Lung & Respiratory Infections

Scarlet fever is caused by an infection with group A streptococcus bacteria (usually strep throat). The bacteria make a toxin (poison) that can cause the scarlet-colored rash that gives this illness its name.

Not all streptococci bacteria make this toxin and not all kids are sensitive to it. Two kids in the same family may both have strep infections, but one child (who is sensitive to the toxin) may develop the rash of scarlet fever while the other doesn’t.

Usually, if a child has this scarlet rash and other symptoms of strep throat, it can be treated with antibiotics. So if your child has these symptoms, it’s important to call your doctor.

Symptoms

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day, the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101°F (38.3°C), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever happens because of a throat infection, the fever usually stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days.

The infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the child may not get a sore throat.

Prevention

The bacterial infection that causes scarlet fever is contagious. A child who has scarlet fever can spread the bacteria to others through nasal and throat fluids by sneezing and coughing. If a child has a skin infection caused by strep bacteria, like impetigo, it can be passed through contact with the skin.

In everyday life, there is no perfect way to avoid the infections that cause scarlet fever. When a child is sick at home, it’s always safest to keep that child’s toothbrush, drinking glasses, and eating utensils separate from those of other family members, and to wash these items thoroughly in hot soapy water. Wash your own hands often as you care for a child with a strep infection.

Treatment

If your child has a rash and the doctor suspects scarlet fever, he or she will usually take a throat culture (a painless swab of throat secretions) to see if the bacteria grow in the laboratory. If a strep infection is confirmed, the doctor will prescribe an antibiotic for your child to be taken for about 10 days.

Caring for Your Child

A child with severe strep throat may find that eating is painful, so serving soft foods or a liquid diet may be best. Include soothing teas and warm nutritious soups, or cool soft drinks, popsicles, or slushies. Make sure that your child drinks plenty of fluids. You can give over-the-counter acetaminophen or ibuprofen for the throat pain.

If the rash itches, make sure that your child’s fingernails are trimmed short so skin isn’t damaged through scratching. Try an over-the-counter anti-itch medicine to help relieve the itching.

When to Call the Doctor

Call the doctor whenever your child suddenly develops a rash, especially if it is accompanied by a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family or in your child’s school has recently had a strep infection.

Sinuses are moist air spaces within the bones of the face around the nose. When they become infected and swell or become irritated, this is called sinusitis (or a sinus infection). These infections usually follow colds or bouts with allergies. Sinusitis is common and easily treated.

Causes

The sinuses are four sets of hollow spaces that are located in the cheekbones (maxillary sinus), the forehead (frontal sinus), behind the nasal passages (ethmoid sinus), and deep in the brain behind the nasal passages (sphenoid sinus). Sinuses are lined with the same mucous membranes that line the nose and mouth.

When someone has a cold or allergies and the nasal passages become swollen and make more mucus, so do the sinus tissues. The drainage system for the sinuses can get blocked, and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to sinusitis.

Symptoms

Sinusitis can cause different symptoms for kids of varying ages.

Younger kids often have cold-like symptoms, including a stuffy or runny nose and slight fever. If your child develops a fever 5-7 days after cold symptoms begin, it could signal sinusitis or another infection (like bronchitis, pneumonia, or an ear infection), so call your doctor.

Many parents mistake cold-related headaches in young kids for sinus infections. But the sinuses in the forehead don’t start developing until kids are 6 or 7 years old and aren’t formed enough to get infected until the early teen years. So headaches in kids who have colds usually aren’t sinus infections.

In older kids and teens, the most common sinusitis symptoms are a cough that doesn’t improve after the first 7 days of cold symptoms, fever, worsening congestion, foul breath, dental pain, ear pain, or tenderness in the face. Sometimes, teens who have sinusitis also develop upset stomachs, nausea, headaches, and pain behind the eyes.

Prevention

Simple changes in your lifestyle or home environment can help lower the risk of sinusitis. For example, during the winter, when your heating system makes the air inside your home abnormally dry, consider using a humidifier to keep home humidity at 45%-50%. This will stop dry air from irritating the sinuses and make them less of a target for infection. It’s important to clean your humidifier regularly to prevent mold growth.

Although sinusitis itself is not contagious, it is often preceded by a cold, which can spread easily, particularly among family or friends. The most effective way to prevent spreading germs is to teach your family the importance of frequent hand washing, particularly when they’re sick.

Treatment

Doctors may prescribe oral antibiotics to treat cases of sinusitis thought to be caused by bacteria. Some doctors may recommend decongestants and antihistamines to help ease symptoms.

Sinusitis caused by a virus usually goes away without medical treatment. Acetaminophen, ibuprofen, and/or warm compresses can help reduce any pain. But over-the-counter cold preparations have not been found to be effective in reducing symptoms and may cause unwanted side effects.

Call the doctor whenever your child has:

• a cold that lasts for more than 10 days without improvement
• a cold that seems to be getting worse after 7 days of symptoms
• symptoms of allergies that don’t clear with the usual allergy medication

Also call the doctor if your child shows any other signs of sinusitis, like pain or stiffness in the cheeks, a fever, or a cold that seems worse than usual.

Symptoms of strep throat, which is very common among kids and teens, include fever, stomach pain, and red, swollen tonsils.

Strep throat usually requires treatment with antibiotics. With the proper medical care — along with plenty of rest and fluids — a child should be back to school and play within a few days.

How Strep Throat Spreads

Anybody can get strep throat, but it’s most common in school-age kids and teens. These infections occur most often during the school year when big groups of kids and teens are in close quarters.

The bacteria that cause strep throat (group A streptococcus) tend to hang out in the nose and throat, so normal activities like sneezing, coughing, or shaking hands can easily spread infection from one person to another. Someone whose strep throat isn’t treated is most likely to spread the infection when the symptoms are most severe, but can still infect others for up to 3 weeks.

That’s why it’s so important to teach kids the importance of hand washing — good hygiene can lessen their chances of getting contagious diseases like strep throat.

Strep Throat vs. Sore Throat

Not all sore throats are strep throats. Most episodes of sore throat — which can be accompanied by a runny nose, cough, hoarseness, and red eyes — are caused by viruses and usually clear up on their own without medical treatment.

A child with strep throat will start to develop other symptoms within about 3 days, such as:

• red and white patches in the throat
• difficulty swallowing
• tender or swollen glands (lymph nodes) in the neck
• red and enlarged tonsils
• headache
• lower stomach pain
• fever
• general discomfort, uneasiness, or ill feeling
• loss of appetite and nausea
• rash

Diagnosis

If your child has a sore throat and other strep throat symptoms, call your doctor. The doctor will likely do a rapid strep test in the office, using a cotton swab to take a sample of the fluids at the back of the throat. The test only takes about 5 minutes.

If it’s positive, your child has strep throat. If it’s negative, the doctor will send a sample to a lab for a throat culture. The results are usually available within a few days.

Treatment

In most cases, doctors prescribe about 10 days of antibiotic medication to treat strep throat. Within about 24 hours after starting on antibiotics, your child will probably no longer have a fever and won’t be contagious; by the second or third day, other symptoms should start to go away.

Even if your child feels better, he or she should continue to take the antibiotics as prescribed. Otherwise, bacteria can remain in the throat and symptoms can return. Completing all the antibiotics the doctor prescribed is the best way to prevent other health problems that can be caused by a strep infection, such as rheumatic fever (which can permanently damage the heart), scarlet fever, blood infections, or kidney disease.

To prevent your sick child from spreading strep throat to others in your home, keep his or her eating utensils, dishes, and drinking glasses separate and wash them in hot, soapy water after each use. Also, your child shouldn’t share food, drinks, napkins, handkerchiefs, or towels with other family members.

Make sure your child covers all sneezes or coughs (if a tissue isn’t handy, kids should sneeze or cough into a shirtsleeve, not their hands) to prevent passing infectious droplets to others. Also, have your child use a new toothbrush after the antibiotic treatment starts and he or she is no longer contagious.

Caring for Your Child

You can help your child feel better while battling strep throat. Give plenty of liquids to prevent dehydration, such as water or ginger ale, especially if he or she has had a fever. Avoid orange juice, grapefruit juice, lemonade, or other acidic beverages, which can irritate a sore throat. Warm liquids like soups, sweetened tea, or hot chocolate can be soothing.

Talk to your doctor about when your child can return to school and other normal activities.

Tuberculosis (popularly known as “TB”) is a disease caused by the bacteria Mycobacterium tuberculosis. It mainly infects the lungs, although it also can affect other organs.

When someone with untreated TB coughs or sneezes, the air is filled with droplets containing the bacteria. Inhaling these infected droplets is the usual way a person gets TB.

One of the most dreaded diseases of the 19th century, TB was the eighth leading cause of death in children 1 to 4 years of age during the 1920s. As the general standard of living and medical care improved in the United States, the incidence of TB decreased. By the 1960s, it wasn’t even in the top 10 causes of death among children of any age group.

But TB is making a comeback in the United States today — particularly among the homeless, those in prison, and those rendered susceptible because of HIV infection.

Signs and Symptoms

In older infants and children, latent tuberculosis infection (LTBI), which is the first infection with the tuberculosis bacteria, usually produces no signs or symptoms. In addition, a chest X-ray shows no signs of infection.

In most cases, only a tuberculin skin test (used to figure out if someone has been infected by the tuberculosis bacteria) is positive, indicating that the child has been infected. Children with a positive tuberculin test, even if they show no disease, will usually need to receive medication.

This primary infection usually resolves on its own as a child develops immunity over a 6- to 10-week period. But in some cases, it can progress and spread all over the lungs (called progressive tuberculosis) or to other organs. This causes signs and symptoms such as fever, weight loss, fatigue, loss of appetite, and cough.

Another type of infection is called reactivation tuberculosis. Here, the primary infection has resolved, but the bacteria are dormant, or hibernating. When conditions become favorable (for instance, due to lowered immunity), the bacteria become active.

Tuberculosis in older kids and adults may be of this type. The most prominent symptom is a persistent fever, with sweating during the night. Fatigue and weight loss may follow. If the disease progresses and cavities form in the lungs, the person might have coughing and the production of saliva, mucus, or phlegm that may contain blood.

Prevention

The prevention of TB depends on:

• avoiding contact with those who have the active disease
• using medications as a preventive measure in high-risk cases
• maintaining good living standards

New cases and potentially contagious patients are identified through proper use and interpretation of the tuberculin skin test.

A vaccine called BCG (Bacille Calmette-Guérin) is considered controversial because it isn’t very effective in countries with a low incidence of TB. For this reason, BCG isn’t usually given in the United States. However, it may be considered for kids emigrating to countries where TB is prevalent.

Contagiousness

Tuberculosis is contagious when it’s airborne and can be inhaled by others. In general, kids are not considered contagious, and usually get the infection from infected adults.

The incubation period (the time it takes for a person to become infected after being exposed) varies from weeks to years, depending on the individual and whether the infection is primary, progressive, or reactivation TB.

Treatment

A doctor may recommend hospitalization for the initial evaluation and treatment of TB, especially if:

• the child is a young infant
• there are severe drug reactions
• there are other diseases along with TB

However, most kids with tuberculosis can be treated as outpatients and cared for at home. The treatment is usually in the form of oral medications. Rarely, three or four drugs may be prescribed. Even though treatment may require months to complete, it’s vitally important that the full course of medications be taken in order for tuberculosis to be cured.

Duration

Tuberculosis is a chronic disease that can persist for years if it isn’t treated.

When to You Call the Doctor

Call the doctor if your child:

• has been in contact with a person who has (or is suspected to have) tuberculosis
• has persistent fever
• complains of sweating at night
• develops a persistent, chronic cough

During the school year, it can seem like kids pick up one bug after another. One week it’s a runny nose, the next a sore throat, or both. Most of the time, these bugs only last for about a week. But those that linger on for longer can sometimes turn into walking pneumonia.

Walking pneumonia, or atypical pneumonia, is a less serious form of the lung infection pneumonia. It’s caused by Mycoplasma bacteria, which causes cold-like symptoms in addition to a low-grade fever and a hacking cough.

Most kids with this form of pneumonia will not feel sick enough to stay at home — hence, the name “walking” pneumonia — and usually will feel well enough to go to school. But even a child who feels fine needs to stay at home for a few days until antibiotic treatment kicks in and symptoms improve.

Signs and Symptoms

Colds that last longer than 7 to 10 days or respiratory illnesses like respiratory syncytial virus (RSV) can develop into walking pneumonia. Symptoms can come on suddenly or take longer to appear. Those that have a slow onset tend to be more severe.

Here’s what to look for:

• low-grade fever of 101°F (38.5°C) or below
• headache, chills, sore throat, and other cold or flu-like symptoms
• rapid breathing or breathing with grunting or wheezing sounds
• labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each breath)
• hacking cough
• chest pain or stomach pain
• malaise (feeling of discomfort)
• vomiting
• loss of appetite (in older kids) or poor feeding (in infants)

Symptoms usually depend on where in the body the infection is concentrated. A child whose infection is in the top or middle part of the lungs will probably have labored breathing. Another whose infection is concentrated in the lower part of the lungs (near the abdomen) may not have breathing problems at all, but may have an upset stomach, nausea, or vomiting.

Diagnosis

Walking pneumonia is usually diagnosed through a physical examination. The doctor will monitor your child’s breathing and listen for a hallmark crackling sound that often indicates walking pneumonia.

If pneumonia is suspected, a chest X-ray or bacterial culture of mucus from the throat or nose might be done to confirm the diagnosis.

Treatment

Antibiotics are an effective treatment for walking pneumonia. A 7- to 10-day course of oral antibiotics is usually recommended. If your doctor prescribes antibiotics, make sure your child takes them on schedule for as long as directed to recover more quickly.

Once on antibiotics, your child has a minimal risk of passing the illness on to other family members, but encourage everyone in your household to wash their hands frequently and correctly (for at least 20 seconds, rubbing hands together with soap and warm water).

Don’t let your child share drinking glasses, eating utensils, towels, or toothbrushes, and remind everyone to wash their hands after touching any used tissues. Also make sure that your kids are up to date on their immunizations to help protect them from other infections.

Home Health

While recovering from walking pneumonia, your child should drink fluids throughout the day to flush the system and rid the body of toxins (especially if he or she has a fever). Ask the doctor before you use a medicine to treat a cough because cough suppressants stop the lungs from clearing mucus, which may not always be helpful for lung infections like walking pneumonia.

If your child has chest pain, try placing a heating pad or warm compress on the chest area. Take your child’s temperature at least once each morning and each evening, and call the doctor if it goes above 102°F (38.9°C) in an older infant or child, or above 100.4°F (38°C) in an infant under 6 months of age.

With treatment, most types of bacterial pneumonia go away within 1 to 2 weeks. However, walking pneumonia can take up to 4 to 6 weeks to resolve completely.

Whooping cough (pertussis) is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It mainly affects babies younger than 6 months old who aren’t yet protected by immunizations, and kids 11 to 18 years old whose immunity has started to fade.

Whooping cough causes severe coughing spells, which can sometimes end in a “whooping” sound when the child breathes in.

Before a vaccine was available, pertussis killed about 9,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 20. But in recent years, the number of cases has started to rise. In 2012, the number of whooping cough cases spiked up to almost 50,000, the highest level since the 1950s.

Signs & Symptoms

The first symptoms of whooping cough are similar to those of a common cold:

• runny nose
• sneezing
• mild cough
• low-grade fever

After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, a child may turn red or purple. At the end of a spell, the child may make the characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.

While many infants and younger kids with whooping cough develop the coughing fits and accompanying whoop, not all do. And sometimes babies don’t cough or whoop as older kids do. Infants may look as if they’re gasping for air with a reddened face and may actually stop breathing (this is called apnea) for a few seconds during very bad spells.

Adults and teens may have milder or different symptoms, such as a prolonged cough (rather than coughing spells) or coughing without the whoop.

Contagiousness

Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person’s nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Others then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Infected people are most contagious during the earliest stages of the illness for up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.

Prevention

Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.

DTaP immunizations are routinely given in five doses before a child’s sixth birthday. For additional protection in case immunity fades, experts recommend that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they’re 11 or 12 years old.

The Tdap vaccine is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid. It also should be given to adults who did not receive it as preteens or teens. The vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.

Getting the vaccine is especially important for people who are in close contact with infants, because babies can develop severe and potentially life-threatening complications from whooping cough. An adult’s immunity to whooping cough lessens over time, so getting vaccinated and protecting yourself against the infection also helps protect your infant or child from getting it.

As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.

People who live with or come into close contact with someone who has pertussis should receive antibiotics to prevent the spread of the disease, even if they’ve already been vaccinated against it. Young kids who have not received all five doses of the vaccine may need a booster dose if exposed to an infected family member.

Incubation

The incubation period (the time between infection and the start of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.

Duration

Pertussis usually causes prolonged symptoms — 1 to 2 weeks of common cold symptoms, followed by up to 3 months of severe coughing.

The last stage consists of another few weeks of recovery with gradual clearing of symptoms. In some children, the recovery period can last for months.

Treatment

Call the doctor if you suspect that your child has whooping cough. To make a diagnosis, the doctor will take a medical history, do a thorough physical exam, and may take nose and throat mucus samples to be checked in a lab. Blood tests and a chest X-ray also might be done.

Whooping cough is treated with antibiotics. Many experts believe that antibiotics are most effective in shortening the length of the infection when they’re given in the first stage of the illness, before coughing spells begin. But even if antibiotics are started later, they’re still important because they can stop the spread of the pertussis infection to others. Ask your doctor whether preventive antibiotics or vaccine boosters for other family members are needed.

Some kids with whooping cough need to be treated in a hospital. Babies and younger children are more likely to be hospitalized because they’re at greater risk for problems like pneumonia. Whooping cough can be life-threatening for infants younger than 6 months, so they almost always need hospital treatment.

Other potential complications include difficulty breathing, periods of apnea, needing oxygen (particularly during a coughing spell), and dehydration.

While in the hospital, a child may need suctioning to clear the airways. Breathing will be watched closely, and oxygen given if needed. Intravenous (IV) fluids might be needed if a child shows signs of dehydration or has difficulty eating. Precautions will be taken to prevent the infection from spreading to other patients, hospital staff, and visitors.

Home Care

If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your doctor prescribed. Giving cough medicine probably will not help, as even the strongest usually can’t relieve the coughing spells of whooping cough. The cough is actually the body’s way of trying to clear the airways. (Due to potential side effects, cough medicines are never recommended for children under age 6.)

During recovery, let your child rest in bed and use a cool-mist vaporizer to help soothe irritated lungs and breathing passages. (Be sure to follow directions for keeping it clean and mold-free.) And keep your home free of irritants that can trigger coughing spells, such as aerosol sprays; tobacco smoke; and smoke from cooking, fireplaces, and wood-burning stoves.

Kids with whooping cough may vomit or not eat or drink much because of the coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to pee (or in infants, fewer wet diapers).

When to Call the Doctor

Call the doctor if you think that your child has whooping cough or has been exposed to someone with whooping cough, even if your child has already had all scheduled pertussis immunizations.

This is especially important if your child has long coughing spells and:

• the coughing make your child’s skin or lips turn red, purple, or blue
• your child vomits after coughing
• there’s a whooping sound after the cough
• your child has trouble breathing or seems to have brief periods of not breathing (apnea)
• your child seems very sluggish

If your child has been diagnosed with whooping cough and is being treated at home, get immediate medical care if he or she develops difficulty breathing or shows signs of dehydration.