Recommendations after ARVI. Orvi in \u200b\u200bchildren: the beginning of beginnings

Acute respiratory viral infections (ARVI) in the practice of a pediatrician is a topical topic. Taking into account the fact that one child has, on average, 1 to 8 diseases per year, each doctor has significant experience in diagnosis and treatment. The mentioned experience is not only professional, but also personal - ARVI, this is exactly the pathology in relation to which the doctor with sad regularity has to "use" not only patients, but also his own children and himself. Theoretical aspects related to etiology, pathogenesis and epidemiology ARVI are well known. The spectrum of pathogens and the main pathogenetic mechanisms are fully and specifically reflected in any textbook on infectious diseases. But applied issues - from terminology to the scope of treatment measures - remain largely uncoordinated to this day.
Popular wisdom is rather skeptical about the possibilities of medicine, claiming that the treatment of the disease (more precisely flu, colds, ARI, ARVI) lasts one week, and in the absence of such, recovery occurs in 7 days.
The above ARI, flu, cold and ARVI, from the point of view of the layman, are perceived as synonyms, but in the medical environment there is no clear differentiation of these terms.
Recall that ARVI - this group acute viral infections , affecting various parts of the respiratory tract and having similar clinical symptoms. Etiologically, it (group) is represented by epitheliotropic (rhinovirus, parainfluenza virus, RS virus) and lymphotropic viruses (adenovirus).
A disease caused by each of the listed viruses, has its own semiotic features, taking into account the selective defeat of epithelial cells in a certain area of \u200b\u200bthe respiratory tract. At the same time, this selectivity is influenced by a significant number of factors (virulence, age, immune status, environmental conditions, therapy tactics), therefore, we can only talk about a greater or lesser frequency of occurrence of specific symptoms, but not about their pathognomonicity. Simply put, if rhinovirus affects, as a rule, epithelial cells of the nasal mucosa, this does not mean that acute pharyngitis cannot be called exactly rhinovirus... Yes, the lesion of the larynx is typical for the virus parainfluenza, but due to it bronchitis or rhinitis- they are not rare, in turn.
Flu in the aspect under consideration - just a particular variant ARVI with its epidemiological and clinical features due to the variability of the antigenic structure virus and its tropism to the epithelial cells of the bronchial mucosa.
Virological studies make it possible to clarify the type of pathogen and formulate a clinical diagnosis in accordance with the requirements of the ICD (parainfluenza infection, rhinovirus infection, influenza A, etc.). But clinical symptoms allow the doctor to only assume the type of pathogen with varying degrees of probability. It is clear that the combination of fever, pharyngitis and conjunctivitis makes it possible to assume with almost 100% probability adenovirus infection, and acute bronchiolitis in a child of the first year of life - RS infection. Exceptions only confirm the rule, hence the understandable love of pediatricians for the unifying term " ARVI", especially given the fact that co-infections are far from uncommon.
However, the main value of the term itself ARVI consists in a clear designation of precisely viralthe nature of the disease and this is very important, because the tactics of therapy to a very small extent is determined by the type of pathogen and to a very large extent - by the level of preferential localization of the pathological process (rhinitis, pharyngitis, laryngitis, tracheitis, bronchitis). As a consequence - the practical feasibility and self-sufficiency of such, for example, a diagnosis as " ARVI, nasopharyngitis "or" ARVI, bronchitis ".
A counterweight ARVI, the term " ARI"that is, spicy respiratory disease , in no way reveals the etiological structure of the disease, combining pathological conditions completely different in the pathogenetic and therapeutic sense. Sharp viral and acute bacterial infections, bacterial complications ARVI and exacerbation of chronic infections of the nasopharynx - often have similar, but not at all identical clinical symptoms, and the tactics of therapeutic effects differ in principle. In view of the above, the use of the term " ARI"unwittingly implies the ambiguity of the diagnosis, which is quite acceptable in the practice of an ambulance paramedic, but not entirely correct for a doctor.
The mentioned "incorrectness" also applies to the concept " cold". This word is not often found in the domestic special literature, but it is easy to find in popular articles, translated monographs, commercials and annotations to dietary supplements. From the point of view of the explanatory dictionary, cold is a disease associated with hypothermia. Most often we are talking about the activation of chronic inflammatory processes (tonsillitis, adenoiditis), less often - about ARVI, the ease of development of which, after colds, easily explained by a decrease in local immunity respiratory tract.

The breadth of views on the tactics of therapeutic influences is striking in its diversity. At the same time, it is extremely difficult to give an adequate, truly scientific assessment of the effectiveness of specific pharmacological agents and treatment methods. This is due to the transience and, in most cases, the insignificant severity of the disease, when it is difficult to be sure that the improvement was achieved precisely due to the use of a certain medicine, and did not occur as a result of a natural development of events.
It is not surprising that, having set out to prove the effectiveness of any drug, it is not difficult to achieve a result, because most patients will safely turn into healthy ones within one week.
Hence, two global trends in assessing the role of pharmacological drugs:

The statement of the fact that the effectiveness of this group of drugs has not been proven, for example: "Expectorants reduce the viscosity of sputum. The effectiveness and benefits in comparison with drinking plenty of fluids have not been proven."

Reasoned attempts to justify the use of everything that will not harm, for example: "The use of bifidumbacterin-forte in acute respiratory viral infections (ARVI) in children has shown that it is effective in the treatment of this pathology. "

Taking into account the above quotes, the practicing physician is often at a dead end: on the one hand, several hundred, if not thousands of pharmacological agents can be used with a reference to the achievements of medical science, on the other hand, the effectiveness of the vast majority of them has not been convincingly proven.
Fueling the fire adds a changing attitude towards many drugs that have been successfully used for decades ARVI... A typical example is the categorical prohibition on using viral infections in children aspirin, due to the real threat of Reye's syndrome development.
Many authors of serious studies draw attention to the fact that no pathological condition can be compared with ARVI by the number of complications associated with the therapy. If we add to this the fight against polypharmacy, constantly declared by WHO, then it becomes clear that an increasing number of practical pediatricians realize that the child's body in the overwhelming majority of cases is able to cope with respiratory viral infection... The task of the parents and the doctor is to create conditions under which the struggle of the micro- and macroorganism with the highest possible probability will end with the victory of the latter.
The implementation of the above conditions implies the solution of three major tasks.
I. Optimization of the physical parameters of the inhaled air.
Pathogenetic rationale. Taking into account epitheliotropy respiratory viruses, hypersecretion of mucosal glands occurs at all levels of the respiratory tract. The resulting secretion (sputum, nasal mucus) is one of the main factors of antiviral defense: both specific (IgA) and non-specific (for example, lysozyme).
When a child is sick ARVI, breathes dry and warm air, the violation of the rheological properties of the secretion occurs within several hours - the real duration has an inverse relationship with the severity of the fever. The thickened sputum not only ceases to fulfill its protective functions, but also, depending on the lesion of a certain level of the respiratory tract, disrupts the patency of the airways, ventilation of the sinuses and tympanic cavity. Hence, the increased risk of complications - pneumonia, sinusitis, otitis media, respectively.
Thus, clean, cool, humid air in the room where the sick child is located is a prerequisite for the optimal course of the disease (desirable physical parameters are temperature 17-19 о С, humidity 75-90%).

Ideally a room with a minimum of dust accumulations (carpets, upholstered furniture, soft toys, books not behind glass, etc.).

Frequent wet cleaning.

The use of household air humidifiers.

Refusal to use heaters.

Ventilation of the room.

Warm clothes.

II. Active rehydration.
Pathogenetic rationale. Fever, difficulty in nasal breathing, an increase in perspiratory losses, as a result - hemoconcentration, impaired rheology of blood and sputum. The drier the air, the greater the loss of liquid for its humidification.
Practical implementation methods:

Drink plenty of water: mineral water, balanced saline solutions, raisin decoction, compote, tea.

The temperature of the liquid used for drinking should be close to body temperature (maximum shortening of the absorption time).

Standard criteria for the effectiveness of rehydration are skin and mucous membrane moisture, urine output, fever, and heart rate.
III. Feeding on appetite.
Absence or significant decrease in appetite in a child who is ill ARVI, is a typical symptom. Its severity is directly related to the severity of the disease and has an absolute biological feasibility.
Practical recommendations:

Attempts to force feed are unacceptable.

Focus on carbohydrate-rich foods.

Decrease in one-time food volume with an increase in the number of feedings.

The paradox of the situation lies in the fact that the implementation of the three tasks listed above is entirely entrusted to the relatives of the sick child. This is, in fact, the main problem of treatment. ARVIbecause actions that are unambiguously necessary are constantly in conflict with the ideas of most parents about what is good and what is bad for a sick child.
The domestic mentality traditionally considers abundant food and warmth as the obligatory needs of the child's body, and the doctor as an obligatory source of recipes. Actions that contradict public opinion constantly serve as a pretext for conflicts at all levels - from the relationship between the pediatrician and the parents and ending with the contacts of the same pediatrician with his own superiors.
Two typical examples.
1. Prescribed 10 drugs, including an antibiotic, the disease was complicated by pneumonia. The child is to blame, of course, because he is weak.
"Nothing" has been assigned (because to put in order the children's room, to actively water and not to force-feed is "nothing"). The disease was complicated by pneumonia. The doctor is to blame, of course, because "nothing" has been prescribed.
2. The disease was complicated by pneumonia, which required hospitalization. "Debriefing" in the office of the authorities. If the management does not find the prescribed drugs on the card, the standard conclusions about "inadequate therapy" and "underestimation of the severity of the condition" will not be long in coming.
So it turns out that aRVI treatment Without drugs, to put it mildly, it is fraught, because it is not accepted to call it "real" treatment.
You can, of course, complain about the hard lot of the pediatrician.
One can dream of those times when the need to disseminate simple and very necessary information about the principles of helping a sick child will be entrusted to high school, since this is no less important than sines, cosines and initial sexual training.
It is hoped that the tactics of limiting the pharmacological load as much as possible will be put on the heads of doctors in the form of "methodological recommendations" adapted to the real working conditions of a pediatrician and the mentality of the population.
But you can already not complain and not dream, in the hope of good uncles from the Ministry of Health, but really act.
The main thing, perhaps, is the realization that spending 15 minutes talking with relatives is much easier, more effective and safer than dealing with the consequences of active pharmacotherapy or treating pneumonia caused by antibiotic-resistant strains of bacteria.
An indispensable consequence of limiting the drug load is the need to take into account the social factors and individual characteristics of the sick child, more active dynamic monitoring, careful control over the implementation of prescriptions and, finally, timely correction of therapeutic tactics.
Fundamental position: we are talking about limiting the use of pharmacological agents, and not about rejecting their use raised to the level of dogma. In the end, symptomatic therapy aimed at alleviating subjectively unpleasant sensations that inevitably accompany the entire course of the disease is one of the direct tasks of the doctor. And the restoration of nasal breathing, through the rational intranasal use of adrenergic agonists and the use of paracetamol with poor fever tolerance are logical and quite reasonable ways to solve this problem.
I would like to emphasize once again that we are not talking at all about crossing out the achievements of medical science and denying the importance of pharmacological assistance in the treatment of severe and complicated forms. ARVI... At the same time, narrowing and concretizing indications, listing specific clinical situations when it is impossible to do without "real" treatment is the most urgent task.
But this is already a topic for another work ...

LITERATURE
1. Komarovsky E.O. Viral croup in children. Clinic. Diagnostics. Therapy tactics. Kharkov, Folio, (1993).
2. Pediatrics. Ed. J. Gref. Per. from English - M., Practice (1997).
3. Rigelman R. How to avoid medical errors. A practitioner's book. Per. from English - M., Practice (1994).
4. Feklisova L.V. et al. New approaches to the use of probiotics in the complex treatment of acute respiratory viral infections in children. Epidemiology and infectious diseases, 5 (2001).
Published in the medical newspaper "Medicus Amicus", No. 6 2002. www.medicusamicus.com

ARVI in children Is a set of viral infections with an acute course of the clinical picture that affect the respiratory tract at different levels and have a similar clinical symptom complex. Etiopathogenetically, this category of diseases is represented by viruses with tropism in relation to epithelial cells, as well as organs of the lymphatic system.

Each etiopathogenetic form of ARVI in children is distinguished by semiotic features, the selectivity of which depends on the degree of variability of the virus, the age of the child, his immune status, environmental conditions, and the tactics of the therapy used. The incubation period of ARVI in children varies over a wide time range, depending on the specificity of the pathogen, which explains the high incidence rate among the child population.

Correctly conducted virological analysis allows not so much to determine the type of the virus-causative agent of ARVI in children, but to clearly verify the diagnosis with the indication of the ICD-10 code, in which there are individual sections of parainfluenza, rhinovirus ARVI, etc.

The essence of the term ARVI in children is to define exclusively viral nature this disease, which allows the infectious disease specialist to apply certain methods of drug correction. In addition to indicating in the diagnosis "ARVI" the treating specialist is recommended to indicate the localization of the pathological process.

Causes of ARVI in children

The main etiopathogenetic factors in the occurrence of ARVI in children is the presence of a viral agent, which is played by various types of influenza virus, four types of parainfluenza viruses, adenovirus, two RSV serovars, and rhinoviruses. Almost all pathogens of ARVI in children are RNA-containing viruses, with the exception of adenovirus containing DNA.

Adenoviruses have the highest resistance in the environment, while other pathogens of acute respiratory viral infections in children die from exposure to UV, elevated temperatures and disinfectants in a short time.

In pediatrics, cases of acute respiratory viral infections in children are extremely rare, provoked by the ingestion of enteroviruses ECHO and the Coxsackie type into the child's body, however, every practicing pediatrician and infectious disease specialist should remember about such pathogens, since they cause an atypical form of the disease.

The emergence of ARVI affects children of any age category who have been in close contact with a person with ARVI for a short or long time. In pediatrics, in contrast to the widespread concept of the contact-household mechanism of transmission of a viral infection, ARVI also spreads rather quickly by airborne droplets in children.

Feature of children early age is their increased natural susceptibility to the occurrence of ARVI. The maximum level of contagiousness in ARVI in children under one year old is the first week of the disease. As with everyone infectious diseases, with ARVI in children, there is also some cyclical or seasonal development of the disease, which occurs during the cool period of the year. A noteworthy fact is that after the existing fact of the transferred ARVI in children, only type-specific immunity is formed, which explains the frequent ARVI in a child, which can be observed even within one year.

In a situation where acute respiratory viral infections in children are not caused by the influenza virus, there are isolated outbreaks of the disease, and the tendency to develop full-scale epidemics affecting a large number of the child population is noted only with influenza.

If we consider the pathogenesis of the development of ARVI in children, then infectious disease specialists pay special attention to the issue of the “entrance gate of infection”, which can be not only the proximal airways and conjunctiva of the eyes, but even the digestive tract, which differs from the pathogenesis of ARVI in the adult category of patients. A feature of all pathogens of acute respiratory viral infections in children is their epitheliotropy. The primary stage of etiopathogenesis is the adsorption of the ARVI virus on the surface of the epithelial cell, followed by penetration into the cytoplasm and their enzymatic disintegration.

The reproduction of ARVI viruses in children occurs intracellularly, which inevitably provokes the development of degenerative changes in cells with the subsequent development of inflammatory processes in the mucous membrane in the projection of the entrance gate.

The inevitable outcome of the pathogenesis of acute respiratory viral infections in children is the ingress of a large concentration of viruses into the general bloodstream, the severity of which directly depends on the intensity of dystrophic damage to the epithelium, as well as the length of the pathological process.

A feature of the pathogenesis of acute respiratory viral infections in children is a tendency to the rapid development of a toxic-allergic reaction, provoked by the ingress of not only viruses into the bloodstream, but also the decay products of epithelial cells. The toxic effect in this situation is on all organs of life, however, the most harmful effect is the effect of toxins on the brain and heart of the child.

ARVI in children is often complicated, since at the site of damage to the epithelium of the proximal airways, a violation of their barrier function develops, which is accompanied by massive reproduction of the bacterial flora.

Symptoms and signs of SARS in children

ARVI in infants and older children is always characterized by an acute onset with a maximum rise in body temperature already in the first hours of the disease. Children of the younger age group differ in that they have more pronounced manifestations of intoxication syndrome in the form of lethargy, adynamia, and deterioration in appetite. Intoxication with ARVI in older children is manifested by decreased activity, vomiting, and in severe cases, the appearance of meningeal signs.

The height of the clinical picture in acute respiratory viral infections in children is manifested by the appearance of symptoms of catarrhal syndrome in the form of coughing, the release of a scanty amount of mucous discharge from the nasal passages, a slight hyperemia of the mucous membranes of the oropharynx, "granularity" of the pharyngeal walls. A frequent manifestation of ARVI in children is the appearance of injections of the vessels of the sclera, as well as nasal bleeding of a non-intense nature.

With significant fever during illness, the child may experience a rapid heartbeat, as well as muffled heart sounds. An improvement in the condition of acute respiratory viral infections in children, as a rule, is observed from the third day and is manifested by a decrease in body temperature, a weakening of intoxication with the preservation of catarrhal manifestations or even an increase in their intensity.

The duration of ARVI in children ranges from 7-10 days and depends, first of all, on the type-specificity of the pathogen virus. A characteristic consequence of ARVI in children during the period of convalescence is long-term preservation of asthenization syndrome.

With parainfluenza, which also belongs to the category of acute respiratory viral infections in children, there is a gradual onset of the disease, manifested by coughing, a slight runny nose, and a slight increase in body temperature. Deterioration of the condition is observed, as a rule, on the fourth day of the disease, when the manifestations of intoxication syndrome, laryngotracheitis, etc., increase. In a child after ARVI, the body temperature is normalized, and the symptoms of laryngotracheitis can bother for a long period of time in the form of a sensation of soreness of the oropharynx and pain behind the sternum during coughing. In infancy, with ARVI caused by the parainfluenza virus, there is a hoarse voice and a "barking" cough.

Adenoviral ARVI in children, on the contrary, is characterized by an acute onset with a lightning-fast increase in symptoms. Fever in this situation is wavy in nature, due to the generalization of the process and the appearance of inflammatory changes in the organs of the lymphatic system. A characteristic manifestation of adenoviral ARVI in children is the appearance of the so-called pharyngoconjunctival fever.

In respiratory syncytial viral infection, inflammatory changes affect mainly the lower parts respiratory system, which is manifested by symptoms of bronchitis. Intoxication manifestations are of low intensity or may be absent altogether.

Typical pathognomonic manifestations of rhinoviral ARVI in children is the appearance of abundant serous-mucous discharge from the nasal passages without concomitant intoxication and fever.

The clinical symptoms of enteroviral ARVI in children are similar to rhinovirus, but differs in the appearance of signs of impaired digestive function of the gastrointestinal tract. Diarrhea with ARVI in a child lasts about three days, and the pain syndrome in the abdominal cavity is paroxysmal in nature. Other manifestations of enteroviral ARVI in children are the appearance of serous meningitis, exanthema, herpetic sore throat.

Complications of ARVI in children consist in the addition of a mixed bacterial and viral flora with the formation of foci of infiltration of lung tissue with the involvement of the pleura in the process. Suspicious symptoms in this situation are: an increase in body temperature to febrile numbers, the appearance of respiratory disorders in the form of shortness of breath, small bubbling rales in the lungs with their local location.

In the case when the child is not provided with timely medical correction of pneumonia in ARVI, destructive processes may develop in the lung tissue, the outcome of which is the formation of focal pneumosclerosis.

Temperature with ARVI in children

Fever is typical clinical manifestation not only ARVI in children, but also other diseases of an infectious nature, as it is a kind of compensatory reaction of the child's body in response to the intake of viral agents.

With an increase in skin temperature, stimulation of the production of substances is noted, the action of which is aimed at fighting viruses. Among such substances, interferon occupies a leading position, which is a protein substance that can neutralize viral particles. There is a clear correlation between the production of interferon and the body's temperature response. So, if there is a high temperature with ARVI in children, it means that during this period the child has a maximum production of interferon.

Of course, each child is characterized by individual fever tolerance. In some situations, with ARVI, a child can safely tolerate an increase in temperature even up to 39 degrees, while in others, even a minimal increase provokes a pronounced disorder of well-being. In this regard, infectious disease specialists and pediatricians do not give universal recommendations as to which numbers on the thermometer are a signal for the use of drugs.

With regard to non-drug measures that are shown to all children with ARVI, regardless of the severity of the fever, two methods should be considered: increasing the drinking regime and providing cool humidified air to the room where the child with fever is.

A decrease in body temperature in this situation will occur due to an increase in sweat production. As drinks for soldering a child at elevated temperatures, preference should be given to decoctions of dried fruits. An increase in the drinking regime allows not only to reduce the temperature in ARVI, but also to prevent the development of blood thickening.

There are some situations in which even a minimal increase in temperature is a life-threatening condition for a child. Such situations include a burdened premorbid background of a child, in which there is any disease of the nervous system. The danger lies in the increased risk of developing a convulsive syndrome, which, in the absence of timely medical correction, can cause death.

The most effective drug for fever, which occurs in children with ARVI, is Paracetamol, which is available in various dosage forms, which allows it to be used even at home for children of different ages.

Diagnosis of ARVI in children

Features of verifying the diagnosis of acute respiratory viral infections in children, as well as differential diagnosis depend on the patient's age, premorbid background, the presence of a combined viral infection, the possibility of developing atypical and asymptomatic forms of the disease, as well as complications. In this regard, the etiopathogenetic diagnosis of ARVI in children is very complicated, especially in the case of sporadic damage to the child population.

Thus, a large group of infections affecting the organs of the respiratory system and possessing epitheliotropy are combined by infectious disease specialists and pediatricians into a single diagnosis "", with the exception of.

Laboratory verification of the etiopathogenetic form of ARVI using virological examination techniques is important in epidemics, as well as a significant increase in the incidence among children in schools and kindergartens.

The most effective laboratory determination of the type-specificity of the virus in ARVI in children is "isolation of the pathogen virus and its cultivation on biological material."

Retrospective data on the causative agent of ARVI in children can also be obtained by the method of serological research in the form of a complement binding reaction, a neutralization reaction of paired blood serums, which is carried out at a strict frequency of fourteen days.

Of course, the above methods are very laborious to perform, and also require a long time, which cannot satisfy the requirements of the attending physician.

Currently, virologists have developed a method for the rapid diagnosis of acute respiratory viral infections in children by the method of immunofluorescence detection of antigens of one or another respiratory virus in the epithelial cells of the nasal passages. It takes about four hours to get a reliable opinion.

A severe course of acute respiratory viral infections in children can simulate meningoencephalitis, which requires a differential diagnosis by using the study of cerebrospinal fluid after a lumbar puncture. Pharyngoconjunctival fever, which is observed with adenoviral ARVI in children, needs to be differentiated with diphtheria lesions of the conjunctiva. In addition, experienced infectious disease specialists always assess the epidemiological situation, which allows them, even in the absence of laboratory diagnostics, to correctly establish the diagnosis.

ARVI treatment in children

For any type of ARVI in children, pathogenetically justified treatment is the appointment of an adequate regimen of antiviral chemotherapy. Unfortunately, many antiviral drugs, produced in large quantities by various pharmaceutical companies, increasingly do not have a pronounced positive effect. And at the same time, with influenza, as one of the forms of acute respiratory viral infections in children, the appointment of antiviral agents in the first day of the disease is mandatory.

Currently in pediatric practice, the most common antiviral agent is Remantadine, which has an inhibitory effect not only against the influenza virus, but also against respiratory syncytial, parainfluenza infection. The recommended therapy for acute respiratory viral infections in children is a five-day course of Remantadine at a calculated daily dose of 1.5 mg per kg of the child's weight. For the treatment of infants with signs of ARVI, Remantadine is used in the form of a syrup in a daily dose of 10 ml. To improve the pharmacological effect of Remantadine, antiviral therapy should be combined with the appointment of No-shpa in a daily dose of 400 mg.

A similar antiviral effect is observed when children with ARVI are prescribed Arbidol, which also enhances the production of endogenous interferon. This drug for ARVI is prescribed to children over the age of two years in a daily dosage of 2 g.

In case of respiratory syncytial ARVI in children, it is advisable to use Ribavirin as an antiviral therapy, which is used in the form of inhalation at a calculated daily dose of 20 mg per kg of the child's weight.

As a local antiviral therapy should be used 0.5% Florenal, oxolinic ointment 1-2%, which have a low toxicity.

Universal antiviral drugs is a group of interferons and their inducers, which not only suppress viral replication, but also stimulate the immunological abilities of the child's body.

Currently, recombinant interferons (Grippferon in the form of intranasal drops in a daily dosage) are widely used in the treatment of ARVI in children. In addition, in relation to infants, Viferon is effectively used in the form of rectal suppositories, which contains not only interferon α-2β, but also vitamins of group E and C.

In practice, for the treatment of acute respiratory viral infections in children, infectious disease specialists use not only chemotherapy drugs, but also herbal products in the form of adaptogens.

Recently, there has been a tendency towards unjustified prescription of antibiotics for children suffering from uncomplicated ARVI. It should be borne in mind that antibacterial agents in children can provoke a number of adverse reactions, the main of which is. In addition, antibiotics have an extremely negative effect on the formation of the normal function of the immune system.

The need for appointment antibacterial drugs with acute respiratory viral infections in children, it occurs with a history of recurrent otitis media, an unfavorable premorbid background in the form of severe malnutrition, congenital malformations, as well as in the presence of manifestations of an immunodeficiency state.

Depending on the type of bacterial flora, various groups of bacterial agents are used in the treatment of children with ARVI. So, the existing signs of otitis media and sinusitis need to be corrected with the use of Amoxicillin orally at a calculated daily dose of 45 mg per kg of the child's weight.

For the treatment of acute respiratory viral infections in children, complicated by the development of pneumonia, it is advisable to use Ceftriaxone 500 mg twice a day parenterally, and in case of an atypical course of the disease, it is recommended to supplement the basic treatment regimen with Macrolides (Azivok at a calculated daily dose of 10 mg per kg of child's weight).

The use of pathogenetic treatment for acute respiratory viral infections in children is necessary in relation to the elimination of the manifestations of acute laryngitis and obstructive bronchitis. The signs of laryngitis in a child are not grounds for the use of antibacterial agents, however, they are an absolute indication for intramuscular administration of Dexamethasone at a calculated dose of 0.6 mg per kg of the child's weight, which prevents further progression of croup. After stopping an acute attack, the child should be transferred to maintenance therapy with inhaled steroid drugs in the form of a nebulizer - Pulmicort 250 mcg per day in combination with antispasmodics (Berodual 0.1 ml twice a day as inhalation).

Symptomatic therapy for ARVI in children must also be included in the complex treatment and antipyretic drugs occupy the leading positions in its composition. medicines... The safest antipyretic agent that is allowed for the treatment of children with signs of acute respiratory viral infections is Paracetamol, a single dosage of which is 15 mg per kg of the child's weight, and the maximum allowable daily dose is 60 mg per kg of body weight. In a situation where there is a complicated course of ARVI, due to the addition of an inflammatory component, Ibuprofen should be preferred in a single calculated dose of 5 mg per kg.

To eliminate nasal congestion, as well as to reduce the discharge of discharge from the nasal passages, vasoconstrictor intranasal drops are used, the duration of therapy in this case should not exceed three days (Vibrocil 0.025% solution). Before use vasoconstrictor drugs the nasal passages should be thoroughly cleaned with saline.

Cough in children should be treated not with the use of codeine-containing drugs, which are contraindicated for children, but with the help of expectorants in combination with mucolytic drugs (Pectolvan C 5 ml twice a day).

Pathogenetically justified is the conduct of non-drug measures, the action of which is aimed at improving the secretion of the mucous membranes of the respiratory tract. The secretion of the child's mucous glands contains the maximum amount of immunoglobulins and lysozyme, the function of which is to inhibit the virus.

To ensure an increase in the production of mucus in the oral and nasal cavity, the child should be in a damp cool room, for which the following recommendations should be followed: remove all objects that quickly accumulate dust, carry out frequent wet cleaning, use household air humidifiers, and refuse to use heaters.

ARVI in children - which doctor will help? If you have or suspect the development of ARVI in children, you should immediately seek advice from such doctors as a pediatrician, an infectious disease specialist.

The most common causes of ARVI are parainfluenza viruses, respiratory syncytial infection, rhinovirus and adenovirus infections. They are transmitted by airborne droplets. In everyday life, ARVI is often called a cold.

Important

In the first three years of life, babies suffer an average of 6-8 colds per year. Children attending kindergarten get sick more often at home. However, by school, kindergarteners begin to catch colds less often, but for those who did not attend the garden, ARVI "flourishes" in primary school.

The reason for this is the "virginity" of the child's immune system. To learn how to resist a particular cold infection, the immune system must first "get to know" it. There is "acquaintance" only through illness, therefore frequent colds are inevitable, but their number will decrease over the years. A child aged 3 to 4 years is normally sick no more than 6 times a year, at the age of 4 to 5 years - no more than 5 times a year, after 5 years - no more than 4 times a year.

If ARVI is observed more often, this is a reason to contact an immunologist. The same as in cases where the number of SARS is within the permissible limits, but the disease gives complications.

Keep in mind

More than 200 viruses can cause SARS. Depending on which one the child's organism "got acquainted" with, the manifestations of the disease may differ. But almost always observed:

• Runny nose. From the nose it can already on the first day "pour a stream", but it happens that at first there is congestion, and the discharge appears later.
• Sore throat, the severity of which depends on which virus caused the disease.
• A cough, which, like a runny nose, may appear immediately or after a couple of days.
• Elevated temperatures body. In some cases - up to subfebrile values \u200b\u200b(37-37.5 ° C), in some - immediately to high.
• General malaise headache.

Treatment

Do not be afraid of ARVI. If the child does not chronic diseases (for example, asthma), in most cases, his body is able to cope with a viral infection on its own. You just need to alleviate the baby's condition by eliminating particularly unpleasant symptoms. For this, drugs are used to reduce nasal congestion, sore throat, cough, etc. As well as inhalation, gargling.

With ARVI with high temperature bed rest is required.

By the way

Often in the clinic, a child is diagnosed not with acute respiratory viral infections, but with acute respiratory infections, that is, an acute respiratory disease. The fact is that a cough, a runny nose, malaise, a rise in temperature can be caused by exposure to the body not only of viruses, but also of some bacteria. To accurately identify the pathogen, you need to conduct an analysis, and it is far from always advisable to spend time on this.

If the analysis was not done, the doctor uses a more general term - "disease" instead of a narrower - "viral infection". The principles of ARVI and ARI treatment are similar, and the doctor will definitely tell you how to proceed.

Memo to parents

Should I give a child an antipyretic drug for ARVI? It depends on its condition and how much the temperature has risen.

If it is below 39 ° C, and the child tolerates it normally, you do not need to take an antipyretic. Give the immune system to fight the infection, because the temperature rises for this.

If the temperature is above 39 ° C, an antipyretic is given.

If the temperature is below 39 ° C, but the child is very worried, cries, he has seizures (or they have had them before), he complains about severe pain in joints, headache, does not show interest in the environment, antipyretic should be given and a doctor should be called.

At temperatures above 40.4 ° C, it is necessary to call an "ambulance" after giving an antipyretic drug.

Prevention

Vaccinations against ARVI do not exist, because there are a lot of viruses and they constantly mutate. Therefore, prevention here has two directions:

Avoiding meeting the virus. In the cold season, it is better to refuse to visit public events and places with a large crowd of people with your child.

Strengthening the body so that the immune system can adequately fight the virus that has entered the body and ARVI is easier and does not give complications. As a rule, most children do not need additional medications for this. But the child must get enough sleep, walk, temper. The house where he lives must be clean and the normal temperature must be maintained. The kid should eat right, getting all the necessary vitamins.

SOS!

Influenza is an acute inflammatory disease of the respiratory tract caused by the virus of the same name.

Influenza is classified as ARVI, but in this group it stands apart, because it is more severe than other respiratory viral infections, often gives serious complications, and in some cases is life threatening.

Need to know

If, with other acute respiratory viral infections, symptoms can occur gradually, and the disease develops smoothly, then the onset of the flu is always acute. The temperature rises sharply to high numbers, headache appears, pain in muscles, in the eyeballs, general malaise is very pronounced. Often times, parents can tell the exact hour when the child is sick.

When such symptoms appear, you should not self-medicate - you need to call a doctor. Today, there are a number of drugs that are highly effective against influenza. The earlier you start taking them, the easier the course of the disease and the lower the risk of complications. So timely diagnosis is very important.

Protection

The best way to prevent influenza is vaccination. The vaccine can be given to a child from 6 months old. Children in our country are vaccinated free of charge.

The vaccine is not absolutely effective, it reduces the incidence by about 80%. In particular, a child can get sick because he has encountered a virus of a different strain than was in the vaccine. But in this case, the disease will be easier than that of an unvaccinated child. In general, the incidence of influenza during an epidemic in vaccinated children is 2.5-4 times lower than in unvaccinated children.

Drugs

Remember, self-medication is life-threatening, for advice on the use of any drugs see a doctor.

In everyday life, this disease is known as the common cold, and doctors in certificates and maps indicate the diagnosis of ARVI - an acute respiratory viral disease.

The reason is infectious agents - viruses transmitted by airborne droplets, through dirty hands and other objects (toys, fabrics, doorknobs). Therefore, the disease is so common in places of mass congestion of children - kindergartens and schools.

Symptoms and Signs

It is very important to recognize the symptoms of ARVI in a child in time and not to confuse them with signs of other diseases. Any parent should be wary of the following deviations in the baby's health:

• lethargy;
• decreased appetite;
• fever, chills with shivering;
• runny nose, nasal congestion (read:);
• irritation, sore throat;
• headache;
• nausea, vomiting;
• coughing, sneezing;
• sweating;
• body aches;
• temperature rise.

The symptoms of childhood acute respiratory viral infections, especially at the initial stage, sometimes very much resemble flu and even pneumonia. Therefore, it is necessary to go to the hospital in time to clarify the diagnosis.

Diagnosis of the disease

At the doctor's appointment, not only those symptoms that the baby complains about (headache, malaise, dizziness, nausea) and which can be detected at home (runny nose, fever, cough) will be identified. The main thing for a doctor is to learn about the processes taking place inside the child's body. And for this, sometimes you have to go through a series of special examinations. Diagnosis of ARVI in children may include:

• RIF (mucosal smear) and PCR;
• serological research methods;
• consultations with a pulmonologist and otolaryngologist;
• radiography of the lungs;
• rino-, pharyngo- and otoscopy.

Diagnostics is 50% of successful treatment even in such a simple matter as children's ARVI. There are some mothers who prefer to treat this "worthless", in their opinion, disease at home. The result even after recovery is a weakened immune system, undermined health, so that a child, due to the negligence of his parents, can get sick several times a year.

ARVI treatment in children

ARVI is successfully treated with various methods, so the choice will depend only on the parents and on the doctor.

At home

ARVI in a child at home can be treated only in cases where health care a doctor is unavailable for one reason or another. Self-medication is a deceptive maneuver that can first improve the patient's condition, and then only aggravate. If it is not possible to see a doctor, you can treat ARVI at home in the following ways:

• antipyretic drugs: paracetamol, ibuprofen, nurofen;
• arbidol;
• tamiflu;
• rimantadine;
• ribavirin;
• acyclovir;
• interferons: viferon, kipferon, influenza;
• immunostimulants: isoprenosine, immunal, riboxin, imudon, bronchomunal, IRS-19, ribomunil, methyluracil.

Provide the patient with plenty of drink and complete rest. In the same home conditions, it would be appropriate to resort to traditional medicine, which will be an excellent addition to the main therapy prescribed by the doctor, but only with his permission.

Folk remedies

Folk remedies are something that is always at hand and absolutely safe, because it is prepared only from natural products bestowed by nature itself:

• rinsing the nose with salt water;
• inhalation over boiled potatoes or eucalyptus;
• pure honey;
• lemon;
• alcohol rubbing at high temperatures;

Before using folk remedies for the treatment of ARVI in a child, you should first consult a doctor in order to avoid complications.

Antibiotics

Modern doctors try not to poison the child's body with antibiotics, especially since the ARVI virus does not react to them. And, nevertheless, if ARVI is in an advanced form, its complications can recede only in front of them. Therefore, doctors often prescribe with this diagnosis:

• biseptol;
• cefuroxime;
• spiramycin.

Homeopathy today is a fairly common method of treating ARVI in children different ages... For the treatment of this disease, most often prescribed:

• vibruko candles;
• aflubin;
• oscillococcinum;
• EDAS-903;
• EDAS-103;
• flu heel.

An experienced doctor will select the appropriate drug for your child that will cope with ARVI in a short time.

Diet

To help a small body get rid of the disease, doctors advise following a certain diet aimed at strengthening the immune system:

• portions of food should be smaller, but they should be given to the child more often;
• water - on demand;
• more fresh fruits and vegetables;
• food should be moderate in calories.

Whichever method of treating childhood acute respiratory viral infections you choose, you must understand that the responsibility falls not only on the shoulders of the doctor, but also on yours. And you should always remember that it is much easier to prevent any disease than to cure it.

Prevention

Smart parents, anticipating another outbreak of SARS in the garden or school (they are especially frequent in the offseason), spend a number preventive measures to prevent this disease:

• exclude child contact with sick children;
• more often make him wash his hands;
• provide him with daily walks in the fresh air and proper nutrition;
• regularly strengthen his immunity.

If it is too late to carry out prevention, and the disease becomes neglected, you need to be aware of the consequences of such serious parental omissions.

Possible complications after ARVI in a child

Complications of untreated or not at all treated ARVI can be:

• bacterial rhinitis;
• tracheitis;
• meningitis;
• pneumonia;
• neuritis;
• radiculoneuritis.

Despite the fact that ARVI is not such a terrible disease as, for example, the same flu, you still cannot take it lightly. Do not start the disease, detect it in time, treat it under the supervision of specialists - and under such conditions, a speedy recovery is guaranteed.

FAQ

How long is the incubation period?

From three days up to two weeks. It all depends on the individual characteristics of the child's body.

What to do if vomiting starts?

In this case, give him antipyretic drugs in the form of rectal suppositories.

Cough left after ARVI: what to do?

A residual cough should not last longer than 2-3 weeks after recovery. If it goes beyond these limits, be sure to show the child to specialists - a pediatrician or an ENT specialist. At home, in this case, you can drink it with erespal in syrup.

How long does ARVI last in children?

Everything is individual. Someone full recovery comes already on the 5-6th day, and in someone the symptoms may persist up to 2-3 weeks.

What to do if diarrhea begins?

Stop rectal medications if you have used them. Treat with pills and syrups. Be patient and wait for the consolidating effect.

What temperature is acceptable?

In the first days of the disease, the baby's temperature can rise to 39 ° C and even higher. It is not recommended to bring down the temperature right away: the body must develop antibodies that will fight the virus. But if it continues to grow up, it is necessary to give antipyretic drugs or do alcohol rubbing.

Rash with ARVI: what to do?

In case of rashes, you should consult a doctor as soon as possible, who will conduct an additional examination to identify the allergen. Perhaps the baby has an intolerance to one of the drugs.

There are a number of conclusions about the dangers of cleaning cosmetics. Unfortunately, not all newly minted moms listen to them. 97% of shampoos use the hazardous substance Sodium Lauryl Sulfate (SLS) or its analogues. Numerous articles have been written about the effects of this chemistry on the health of both children and adults. At the request of our readers, we have tested the most popular brands.

The results were disappointing - the most advertised companies showed the presence of those very dangerous components in the composition. In order not to violate the legal rights of manufacturers, we cannot name specific brands. Mulsan Cosmetic, the only company that passed all the tests, successfully received 10 points out of 10 (read). Each product is made from natural ingredients, completely safe and hypoallergenic.

If you doubt the naturalness of your cosmetics, check the expiration date, it should not exceed 10 months. Be careful with the choice of cosmetics, it is important for you and your child.

Antiviral drugs used in the treatment of ARVI are divided into several groups:

1. Homeopathic remedies (viburcol, aflubin, oscillococcinum);
2. Chemotherapy drugs (remantadine, arbidol, tamiflu);
3. Interferons (suppositories viferon, nasal drops gripferon);
4. Preparations that promote the production of interferons (amiksin, cycloferon);
5. Immunomodulators (immunal, bronchomunal, ribomunil).

Of all the listed drugs, only Tamiflu acts on all types of influenza virus, including avian, having, according to many authors, a very pronounced activity. However, given the possible side effects of this drug, it is used only in inpatient treatment. As for other representatives of this group, despite the fact that rimantadine can be used in children after a year and even the presence of its dosage form in the form of a 0.2% solution in syrup, its use is limited only by a narrow spectrum of action on influenza A and the absence effect with other types of flu or other viral infections. Arbidol can be used as a method of treatment for influenza A and B, starting from the age of 12.

Interferons have become widespread as antiviral therapy in children, since it is with them that the protective antiviral action of the body is associated.

In this case, gripferon as a nose drop can be used from the first days of life. Amiksin is prescribed to children from the age of seven. The drugs of this group have a wide spectrum of action, being considered effective for any viral infection.

As for homeopathic remedies, there is no reliable evidence of the effectiveness of these remedies. In those cases when it comes to a severe course of ARVI, it is necessary to resort to more studied means, turning to homeopathy at the stage of prevention.

Treatment approaches

As for the immunomodulators shown in the prevention of any form viral diseases, then, according to pediatrician Komarovsky E.O., their use for therapeutic purposes is ineffective. Application can be limited only by preventive measures. According to the popular pediatrician E. Komarovsky, the treatment of ARVI in a child should consist of providing such conditions under which the virus dies as quickly as possible in the body. They include:

1. Compliance with the temperature regime at the level of 17-19 degrees, while carrying out the obligatory humidification of the room. It is the moist cool air that does not allow the mucous membranes to dry out and, thereby, provides local immunity;
2. Additional moisturizing of the mucous membranes of the nose and throat with solutions of sodium chloride (one teaspoon per liter of boiled water), as well as pharmacy products of similar action, such as "Aquamaris", "Ektericid";
3. Drink plenty of drinks, using compotes, decoctions, tea, mineral water at room temperature;
4. In cases where the temperature values \u200b\u200bhave exceeded 38 degrees, it is possible to use antipyretic drugs. In this case, the drugs for the treatment of ARVI in children are paracetamol or ibuprofen;
5. The use of aspirin for acute respiratory viral infections in children is contraindicated, since there is a high probability of developing severe side effects;
6. Antibiotic treatment for viral infections is not performed. They can only be used when a secondary bacterial infection is attached.

Treatment should be carried out under the direct supervision of a physician. This is especially true of those cases when

• the patient's condition has worsened;
• antipyretics are ineffective;
• on the 4-5th day of illness, a new temperature jump is noted;
• there are additional symptoms such as pallor of the skin, shortness of breath, purulent discharge from the nose, increased cough, vomiting.

Symptomatic therapy

In order to successfully treat ARVI in children, it is necessary to influence both the cause and the symptoms of the disease.

Hyperthermia, cough and runny nose characterize the body's fight against the virus.

For example, an increase in body temperature is a defense mechanism that enhances the production of interferon, which, in turn, is able to neutralize viruses. Therefore, the standard of treatment for acute respiratory viral infections in children provides for the use of antipyretic drugs, only in cases where

• the child does not tolerate an increase in temperature very well;
• we are talking about a child under the age of three months;
• there is a severe pathology of the nervous and cardiovascular system.

The presence of even a severe cough and runny nose should also not cause much concern for parents, since these symptoms develop in response to attempts by the virus to enter the body.

If these symptoms bother the patient significantly, nasal drops such as nasivin, rinofluimucil are used, which improve nasal breathing and promote the formation of protective mucus. For productive cough, erespal, ambroxol, bromhexine are used. The drugs with the antitussive effect of sinecode, libexin, used for dry hacking cough, should be used as directed and under the supervision of a physician.

Treatment of ARVI in children is to create optimal conditions for the body to fight the virus and prevent the development of complications.