Pediatric Primary Care – Managing Acute Upper Respiratory Infections (URIs) in a Child with Leukemia

Pediatric Primary Care – Managing Acute Upper Respiratory Infections (URIs) in a Child with Leukemia

Childhood leukaemia is a cancer of the WBCs and the most common cancer type among children. In the previous decades, significant advances have been accomplished in therapy for the condition that has resulted in a 10-year 92% survival rate. According to Hakim et al. (2016), acute leukaemia can now be cured with treatment. Although there is no cure for chronic leukaemia, there are treatment options that can often manage its symptoms and control it. Besides, specific individuals who have chronic leukaemia might be candidates for stem cell transportation, which can provide an opportunity for a cure. Still, infectious complications remain a significant cause of mortality and morbidity among children with leukaemia. Of particular concern is respiratory viral infections, characterized by manifestations such as increased hospitalization rates, progression to respiratory tract infections, and mild cold symptoms.

The case presented is of managing a child who has acute upper respiratory infections (URIs) with leukaemia. According to O’Connor et al., (2019), acute URIs are contagious infections of the upper respiratory tract, including the bronchi, larynx, pharynx, throat, and nose. The most well-known URI is the common cold. The hallmark URI symptoms include mucus production, cough, sneezing, nasal congestion, a runny nose, fever, fatigue, and wheezing, which are caused by inflammation of the mucous membranes of the URT. The family of the child believes in natural therapies, including heat treatment, diet therapy, and massage; hence, the need to incorporate their beliefs into the treatment of their child. Although the use of natural treatments is continuously increasing among cancer patients, such therapies are not well studied, and not much is known about their possible interactions with radiotherapy and chemotherapy (O’Connor et al., 2019).

Few patients with acute URIs expect to be given antibiotics when they visit primary care clinics, with most of them coming to seek reassurance, information, and assessment. A healthcare provider needs to recognize such expectations because it may be important when deciding on the treatment and care for such patients. The provider is expected to treat patients and their families with respect and fairly, irrespective of their beliefs and life choices.

The patient’s parents will be requested to complete an anonymous questionnaire to assess for any natural therapies they have been using on their child, both before and after the leukaemia diagnosis. The provider will determine the intention of the parents with the natural treatments and would decide to continue those therapies, promote relaxation, improve muscle function, reduce pain, and start the child on medical interventions. The appropriate treatment for leukaemia in children is chemotherapy. For this treatment, natural therapies will also help in dealing with the side effects and even control some symptoms of leukaemia.

Moreover, URI treatment will focus on relieving such symptoms as fever, nasal congestion, and cough. The medical treatment options available for this purpose include adrenergic agonists, expectant, and antihistamine preparations. The use of antibiotics is also appropriate because most URIs are of viral aetiology. Gargling with salt water is one of the natural therapies that the provider will recommend to the family to help in the prevention of URIs. This therapy can also ease nasal congestion and sore throat pain. Besides, gargling with salt water loosens and minimizes mucus, which contains allergies and bacteria (Ben-Arye et al., 2015).

References

Ben-Arye, E., Dudai, N., Eini, A., Torem, M., Schiff, E., & Rakover, Y. (2015). Treatment of upper respiratory tract infections in primary care: a randomized study using aromatic herbs. Evidence-based complementary and alternative medicine, 2015. https://doi.org/10.1155/2015/690346

Hakim, H., Dallas, R., Zhou, Y., Pei, D., Cheng, C., Flynn, P. M., … & Jeha, S. (2016). Acute respiratory infections in children and adolescents with acute lymphoblastic leukaemia. Cancer, 122(5), 798-805. https://doi.org/10.1002/cncr.29833

O’Connor, R., O’Doherty, J., O’Regan, A., O’Neill, A., McMahon, C., & Dunne, C. P. (2019). Medical management of acute upper respiratory infections in urban primary care out-of-hours facility: a cross-sectional study of patient presentations and expectations. BMJ open, 9(2), e025396. http://dx.doi.org/10.1136/bmjopen-2018-025396

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You see a child whose family believes in natural therapy for illnesses (e.g., diet therapy, massage, heat treatments).

How will you incorporate the family’s beliefs into the treatment of a child with an acute upper respiratory infection?

Pediatric Primary Care Foundation

List strategies that might be used by a pediatric primary care provider to incorporate developmental anticipatory guidance into the following sick visits:

An 18-month-old with an acute upper respiratory infection

A 4-year-old with stool withholding and constipation

A 9-year-old with chronic headaches

A 15-year-old with dysmenorrhea.

The post should be at least 500 words, formatted and cited in the current APA style, with support from at least 2 academic sources.