Intended for healthcare professionals


Recurrent lower respiratory tract infections in children

BMJ 2018; 362 doi: (Published 12 July 2018) Cite this as: BMJ 2018;362:k2698
  1. Fernando Maria de Benedictis, professor and former director of Division of Paediatrics1,
  2. Andrew Bush, professor of paediatrics and paediatric respirology, and consultant paediatric chest physician2
  1. 1Salesi Children’s Hospital Foundation, Ancona, Italy
  2. 2Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
  1. Correspondence to: A Bush a.bush{at}

What you need to know

  • Recurrent lower respiratory tract infection can be regarded as ≥3 annual episodes of documented bronchitis, bronchiolitis, or pneumonia and may merit further investigation for an underlying cause

  • The normal duration of respiratory symptoms in children is longer than commonly believed: acute cough typically resolves within 25 days, the common cold by 15 days, and non-specific respiratory symptoms by 16 days

  • Chronic wet-sounding cough every day for ≥4 weeks merits further investigation for lung disease

  • Recurrent acute cough with cough-free periods of at least a week between bouts is probably due to viral colds

  • A chest x ray is not usually required in children who seem generally well and have no worrying features on history and examination

Acute respiratory infections account for about a third of all paediatric consultations to primary care and 8-18% of acute hospital admissions in the UK.12 Children, especially preschool children, may have up to 6-10 viral colds a year.13 Parents often seek reassurance that all is well, or they may have concerns about a serious illness, sometimes prompted by the family history or a disturbing diagnosis in a friend’s child (see Patient’s perspective box). Sleep disturbance and the time carers may have to be away from work can lead to stress and impaired quality of life.

When consulting with families, distinguish children with recurrent self limiting or minor problems—the majority of cases—from those with a more serious underlying condition who may need investigation and treatment. Differentiate lower and upper respiratory tract infections, which may be difficult because symptoms and signs overlap and both may be present at the same time.34 This article presents a practical approach to diagnosis and management of the otherwise apparently healthy child with recurrent lower respiratory tract infections. Acute respiratory infections and the management of children with …

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