Frequently ill children

In the group of often ill children it is customary to refer children who are prone to frequent respiratory diseases due to transpousal, corrective abnormalities in the body's defense systems and not having persistent organic disorders in them. Frequently ill children are not a nosological form of the disease and not a diagnosis. Depending on the age and social conditions, such children constitute from 15 to 75% of the child population. The criteria for inclusion of children in the group of often ill children, depending on the frequency of episodes of diseases per year and age are presented in Table. 3.50.

In children under 3 years of age, the infectious index (the number of cases of ARI during the year divided by the age of the child in years) can be calculated. In infrequently ill children, the infectious index is 0.2-0.3, and in children - 1.1-3, -5.

Along with the aforementioned most common etiologic factors of acute respiratory viral infection in children in recent years, attention has been drawn to the increased role of mycoplasmas and chlamydia in their development. In young children, as a rule, the etiology of recurrent diseases is associated with several pathogens. Very often in often ill children, the primary viral infection leads to the activation of the endogenous conditionally pathogenic flora. The reason for easier transformation of this microflora into pathogenic microorganisms in a number of children is related to the characteristics of the immune response, which is determined by the corresponding histocompatibility (HLA) gene. The antigenic similarity of some conditionally pathogenic bacteria and the human HLA system creates conditions for limiting the intensity of the immune response upon activation of these pathogens - the hypothesis of antigenic mimicry of microorganisms. This hypothesis to a certain extent explains the causes of bacterial complications in ARVI in some children from the group of often ill children.

Criteria for including children in a group of often ill children

Age	Frequency of acute respiratory infections (episodes / year)
Children of the 1st year of life	4 and more
Children under 3 years	6 and more
Children 4-5 years old	5 and more
Children over 5 years	4 and more

There are two main groups of causes of frequent respiratory diseases in children.

Endogenous risk factors:

• unfavorable ante- and postnatal development of the child: prematurity, morphofunctional immaturity, hypotrophy, anemia, rickets, early artificial feeding, etc .;
• pathology of the central and autonomic nervous system;
• lymphatic-hypoplastic and exudative-catarral anomalies of the constitution;
• age-specific dysplasia of connective tissue;
• dysbiosis of mucous membranes, skin, gastrointestinal tract, bronchopulmonary system;
• foci of chronic infection of the nasopharynx (adenoiditis, tonsillitis, etc.) and the oral cavity;
• infection with mycobacteria tuberculosis;
• primary or secondary ciliary dyskinesia;

Exogenous risk factors:

• high contagiosity of pathogens ARI;
• lack of understanding among the population of the importance of a healthy lifestyle;
• adverse social and living conditions, low material and cultural level of the family;
• adults and other children in a family with chronic foci of infection;
• early (in the age aspect) the beginning of children's visit to preschool institutions;
• second hand smoke;
• micronutrient deficiency food;
• and an atrogenic effect on the immune system (immunosuppressive effect with frequent and prolonged use of antibacterial therapy, diphenin, salicylates, etc.);
• environmental disruption of the environment (a significant increase in the content of various xenobiotics in the air, water, food, their accumulation in the body, which leads to changes in cellular metabolism, homeostatic disorders and perversions of immune defense).

Thus, frequent respiratory diseases in children are often not the result of "secondary immunodeficiency" (a common and not always correct term), but the result of a combination of any of the listed endogenous and exogenous factors.

Treatment, or rather recovery, often ill children consists of eliminating exogenous and mild correction of endogenous causes of the development of this condition.

• The belief of parents in the need for a healthy lifestyle, in the desirability of quitting smoking, in improving the ecology of the home, changing the traditions of nutrition in order to limit the influence of xenobiotics on the baby's body.
• If possible, a later visit to children's institutions.
• Detection and treatment of chronic foci of infection in all family members.
• Organization of a child's day regimen and a balanced diet.
• Hardening.
• Use of air purifiers and devices that create an increased concentration of aeroions (aeroionotherapy).
• Rational vitamin therapy (С, В2, В6, РР, folic acid, beta-carotene), correction of micronutrient deficiency (cobalt, manganese, zinc, copper, manganese, molybdenum).
• Identification and treatment of scarce conditions, diseases of the central and autonomic nervous system.
• Detection and sanation of foci of chronic infection in a child.
• Diagnosis and correction of mucosal dysbiosis.
• Detection and treatment according to indications of infection with Mycobacterium tuberculosis.
• The prescription of drug therapy is strictly according to the indications.

To substances that increase the body's resistance to infections include adaptogeny and biogenic stimulants: apilikvirite (bee jelly with licorice), propolis (bee glue). The plant adaptogens include: extracts of rhodiola rosea, levzeum, eleutherococcus, infusions of zamaniha, magnolia vinegar, aralia. Effective are medicines prepared from echinacea purpurea: echinacin, immunal.

As a prophylaxis of frequent respiratory diseases, combined immunocorrecting drugs (ribosomes + membrane fractions of bacteria), in particular ribomunil, are used. This preparation contains ribosomal fractions of bacteria, most often complicating or causing viral diseases of the respiratory tract (Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Hemophilus influenzae), and proteoglycans of the cell membrane of Klebsiella pneumoniae. Proteoglycans of the cell membrane have an immunomodulatory effect on the nonspecific part of the immune response, and are adjuvants that potentiate specific immunization. The bacterial ribosomes included in the preparation possess the antigenic properties of the corresponding microorganisms, which determines the possibility of carrying out specific immunization.

[1], [2], [3], [4], [5]