Decoding Recurrent Infections in Kids: What’s Normal & What Could Be a Red Flag?

Introduction:

A common reason for bringing a baby or child for a medical consultation is recurrent infections. Recurrent infections in children can be worrying for parents—but are they always a cause for concern? While it’s normal for babies to catch several infections a year due to their developing immune systems, sometimes these infections may signal something more serious. Wondering when it’s just a phase and when it’s a red flag? Read on to decode the signs, causes, and what steps to take.

What are recurrent infections?

Recurrent infections are defined as two or more severe infections in a year, three or more respiratory infections (e.g., otitis, sinusitis, or bronchitis) in one year, or the need for antibiotics for two months/year, which may indicate an underlying issue such as primary immunodeficiency or structural problems.

These infections are usually frequent, severe, prolonged, or accompanied by unusual complications that warrant further investigation.

Babies are born with immature immune systems; due to this, they are more prone to getting a high number of infections. The immune system starts to mature soon after birth in babies; as a result, the number of infections starts to go down over time.

Common causes in children

Recurrent infections in kids are often occurring due to a combination of factors, including:

• Immature immune system
• Exposure to pathogens
• Viral infections
• Lifestyle factors
• Underlying conditions
• Bacterial infections
• Allergies

When it’s a sign of an immune deficiency

Recurrent or persistent infection in kids is the key sign of a primary immunodeficiency (immune system issue). Ongoing infections in childhood are common and do not indicate an immune deficiency in most cases.

Recurrent infections, especially when unusual or severe, can be a sign of an underlying immunodeficiency disorder in kids. The kids with immunodeficiency may present with the following:

• Severe infections
• Frequent infections
• Infections that are slow or heal
• Infections in unusual locations
• Family history of primary immunodeficiency

Severe/serious infections include

• Persistent evidence of inflammation (eg, fever)
• Confinement to bed for a week or more (eg, missing school or other activities)
• Failure to respond to oral antibiotics
• Infections with an unusual pathogen
• Unusual complications (eg, mastoiditis, pleural effusion, abscesses)
• Persistent laboratory abnormalities (eg, leukocytosis, persistent imaging abnormalities, elevated erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP])
• The need for intravenous antibiotics
• Hospitalization

Diagnostic approaches

Children who have a history of serious or unusual or recurrent infections can be hard to diagnose. Healthcare professionals consider the possibility of an immune system because finding it early can lead to better treatment and outcomes.

To differentiate the infections, whether they are due to a normal cause or an issue with the immune system, a careful medical history, physical exam, and possibly lab tests will be performed.

Healthcare professionals should check for the following as a suspicion of an underlying primary or secondary immunodeficiency:

• 6 or more new infections within 12 months
• 2 or more serious sinus infections or pneumonias within one year
• 2 or more episodes of sepsis or meningitis
• 2 or more months of antibiotics with little effect
• Need for intravenous antibiotics and/or hospitalization to clear infections
• Failure to gain weight or grow normally
• Recurrent tissue or organ abscesses
• Resistant superficial or oral candidiasis
• Infection with an opportunistic organism such as Pneumocystis jiroveci (carinii) pneumonia
• Complications from a live vaccine, such as measles, oral polio, varicella, or BCG
• Family history of immunodeficiency or unexplained early death
• Unexplained autoimmunity
• Lymphopenia in infancy

Medical history and physical examination: The doctor understands the pattern of infection, such as frequency, severity, duration, and specific types of infections (e.g., viral, fungal, or bacterial). Considers the family history of recurrent infections.

Performs the physical exam that can reveal clues such as lymph node enlargement, skin lesions, or other abnormalities.

Laboratory testing: Initial screening tests may include a complete blood picture (CBP) to assess the white blood cell counts and differentials, as well as serum immunoglobulin levels (IgG, IgM, IgA, and IgE).

Specific immune function tests: Depending on the observation of signs, medical history, physical examination, CBC report, etc., further tests may be recommended by the doctor to assess specific components of the immune system, such as:

• Antibody response
• Cell-mediated immunity
• Phagocytic function
• Complement system

Specific infections: If the kids are suspected of specific infections, such as urinary tract infections, appropriate cultures and tests should be performed.

Genetic testing: In some cases, genetic testing may be necessary to detect specific gene defects associated with PID.

Treatment options

Recurrent infections in kids can be a sign of an underlying immune deficiency, and treatment options vary depending on the cause and severity.

• Antibiotics or antifungals: They can treat specific infections and can be taken as a prophylactic to prevent infections.
• Immunoglobulin replacement therapy: While it is not a treatment, it provides the necessary antibodies to fight against infections and stay healthy.
• Other treatment options: Gene therapy, bone marrow transplantation, or surgery are treatment options for some PIs (primary immunodeficiencies).
• Nonpharmacologic methods: Sinus rinse and complementary medicine, such as meditation and yoga, assist in lessening infection.

Prevention strategies

Methods to reduce the risk of infection include:

• Maintaining good hygiene
• Vaccination
• Healthy diet
• Adequate sleep
• Multivitamin supplements (with doctor’s suggestion)

Conclusion:

Recurrent infections in children are often a normal part of growing up, especially in the early years when the immune system is still developing. However, frequent, severe, or unusual infections may be a warning sign of an underlying immune deficiency. Early diagnosis, proper testing, and timely treatment can make a big difference in a child’s health and development. If you’re concerned about your child’s infections, it’s important to consult a pediatrician for proper evaluation and guidance.