Frequently ill children

The group of frequently ill children usually includes children susceptible to frequent respiratory diseases due to transient, correctable deviations in the body's defense systems and without persistent organic disorders in them. Frequently ill children are not a nosological form of disease and not a diagnosis. Depending on age and social conditions, such children make up from 15 to 75% of the child population. The criteria for inclusion of children in the group of frequently ill children depending on the frequency of disease episodes per year and age are presented in Table 3.50.

In children under 3 years of age, the infection index can be calculated (the sum of cases of acute respiratory infections during the year, divided by the child's age in years). In children who rarely get sick, the infection index is 0.2-0.3, and in children - 1.1-3.-5.

Along with the previously listed most common etiological factors of acute respiratory viral infections in children, the increased role of mycoplasmas and chlamydia in their development has attracted attention in recent years. In young children, as a rule, the etiology of recurrent diseases is associated with several pathogens. Very often, in frequently ill children, the primary viral infection leads to the activation of endogenous opportunistic flora. The reason for the easier transformation of this microflora into pathogenic in some children is associated with the features of the immune response, which is determined by the corresponding genes of the histocompatibility system (HLA). The antigenic similarity of some opportunistic bacteria and the human HLA system creates conditions for limiting the intensity of the immune response when these pathogens are activated - the hypothesis of antigenic mimicry of microorganisms. This hypothesis to a certain extent explains the causes of bacterial complications in acute respiratory viral infections in some children from the group of frequently ill children.

Criteria for inclusion of children in the group of frequently ill children

Age	Frequency of acute respiratory infections (episodes/year)
Children 1 year of age	4 or more
Children under 3 years old	6 and more
Children 4-5 years old	5 or more
Children over 5 years old	4 or 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-catarrhal constitutional anomalies;
• age-specific connective tissue dysplasia;
• dysbiosis of mucous membranes, skin, gastrointestinal tract, bronchopulmonary system;
• foci of chronic infection of the nasopharynx (adenoiditis, tonsillitis, etc.) and oral cavity;
• infection with Mycobacterium tuberculosis;
• primary or secondary ciliary dyskinesia;

Exogenous risk factors:

• high contagiousness of pathogens causing acute respiratory infections;
• lack of understanding among the population of the importance of a healthy lifestyle;
• unfavorable social and living conditions, low material and cultural level of the family;
• adults and other children in the family with chronic foci of infection;
• early (in terms of age) start of children attending preschool institutions;
• passive smoking;
• micronutrient-deficient nutrition;
• iatrogenic effect on the immune system (immunosuppressive effect with frequent and long-term use of antibacterial therapy, diphenin, salicylates, etc.);
• ecological disturbances of the environment (significant increase in the content of various xenobiotics in the air, water, food products, their accumulation in the body, which leads to changes in cellular metabolism, disturbances in homeostasis and perversions of the immune defense).

Thus, frequent respiratory diseases in children are often not a consequence 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, of frequently ill children consists of eliminating exogenous and gently correcting endogenous causes of the development of this condition.

• Convincing parents of the need for a healthy lifestyle, the advisability of quitting smoking, improving the ecology of the home, changing nutritional traditions in order to limit the impact of xenobiotics on the child’s body.
• If possible, start visiting children's institutions later.
• Identification and treatment of chronic foci of infection in all family members.
• Organizing a child's daily routine and balanced nutrition.
• Hardening.
• Use of air purifiers and devices that create an increased concentration of air ions (aeroionotherapy).
• Rational vitamin therapy (C, B2, B6, PP, folic acid, beta-carotene), correction of microelement deficiency (cobalt, manganese, zinc, copper, manganese, molybdenum).
• Identification and treatment of deficiency states, diseases of the central and autonomic nervous system.
• Identification and treatment of foci of chronic infection in a child.
• Diagnostics and correction of dysbiosis of mucous membranes.
• Detection and treatment of Mycobacterium tuberculosis infection according to indications.
• Prescribing drug therapy strictly according to indications.

Adaptogens and biogenic stimulants are substances that increase the body's resistance to infections: apiliquirit (royal jelly with licorice), propolis (bee glue). Plant adaptogens include: extracts of Rhodiola rosea, leuzea, eleutherococcus, infusions of zamaniha, Chinese magnolia vine, aralia. Medicines made from purple echinacea are effective: echinacin, immunal.

Combined immunocorrective drugs (ribosomes + membrane fractions of bacteria), in particular ribomunil, are used to prevent frequent respiratory diseases. This drug contains ribosomal fractions of bacteria that most often complicate viral diseases of the respiratory tract or cause them (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 non-specific link of the immune response, and are also adjuvants that potentiate specific immunization. The bacterial ribosomes included in the drug have antigenic properties of the corresponding microorganisms, which determines the possibility of specific immunization.

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