in a specialised setting , or
failing th at, trach eotom y.
– Spasmodic laryngitis in a ch ild w ith rh initis or m easles: sud d en, nocturnal onset
w ith coug h ing fits follow ed by period s of suffocation and inspiratory d yspnoea. T h e
ch ild m ay d ev elop strid or. T h e v oice rem ains h oarse after th e attack. T h e ch ild
rem ains afebrile.
• M onitor th e ch ild , try to keep h im calm . H av e h im breath e in a h um id
env ironm ent
(near a bow l of w ater or w et tow el).
Acute laryngitis
L aryng itis is an acute infection of th e laryng eal m ucosa of v iral or som etim es bacterial 2
orig in.
Clinical features common to all laryngitis
– Inspiratory d yspnoea w ith coug h and h oarse v oice. C h est ind raw ing and strid or m ay
be present.
– Sig ns of serious illness: sw eating , tach ycard ia, cyanosis, altered lev el of
consciousness.
E xam ine ch ild ren in a sitting position. D o not lay ch ild ren d ow n: th ere is a risk of
respiratory airw ay obstruction.
Aetiology and treatment
Children over 6 months
1st case: rapid onset dyspnoea (over a few hours)
– Acute epiglottitis d ue to Haemophilus influenzae: sud d en onset, sev ere d yspnoea,
ch est ind raw ing , h ig h fev er, cerv ical lym ph ad enopath y. T h e ch ild is sitting ,
breath ing
th roug h th e m outh , d rooling clear saliv a w h ich h e cannot sw allow d ue to
d ysph ag ia.
T h e ov erall cond ition m ay d eteriorate v ery quickly.
• A v oid exam ining th e larynx (risk of respiratory arrest), d o not lay th e ch ild d ow n ,
keep h im in a sitting position.
• H av e th e ch ild breath e in a h um id env ironm ent (next to a bow l of w ater or a w et
ctoewftriaexlo).ne IM : 1 0 0 m g / kg / d ay in 2 injections for 5 d ays
• A ntibiotic treatm ent:
ampicillin I V : 2 0 0 m g / kg / d ay in 3 or 4 injections, ch ang e as soon as possible to oral
or, failing th at,
treatm ent w ith amoxicillin P O : 1 0 0 m g / kg / d ay in 2 or 3 d iv id ed d oses to
cholmoramplpehtenicol I V : 1 0 0 m g / kg / d ay in 3 injections, ch ang e as soon as possible to
5 d ays of treatm ent
or
oral treatm ent, at th e sam e d osag es to com plete 5 d ays of treatm ent
• If a patient h as sev ere respiratory d istress: intubation in a specialised setting , or
failing th at, trach eotom y.
– Spasmodic laryngitis in a ch ild w ith rh initis or m easles: sud d en, nocturnal onset
w ith coug h ing fits follow ed by period s of suffocation and inspiratory d yspnoea. T h e
ch ild m ay d ev elop strid or. T h e v oice rem ains h oarse after th e attack. T h e ch ild
rem ains afebrile.
• M onitor th e ch ild , try to keep h im calm . H av e h im breath e in a h um id
env ironm ent
(near a bow l of w ater or w et tow el).
