Acute Respiratory infections in Children

Pattern recognition :

Signs	Classification	Treatment
Tender Swelling behind the ear	Mastoiditis	Give first dose of IV antibiotic Give paracetamol for pain relief Refer urgently to ENT Surgeon.
Pus is seen draining from the Earn and discharge is reported for < 14 days OR Ear pain	Acute Ear Infection(ASOM)	Give Amoxycillin for 10 days or Cotrimoxazole 8 mg/kg of TM in 2 div doses Give paracetamol for relief of pain Dry ear by wicking Follow up after 5 days
Pus is seen draining from the Earn and discharge is reported for < 14 days	Chronic ear infection (CSOM)	Dry the ear by wicking* Send an ear swab for culture and sensitivity Give antibiotics as per sensitivity pattern for 10 days ENT evaluation
No ear pain and no pus seen draining from the ear	No ear infection	No additional treatment.

Note:

High pitched, incessant cry and tugging at the ears following an attack of upper respiratory infection indicates acute ear infection in neonates and infants.
Otoscopic examination should routinely be done for all children presenting with an acute upper respiratory infection in Pediatric office practice.
A bulging, opacified, discoloured ear drum through which the land marks are poorly visualized, with decreased mobility of the drum, defines acute otitis media
The patient should be reevaluated within 30 days of starting therapy to determine the persistence of middle ear infection.
Persistence of middle ear effusion for more than 8 weeks (glue ear) with an immobile tympanic membrane indicates chronic otitis media, requiring ENT surgeon consultation and intervention.
Otorrhea > 14 days with tympanic membrane perforation or cholesteatoma, is a sequelae to ASOM and the patient should be referred to otorhinolaryngologist for evaluation and management.
Children with recurrent otitis media or chronic otitis media require audiological evaluation.