It can be difficult to know when to investigate further for recurrent infections in children. It is normal for a healthy child to have 4 – 8 respiratory infections per year. When starting nursery or school and during winter months children are likely to pick up recurrent infections.
Most children with recurrent infections have a normal immune system. Other features associated with recurrent infections may make you consider investigating further for immunodeficiency and other pathology. Children with these features should be referred to a specialist for further assessment.
- Chronic diarrhoea since infancy
- Failure to thrive
- Appearing unusually well with quite a severe infection, for example afebrile with a large pneumonia
- Significantly more infections than expected, particularly bacterial lower respiratory tract infections
- Unusual or persistent infections such as cytomegalovirus, candida and pneumocystis jiroveci
Investigations
The choice of investigations will be guided by a full history and examination.
- Full blood count: low neutrophils suggest a phagocytic disorder and low lymphocytes suggest a T cell disorder
- Immunoglobulins: abnormalities suggest a B cell disorders
- Complement proteins: abnormalities suggest a complement disorder
- Antibody responses to vaccines, specifically pneumococcal and haemophilus vaccines
- HIV test if clinically relevant
- Chest xray for scarring from previous chest infections
- Sweat test for cystic fibrosis
- CT chest for bronchiectasis
Last updated January 2020