Insights on Recurrent Pneumonia: Risks in Kids with Developmental Delays

It’s a deadly disease. While pneumonia can be treated, the risks are higher for a child with developmental challenges.

Here's why:

There are communication difficulties with a developmentally challenged child that can possibly lead to two problems¹:

1. delay in the recognition of respiratory problems; and 
2. difficulty in establishing the precise diagnosis.

If you are parenting a child with global developmental delay, you probably understand the challenges we encounter when it comes to accurately identifying medical concerns.

When you’re dealing with a case of recurrent pneumonia in a child with developmental delays having multiple episodes in a year, it becomes more important than ever to learn about prevention and control.

Here in the Philippines, pneumonia takes the lives of many children each year. The Department of Health reported that pneumonia is the number one leading cause of child mortality². Data from the DOH 2010 records is presented below.

Before we keep going, you should know that Eira was vaccinated with pneumoccocal vaccine, Prevnar. 

She received the vaccine when she was a little over one year old. Unfortunately, for whatever reason, she was admitted for pneumonia soon after the vaccination. It’s not the first time she had pneumonia and we’re not saying the vaccination was the culprit for her hospitalization.

December 2011 | Eira spent the holidays @ San Pedro Hospital, Davao City | Diagnosis: Pneumonia

But she continues to suffer from recurrent pneumonia despite the vaccination.

Eira’s recurrent pneumonia could be caused by many other factors. For one, she is diagnosed with asthma. Asthma triggers could lead to viral infection and progress to pneumonia. But I guess, that is something we may never find out for certain.

September 2017: At 7, Eira still suffers from recurrent pneumonia | Shot in SPH Davao before going in for X-ray

A parent's perspective: Understanding pneumonia

From a parent dealing with pneumonia several episodes in a year, here's what I understand.

When infection reaches one or both lungs, the airways swell resulting to a buildup of mucus or fluid in the air sacs making it difficult to breathe because the airways are blocked and oxygen could hardly reach the blood. That’s why, we cringe at the first sign of colds or cough.

Pneumonia is a bacterial or viral infection of the lungs... it causes inflammation of the air sacs in one or both lungs.³

In Eira’s case, as soon as she catches colds or starts to cough, the mucus build-up takes just overnight and her body goes into relapse. Her temperature quickly heats up, breathing gets faster and labored with wheezing sound, her appetite reduced (if not completely gone), and in some episodes she throws up any food or fluid intake and begins to dehydrate. 

Timely and proper management is crucial.

In most episodes we experienced, she acquires viral infection when exposed to a human carrier, or in some cases triggered by asthma attacks; and that progresses into bacterial infection requiring treatment with antibiotics.


We have to constantly watch out for anyone carrying viral infection that could quickly spread simply by coughing or sneezing and transmitted to her. Pneumonia could also be caused by fungal infection, a rare case.

Thankfully, Eira never had pneumonia caused by fungal infection.

Image Source: tabletsmanual.com

The above image shows you the anatomy of the lungs to have a better understanding of what pneumonia looks like. It usually begins after an infection in the upper respiratory tract moving to the lungs.

Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.⁴

Breathing gets difficult the moment infection sets in and fluid fills the air sacs in one lung or in some cases, both.

In our series of ER rush, emergency responders who knew us would quickly check for Eira’s SO₂ (blood oxygen saturation) level. They use a handy pulse-oximeter. It measures how much oxygen the blood is carrying and indicates the health functions of the lungs.

More often than not, Eira’s dropping SO₂ levels require additional oxygen support.

Prevention and control: Responding on time with proper management

I should stress that medical management may be different for every child. 

Eira’s condition may not be the same with your child’s. It’s important that you consult with your pediatrician specializing in pulmonology and discuss what you can do from home as first responders to care that may help prevent or control the progress of your child’s recurrent pneumonia.

For us, at the first sign of viral infection, our pulmonologist stresses the importance of keeping the airways open.

Before we started her on Seretide, she was given Meptin. It’s a bronchodilator that helps keep the airways open for 24 hours. It helps ease her breathing.

But recently, it seems that her asthma attacks cannot be sufficiently controlled with a regular steroid inhaler with salbutamol neb (reliever med).

So, we shifted to Seretide per doctor’s order.

That means we’re skipping on Meptin. And that’s because seretide contains a combined active ingredients: salmeterol and fluticasone propionate that already helps reduce the inflammation in the lungs and keeps the airways open.

The device above is called a babyhaler. If your pediatrician recommended the use of a babyhaler on your child, make sure you learn the proper technique of using the device. The video below is a helpful demo with Ann Toother, a Clinical Nurse Specialist (Respiratory) on how you should properly use the babyhaler when delivering medication.

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What we do from home controlling pneumonia

As parents, we should be equip with proper education on how to properly respond on time during emergencies to control and prevent the progress of pneumonia.

• Treating acute breathing emergencies… 

The nebulizer kit has always been our good friend during emergencies at home. When breathing gets troubled, tight or difficult, treatment with Salbutamol Nebule Solution using a portable nebulizer provides quick relief to the lungs as it quickly delivers the medication directly to the respiratory tract and helps prevent respiratory problems from developing.

Tip: Use the baby mask from the neb kit for optimized treatment effect.

Recommended for you:

OMRON MicroAIR U100 Portable, Pocked-Sized, Silent Mesh Nebuliser 

• Medication container capacity: 10ml maximum. 

• Easy to assemble, simple preparation 

• Wide medication compliance  

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• Keeping fever down… 

Fever is the body’s natural response to threats such as viral or bacterial infections. While it is a good sign that shows your body is putting up a good fight against infection, it’s important to keep it down when the body temperature rises. Eira usually hits 38 to 39 degrees and at one point her fever reached over 40 degrees despite the antibiotics and paracetamol.

Risk for convulsion is high during peak points of fever.

So we don’t simply rest our faith on paracetamol alone in keeping fever down. Applying cold compress on the whole body has been an effective method in breaking a fever. With Eira, it’s only a matter of minutes after applying cold compress then her temperature goes back up again. That makes it more important to monitor and continuously apply cold compress to keep her body temperature low.

• Hydrating… 

The risk for dehydration when your child loses appetite or when there is fluid losses is common.

This is important: Our pulmonologist cautions against giving children Gatorade for purposes of hydrating. It contains high level of sugar that can make diarrhea worse, according to pediatrician Jo Ann Ryhans.

We give Eira pedialyte. This is recommended by her pediatricians. It helps prevent dehydration and replace losses of nutrients and electrolytes when vomiting or sometimes suffering from diarrhea. It contains balanced levels of salt and sugar made-to-measure for the needs of children.

Special Note: Consume Pedialyte within 24 hours after opening.

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But we keep a sharp eye in observing her condition. There are cases when dehydration is severe and she needs IV insertion at fast drip. Be quick to know if your child is severely dehydrated and call 911 if you observe these signs--

• lethargic, or sleepy
• dry lips
• does not urinate in over 12 hours
• weak, or nauseated
• labored or tight breathing
• vomiting
• pale skin

Notes: Eira is also partially diagnosed with RSS, so when she begins to lose appetite and refuses to take in any food or fluid within four hours, it’s our cue to ER rush because she could be at risk for hypoglycemia. 

I’m sure you know your child better. If you feel that something is not right, don’t think twice and take your child to the nearest emergency clinic.

• Controlling fluid losses… 

A bad episode of recurrent lung infection has Eira on lots of fluid losses. Stomach disorder causes her to throw up at every attempt to intake fluid or food. We’re always ready with Domperidone. It’s an oral medication to prevent reflux and relieve symptoms of vomiting and possible nausea and loss of appetite. In episodes of viral infection, this usually works and she recovers her appetite soon after a full rest.

But with bacterial infection, it’s always necessary for antibiotics before she recovers back to health with restored energy and appetite.

Some helpful tips for prevention

• Serve healthy foods
• Encourage active play
• Identify and avoid allergic triggers
• Create a habit to wash hands before handling food and eating
• Upon arriving home, instruct to wash up after a few minutes of rest
• Avoid allergic triggers such as powder, pollens, fabric conditioners, scents, etc.
• Seek advice from pediatrician if your child have trouble swallowing
• Make sure your child gets enough rest
• Avoid contact with sick people
• Don't use alcohol heavily

Final Insights

I get it. I cannot bubble-wrap my kid from all pathogens. But the thought of losing my daughter to pneumonia scares the crap out of me. Every time.

So, prevention and control are what we recognize as the two strong shields against pneumonia. And it starts with proper education.

• Recognize the early signs of infection
• Consult with your pediatrician about how you can prevent and control the progress of pneumonia in your child
• Be quick to take note of details you observe and be completely open in sharing the information with your pediatrician during consult for a more precise diagnosis.
• Call it paranoia, but I can recognize the first sign of asthma attack and / or viral infection in my child. Early recognition is one of the keys to preventing and controlling the progress of pneumonia.

I choose to prepare for this battle and win. So, I throw a lot of questions at our pulmonologist that helps me provide better care for my child with developmental delays at home.

Do you have questions, too?

We can ask our doctors and get you answers direct from relevant medical professionals and specialists. Simply fill up the box below for your questions.

If you learned something from this article, please share with your families and friends. Join us again in the next blog!

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References:

¹Seddon PC, Khan Y. “Respiratory problems in children with neurological impairment.” Archives of Disease in Childhood 2003;88:75-78.

²Department of Health. Retrieved on November 24, 2017 from http://www.doh.gov.ph/Statistics/Leading-Causes-of-Child-Mortality

³Asthma Respiratory Foundation, NZ. “Living with Childhood Pneumonia.” Retrieved on November 24, 2017 from https://www.asthmafoundation.org.nz/your-health/living-with-childhood-pneumonia

⁴The Nemours Foundation. “Infections: Pneumonia.” Retrieved on November 24, 2017 from http://kidshealth.org/en/parents/pneumonia.html

⁵Schochet, Peter N. and Lie, Hauw S. “Recurrent Pneumonia in Children.” Pedilung. Retrieved on November 24, 2017 from http://pedilung.com/pediatric-lung-diseases-disorders/recurrent-pneumonia-in-children/