Rhinitis in children: symptoms and treatment
The content of the article:
- The reasons for the development of pathology
- Rhinitis symptoms in children
- Diagnostics
- Treatment of rhinitis in children
- Possible complications
- Video
Rhinitis in children is one of the most common diseases. Why is the disease dangerous? For what reason is it developing, and what contributes to this? What symptoms of rhinitis in children require special attention? What are the main treatments?
Rhinitis is one of the most common diseases in children.
Rhinitis, or runny nose, is characterized by an inflammatory lesion of the nasal mucosa and is manifested by difficulty in nasal breathing, profuse nasal discharge, and a violation of the general condition of the child.
In the course of the disease, rhinitis can be:
- acute;
- subacute;
- chronic.
Depending on the severity of symptoms, a runny nose can be mild, moderate or severe.
Depending on the etiological factor, rhinitis is divided into:
- infectious (specific);
- vasomotor: allergic and neurovegetative;
- hypertrophic;
- atrophic.
Allergic rhinitis can be:
- seasonal;
- year-round: intermittent and persistent.
ICD-10 code (International classification of the 10th revision):
- J0 - vasomotor rhinitis;
- J1 - allergic rhinitis;
- J0 - chronic rhinitis.
The reasons for the development of pathology
The causes and mechanism of rhinitis depend on the form of the disease. In this case, predisposing factors play an important role:
- general or local decrease in immunity;
- genetic predisposition;
- anomalies in the development of the upper respiratory tract;
- congenital diseases (cystic fibrosis);
- trauma, surgery in the nasal cavity;
- foreign bodies, polyps, nasal neoplasms;
- the presence of adenoids;
- curvature of the nasal septum;
- concomitant chronic diseases;
- environmental factors: environmental pollution, increased background radiation;
- prenatal and perinatal factors: mother's smoking, prematurity, artificial feeding.
Most often, children are diagnosed with acute infectious rhinitis caused by viruses or bacteria on the nasal mucosa
An infectious rhinitis can be caused by viruses (influenza virus, parainfluenza, adenovirus, respiratory syncytial virus, rhinovirus) or bacteria (staphylococci, pneumococci, Haemophilus influenzae). The disease can take a protracted course in weakened children with reduced immunity and in the presence of chronic foci of infection. Acute infectious rhinitis in children is the most common form of the disease.
Allergic rhinitis occurs when allergens enter the body. At the first contact, they cause sensitization, and at subsequent contact, they lead to the development of allergic reactions.
Allergic rhinitis occurs due to repeated contact with allergens, in particular with plant pollen
Common allergens that cause the common cold are house dust mites, pollen from trees, grasses and weeds, animal allergens and molds.
With repeated contact of a sensitized organism with an allergen, IgE-dependent inflammation develops in the nasal mucosa. Mediators of inflammation (histamine, prostaglandins, tryptase, leukotrienes) are released, which damage the nasal mucosa and contribute to the intensification of the symptoms of allergic rhinitis.
Also, the reason for the development of allergic rhinitis in children can be psychological trauma in the family, school, etc. Under stress, a weakened child's body becomes susceptible to various environmental factors. Thus, acute respiratory viral diseases, in which the body produces virus-specific immunoglobulins E (IgE), mediators of inflammation and allergies, can become triggers in the development of rhinitis.
The development of the neurovegetative form of vasomotor rhinitis is associated with an increase in the tone of the parasympathetic division of the autonomic nervous system, which results in vascular neurosis of the nasal mucosa.
Hypertrophic rhinitis occurs as a result of the proliferation of the mucous membrane with the involvement of the periosteum and bone tissue of the turbinates.
Atrophic rhinitis develops as a result of impaired blood supply and innervation of the mucous membrane and underlying tissues of the nasal cavity. The reason may be previous severe infectious diseases, hormonal disorders, various injuries to the nose.
Rhinitis symptoms in children
In children, the main symptoms of rhinitis are:
- difficulty in nasal breathing;
- nasal congestion;
- change in timbre of voice and nasalness (rhinolalia);
- itchy nose;
- sneezing;
- decreased sense of smell;
- impairment of memory and cognitive abilities;
- sleep disturbance;
- increased fatigue, lethargy;
- headaches;
- hearing impairment.
A runny nose in children can be aggravated by external stimuli: cold, smoke, household chemicals.
Rhinitis can result in hypoxia of brain tissue.
Nasal obstruction leads to impaired gas exchange in the blood, tissue and organ hypoxia. The child begins to lag behind in physical and mental development. The consequence of hypoxia is also an increase in arterial, intracranial and intraocular pressure.
Insufficient oxygenation of the blood leads to hypoxia of the brain tissue, which affects the activity of the child's central nervous system. In these children, behavioral abnormalities are often mistaken for attention deficit hyperactivity disorder.
Violation of nasal breathing leads to the development of the following pathologies:
- deformation of the chest;
- deformation of the facial skeleton, including maxillofacial deviations, retrognathia, retrusion;
- gothic hard palate.
Oral breathing is directly related to the formation of malocclusion, dysfunction of the temporomandibular joints, and narrowing of the dental arches. Stomatitis, gingivitis, carious lesions of the teeth may develop.
With a cold, anterior closed rhinolalia or nasal nasal is often observed, which is directly related to the problems of early childhood communication.
Diagnostics
In the diagnosis of various forms of rhinitis, it is necessary to take into account the age-related anatomical and functional characteristics of the child's body. Differential diagnosis plays an important role.
When diagnosing rhinitis in infants, partial choanal atresia should be excluded
In newborns and infants, it is necessary to exclude congenital anomalies, in particular, partial choanal atresia. At the same time, the baby has difficulty breathing, a violation of sucking, he cannot capture the mother's breast. Older children complain of impaired nasal breathing through one or both halves of the nose.
Also, choanal atresia can be the result of trauma or inflammation. Respiratory failure may develop.
In case of unilateral rhinitis, the likelihood of a foreign body in the nose must be considered
In children 2–5 years old, foreign bodies in the nose are often diagnosed, against the background of which there is a prolonged purulent rhinitis. A foreign body can get caught when the child plays with small objects. The rhinitis developing in this case is unilateral, discharge from the nasal passages may be yellow-green, with an unpleasant odor, and nosebleeds are possible.
When examining a child with rhinitis, oral breathing immediately attracts attention, which can also occur with pathology of the pharynx and lower respiratory tract. It is necessary to exclude chronic tonsillitis, hypertrophy of the palatine tonsils, bronchitis, pneumonia.
One of the signs of a runny nose is dermatitis of the vestibule of the nose, which occurs due to constant irritation of the skin with nasal discharge.
A rhinoscopy is performed, which reveals edema and hyperemia of the mucous membranes. On the walls and in the lumen of the nasal cavity, mucus, watery or serous-purulent discharge and crusts are visible.
In a clinical analysis of blood, depending on the form of rhinitis, leukocytosis with a leukocyte shift or eosinophilia is detected.
Bacteriological seeding of nasal discharge with determination of antibiotic sensitivity is shown.
In some cases, computed tomography or x-rays of the nose and sinuses are required
According to the indications, an x-ray or computed tomography of the nose and paranasal sinuses is performed.
If allergic rhinitis is suspected, a blood test for total IgE is prescribed, as well as skin testing to identify causal allergens.
Treatment of rhinitis in children
Therapy of rhinitis in children should be comprehensive, taking into account the form of the disease, the severity of clinical manifestations and the general condition of the body.
Intranasal drops or sprays are prescribed as part of a complex treatment
Nasal decongestants play a significant role in the treatment and prevention of complications. The drugs in this group include:
- phenylaminoethanol derivatives: norepinephrine, epinephrine, phenylephrine;
- imidazole derivatives: naphazoline, xylometazoline, oxymetazoline, tetrizoline.
Vasoconstrictor drugs effectively restore the child's nasal breathing by activating the α-adrenergic receptors of the vessels of the nasal mucosa, which leads to a decrease in hyperemia and edema, as a result of which nasal secretion decreases.
When prescribing and using nasal vasoconstrictors, it is very important to remember that in children, the relative area of the nasal mucosa is much larger than in adults. For an infant, the adult dosage of the drug per 1 kg of body weight exceeds the required dose by 30 times. Therefore, vasoconstrictor drugs in children should be used in minimal doses. Preference is given to long-acting decongestants - oxymetazoline, xylometazoline. The use of these tools allows you to reduce the frequency of appointment.
Elimination of the allergen plays an important role in the treatment of allergic rhinitis. To prevent prolonged contact of the allergen with the mucous membrane of the upper respiratory tract, agents for irrigation therapy are actively used:
- isotonic and hypertonic solutions;
- solutions based on sea water;
- antiseptic solutions.
It is possible to carry out inhalations with essential oils or glucocorticoid drugs prescribed by a doctor. At home, you can use a special device - a nebulizer.
Inhalation with a nebulizer is one of the most effective treatments
Antihistamines are prescribed to relieve tissue swelling and reduce symptoms of allergic rhinitis. As a basic therapy, depending on the severity of the condition, oral or intranasal (sprays, drops) antihistamines of the second generation are selected:
- Desloratadine: from 6 months;
- Loratadin: from 2 years old;
- Cetirizine: from 6 years old.
After eliminating the violation of nasal breathing, children with speech defects are sent to a speech therapist, where they learn correct speech breathing in the classroom.
According to pediatrician E. O. Komarovsky, it is important to remember that the best "treatment" for a cold is a doctor.
Possible complications
In children, the most common complication of rhinitis is acute otitis media. This is due to the anatomical features (short and wide auditory tube). The development of otitis media can be facilitated by air travel (aerootitis). A rapid drop in barometric pressure increases the likelihood of barometric injury. In cases where, during an exacerbation of rhinitis, the flight cannot be postponed, it is recommended to use vasoconstrictor drugs to prevent complications.
In pediatric patients, swelling of the nasal mucosa with rhinitis often leads to difficulty in the outflow of secretion from the paranasal sinuses and the development of sinusitis.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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