General Information

Children with chronic lung disease are very common. The most common chronic lung disease is, of course, asthma. Asthma occurs in up to 10 percent of all children and can be a particular problem for African American children. Other lung disease include cystic fibrosis, and bronchopulmonary dysplasia (BPD). Many children who have wheezing may not have a diagnosis of asthma, yet are similar in that they have repeated episodes of wheezing.

Children with lung disease are not usually more prone to illness, but may have more difficulty when they contract them. They often will have significant problems with viruses that cause coughing, as this will often worsen their breathing problems. Many children who have lung disease need to have "breathing treatments". These treatments are generally easy to give. These medications are safe and effective in treating children with wheezing. They do not pose a risk to other children in childcare.

The first sign that children with lung disease are having more problems is often increased coughing. Parents should be notified if these children have increased and persistent coughing. As lung disease worsens, children begin to have faster breathing and more difficulty breathing. If a child with chronic lung disease begins to have difficulty in breathing, the child should be seen immediately by their doctor.

Infectious Risks

Children with cystic fibrous, asthma, bronchopulmonary dysplasia, or other chronic pulmonary disease are not at increased risk of acquiring infection. However, they are at greatly increased risk of developing severe trouble breathing with infections that ordinarily cause only mild upper respiratory infection, bronchitis, flu and in the healthy child.

Infection Control

Special Infection Control Needs: Preventing infection is the hallmark of effective control in this these children. Vaccination is especially important including pneumococcal vaccine, Haemophilus influenzae type b vaccine and yearly immunizations with the influenza vaccine. If possible the infant with chronic lung disease should have limited number of caretakers who thus minimize the child’s exposure to a large number of infections. Consideration should be given to avoiding group childcare during times when many children at the center or school have upper respiratory illness (e.g., winter months). For the child with cystic fibrosis who is infected with the bacteria Burkholderia cepacia, other children with CF are at risk of becoming infected with this pathogen and thus should not be in contact with the infected child.

There are no risks caused by children with chronic pulmonary disease.

Children with pulmonary disease who have worsening of their pulmonary symptoms (cyanosis, grunting, altered breathing, increase in cough, vomiting) should be seen promptly by their physician. They should not be monitored in the childcare or preschool setting.

Exclusion for infectious diseases should be guided by the recommendations for all children (note section IV and the specific pathogen in Section V) realizing children with chronic pulmonary problems may have prolonged and more serious course.

Personnel should be extremely cautious in caring for the child with chronic lung disease to ensure that mild infection they or other attendees have is not spread to these children. This is best effected through careful handwashing, particularly after handling children with other viral respiratory illnesses.

Parental Advice

Parents of healthy children should be advised that children with chronic lung disease pose no unusual infectious risks to healthy children.

Parents of a child with chronic lung disease should monitor their child for signs and symptoms of increased respiratory distress, particularly during seasons of increased viral respiratory illness. They should consider avoiding childcare during periods in which there are high prevalence rates of respiratory illness. Parents should ideally have the child cared for by a limited number of caregivers