Журнал «Здоровье ребенка» 7 (50) 2013

Most young children periodically suffer from respiratory diseases.   The development and progression of which is dependent from condition of the chil’s immune system (IS). There are some critical periods of development of IS. The most intensive period is neonatal, when persists deficiency of the skin barrier and mucous membranes, incomplete phagocytosis, low SIgA, complement components and synthesis of key cytokines, NK-lymphocytes. The second critical period  is the age of 3-6 months,  lymphocytes  activate (CD8), hypogammaglobulinemia occurs by reducing the level of maternal antibodies and their own lack of synthesis, low levels of interferon and SIgA. The main thing is that the immune response  through the synthesis of type 1 nonspecific class antibodies Ig G without the formation of immunological memory. At the age of 2-3 years, the child enters a day care center. On the background of the primary immune response increases the sensitivity of the B-lymphocytes to cytokines.  T-helper cells are activated, synthesis of a specific antibody IgG become normal. Because of the reduced activity of local immunity children of this age are highly susceptible to bacterial and viral infections, especially respiratory and ENT. It should be emphasized and the 4th critical period (4-6 years) is the second physiological chiasm, when the formation of the secondary immune response is due to the intensive synthesis of specific antibodies (IgG), the formation of an immunological memory, and low activity of local immunity.

 Viruses induced immunosuppression may persist for 2-2.5 years in preschool children and accompanied by frequent recurrent respiratory diseases, especially viral origin. According to the statistic of 2011, only 11% of preschool children are basically healthy 38% - are classified as "sickly", more than 50% of children have chronic diseases.

 On average, each child of a group of sickly suffer from acute respiratory infections more than 5 times per year. Recurrent disease may caused sensitization and create conditions for the development of generalized hypersensitivity reactions and the subsequent formation of obstructive bronchitis, bronchial asthma and other bronchopulmonary diseases. Most pediatricians have already adapted to the term OIC (often ill children). However, controversy continues, especially in definition of diagnosis. Indeed, often it is simply ARD, without complications, and to focus attention on the frequency of acute respiratory disease, the doctor still says that this child is sickly.  In our opinion,  it’s the time to find the cause of frequent acute respiratory infections and act on it. The term FRDC - frequent and recurrent disease in children (ML Aryayev, 2006) for this group is irrelevant, since it is only about ARI! We agree that it can not be diagnosed, but the confirmation of the frequency   of respiratory diseases will allow time to find its cause. In most cases, the true cause of recurrent respiratory pathology in children are still immune disorders leading to reduced resistance to infectious agents.

We are interested in the principles of recovery and treatment of sickly children. Often these problems can  be solved by pediatricians and family physicians, but it is better  by immunologists. For example to reduce number of risk factors, decreasing  of irrational use of antibiotics, the timing of receipt of a PO. It is completely  responsibility of the pediatrician or family doctor. But questions  of the  immune regulation must be solved by experts. The need of  regulation of the immune system must make pediatrician stop  giving  recommendations, and prescribing immunocorrective therapy. As for the prevention of recurrent respiratory infections it is the prerogative of the pediatric service.

 Conclusion: Correction of functionally immature immune system of the child  it is very difficult and responsible thing. Therefore, the selection and application of various types of immunomodulators should be  strictly controled by immunologists.