Lower respiratory tract infection in children : when are further investigations warranted?

The substantial decline in the burden of childhood community acquired lower respiratory tract infections (LRTI) over the last decades is associated with improvements in immunization, nutrition, socioeconomic, and control of the HIV epidemic (1). However, LRTI remains the commonest cause of under-5 mortality outside the neonatal period (1). Although most children with LRTI fully recover, a proportion develop chronic respiratory symptoms and/or sequelae; reasons include host factors (immunosuppression, poor secretion clearance, airway abnormalities or genetic factors), infectious causes (TB or adenovirus), and/or adverse environmental factors. Early identification and management of children at-risk of respiratory sequelae may help to preserve long-term lung health. However, knowing who and when to investigate is challenging as there is little high-level evidence to support the timing and extent of investigations required.Supplementary Figure 1: Pathway for children that require further investigation.Supplementary Figure 2: Patterns of lower respiratory tract symptoms over a 12 month period [Adapted Penny ME. Pediatr Infect Dis. (1993) 12:762–3].Supplementary Figure 3: Infographic demonstrating how airway obstruction by a foreign body (B) or impairment of muco-ciliary mechanism (C) result in stasis of secretions and inflammation as compared to normal (A).Supplementary Figure 4: Managment steps of children with chronic respiratory symptoms or at-risk of respiratory sequelae.http://www.frontiersin.org/Pediatricsam2022Paediatrics and Child Healt